Single-meal Studies Research Articles

Effects of Single Low-Carbohydrate, High-Fat Meal Consumption on Postprandial Lipemia and Markers of Endothelial Dysfunction: A Systematic Review of Current Evidence.

Postprandial lipemia (PPL) is associated with increased risk of endothelial dysfunction (ED), a precursor of atherosclerotic cardiovascular disease (ASCVD). The effects of low-carbohydrate, high-fat (LCHF) diets on ASCVD risk are uncertain; therefore, gaining a greater understanding of LCHF meals on PPL may provide valuable insights. The current systematic review investigated the effects of single LCHF meal consumption on PPL and markers of ED. CINAHL Plus, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for key terms related to endothelial function, cardiovascular disease, glycemia, lipemia, and the postprandial state with no restriction on date. Full-text articles were independently screened by 2 reviewers, of which 16 studies were eligible to be included in the current review. All trials reported a minimum analysis of postprandial triglycerides (PPTG) following consumption of an LCHF meal (<26% of energy as carbohydrate). Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Single-meal macronutrient composition was found to play a key role in determining postprandial lipid and lipoprotein responses up to 8 hours post-meal. Consumption of LCHF meals increased PPTG and may contribute to ED via reduced flow-mediated dilation and increased oxidative stress; however, energy and macronutrient composition varied considerably between studies. Consumption of an LCHF meal had a negative impact on PPL based on some, but not all, single-meal studies; therefore, the contribution of LCHF meals to cardiometabolic health outcomes remains unclear. Further research is needed on specific categories of LCHF diets to establish a causal relationship between postprandial modulation of lipids/lipoproteins and impaired vascular endothelial function. PROSPERO registration no. CRD 42023398774.

Dietary glycaemic index and cognitive function: prospective associations in adults of the 1946 British birth cohort.

Evidence suggests that the rate of glucose release following consumption of carbohydrate-containing foods, defined as the glycaemic index (GI), is inversely associated with cognitive function. To date, most of the evidence stems from either single-meal studies or highly heterogeneous cohort studies. We aimed to study the prospective associations of diet GI at age 53 years with outcomes of verbal memory and letter search tests at age 69 years and rate of decline between 53 and 69 years. Longitudinal population-based birth cohort study. MRC National Survey for Health and Development. Cohort members (n 1252). Using multivariable linear and logistic regression, adjusted for potential confounders, associations of higher-GI diet with lower verbal memory, lower letter search speed and lower number of hits in a letter search test were attenuated after adjustments for cognitive ability at age 15 years, educational attainment, further training and occupational social class. No association was observed between diet GI at 53 years and letter search accuracy or speed-accuracy trade-off at 69 years, or between diet GI at 53 years and rate of decline between 53 and 69 years in any cognitive measure. Diet GI does not appear to predict cognitive function or decline, which was mainly explained by childhood cognitive ability, education and occupational social class. Our findings confirm the need for further research on the association between diet and cognition from a life-course perspective.

Endogenous glucose production after sequential meals in humans: evidence for more prolonged suppression after ingestion of a second meal.

Single-meal studies have shown that carbohydrate ingestion causes rapid and persistent suppression of endogenous glucose production (EGP). However, little is known about the regulation of EGP under real-life eating patterns in which multiple carbohydrate-containing meals are consumed throughout the day. Therefore, we aimed to characterize the regulation of EGP in response to sequential meals, specifically during the breakfast-lunch transition. Nine healthy individuals (5 men, 4 women; 32 ± 2 yr; 25.0 ± 1.4 kg/m2) ingested two identical mixed meals, each containing 25 g of glucose, separated by 4 h, and EGP was determined by the variable infusion tracer-clamp approach. EGP was rapidly suppressed after both meals, with the pattern and magnitude of suppression being similar over the initial 75-min postmeal period. However, EGP suppression was more transient after breakfast compared with lunch, with EGP returning to basal rates 3 h after breakfast. In contrast, EGP remained in a suppressed state for the entire 4-h postlunch period. This occurred despite each meal eliciting similar plasma glucose and insulin responses. However, there was greater suppression of plasma glucagon levels after lunch, likely contributing to this response. These findings highlight the potential for distinct regulation of EGP with each meal of the day and suggest that EGP may be in a suppressed state for much of the day, since EGP did not return to basal rates even after a lunch meal containing a modest amount of carbohydrate.

