Moderate Intake Research Articles

Soy intake and breast cancer risk: a prospective study of 300,000 Chinese women and a dose\u2013response meta-analysis

Epidemiological evidence on the association of soy intake with breast cancer risk is still inconsistent due to different soy intake levels across previous studies and small number of breast cancer cases. We aimed to investigate this issue by analyzing data from the China Kadoorie Biobank (CKB) study and conducting a dose–response meta-analysis to integrate existing evidence. The CKB study included over 300,000 women aged 30–79 from 10 regions across China enrolled between 2004 and 2008, and followed-up for breast cancer events until 31 December 2016. Information on soy intake was collected from baseline, two resurveys and twelve 24-h dietary recalls. We also searched for relevant prospective cohort studies to do a dose–response meta-analysis. The mean (SD) soy intake was 9.4 (5.4) mg/day soy isoflavones among CKB women. During 10 years of follow-up, 2289 women developed breast cancers. The multivariable-adjusted relative risk was 1.00 (95% confidence interval [CI] 0.81–1.22) for the fourth (19.1 mg/day) versus the first (4.5 mg/day) soy isoflavone intake quartile. Meta-analysis of prospective studies found that each 10 mg/day increment in soy isoflavone intake was associated with a 3% (95% CI 1–5%) reduced risk of breast cancer. The CKB study demonstrated that moderate soy intake was not associated with breast cancer risk among Chinese women. Higher amount of soy intake might provide reasonable benefits for the prevention of breast cancer.

Moderate Red Wine Intake in Secondary Prevention for Patients with Cardiovascular Disease

The cardioprotective effect of moderate and regular wine consumption in primary prevention has been well documented. The goal of the present investigation..

The amazing bond among wine consumption, health and hedonistic well-being

PurposeWine, fruits, vegetables and whole grains are the main products of a healthy diet. The purpose of this paper is to scrutinize the existence of an interesting and evocative bond among moderate intake of wine, health and well-being.Design/methodology/approachBy means of a fuzzy cluster analysis, the authors try to investigate the existence of groups of regions similar in wine consumption, subjective well-being, health and social relations. The latter are expressed through composite indicators, built and developed by Istat within the Italy ESW project’s activities (equitable and sustainable well-being). The analysis also investigates how this link has evolved over time. Data are related to refer to the situations in 2010 and 2017 in 21 regions of Italy.FindingsResults obtained in 2010 seem to confirm the hypothesis of the existence of a link among moderate wine consumption, hedonism well-being and health, and in addition, findings highlight the so-called North‒South gap, that is the strong differences and economic issues among the different areas of the country. Then, outcomes obtained for 2017 appear in line with 2010 results.Originality/valueSeveral authors from medicine, economics and chemistry domain strongly suggest and demonstrate that regular and moderate intake of wine reduces the incidence of heart disease, diabetes mellitus and hormonal problems, and correlatively increases longevity. In this work, the authors develop further research step including the aspects related to personal well-being and social relations under the umbrella of a hedonism approach. Finally, results highlight the existence of an amazing tie among moderate intake of wine consumption, well-being and health.

Aerobic exercise modulates cardiac NAD(P)H oxidase and the NRF2/KEAP1 pathway in a mouse model of chronic fructose consumption.

