Reduction In Fat Intake Research Articles

Changes in immunological parameters by ageing in rural healthy Indian adults and their associations with sex and lifestyle

Several factors including sex and lifestyle have been reported to contribute to the age-related alteration of immune functions. The study was undertaken to determine age-related differences in the proportion of peripheral blood mononuclear lymphocytes in the Indian population using blood samples from 67 healthy adults (33 females and 34 males) aged between 20 and 80 years old. In the linear regression analysis to estimate the relationship with age categories, there was a significant increase in the frequency of natural killer cells with ageing, while their cytolytic activity significantly declined. The frequency of CD4+ T cells increased with age, whereas that of CD8+ T cells decreased, resulting in the age-associated increase of the CD4/CD8 ratio. The subsets of B cells did not show any significant relationship with age. Although there were variations between the male and female subgroups in effect size of ageing, the trends were in the same direction in all the parameters. Reduced fat intake was associated with a lower frequency of CD4+ T cells, and higher serum cotinine level was associated with a higher CD4/CD8 ratio. The results indicate that cellular immunity in the Indian population is affected by ageing, while humoral immunity is less susceptible to ageing.

Community-based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis

Background: Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people. Methods: According to PRISMA guidelines, in this systematic review and meta-analysis, databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software. Results: Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82 % of studies using the technology were effective in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P <0.05). Conclusion: Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. In addition, long-term and high frequency interventions focusing on reducing fat intake are desirable.

Effect of defatted rice bran supplementation on metabolic parameters and inflammatory status in overweight/obese adults with hypercholesterolemia: a randomized, placebo-controlled intervention

BackgroundDefatted rice bran (DRB) is a byproduct of rice bran oil production rich in fiber, protein, and antioxidant compounds that may confer beneficial effects on metabolic profiles in humans. The current study aimed to investigate the effects of DRB supplementation on anthropometric and blood biochemical indices, dietary intake, and inflammatory status in overweight/obese subjects with hypercholesterolemia.MethodsIn a 12-week-randomized placebo-controlled trial, 61 overweight/obese participants with a total cholesterol level > 200 mg/dL were randomly assigned either to 30 g/d DRB (n = 30) or to 10 g/d maltodextrin (n = 31).ResultsDRB intervention significantly reduced systolic and diastolic blood pressure by 4.27 and 4.50%, respectively (126.20 ± 13.63 to 120.60 ± 13.72 mmHg, p = 0.0003 and 80.87 ± 7.38 to 77.17 ± 9.83 mmHg, p = 0.0035). HbA1c also decreased significantly by 3.59% (5.89% ± 0.76% to 5.66% ± 0.62%, p = 0.0001) after DRB supplementation. Total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels also decreased insignificantly by 3.12, 1.32, and 1.53%, respectively, after DRB supplementation. Insignificant differences in fasting blood glucose, insulin, homeostatic model assessment of insulin resistance, quantitative insulin sensitivity check index, hs-CRP and homocysteine levels were also observed after DRB intervention. Reduction in caloric and fat intake were reported in DRB groups.ConclusionsDRB supplementation improved blood pressure and HbA1c levels. It also lowered blood cholesterol, albeit insignificantly. Caloric and fat intake were also significantly lower after DRB supplementation. Further study is needed to evaluate the mechanisms by which DRB improves these metabolic indices.Trial registrationThai Clinical Trial Registration (https://www.thaiclinicaltrials.org/.) Thai Clinical Trial Registration number: TCTR20191020003. Registered 20 October 2019.

Nutritional Status and Adequacy of Dietary Intake of an Elite 1000m Flat Water Kayak Paddler