Low-phytate wholegrain bread instead of high-phytate wholegrain bread in a total diet context did not improve iron status of healthy Swedish females: a 12-week, randomized, parallel-design intervention study

PurposeTo investigate the effects of eating wholegrain rye bread with high or low amounts of phytate on iron status in women under free-living conditions.MethodsIn this 12-week, randomized, parallel-design intervention study, 102 females were allocated into two groups, a high-phytate-bread group or a low-phytate-bread group. These two groups were administered: 200 g of blanched wholegrain rye bread/day, or 200 g dephytinized wholegrain rye bread/day. The bread was administered in addition to their habitual daily diet. Iron status biomarkers and plasma alkylresorcinols were analyzed at baseline and post-intervention.ResultsFifty-five females completed the study. In the high-phytate-bread group (n = 31) there was no change in any of the iron status biomarkers after 12 weeks of intervention (p > 0.05). In the low-phytate bread group (n = 24) there were significant decreases in both ferritin (mean = 12%; from 32 ± 7 to 27 ± 6 µg/L, geometric mean ± SEM, p < 0.018) and total body iron (mean = 12%; from 6.9 ± 1.4 to 5.4 ± 1.1 mg/kg, p < 0.035). Plasma alkylresorcinols indicated that most subjects complied with the intervention.ConclusionsIn Swedish females of reproductive age, 12 weeks of high-phytate wholegrain bread consumption had no effect on iron status. However, consumption of low-phytate wholegrain bread for 12 weeks resulted in a reduction of markers of iron status. Although single-meal studies clearly show an increase in iron bioavailability from dephytinization of cereals, medium-term consumption of reduced phytate bread under free-living conditions suggests that this strategy does not work to improve iron status in healthy women of reproductive age.

Effect of dietary fatty acid composition on substrate utilization and body weight maintenance in humans

Dietary fat content is a primary factor associated with the increase in global obesity rates. There is a delay in achieving fat balance following exposure to a high-fat (HF) diet (≥ 40% of total energy from fat) and fat balance is closely linked to energy balance. Exercise has been shown to improve this rate of adaptation to a HF diet. Recently, however, the role of dietary fatty acid composition on energy and macronutrient balance has come into question. We chose studies that compared monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and saturated fatty acids (SFA). We have reviewed studies that measured diet-induced thermogenesis (DIT), energy expenditure (EE), or fat oxidation (FOx) in response to a HF meal challenge, or long-term dietary intervention comparing these fatty acids. While single-meal studies show that SFA induce lower DIT and FOx compared to unsaturated fats, the effect of the degree of unsaturation (MUFA vs. PUFA) appears to yet be determined. Long-term dietary interventions also support the notion that unsaturated fats induce greater EE, DIT, and/or FOx versus SFA and that a high MUFA diet induces more weight loss compared to a high SFA diet. Sex and BMI status also affect the metabolic responses to different fatty acids; however, more research in these areas is warranted. SFA are likely more obesigenic than MUFA, and PUFA. The unsaturated fats appear to be more metabolically beneficial, specifically MUFA ≥ PUFA > SFA, as evidenced by the higher DIT and FOx following HF meals or diets.

Iron and zinc nutrition in the economically-developed world: a review.

This review compares iron and zinc food sources, dietary intakes, dietary recommendations, nutritional status, bioavailability and interactions, with a focus on adults in economically-developed countries. The main sources of iron and zinc are cereals and meat, with fortificant iron and zinc potentially making an important contribution. Current fortification practices are concerning as there is little regulation or monitoring of intakes. In the countries included in this review, the proportion of individuals with iron intakes below recommendations was similar to the proportion of individuals with suboptimal iron status. Due to a lack of population zinc status information, similar comparisons cannot be made for zinc intakes and status. Significant data indicate that inhibitors of iron absorption include phytate, polyphenols, soy protein and calcium, and enhancers include animal tissue and ascorbic acid. It appears that of these, only phytate and soy protein also inhibit zinc absorption. Most data are derived from single-meal studies, which tend to amplify impacts on iron absorption in contrast to studies that utilize a realistic food matrix. These interactions need to be substantiated by studies that account for whole diets, however in the interim, it may be prudent for those at risk of iron deficiency to maximize absorption by reducing consumption of inhibitors and including enhancers at mealtimes.