The present study investigated the effects of exercise on the cardiac nuclear factor (erythroid-derived 2) factor 2 (NRF2)/Kelch-like ECH-associated protein 1 (KEAP1) pathway in an experimental model of chronic fructose consumption. Male C57BL/6 mice were assigned to Control, Fructose (20% fructose in drinking water), Exercise (treadmill exercise at moderate intensity), and Fructose + Exercise groups (n = 10). After 12 wk, the energy intake and body weight in the groups were similar. Maximum exercise testing, resting energy expenditure, resting oxygen consumption, and carbon dioxide production increased in the exercise groups (Exercise and Fructose + Exercise vs. Control and Fructose groups, P < 0.05). Chronic fructose intake induced circulating hypercholesterolemia, hypertriglyceridemia, and hyperleptinemia and increased white adipose tissue depots, with no changes in blood pressure. This metabolic environment increased circulating IL-6, IL-1β, IL-10, cardiac hypertrophy, and cardiac NF-κB-p65 and TNF-α expression, which were reduced by exercise (P < 0.05). Cardiac ANG II type 1 receptor and NAD(P)H oxidase 2 (NOX2) were increased by fructose intake and exercise decreased this response (P < 0.05). Exercise increased the cardiac expression of the NRF2-to-KEAP1 ratio and phase II antioxidants in fructose-fed mice (P < 0.05). NOX4, glutathione reductase, and catalase protein expression were similar between the groups. These findings suggest that exercise confers modulatory cardiac effects, improving antioxidant defenses through the NRF2/KEAP1 pathway and decreasing oxidative stress, representing a potential nonpharmacological approach to protect against fructose-induced cardiometabolic diseases.NEW & NOTEWORTHY This is the first study to evaluate the cardiac modulation of NAD(P)H oxidase (NOX), the NRF2/Kelch-like ECH-associated protein 1 pathway (KEAP), and the thioredoxin (TRX1) system through exercise in the presence of moderate fructose intake. We demonstrated a novel mechanism by which exercise improves cardiac antioxidant defenses in an experimental model of chronic fructose intake, which involves NRF2-to-KEAP1 ratio modulation, enhancing the local phase II antioxidants hemoxygenase-1, thioredoxin reductase (TXNRD1), and peroxiredoxin1B (PDRX1), and inhibiting cardiac NOX2 overexpression.

Sunlight exposure, consumption of vitamin D-rich foods and vulvovaginal candidiasis in an African population: a prevalence case-control study.

To date, only two studies have investigated the relationship between vitamin D (vitD) deficiency and candidiasis in spite of vitD's antimicrobial and immunomodulatory roles. We examined the relationship between sunlight exposure and consumption of vitD-rich foods, markers of vitD status, and vulvovaginal candidiasis (VVC) in an African population to add to the limited evidence and stimulate additional research. Three hundred cases (females diagnosed as suffering from VVC) and three hundred controls (females diagnosed as suffering from any condition other than VVC) were selected from three health facilities in Cape Coast, Ghana. Sunlight exposure was assessed in a structured questionnaire with a food frequency questionnaire used to ascertain the frequency of consumption of vitD-rich foods. Self-reported low sunlight exposure was associated with 3.38 (95% CI:1.99, 5.74) increased odds of VVC. Low and moderate sunlight exposure estimated by outdoor visits was also associated with increased odds of VVC. In sensitivity analysis restricted to matched sunlight exposure data, low and moderate exposure was associated with 5.78 (95% CI: 2.57, 12.99) and 3.53 (95% CI: 1.85, 6.75) increased odds of VVC. Odds of VVC increased with decreasing levels of consumption of vitD-rich foods (Likelihood-ratio test trend p = 0.1382). In the joint analysis, low and moderate vitD intake was associated with much higher increased odds of VVC. Our findings should be confirmed in prospective studies and clinical trials to strengthen the evidence base for preventive action and to also inform clinical decision making.

Current level of fish and omega-3 fatty acid intakes and risk of Type 2 diabetes in China

Whether fish and marine omega-3 polyunsaturated fatty acid (PUFA) intakes are linked to type 2 diabetes (T2D) risk remains unclear in China. We aimed to assess the long-term associations in a nationwide cohort. Overall 15,100 Chinese adults, aged ≥20 years, were included from China Health and Nutrition Survey. The cumulative averages of fish and marine omega-3 PUFA intakes were evaluated based on 3-day 24-h records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of T2D risk. Overall 1017 T2D cases were documented over a median of 14 years of follow-up. Compared with non-fish consumers, low and moderate fish consumption were associated with higher T2D risk whereas high fish consumption was not associated. Multivariable-adjusted HRs (95% CIs) for low and moderate fish consumption were 1.43 (1.09, 1.86) and 1.42 (1.07, 1.85) respectively in men, and were 1.58 (1.22, 2.02) and 1.39 (1.08, 1.83) respectively in women. In meat substitution analyses, low and moderate fish consumption was related to 55% and 69% higher T2D risk for men, and was associated with 68% and 54% higher T2D risk for women, respectively. Fried but not non-fried fish intake was associated with higher T2D risk. Intake of marine omega-3 PUFAs was dose-dependently associated with higher T2D risk for both men and women (P-trend<0.001). Overall low and moderate intakes of fish, especially fried fish, and marine omega-3 PUFAs were associated with higher T2D risk. Current level of fish and marine omega-3 PUFA consumption is not protective against T2D incidence among Chinese people.