Background: Sports performance, besides the mental and emotional features of the athlete, is the outcome from the correct combination of training load, rest/ recovery and nutrition. Nutritional deficits or excesses can be deleterious for sports performance, particularly in sports that rely on high power output as 1000m kayak paddler. Objective: To describe the nutritional intake habits of a highly performing kayaker, and its adequacy for training, as only few studies have focused on this type of sports. Methods: An elite male kayaker specialized in 1000m flat-water races, World Champion, European Champion and Silver medallist in the London Olympic Games (35 years) reported his food intake for 7 consecutive days during a specific preparation period. Results: Daily average energy intake was 3174 ± 306 kcal; the intake of carbohydrates was 47.8 ± 9.3% (4.4 ± 1.2 g.kg-1. body weight. day-1), protein 20.8 ± 4.3% (1.9 ± 0.3 g.kg-1body weight. day) and fat intake was 31.4 ± 5.2% (1.3 ± 0.2 g. kg-1 body weight day. d-1). Fiber average consumption was 23.6 ± 9.2 g/day and cholesterol 638 ± 218 g/day. While water-soluble vitamins were within the recommended levels, fat-soluble vitamins and beta-carotene were below athletes’ recommendations. All macro minerals intake was within the Dietary References Intake (DRI) for general population values as well as the trace elements with exception of iodine and molybdenum. Also, an unbalanced ratio between omega-6/omega-3 fatty acids was observed. Conclusion: This kayaker had a caloric intake adequate to the training requirement of the analyzed week. However, a reduction in fat intake and an increment in carbohydrate should be promoted in order to achieve dietary recommendations for athletes. The low intake of fat-soluble vitamins and beta-carotene found may justify the use supplementation. Keywords: kayaking, nutrition, macronutrients, vitamins, minerals

Palm-based cellulose nanofiber isolated from mechano-chemical processing as sustainable rheological modifier in reduced fat mayonnaise.

Reducing fat intake from our daily diet serves to be an effective way to combat the rising obesity issue worldwide. Hence, reducing fat content in mayonnaise, a high fat food product, is one of the primary trends in the food industry. To date, research on the use of nanocellulose, a new and emerging form of fat mimetic, in mayonnaise formulation remains limited. This study sets out to formulate reduced fat 5%, 15%, and 30% mayonnaise using varying concentration of nanocellulose synthesized from palm pressed fiber followed by a 20‐day stability study. Nanocellulose was synthesized with particle size of 106.0 ± 18.7 nm and zeta potential of −72.5 ± 2.26 mV. It was used as fat mimetic in mayonnaise. Rheological analysis conducted showed that incorporation of nanocellulose into reduced fat mayonnaise formulation was able to counteract the loss of viscosity in mayonnaise caused by fat content reduction. This finding was further supported by the smaller oil droplets that are closely packed in reduced fat mayonnaise formulation when viewed under light microscope. Nonetheless, significant oil droplet coalescence was found in reduced fat mayonnaise formulations during storage period which could lead to loss of viscosity. Taken together, these findings suggest that CNF was able to act as fat mimetic upon formulation of mayonnaise but the same cannot be said during long term storage of mayonnaise.Practical ApplicationWe successfully isolated nanocellulose from palm biomass (palm pressed fiber) using green approach and used it as a fat replacer for preparation of 5%, 15%, and 30% reduced fat mayonnaise. A computation study revealed a strong binding affinity of the nanocellulose on the lipase active site essential to inhibit the digestion of fats and oils. Therefore, nanocellulose demonstrated a huge potential to be used as not only as fat replacer but also rheological modifier for the development of reduced fat or vegan foods.

552-P: Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight and Body Composition in Overweight Adults: A Randomized Clinical Trial

Objective: The aim was to identify changes in food, nutrient intake, and diet quality on a low-fat vegan diet and associations with changes in body weight and body composition. Methods: Overweight adults (n=244) were randomly assigned to follow a low-fat vegan diet (n=122) or make no diet changes (n=122) . Main outcome measures were changes in food intake, macro- and micronutrient intake, and dietary quality as measured by AHEI-2010, analyzed from 3-day diet records, and associations with changes in body weight and body composition. A repeated measure analysis of variance (ANOVA) model, Spearman correlations, and linear regression were used for statistical analysis. Results: The intervention group’s AHEI-20increased by 6.0 points on average in contrast to no significant change in the control group (treatment effect +7.2 [95% CI +3.7 to +10.7]; p<0.001) . Increase in AHEI-20correlated with reduction in body weight (r=0.14; p=0.04) , fat mass (r=-0.14; p=0.03) , and HOMA-IR (r=-0.17; p=0.02) , after adjustment for changes in energy intake. Fruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the intervention group. Intake of meat, fish and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most strongly associated with increased intake of legumes (r=‑0.38; p<.0001) and decreased intake of total meat, fish, and poultry (r=+0.43;p<.0001) . Reduced fat intake was associated with reduced body weight (r=+0.15; p=0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r=+0.14; p=0.04) . Conclusions: Diet quality as measured by AHEI-20improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. Increased legume intake was the strongest single food group predictor of weight loss. Disclosure H.Kahleova: None.