A Complete Diet-Based Algorithm for Predicting Nonheme Iron Absorption in Adults1,2

Many algorithms have been developed in the past few decades to estimate nonheme iron absorption from the diet based on single meal absorption studies. Yet single meal studies exaggerate the effect of diet and other factors on absorption. Here, we propose a new algorithm based on complete diets for estimating nonheme iron absorption. We used data from 4 complete diet studies each with 12–14 participants for a total of 53 individuals (19 men and 34 women) aged 19–38 y. In each study, each participant was observed during three 1-wk periods during which they consumed different diets. The diets were typical, high, or low in meat, tea, calcium, or vitamin C. The total sample size was 159 (53 × 3) observations. We used multiple linear regression to quantify the effect of different factors on iron absorption. Serum ferritin was the most important factor in explaining differences in nonheme iron absorption, whereas the effect of dietary factors was small. When our algorithm was validated with single meal and complete diet data, the respective R2 values were 0.57 (P < 0.001) and 0.84 (P < 0.0001). The results also suggest that between-person variations explain a large proportion of the differences in nonheme iron absorption. The algorithm based on complete diets we propose is useful for predicting nonheme iron absorption from the diets of different populations.

A complete meal based algorithm for predicting nonheme iron absorption

It is not feasible to conduct human studies to study all possible combinations of the various factors that affect nonheme iron absorption. Many algorithms have been developed in the past to estimate nonheme iron absorption based on single meal studies. However, exaggerating effect of the factors in single meal studies is well known. The objective of this study was to develop an algorithm based on a complete diet for estimating nonheme iron absorption. We used data from 4 complete diet studies that had 12–14 subjects who consumed 3 different diets (n=159), typical, high and low meat, tea, calcium and vitamin C. Multiple linear regression with a mixed effect model was used. Our results suggest that serum ferritin contributed significantly to the variability in nonheme iron absorption and the effect of dietary factors was small. The predicted absorption values correlated significantly with the observed values from single and complete meal studies (R2=0.57, P&lt;0.001 and R2= 0.93, P&lt; 0.0001, respectively). When iron absorption was predicted from intervention study data in subjects with ≤15μg/L serum ferritin, the values were similar to observed values (18.6 vs 18.8%). Although interpersonal variation explains a large proportion of the differences in nonheme iron absorption, our algorithms with complete meals will be useful in predicting nonheme iron absorption from usual diets of varied populations.Grant Funding Source : IFPRI/HarvestPLUS and MI

Calcium Does Not Inhibit the Absorption of 5 Milligrams of Nonheme or Heme Iron at Doses Less Than 800 Milligrams in Nonpregnant Women ,

Calcium is the only known component in the diet that may affect absorption of both nonheme and heme iron. However, the evidence for a calcium effect on iron absorption mainly comes from studies that did not isolate the effect of calcium from that of other dietary components, because it was detected in single-meal studies. Our objective was to establish potential effects of calcium on absorption of nonheme and heme iron and the dose response for this effect in the absence of a meal. Fifty-four healthy, nonpregnant women were selected to participate in 4 iron absorption studies using iron radioactive tracers. We evaluated the effects of calcium doses between 200 and 1500 mg on absorption of 5 mg nonheme iron (as ferrous sulfate). We also evaluated the effects of calcium doses between 200 and 800 mg on absorption of 5 mg heme iron [as concentrated RBC (CRBC)]. Calcium was administered as calcium chloride in all studies and minerals were ingested on an empty stomach. Calcium doses ≥1000 mg diminished nonheme iron absorption by an average of 49.6%. A calcium dose of 800 mg diminished absorption of 5 mg heme iron by 37.7%. In conclusion, we demonstrated an isolated effect of calcium (as chloride) on absorption of 5 mg of iron provided as nonheme (as sulfate) and heme (as CRBC) iron. This effect was observed at doses higher than previously reported from single-meal studies, starting at ~800 mg of calcium.