Intake of selected foods and beverages and serum uric acid levels in adults: ELSA-Brasil (2008-2010).

To investigate the association between the intake of selected food groups and beverages and serum uric acid (UA). Cross-sectional study using the baseline data (2008-2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Food intake was assessed by food frequency questionnaire with 114 items. Linear and logistic regressions investigated the associations between the daily intake of each food group (servings/d) and UA (mg/dl) and hyperuricemia (UA ≥ 6·8 mg/dl), respectively. All the analyses were adjusted for potential confounders, energy intake and all food groups. Teaching and research institutions from six Brazilians states. The participants were 14 320 active and retired civil servants, aged 35-74 years. Higher intake of dairy products was associated with lower serum UA levels in both sexes, with a statistical dose-response gradient. High meat intake was associated with high UA only in women, and high intake of organ meats, in men. Intake of fish and fruits, vegetables and legumes were not associated with serum UA. In men, moderate and high intake of alcoholic beverages, specifically beer and spirits, but not wine, increased UA. In women, only high intake of alcoholic beverages, specifically beer, was associated with increased serum UA. Similar associations were seen for hyperuricemia. Results suggest a potential beneficial role of dairy products consumption on UA levels. The association between alcohol intake and UA differed according to type of beverage and between sexes. Results reinforce the need to consider the whole diet in the analysis and to conduct sex stratified analysis.

P2683Beneficial effects of red wine intake upon gut microbiota and parallel effects upon plasma metabolomics

Abstract Background Evidence suggests that red wine (RW) components can influence favorably gut microbiota. However, Interactions of RW, gut microbiota and plasma metabolomics remain unclear. Purpose The goal of this study was to assess the effects upon gut microbiota and plasma metabolomic profile of short-term, moderate RW intake in patients (pts) with documented coronary artery disease (CAD) Methods Forty-two males aged 60.4±5.4 years (SD) with documented CAD by angiography underwent a randomized, crossover, controlled, interventional trial. They were assigned to either RW treatment or abstinence from any alcoholic beverage, as control. Each treatment was preceded by a 2-week washout period. During the RW intervention, subjects ingested 250 ml of RW per day/ 5 days a week/ 3 weeks. Fasting blood samples and fecal samples were collected 4 times, after washout and at the end of each 3-week intervention. Gut microbiota was analysed by 16 S rRNA gene sequences and plasma metabolomics was performed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy. Twenty pts chosen randomly had their global metabolic profiles examined at all visits. Diet was carefully controlled and quantified by a 3 day/week questionnaire at beginning and end of the study. Prebiotics, probiotics were not allowed during the study. Patients in need for antibiotic therapy were not included. Results In the RW period compared to abstinence, fecal metagenomic revealed a decrease in abundance of Collinsella, a bacterial genus correlated with atherosclerosis; an increase in Eubacterium, genus related to fiber digestion and bile acid metabolism; and a significant increase in alpha diversity (p&lt;0.05 for all). In plasma, trimethylamine N-oxide (TMAO), fell non-significantly post RW consumption. HDL and resveratrol increased after RW consumption (p&lt;0.05). Plasma metabolomic analysis of 20 pts revealed microbiome related changes associated with RW consumption: decreased levels of phenylalanine, benzoate, tyrosine and tryptophan; lower levels of primary bile acids (BA) cholate, taurocholate, and also secondary BA deoxycholate and lithocholate sulfate. In parallel, RW elevated androgenic steroids and decreased beta oxidation (p&lt;0.05 for all). Simultaneously total energy, proteins, carbohydrates and fat components of the diet did not change significantly. Conclusions Moderate RW ingestion augmented microbiota diversity, increased the proportion of putative anti-atherosclerotic bacteria and influenced plasma metabolomics. RW influenced energy metabolism through gut microbiota related plasma changes in amino acids, nucleotide profile, bile acids, androgenic steroids and beta-oxidation. These findings furnish some novel insight into mechanisms whereby RW may mitigate atherosclerosis. Acknowledgement/Funding FAPESP (Fundacao de Amparo à Pesquisa do Estado de Sao Paulo), IBRAVIN (Instituto Brasileiro do Vinho), Banco Bradesco SA

Association between ALOX15 gene polymorphism and brick-tea type skeletal fluorosis in Tibetans, Kazaks and Han, China