Closer to the Root: The Potential of Traditional Food Systems Interventions for Obesity Prevention

ObjectivesWe review the project design, implementation experiences, and study findings from obesity prevention trials (OPTs) in Native American communities to identify future directions for obesity and chronic disease prevention. MethodsWe use a case study methodology to highlight three OPTs and identify themes across studies. We included three OPTs: Navajo Healthy Stores (NHS), OPREVENT1, and OPREVENT2. NHS was a food-store based environmental intervention, while OPREVENT1 and OPREVENT2 were multi-level, multi-component interventions with store, school, worksite, and media components (OPREVENT1) and combined with a policy-based component (OPREVENT2). ResultsAll studies showed mixed success in achieving behavioral and health outcomes. NHS intervention exposure was associated with reduced BMI, and found improvements in intentions, cooking methods, and food getting comparing intervention with control regions. The program was sustained for several years after the trial was completed. OPREVENT1 trial resulted in significant reductions in waist circumference, reduced soda consumption, and increased physical activity (PA) comparing intervention and comparison communities. The OPREVENT2 trial had significant reductions in PA, calorie intake, carbohydrate, and dietary fat intake comparing intervention and comparison communities. ConclusionsWorking with health staff can enhance intervention sustainability, which is also impacted by health center capacity and funding. All studies had strong evaluation designs, with high retention and low refusal rates. All studies included store components that aimed to improve healthy food access on-reservation and point-of-purchase promotion. Although all studies demonstrated impacts on behaviors and modest impacts on health outcomes, taking a food-systems approach could increase the likelihood of improved outcomes by addressing the root of healthy food access and obesity: diminished traditional food systems. These interventions hold great potential for supporting significant health outcomes by supporting traditional food-getting practices, preparation, and intake. Such interventions require strong community-academic partnerships since these food systems and knowledge belong to tribal nations and communities. Funding SourcesNHLBI & USDA.

Impact of COVID-19 Vaccination Status and Confidence on Dietary Practices among Chinese Residents.

Healthy diets promote immune functions and have been shown to reduce COVID-19 severity. In 2021, COVID-19 vaccines have become available to the general public. However, whether vaccination status could affect individual and populational health behaviors is unknown. This study aimed to investigate the impacts of vaccination status and confidence on dietary practices. An online survey was conducted in August 2021. We collected data on dietary intake, diversity and behaviors, vaccination status and confidence and socio-demographic characteristics. Among the 5107 responses received, a total of 4873 study participants were included in the final analysis. Most of our participants aged between 18 and 45 years and 82% of them were fully vaccinated against COVID-19. Household level dietary diversity was found to be higher among people who were fully vaccinated (β = 0.321, 95%CI: 0.024 to 0.618) or who were more confident in the protectiveness of the vaccine (β for tertile 3 comparing with lowest tertile = 0.544, 95%CI: 0.407, 0.682). Vaccination promoted the intake of seafood, but it was also positively associated with the consumption of sugar, preserved, fried and barbequed foods and reduced vegetable intake. Higher vaccination confidence was associated with increased consumption of seafood, bean, fruits and vegetables and reduced fat intake. Changes in dietary behaviors compared with early 2021 (when vaccination was not common) were observed and differed by vaccination status and confidence level. Conclusion: COVID-19 vaccination status and confidence had varied, and possibly negative, impacts on dietary intake and behaviors. Our results suggest that vaccination status and confidence might be significant influencing factors affecting people’s health behaviors and highlight that healthy eating should be consistently promoted to prevent poor dietary practices during global health crisis.

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight, Body Composition, and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity. ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health. DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications. Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes. InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets. Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed. Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression. ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = −0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = −0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = −0.17; P = 0.02), after adjustment for changes in energy intake. ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.