Algorithms to Assess non-Heme Iron Bioavailability

While sufficient information exists on the effect of individual factors on iron absorption, their net effect in a mixed meal is less well characterized, being dependent on the combination and quantity of the factors present in the meal. Over a period of more than 25 years, several models have been developed to estimate non-heme iron bioavailability, either to assess iron absorption from a meal or iron sufficiency in populations. Initially, a model was developed to calculate iron absorption in individuals with varying iron status that included only enhancers. This model was useful in classifying the diets but has limited value for accurale assessment. Later models were modified and improved by including inhibitors in the calculations. However, some included either phytate or tea but not in combination. The models that included all the factors in calculations assumed their effect was independent and additive rather than interactive, which is an important issue in addressing iron bioavailability. Although some of the models correlated estimated bioavailability with iron status of the population, the accuracy of the estimations is of concern due to lack of quantitative measurements of bioavailability modifiers, inability to consider interactive effects, and the use of non-iron status measurements. Recent research has led to the development of refined models to assess iron bioavailability of complex meals by comprehensively taking into consideration the interactive effect among enhancers and inhibitors. However, the models are based on single-meal studies and their application to whole diets at a population level is not clear. Accurate measurements of dietary factors and independent validation are needed before using these models. To date, no single model is applicable to all diets and additional studies are needed to develop new models to predict bioavailability of whole diets accurately, in addition to addressing dietary adequacy in all populations.

Long-term calcium supplementation does not affect the iron status of 12–14-y-old girls

Single-meal studies have established that calcium has an acute inhibitory effect on the absorption of iron. However, there is growing evidence that high calcium intakes do not compromise iron status. We evaluated whether long-term calcium supplementation taken with the main meal affected biomarkers of iron status in adolescent girls with high requirements of both iron and calcium. The study was a randomized, double-blind, placebo-controlled trial of supplementation with 500 mg Ca/d for 1 y among 113 adolescent girls aged 13.2 +/- 0.4 y at enrollment. Participants were advised to take the supplement with their evening meal, which usually contributes the majority of dietary iron. Iron status was assessed at baseline and after 1 y of supplementation by measuring hemoglobin and serum concentrations of ferritin and transferrin receptors (TfRs). The mean (+/-SD) hemoglobin at enrollment was 134 +/- 9 g/L, geometric mean serum ferritin was 26.3 microg/L (interquartile range: 18.6-39.4 microg/L), and serum TfR was 4.19 mg/L (3.52-5.10 mg/L). Daily calcium supplementation had no effect on the least-squares mean concentrations of iron-status markers adjusted for their baseline values (hemoglobin: 136 and 134 g/L, P = 0.31; ferritin: 25.4 and 26.1 microg/L, P = 0.73; TfR: 4.1 and 4.4 mg/L, P = 0.12; and the ratio of TfR to ferritin: 160 and 161 in the calcium and placebo groups, respectively; P = 0.97). Although it remains to be shown in iron-deficient persons, long-term iron status does not seem to be compromised by high calcium intakes.

Long-term calcium supplementation does not affect the iron status of 12–14-y-old girls

Background: Single-meal studies have established that calcium has an acute inhibitory effect on the absorption of iron. However, there is growing evidence that high calcium intakes do not compromise iron status. Objective: We evaluated whether long-term calcium supplementation taken with the main meal affected biomarkers of iron status in adolescent girls with high requirements of both iron and calcium. Design: The study was a randomized, double-blind, placebo-controlled trial of supplementation with 500 mg Ca/d for 1 y among 113 adolescent girls aged 13.2 ± 0.4 y at enrollment. Participants were advised to take the supplement with their evening meal, which usually contributes the majority of dietary iron. Iron status was assessed at baseline and after 1 y of supplementation by measuring hemoglobin and serum concentrations of ferritin and transferrin receptors (TfRs). Results: The mean (±SD) hemoglobin at enrollment was 134 ± 9 g/L, geometric mean serum ferritin was 26.3 μg/L (interquartile range: 18.6–39.4 μg/L), and serum TfR was 4.19 mg/L (3.52–5.10 mg/L). Daily calcium supplementation had no effect on the least-squares mean concentrations of iron-status markers adjusted for their baseline values (hemoglobin: 136 and 134 g/L, P = 0.31; ferritin: 25.4 and 26.1 μg/L, P = 0.73; TfR: 4.1 and 4.4 mg/L, P = 0.12; and the ratio of TfR to ferritin: 160 and 161 in the calcium and placebo groups, respectively; P = 0.97). Conclusion: Although it remains to be shown in iron-deficient persons, long-term iron status does not seem to be compromised by high calcium intakes.