ABSTRACT To evaluate the association between ALOX15 gene polymorphism and skeletal fluorosis (SF), a case-control study was conducted. A total of 1023 individuals, including 308 Tibetans, 290 Kazaks and 425 Han, were enrolled in this study, in which cases and controls were 278 and 745, respectively. SF was diagnosed by X-ray absorptiometry. SNPs were genotyped using the Sequenom Mass ARRAY system. The genotypes of ALOX15 rs7220870, rs2664593 and rs1107852 were not associated with the risk of SF. After reconstructing the haplotype of rs7220870 and rs11078528, the risk effect of haplotype CA was found in Han participants aged ≤45 years or with moderate fluoride intake. Diplotype of CC/CC had a protective effect on SF risk in Han participants; whereas, CA/CC diplotype showed a risk effect on SF risk in participants aged ≥65; Our results provide the first evidence of an association between ALOX15 gene polymorphism and SF risk in Han participants. Abbreviation: SF: Skeletal fluorosis; SNP: Single Nucleotide polymorphism

Lifestyle factors modulate postprandial hypertriglyceridemia: From the CORDIOPREV study

Background and aimsRecent evidence suggests that postprandial hypertriglyceridemia (PPT) is associated with the incidence of CVD. Several non-modifiable factors (genetics, age, gender) and lifestyle factors (physical activity, smoking, regular alcohol) have shown their ability to modulate PPT. We evaluate the influence of regular alcohol intake, physical activity and smoking habit modulating PPT in the CORDIOPREV study (NCT00924937). Methods1002 patients were subject to an oral fat load test meal and serial blood samples were drawn at 0, 1, 2, 3 and 4 h during postprandial state. A PPT concentration above 2.5 mmol/L (220 mg/dL) at any time point has been established as a detrimental response. Alcohol consumption was defined as non-drinkers, moderate and severe intake; regular physical activity exceeding than or lower than 1000 MET/week; smoking habit was classified in current, never, recent ex-smokers and long-term ex-smokers. ResultsThe prevalence of undesirable PPT response was 68% in current, 58% in recent ex-smokers, 49% in long-term ex-smokers and 48% in never smokers (p < 0.001). Current and recent ex-smokers displayed higher PPT response as well as a greater area under the curve (AUC) and higher incremental (iAUC) of triglycerides (TG) compared with long-term ex-smokers and never smokers (p < 0.05), without differences among these subgroups. No differences were observed in the magnitude of PPT according to regular physical activity or alcohol intake habits. ConclusionsSmoking is an independent risk factor modulating the magnitude of PPT. However, after tobacco cessation, ex-smokers show a progressive decrease on their PPT to reach levels similar to those of never smokers.

Red meat and dietary iron intakes are associated with some components of metabolic syndrome: Tehran Lipid and Glucose Study

BackgroundThis study was conducted to investigate whether the daily consumption of haem, non-haem, total iron and red meat can affect the occurrence of metabolic syndrome (MetS) and its components.MethodsEligible adults (n = 4654) were selected from among participants of the Tehran Lipid and Glucose Study with an average follow-up of 3.8 years. Dietary intakes were assessed using a valid and reliable semi-quantitative food frequency questionnaire. Anthropometrics and biochemical variables were evaluated at baseline and follow-up examinations. The occurrence of MetS and its components were assessed in relation to haem, non-haem, total iron and red meat intakes.ResultsThere was no relationship between different types of dietary iron and red meat intakes and the incidence of MetS in the Tehranian population. Risk of hypertension decreased from quartiles 1 to 4 for haem iron (HR: 1.00, 0.92, 0.81, 0.80, Ptrend < 0.01) and red meat intake (HR: 1.00, 0.89, 0.84, 0.77, Ptrend < 0.01). The association between hyperglycemia and the fourth quartile of total iron intake was significant (HR = 1.98, 95% CI 1.08–3.63); and the risk of high triglyceride appeared to increase in higher quartiles of total iron intake (HR: 1.00, 1.17, 1.49, 1.75, Ptrend = 0.01) compared to lower quartiles.ConclusionOur study suggests a potentially protective relationship of haem and moderate red meat intake against development of high blood pressure; and higher intake of total iron is related to hyperglycemia and high triglyceride.