Dietary Fat Intake: Associations with Dietary Patterns and Postmenopausal Breast Cancer-A Case-Control Study.

Simple SummaryBreast cancer (BC) is the most common cancer in females worldwide. Although fat has been hypothesized to be involved in BC etiology, the results of available studies are inconclusive. The aim of this study was to assess the associations of dietary fat intake, including an individual’s percentage of energy from dietary fat (Pfat) with peri- and postmenopausal breast cancer (BC) occurrence in women. The associations between Pfat and dietary patterns (DPs) were also examined. The current findings strengthen reports that a higher dietary fat intake may contribute to an increased incidence of BC, which indicates a need to reduce dietary fat intake in cancer prevention.The aim of this study was to assess the associations of dietary fat intake with BC occurrence and dietary patterns. This case-control study involved 420 women aged 40–79 years from northeastern Poland, including 190 newly diagnosed BC cases. Dietary data were collected using a food frequency questionnaire (62-item FFQ-6®). The Quick Food Scan of the National Cancer Institute and the Percentage Energy from Fat Screener scoring procedures were used to estimate the percentage energy from dietary fat (Pfat). The odds of BC occurrence was three times higher in the Pfat > 32%. The Pfat > 32% was positively associated with the ‘Non-Healthy’ DP and inversely associated with the Polish-aMED® score, ‘Prudent’ DP, and ‘Margarine and Sweetened Dairy’ DP. This case-control study suggests that a higher dietary fat intake (>32%) may contribute to an increased occurrence of peri- and postmenopausal breast cancer in women. Given the obtained results, an unhealthy dietary pattern characterized by the consumption of highly processed, high in sugar foods and animal fat foods should be avoided to reduce fat intake. Instead, the frequent consumption of low-processed plant foods, fish, and moderate consumption of low-fat dairy should be recommended since this pro-healthy diet is inversely associated with dietary fat intake.

Cognitive function and elderly macronutrient intakes from rural diets in Qingdao, China.

Energy provided by macronutrients plays a key role in healthy aging. This study therefore explored the association between macronutrients and cognitive function in elderly populations in rural areas of Qingdao, China. This study included 1,504 participants over the age of 65 recruited from Licha Town, Qingdao City, China. Dietary intake was measured using the Food Frequency Questionnaire, and cognitive function was assessed using the Mini-Mental State Examination. Logistic regression models were used to evaluate the association between dietary macronutrient intake and cognitive function. In addition, restricted cubic bars were applied to determine the dose-response relationship between macronutrient ratios and cognitive performance. A total of 877 adults over the age of 65 were included. After adjusting the weighted multiple variables, significant positive associations were revealed between protein and moderate carbohydrate intake and cognitive ability, but a negative association between fat intake and cognitive performance was identified. After calculating the daily energy supply ratio, similar associations were revealed between fat and protein intake and cognitive function. Furthermore, the ratio of proteins to carbohydrates had a U-shaped relationship with cognitive function (pnonlinearity=0.674), whereas the ratio of proteins to fats was L-shaped with lower cognitive function (pnonlinearity<0.001). Compared with the lowest quartile of the ratio of protein to fat intake, the weighted adjusted OR (95% CI) of the highest quartile was 0.509 (0.314, 0.827) for low cognitive performance. With an adequate carbohydrate supply, appropriately increasing dietary protein intake and reducing fat intake might benefit the cognitive function of elders in rural areas.

Desire to lose weight was associated with the adoption of weight control strategies but not healthier lifestyle behaviours among post-bariatric surgery patients: NHANES 2013-2018.