Pork meat increases iron absorption from a 5-day fully controlled diet when compared to a vegetarian diet with similar vitamin C and phytic acid content

Meat increases absorption of non-haem iron in single-meal studies. The aim of the present study was to investigate, over a 5 d period, the potential increasing effect of consumption of pork meat in a whole diet on the fractional absorption of non-haem iron and the total absorption of iron, when compared to a vegetarian diet. A randomised cross-over design with 3 x 5 d whole-diet periods with diets containing Danish-produced meat, Polish-produced meat or a vegetarian diet was conducted. Nineteen healthy female subjects completed the study. All main meals in the meat diets contained 60 g of pork meat and all diets had high phytic acid content (1250 mumol/d). All main meals were extrinsically labelled with the radioactive isotope (59)Fe and absorption of iron was measured in a whole body counter. The non-haem iron absorption from the Danish meat diet was significantly higher compared to the vegetarian diet (P=0.031). The mean fractional absorption of non-haem iron was 7.9 (se1.1), 6.8 (se 1.0) and 5.3 (se 0.6) % for the Danish and Polish meat diets and vegetarian diet, respectively. Total absorption of iron was higher for both meat diets compared to the vegetarian diet (Danish meat diet: P=0.006, Polish meat diet: P=0.003). The absorption ratios of the present study were well in accordance with absorption ratios estimated using algorithms on iron bioavailability. Neither the meat diets nor the vegetarian diets fulfilled the estimated daily requirements of absorbed iron in spite of a meat intake of 180 g/d in the meat diets.

Meal size of high-fat food is reliably greater than high-carbohydrate food across externally-evoked single-meal tests and long-term spontaneous feeding in rat

A series of studies in rat using isoenergetic (kcal/ml) liquid diets differing in fat content has previously found dietary fat to dose-dependently increase daily caloric intake. In single-meal tests in which meal initiation was externally evoked in feeding-associated environments, the behavioral expression of this overeating was found to be larger meal intake. The present studies confirmed the ecological validity of this larger meal size of high-fat diet (HF) relative to high-carbohydrate diet (HC): meal size of HF>HC in home-cage testing (Experiment 1), and during undisturbed, spontaneous feeding in which ingestive behavior was continuously monitored (Experiments 2 and 3). These findings demonstrate that single-meal paradigms yield results consistent with spontaneous feeding of high-fat and high-carbohydrate liquid diets, thus supporting the use of single-meal studies to better understand the physiological bases of elevated caloric intake associated with chronic consumption of a high-fat diet.