Maternal polymorphisms in the FADS1 and FADS2 genes modify the association between PUFA ingestion and plasma concentrations of omega-3 polyunsaturated fatty acids

There is a lack of studies about polymorphisms in FADS genes in pregnant women. We aimed to verify the interaction between three FADS gene polymorphisms (rs174561; rs174575; rs3834458) and dietary α-linolenic acid (ALA) or linoleic/α-linolenic acid ratio (LA/ALA) and plasma concentrations of omega-3 (n−3) PUFAs in pregnant women. Of the 250 women evaluated, the homozygous for the rs174561 and rs3834458 minor allele had high plasma ALA concentrations at the highest ALA and LA/ALA ratio tertile (p < 0.05). Plasma concentrations of EPA and DHA were not influenced by diet. For the rs174575 SNP, pregnant women who carried the minor allele presented lower proportions of plasma EPA in the second LA/ALA ratio tertile (p < 0.05). Increased dietary intake of ALA and LA/ALA ratio promoted plasma ALA accumulation in homozygotes for the minor allele rs174561 and rs3834458. Moderate intake of LA/ALA ratio may reduce plasma concentration of EPA in pregnants carrying the rs174575 minor allele.

Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis

Summary Background Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality. Methods We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake ( 4200 kcal per day for men and 3600 kcal per day for women). The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality. Findings During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption ( 70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87). Interpretation Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality. Funding National Institutes of Health.

Flavonoid intake is associated with lower mortality in the Danish Diet Cancer and Health Cohort

Flavonoids, plant-derived polyphenolic compounds, have been linked with health benefits. However, evidence from observational studies is incomplete; studies on cancer mortality are scarce and moderating effects of lifestyle risk factors for early mortality are unknown. In this prospective cohort study including 56,048 participants of the Danish Diet, Cancer, and Health cohort crosslinked with Danish nationwide registries and followed for 23 years, there are 14,083 deaths. A moderate habitual intake of flavonoids is inversely associated with all-cause, cardiovascular- and cancer-related mortality. This strong association plateaus at intakes of approximately 500 mg/day. Furthermore, the inverse associations between total flavonoid intake and mortality outcomes are stronger and more linear in smokers than in non-smokers, as well as in heavy (>20 g/d) vs. low-moderate (<20 g/d) alcohol consumers. These findings highlight the potential to reduce mortality through recommendations to increase intakes of flavonoid-rich foods, particularly in smokers and high alcohol consumers.

Association of Fruit and Vegetable Intake and Frailty among Chinese Elders: A Cross-Sectional Study in Three Cities.

To examine the association of FVI and frailty in Chinese elders. A sectional study was conducted in three cities (Shanghai, Zhengzhou, and Baoji) in China from June 2017 to June 2018. A total of 5699 participants from 49 districts were included in the current study by two-stage sampling methods. Frailty was measured by a validated Chinese version of the FRAIL scale. FVI per day was measured by two single questions. The sample proportion with sufficient fruit intake was 36.7%, and 44.7% reported sufficient vegetable intake. The sample proportions that were robust, pre-frail, and frail were 43.6%, 38.3%, and 18.1%, respectively. Compared with low FVI, after including covariates, the odds ratio (OR) of frailty was 0.84 (95% CI: 0.73-0.97) for moderate fruit intake and 0.81 (95% CI: 0.70-0.94) for enough fruit intake; the OR of frailty was 0.83 (95% CI: 0.68-0.91) for moderate vegetable intake and 0.77 (95% CI: 0.64-0.93) for enough vegetable intake. High FVI was negatively associated with the OR of frailty in Chinese elders. This finding implies it is important to promote FVI among adults to prevent frailty.

Mediterranean diet and health status: Active ingredients and pharmacological mechanisms.

The Mediterranean diet (MedDiet) is one of the most widely described and evaluated dietary patterns in scientific literature. It is characterized by high intakes of vegetables, legumes, fruits, nuts, grains, fish, seafood, extra virgin olive oil, and a moderate intake of red wine. A large body of observational and experimental evidence suggests that higher adherence to the MedDiet is associated with lower risk of mortality, cardiovascular disease, metabolic disease, and cancer. Current mechanisms underlying the beneficial effects of the MedDiet include reduction of blood lipids, inflammatory and oxidative stress markers, improvement of insulin sensitivity, enhancement of endothelial function, and antithrombotic function. Most likely, these effects are attributable to bioactive ingredients such as polyphenols, monounsaturated and polyunsaturated fatty acids, or fibre. This review will focus on both established and less established mechanisms of action of biochemical compounds contained in a MedDiet. LINKED ARTICLES: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc.

Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial.

BackgroundPregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women.Methods and findingsWe conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks’ gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori.We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3–10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0–64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56–1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58–1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47–0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference −1.2 Kg, 95% CI −2.2 to −0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53–0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study’s limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers.ConclusionsA simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes.Trial registrationClinicalTrials.gov NCT02218931.

Prospective associations between beverage intake during the midlife and subclinical carotid atherosclerosis: The Study of Women's Health Across the Nation.

BackgroundThe potential impacts of beverage intake during the midlife on future subclinical atherosclerosis among women are unclear. The aim of this study was to evaluate the prospective associations between the intakes of eight beverage groups and subclinical carotid atherosclerosis in midlife women.MethodsData came from the Study of Women’s Health Across the Nation, a multicenter, multiethnic, and prospective cohort study. A total of 1,235 midlife women had measures of subclinical carotid atherosclerosis and repeatedly beverage intake data collected using a validated food frequency questionnaire. Beverages were aggregated into eight groups, including coffee, tea, sugar-sweetened beverages, artificially sweetened beverages, fruit juices, whole milk, milk with lower fat content, and alcoholic beverages. The associations of beverage intake with common carotid artery intima-media thickness (CCA-IMT) and adventitial diameter (CCA-AD) were estimated using linear models; the associations with carotid plaque were estimated using log-binomial models.ResultsCoffee intake was associated with CCA-IMT in an inverted J-shaped pattern. After adjusting for covariates, women with >0 to <1 cup/day and 1 to <2 cups/day of coffee intake had a 0.031 mm (95% CI: 0.012, 0.051) and a 0.027 mm (95% CI: 0.005, 0.049) larger CCA-IMT, respectively, than coffee non-drinkers. Women who consumed ≥2 cups/day of coffee did not have significantly different CCA-IMT than non-drinkers. There was an inverse linear association between moderate alcoholic beverages intake and CCA-IMT (P-trend = 0.014). Whole milk intake had inverted U-shaped associations with CCA-IMT and carotid plaque. No significant associations were found between other beverage groups and subclinical atherosclerosis.ConclusionsIn midlife women, occasional coffee intake may be associated with more subclinical atherosclerosis while moderate alcoholic beverages intake may be associated with less subclinical atherosclerosis. Future work should focus on the determination of the optimal beverage intake profile for maximum cardiovascular benefits in midlife women.

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

ObjectiveTo summarise the evidence of associations between dietary factors and incidence of type 2 diabetes and to evaluate the strength and validity of these associations.DesignUmbrella review of systematic reviews with...

Effect of essential amino acid supplementation and aerobic exercise on insulin sensitivity in healthy older adults: A randomized clinical trial

The combination of prolonged essential amino acid (EAA) supplementation and aerobic exercise training (Ex) improves muscle protein metabolism, strength and function in healthy older adults. However, excess EAA intake may worsen insulin sensitivity. Here we report the effects of EAA supplementation (EAA, n=11), placebo (PLA, n=10), aerobic exercise with placebo (Ex+PLA, n=11) or Ex with EAA supplementation (Ex+EAA, n=10) for 22 weeks on insulin sensitivity in non-diabetic older adults. A 2×2 design with block randomization and double blinding for supplement or placebo was used. Subjects ingested EAA (15g) or placebo daily. Exercising subjects participated in supervised progressive vigorous treadmill walking 3 times weekly. Measures of insulin sensitivity by oral glucose tolerance testing were collected at baseline and 22 weeks. Dietary intakes of protein and specific amino acids were determined in a subset of subjects. Overall, exercise improved insulin sensitivity, while EAA supplementation had no effect. In the dietary subset, post-intervention insulin sensitivity did not correlate significantly with the total intake of EAA, anti-angiogenic amino acids (cysteine, methionine), or branched-chain amino acids (isoleucine, leucine, valine). Overall, we conclude that in healthy older adults with moderate protein intake, EAA supplementation is metabolically safe as it does not decrease insulin sensitivity regardless of its combination with aerobic exercise. Thus, daily protein intake should be controlled for when modeling insulin sensitivity. Future studies should explore the role of increased blood flow as a potential explanatory factor for the observed interaction between aerobic exercise and supplementation. NCT00872911.