The desire to lose weight is presumably high among patients with severe obesity who have undergone bariatric surgery. The purpose of this study is to examine the associations of desire to lose weight with weight control strategies, depressive symptoms and lifestyle behaviours among post-bariatric surgery patients. Participants were adults who participated in the National Health and Nutrition Examination Survey (2013-2018) and self-identified a history of bariatric surgery. The desire to lose weight, weight control strategies, depressive symptoms, physical activity and sitting time were measured by self-report questionnaires. Dietary information was derived from 24-h dietary recalls. The correlates of the desire to lose weight were examined by logistic or linear regressions with appropriate weighting and variance estimation techniques, adjusting for covariates such as length of time post-surgery. Results showed that at a mean of 7.8 (standard deviation [SD]=0.5) years post-surgery (N= 142), 88.6% of participants wanted to weigh less. The average total energy intake was 1747 (SD=72) kcal/day with 36.2% (SD=0.7%) of the energy from total fat; the median total moderate-intensity physical activity was 88.5min/week; and the mean sitting time was 796.0 (SD=47.0) min/day. The desire to lose weight was positively associated with the adoption of healthy weight control strategies (odds ratio 17.4, 95% confidence interval 3.5-87.0, p< .01). No other significant associations were observed. Findings highlight the need for studies to improve patients' lifestyle behaviours post-surgery (e.g., reduce fat intake, increase physical activity) and examine the correlates of desire to lose weight in larger samples.

Anatabine, Nornicotine, and Anabasine Reduce Weight Gain and Body Fat through Decreases in Food Intake and Increases in Physical Activity.

Obesity is a leading cause of preventable death in the United States. Currently approved pharmacotherapies for the treatment of obesity are associated with rebound weight gain, negative side effects, and the potential for abuse. There is a need for new treatments with fewer side effects. Minor tobacco alkaloids (MTAs) are potential candidates for novel obesity pharmacotherapies. These alkaloids are structurally related to nicotine, which can help reduce body weight, but without the same addictive potential. The purpose of the current study was to examine the effects of three MTAs (nornicotine, anatabine, and anabasine) and nicotine on weight gain, body composition, chow intake, and physical activity. We hypothesized that the MTAs and nicotine would reduce weight gain through reductions in chow intake and increases in physical activity. To test this, male Sprague Dawley rats were housed in metabolic phenotyping chambers. Following acclimation to these chambers and to (subcutaneous (sc)) injections of saline, animals received daily injections (sc) of nornicotine, anabasine, anatabine, or nicotine for one week. Compared to saline-injected animals that gained body weight and body fat during the treatment phase, injections of nornicotine and anatabine prevented additional weight gain, alongside reductions in body fat. Rats receiving anabasine and nicotine gained body weight at a slower rate relative to rats receiving saline injections, and body fat remained unchanged. All compounds reduced the intake of chow pellets. Nornicotine and nicotine produced consistent increases in physical activity 6 h post-injection, whereas anabasine’s and anatabine’s effects on physical activity were more transient. These results show that short-term, daily administration of nornicotine, anabasine, and anatabine has positive effects on weight loss, through reductions in body fat and food intake and increases in physical activity. Together, these findings suggest that MTAs are worthy of further investigations as anti-obesity pharmacotherapies.

Changes in Plasma Choline and the Betaine-to-Choline Ratio in Response to 6-Month Lifestyle Intervention Are Associated with the Changes of Lipid Profiles and Intestinal Microbiota: The ICAAN Study.

Trimethylamine N-oxide (TMAO) and its precursors, including choline, betaine, and L-carnitine, are gut microbiota-related metabolites associated with the risk of obesity. We aimed (1) to comprehensively examine whether the changes in plasma TMAO and its precursors induced by lifestyle intervention are associated with the improvements in plasma metabolic parameters; and (2) to identify the fecal microbiome profiles and nutrient intakes associated with these metabolites and metabolic index. Data from 40 participants (obese children and adolescents) having the plasma metabolites data related to the changes in BMI z-scores after 6-month lifestyle intervention were analyzed. In this study, we observed that choline and the betaine-to-choline ratio (B/C) showed different patterns depending on the changes in BMI z-scores by the response to lifestyle intervention. During the 6 months, an increase in choline and a decrease in B/C were observed in non-responders. We also found that changes in choline and B/C were associated with the improvements in plasma lipid levels. Individuals who showed reduced choline or increased B/C from the baseline to 6 months had a significant decrease in LDL-cholesterol over 6 months compared to those with increased choline or decreased B/C, respectively. In addition, the increase in choline or decrease in B/C was associated with the increase in plasma triglycerides. The distribution of gut microbiota belonging to the Firmicutes, such as Clostridia, Clostridiales, Peptostreptococcaceae, Romboutsia, and Romboutsia timonensis was altered to be lower during the 6 months both as choline decreased and B/C increased. Moreover, the decrease in choline and the increase in B/C were associated with reduced fat intake and increased fiber intake after the 6-month intervention. Finally, lower abundance of Romboutsia showed the association with lower LDL-cholesterol and higher intake of fiber. In summary, we demonstrated that reduced choline and increased B/C by lifestyle intervention were associated with the improvements of LDL-cholesterol and triglycerides, low-fat and high-fiber intakes, and low abundance of Firmicutes. These indicate that changes to circulating choline and B/C could predict individuals’ changes in metabolic compositions in response to the lifestyle intervention.