Enhancers of Iron Absorption: Ascorbic Acid and other Organic Acids

Ascorbic acid (AA), with its reducing and chelating properties, is the most efficient enhancer of non-heme iron absorption when its stability in the food vehicle is ensured. The number of studies investigating the effect of AA on ferrous sulfate absorption far outweighs that of other iron fortificants. The promotion of iron absorption in the presence of AA is more pronounced in meals containing inhibitors of iron absorption. Meals containing low to medium levels of inhibitors require the addition of AA at a molar ratio of 2:1 (e.g., 20 mg AA: 3 mg iron). To promote absorption in the presence of high levels of inhibitors, AA needs to be added at a molar ratio in excess of 4:1, which may be impractical. The effectiveness of AA in promoting absorption from less soluble compounds, such as ferrous fumarate and elemental iron, requires further investigation. The instability of AA during food processing, storage, and cooking, and the possibility of unwanted sensory changes limits the number of suitable food vehicles for AA, whether used as vitamin fortificant or as an iron enhancer. Suitable vehicles include dry-blended foods, such as complementary, precooked cereal-based infant foods, powdered milk, and other dry beverage products made for reconstitution that are packaged, stored, and prepared in a way that maximizes retention of this vitamin. The consumption of natural sources of Vitamin C (fruits and vegetables) with iron-fortified dry blended foods is also recommended. Encapsulation can mitigate some of the AA losses during processing and storage, but these interventions will also add cost. In addition, the bioavailability of encapsulated iron in the presence/absence of AA will need careful assessment in human clinical trials. The long-term effect of high AA intake on iron status may be less than predicted from single meal studies. The hypothesis that an overall increase of dietary AA intake, or fortification of some foods commonly consumed with the main meal with AA alone, may be as effective as the fortification of the same food vehicle with AA and iron, merits further investigation. This must involve the consideration of practicalities of implementation. To date, programs based on iron and AA fortification of infant formulas and cow's milk provide the strongest evidence for the efficacy of AA fortification. Present results suggest that the effect of organic acids, as measured by in vitro and in vivo methods, is dependent on the source of iron, the type and concentration of organic acid, pH, processing methods, and the food matrix. The iron absorption-enhancing effect of AA is more potent than that of other organic acids due to its ability to reduce ferric to ferrous iron. Based on the limited data available, other organic acids may only be effective at ratios of acid to iron in excess of 100 molar. This would translate into the minimum presence/addition of 1 g citric acid to a meal containing 3 mg iron. Further characterization of the effectiveness of various organic acids in promoting iron absorption is required, in particular with respect to the optimal molar ratio of organic acid to iron, and associated feasibility for food application purposes. The suggested amount of any organic acid required to produce a nutritional benefit will result in unwanted organoleptic changes in most foods, thus limiting its application to a small number of food vehicles (e.g., condiments, beverages). However, fermented foods that already contain high levels of organic acid may be suitable iron fortification vehicles.

Iron nutrition in the UK: getting the balance right

Fe homeostasis is considered in the context of the UK diet, using information on Fe intake and status from the National Diet and Nutrition Surveys. The importance of assessing Fe availability rather than total Fe intake is discussed. Dietary and host-related factors that determine Fe bioavailability (Fe utilised for Hb production) are reviewed using information from single-meal studies. When adaptive responses are taken into consideration, foods associated with higher Fe status include meat (haem-Fe and the 'meat factor') and fruits and fruit juice (vitamin C). Foods that may have a negative impact include dairy products (Ca), high-fibre foods (phytate) and tea and coffee (polyphenols), but the effects are more apparent in groups with marginal Fe deficiency, such as women of childbearing age. Analysis of dietary intake data on a meal-by-meal basis is needed to predict the influence of changing dietary patterns on Fe nutrition in the UK. Current information suggests that in the UK Fe deficiency is a greater problem than Fe overload.

Calcium from milk or calcium-fortified foods does not inhibit nonheme-iron absorption from a whole diet consumed over a 4-d period

Single-meal studies have indicated that calcium inhibits iron absorption in humans. However, numerous dietary factors influence iron absorption, and the effect of calcium may not be as pronounced when calcium is served as part of a whole diet. We investigated the effect of 3 sources of calcium served with the 3 main meals on nonheme-iron absorption from a 4-d diet. (59)Fe absorption was estimated from whole-body retention measurements in 14 women aged 21-34 y, each of whom consumed four 4-d diets in a randomized crossover design. The diets differed in the source of calcium as follows: a basic diet (BD) with a low content of calcium (224 mg Ca/d), a BD with a glass of milk served at each meal (826 mg Ca/d), a BD with calcium lactate (802 mg Ca/d), and a BD with a milk mineral isolate containing calcium (801 mg Ca/d). The 2 latter calcium sources were added to selected foods of the BD (rye bread, white bread, chocolate cake, and orange juice), and these foods were consumed with the 3 meals. All diets provided 13.2 mg Fe/d. No significant differences in nonheme-iron absorption were found between the BD and the BD supplemented with milk, calcium lactate, or the milk mineral isolate [7.4% (95% CI: 5.3%, 10.5%), 5.2% (3.5%, 7.9%), 6.7% (5.0%, 8.9%), and 5.1% (3.2%, 7.9%), respectively; P = 0.34]. Consumption of a glass of milk with the 3 main meals or of an equivalent amount of calcium from fortified foods does not decrease nonheme-iron absorption from a 4-d diet.