Letter to the editor concerning: Stroke and diets: A review

Dear Editor, It is with great interest that we read the recently published review entitled “Stroke and Diets” in the Tzu Chi Medical Journal[1]. The authors provide a concise and up-to-date discussion on the role of different dietary patterns in the prevention of stroke. Lin et al. concluded that “vegetarian (meatless) diets have a significant impact on major risk factors of stroke” and highlighted their importance in both stroke prevention and management. We agree that plant-based diets are beneficial with regard to stroke risk factor management (including hypertension, obesity, and atrial fibrillation[2]), yet we also believe that it is of paramount importance to differentiate between different plant-based eating patterns in greater detail. In particular, the lacto-ovo-vegetarian diet (which includes dairy products such as milk, cheese, and yoghurt) and the vegan diet (defined by the absence of all animal foods) may have different effects on several established stroke risk factors. The Adventist Health Study-2 cited by Lin revealed that lacto-ovo-vegetarians had a significantly higher body mass index (25.7 ± 5.1 kg/m 2) than those consuming a vegan diet (23.6 ± 4.4 kg/m2)[3]. Diabetes, another major stroke risk factor, was also found more frequently in vegetarians than in vegans [Figure 1] [3].Figure 1: Prevalence of type-2-diabetes (in %) among different dietary patterns in the Adventist Health Study-2One important difference between both dietary patterns is that vegan diets exclude cheese, a food high in (saturated) fat and sodium. Excessive intake of both of these nutrients has been frequently associated with an increased stroke risk[4]. The higher cheese (and subsequently sodium) intake in vegetarians also served as one of several potential explanations why vegetarians were shown to have higher rates of hemorrhagic and total stroke than omnivores in the EPIC-Oxford study[5]. Of note, this study has been often criticized for combining vegetarians and vegans in the same group and a recent cohort study by Chiu et al. revealed opposite finding[6]. A Taiwanese vegetarian diet was associated with a lower risk of ischemic and hemorrhagic strokes[6]. Yet, the low number of daily dairy servings in this examined Taiwanese cohort (compared to European or American vegetarian cohorts) warrants special consideration. Taiwanese vegetarians had a median daily intake of only 0.2 dairy servings (1 serving of dairy was defined as 8 g protein) per day, whereas EPIC-Oxford vegetarians consumed significantly more: 232.3 (±207.3) ml dairy milk and 26.8 (±25.4) g dairy cheese per day[5]. This raises the question whether the comparably low dairy intake is potentially a unique feature to the Taiwanese vegetarian diet? Is it not conceivable that this substantial difference (and the implied reduction in daily saturated fat and sodium intake) could mediate some of the health effects of the Taiwanese vegetarian diet? Finally, it would also be interesting whether the authors are aware of different stroke risk profiles of Taiwanese vegetarians (consuming few dairy products) and Taiwanese vegans (avoiding all dairy products)? Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Online-Based Nutrition Education to Reduce Sugar, Salt, and Fat Intake in School Children: A Research Protocol

BACKGROUND: Indonesia is currently facing a very complex health problem. Non-communicable diseases (NCDs), for instance, are not only suffered by adolescence or adults, but nowadays, children are also facing the same problem. In children, obesity can be a dangerous risk factor for NCDs later in life. In 2013, the prevalence of overweight and obese children aged 5–12 years in Indonesia reached 18.8%. Meanwhile, in the industrial era 4.0, the development of technology and information is running very rapidly and may affect on food preferences of children, especially sugar, salt, and fat intake on children. Hence, schools play an important role in helping students establish healthy eating behaviors. AIM: Since nutrition was not a curriculum in elementary school Indonesia and studies related to nutrition education with the intensive methods through online platforms are still limited, this study aims to explore the effectiveness of 8-week nutrition education related to improving knowledge, attitude, practice, subjective norms, and perceived behavior control of children toward limiting sugar, salt, and fat intake on children aged 8–12 years. METHODS: This is a randomized control trial study by giving nutrition education intervention related to sugar, salt, and fat consumption to schoolchildren. This study targets elementary schoolchildren using a quasi-experiment design with a pre-post test control group design. The study will be conducted online in 3 urban areas (center) in Indonesia, namely: Surabaya, Semarang, and Makassar City. There are 13 elementary schools involved, consisting of 5 schools from Surabaya City, 4 from Semarang City, and 4 from Makassar City. A total of 300 elementary school students aged 8–12 years as well as 26 teachers are joining in this research. This study has the number: U1111-1268-9302 for the Universal Trial Number and approved by Thai Clinical Trial Registry (TCTR) with identification number: TCTR20210824013.

Modification of cardiovascular disease risk by health behaviour change following type 2 diabetes diagnosis.

Among adults with type 2 diabetes (T2D), unhealthy behaviours are associated with increased risk of cardiovascular disease (CVD) events. To date, little research has considered whether healthy changes in behaviours following T2D diagnosis reduce CVD risk. A cohort of 867 adults with screen-detected T2D, participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, were followed for 10years for incidence of CVD events. Diet, alcohol consumption, moderate/vigorous physical activity and smoking were assessed by questionnaire at the time of T2D screening and 1year later. We estimated associations between health behaviours and CVD using Cox regression. We assessed modification of the associations by behaviour change in the year following T2D diagnosis. Smoking [hazard ratio (HR): 1.73 (95% CI: 1.04, 2.87)] and high fat intake [HR: 1.70 (95% CI: 1.02, 2.85)] were associated with a higher hazard of CVD, while high plasma vitamin C [HR: 0.44 (95% CI: 0.22, 0.87)] and high fibre intake [HR: 0.60 (95% CI: 0.36, 0.99)] were associated with a lower hazard of CVD. Reduction in fat intake following T2D diagnosis modified associations with CVD. In particular, among those with the highest fat intake, decreasing intake attenuated the association with CVD [HR: 0.75 (95% CI: 0.36, 1.56)]. Following T2D diagnosis, decreasing fat intake was associated with lower long-term CVD risk. This evidence may raise concerns about low-carbohydrate, high-fat diets to achieve weight loss following T2D diagnosis. Further research considering the sources of fat is needed to inform dietary recommendations. This trial is registered as ISRCTN86769081. Retrospectively registered on 15 December 2006.

Feasibility Study of a Newly Developed Technology-Mediated Lifestyle Intervention for Overweight and Obese Young Adults.

Background: Poor eating habits and sedentary lifestyle are common among young adults and increase the risk for chronic diseases later in life. Due to the widespread use of information technology among young adults, the Rashakaty (Fitness for Me) study aimed to develop and test the feasibility of a technology-based nutrition education intervention. This would support overweight and obese university students to achieve weight loss, enhance nutrition knowledge, and increase physical activity levels. Methods: We enrolled 246 participants in a 16-week non-randomized feasibility study with two arms: Rashakaty-Basic and Rashakaty-Enhanced. The intervention was guided by social cognitive theory and was delivered via a website and mobile apps. Results: Among the 161 participants who completed the endline assessments, there was no significant difference in weight loss between the two arms. However, waist circumference decreased more (p = 0.003) in the Rashakaty -Enhanced group. Additionally, changes in knowledge related to sources of nutrients (p < 0.001) and diet–disease relationships (p = 0.006) were significantly higher among the Rashakaty-Enhanced group. Rashakaty-Enhanced participants reported increased number of days spent on moderate physical activity (p = 0.013) and minutes walked (p < 0.001). Moreover, they also reported higher scores in social support from friends to reduce fat intake (p = 0.006) and from family and friends to increase physical activity (p = 0.001). Conclusions: The results of this feasibility study can assist in the development and implementation of future technology–mediated health promotion programs in the UAE, especially for young adults.