Phytosterols and cholesterol metabolism.

Phytosterols are plant sterols structurally similar to cholesterol that act in the intestine to lower cholesterol absorption. Because they have very low systemic absorption and are already present in healthy diets, increasing the intake of phytosterols may be a practical way to reduce coronary heart disease with minimum risk. Phytosterols displace cholesterol from intestinal micelles, reducing the pool of absorbable cholesterol, but they are also rapidly taken up by enterocytes and increase expression of the adenosine triphosphate-binding cassette A1 sterol transporter. Phytosterol esters dissolved in food fat reduce LDL-cholesterol by 10% at a maximum effective dose of 2 g/day. However, this work probably understates the true effectiveness of phytosterols because it does not account for those naturally present in baseline diets. Single meal studies show that phytosterols in intact foods are bioactive at doses as low as 150 mg. The potential effectiveness of phytosterols has been improved in several ways. Individuals most likely to respond have been identified as having high cholesterol absorption and low cholesterol biosynthesis. Phytosterols can be emulsified with lecithin and delivered in non-fat or low-fat foods and beverages, and the amount of fat in fat-based preparations can be reduced substantially with the retention of bioactivity. Phytosterols effectively reduce LDL-cholesterol when given as supplements, and the smaller amounts in natural foods also appear to be important. Future work will focus on the better delivery of phytosterols in natural foods and supplements and on further defining the mechanisms of action.

An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes

In single-meal studies, dietary protein does not result in an increase in glucose concentrations in persons with or without type 2 diabetes, even though the resulting amino acids can be used for gluconeogenesis. The metabolic effects of a high-protein diet were compared with those of the prototypical healthy (control) diet, which is currently recommended by several scientific organizations. The metabolic effects of both diets, consumed for 5 wk each (separated by a 2-5-wk washout period), were studied in 12 subjects with untreated type 2 diabetes. The ratio of protein to carbohydrate to fat was 30:40:30 in the high-protein diet and 15:55:30 in the control diet. The subjects remained weight-stable during the study. With the fasting glucose concentration used as a baseline from which to determine the area under the curve, the high-protein diet resulted in a 40% decrease in the mean 24-h integrated glucose area response. Glycated hemoglobin decreased 0.8% and 0.3% after 5 wk of the high-protein and control diets, respectively; the difference was significant (P < 0.05). The rate of change over time was also significantly greater after the high-protein diet than after the control diet (P < 0.001). Fasting triacylglycerol was significantly lower after the high-protein diet than after the control diet. Insulin, C-peptide, and free fatty acid concentrations were not significantly different after the 2 diets. A high-protein diet lowers blood glucose postprandially in persons with type 2 diabetes and improves overall glucose control. However, longer-term studies are necessary to determine the total magnitude of response, possible adverse effects, and the long-term acceptability of the diet.

Iron metabolism and requirements in early childhood: do we know enough?: a commentary by the ESPGHAN Committee on Nutrition.

*University of Lancashire, Lancashire, United Kingdom; †University of Milano, Milano, Italy; ‡University of Lund, Malmo, Sweden; §Hopital des Enfants Malades, Paris, France; Hopital Necker Enfants-Malades, Paris, France, ¶Umea University, Umea, Sweden; #University of Munich, Munich, Germany; **Free University of Amsterdam, Amsterdam, The Netherlands; ††Royal Veterinary and Agricultural University, Frederiksberg, Denmark; ‡‡CHUV University Hospital, Lausanne, Switzerland; §§University of Liege, Liege, Belgium; Medical University of Warsaw, Warsaw, Poland; and ¶¶University of Glasgow, Glasgow, United Kingdom