Low-Fat Dietary Modification and Risk of Ductal Carcinoma In Situ of the Breast in the Women's Health Initiative Dietary Modification Trial.

Results of observational studies of the association between dietary fat and risk of invasive breast cancer have been inconsistent. In the Women's Health Initiative dietary modification (DM) randomized trial designed to lower fat intake, the intervention was not associated with a statistically significant reduction of overall breast cancer risk. However, the DM association with risk of ductal carcinoma in situ (DCIS) of the breast, a putative breast cancer precursor, has not been reported. A total of 48,835 postmenopausal women, ages 50-79 years at enrollment, with no breast cancer history and ≥32% of total energy intake from fat, were randomly assigned either to a dietary intervention (n = 19,541) designed to reduce total fat intake to 20% of energy and to increase vegetable, fruit, and grain consumption, or to a comparison group (n = 29,294). Cox proportional hazards models were used to estimate HRs and 95% confidence intervals for the association between the intervention and DCIS risk. During 18.7 years (median) cumulative follow-up, including intervention (∼8.7 years) and post-intervention phases (∼13.0 years), 817 DCIS cases were ascertained. No evidence of an association between the DM intervention and DCIS risk was observed overall, or by trial phase (intervention and post-intervention). Similarly, no associations were found in subgroups defined by potential risk factors for DCIS. DM aiming to reduce fat intake was not associated with altered risk of DCIS. These results do not provide evidence of an association between dietary fat reduction and the risk of DCIS among postmenopausal women.

A Mediterranean Meal Plan Modulates Human Milk Composition in Women With Obesity

ObjectivesHuman milk (HM) is impacted by both maternal obesity and diet. HM from women with obesity has higher fat, leptin and insulin concentrations. Additionally, maternal dietary fat intake is associated with increased HM fat content. The objective of this study was to determine the impact of a Mediterranean meal plan on the composition of HM from women with obesity. MethodsIn this pilot study, thirteen women with obesity (body mass index (BMI) ≥ 30 kg/m2) enrolled at five months post-partum and followed a provided Mediterranean meal plan focused on reducing fat intake and increasing unsaturated fat and fiber intake for four weeks. Participants’ diet was assessed using Nutrition Data System for Research. HM was collected at baseline and after the 4-week intervention and the concentrations of metabolites, hormones and cytokines were assayed. Wilcoxon signed-rank tests and analysis of variance were used to assess changes in participant diet and HM composition. Summary statistics are presented as mean ± standard deviation. ResultsThe participants’ Healthy Eating Index Score, a measure of diet quality, significantly improved (38.3 ± 5.13 vs. 78.2 ± 6.75, p < 0.001) and total fat intake was significantly lower (99.6 ± 23.3 g vs. 66.9 ± 12.0 g/day, p < 0.001) after the intervention. Human milk leptin (694 ± 464 pg/ml vs. 437 ± 324 pg/ml, p = 0.007) and tumor necrosis factor α (0.515 ± 0.267 pg/ml vs. 0.310 ± 0.127 pg/ml, p = 0.010) concentrations were lower post intervention, whereas HM macronutrient composition was unchanged. The concentrations of several individual human milk oligosaccharides (HMO) and total HMOs (7720 ± 797 nmol/ml vs. 6986 ± 940 nmol/ml, p = 0.049), as well as HM tyrosine concentration (18.2 ± 6.16 nmol/ml vs. 14.5 ± 4.69 nmol/ml, p = 0.005) were significantly lower post intervention. ConclusionsThe composition of HM from women with obesity can be modulated by short-term adherence to a Mediterranean meal pattern. These findings merit further studies that use longer interventions and examine the impact of any changes in HM composition on infant growth and development. Modifying HM composition via a dietary intervention may provide a novel strategy to promote child development and health. Funding SourcesUSDA ARS #6026-51,000-010-05S and #6026-51,000-012-06S, NIH/NIDDK R01DK107516, Arkansas Children’s Research Institute/Arkansas Biosciences Institute GR037121.