Whole Grain Intake Research Articles

726-P: Mediterranean Diet Adherence and Association with Cardiometabolic Risk after Behavioral Weight Intervention in Older Adults

Adherence to a Mediterranean (Med) diet pattern, characterized by increased intake of fruits, nuts/seeds, vegetables, legumes, whole grains, seafood, yogurt and vegetables, and decreased intake of red/processed meats, refined grains, starches and added sugars, is associated with reduced cardiometabolic risk independent of total calorie intake or single nutrients. We examined whether adherence to Med diet was associated with risk factor change in the context of a behavioral weight management trial for U.S. community-dwelling older adults at elevated diabetes and cardiovascular risk. The Pitt Retiree Study (n=322) examined the impact of 12 weekly group lifestyle sessions on weight and cardiometabolic risk (BMI, waist, glucose, lipids, and blood pressure) in older adults (age 65-80 yrs). Dietary goals included calorie reduction, <30% of total calories from fat, lean protein at most meals, and following USDA MyPlate guidelines but not a Med diet. Adherence to a Med diet pattern (0-14 score) was assessed at baseline, 4, 12, and 24 months and categorized as low (0-5), moderate (6-9), or high (≥10). The baseline median Med diet score was 6 (range 0-13), with 45% categorized as low, 50% moderate, 5% high. Women were more adherent than men (p<0.01). Adjusting for sex, higher scores were correlated with older age (p=0.02), lower baseline BMI (p=0.01) and smaller waist (p=0.01). Median [IQR] scores improved at 4 months (+1 [0, +2] p<.001) with 27% low, 63% moderate, 10% high. Each 1-unit Med diet increase was associated with -0.1 kg/m2 BMI (SE=0.04, p=.006) and -1.0 mmHg Systolic BP (SE=0.47, p=0.03) at 4 months. Med diet improvement was maintained at 12 (+1, [0, +2] p<.001) and 24 months (n=299, +1 [0, +2] p<.001). Adherence to a food pattern consistent with a Med diet improves after lifestyle intervention, even when not specifically prescribed, and is associated with weight and blood pressure benefits. Importantly, older adults sustain change in dietary quality over 2 years. Disclosure R.G. Miller: None. E.M. Venditti: None. M.D. Marcus: None. L.J. Germeroth: None. R.P.K. Conlon: None. M.D. Levine: None. T. Costacou: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096404)

Skipping Breakfast Is Associated with Diet Quality and the Distribution of Food Intake Throughout the Day: NHANES 2005–20016

Abstract Objectives Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. Methods Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c <5.7%, n = 14,701), prediabetes (HbA1c 5.7–6.4%, n = 5855) and diabetes (HbA1c (≥6.5%, n = 2881). Dietary intakes were assessed using a multiple pass 24-hour recall to estimate intakes from the foods and beverages reported as consumed on the day prior to the NHANES visit. Breakfast was self-defined by participants. Total population-based means (95% CI) of nutrient intakes, MyPlate equivalents, and Healthy Eating Index 2015 scores from the day of intake were calculated across levels of glycemic control and skipping breakfast status. Results Across all groups, adults who reported breakfast consumption had a significantly better overall diet quality, while total intakes of whole grains and fiber were significantly lower in those who skipped breakfast. Intakes of added sugars were not significantly different between those who skipped versus consumed breakfast. Conclusions The absence of breakfast on the day of intake was related to differential intakes of several nutrients related to healthy eating and glycemic management, resulting in a poorer overall diet quality. Healthcare professionals could evaluate meal skipping patterns and its impact on overall nutrient intakes, and the distribution of food intake throughout the day, in people with diabetes, to help improve disease management. Funding Sources Abbott Nutrition.

Group Activities Designed for Geriatric Nutrition at Community Centers Improve Frailty in Older Adults: A Place-Randomized Controlled Trial

Abstract Objectives Recent interventional studies have shown that frailty can be improved by modifying dietary quality. In this study, we developed a set of nutrition-centric health promotion activities for elderly participants of the community care centers and examined the efficacy of these activities on slowing down the development or regression of frailty. Methods This cluster-randomized controlled trial was conducted between 09/2018 and 12/2019 at 13 communities in Taipei, Taiwan. Seven communities (124 subjects) was randomly assigned into the control group (1 hour exercise per week for 3 months) and another 6 (95 subjects) was in the intervention group (the exercise program + nutrition grouped activities, 1 hour per week for 3 months). The intervention programs included: (a) training on-site staffs to use motivational interview technique to communicate, to estimate participant's energy requirement, and to learn how to provide proper amounts of foods to individual elderlies, (b) nutrition grouped activities on ①know my plate, ②wholegrains, ③ drinking teas with dairy, and nuts, ④novel ways to eat fruit and vegetables, ⑤healthy breakfast ideas. In the first month, we intervened with the activities laid out above; in the second month, we conducted a qualitative discussion on elders’ dietary changes; in the third month, we designed activities that helped break down barriers in order to establish long-term change in dietary habits. Improvement in frailty scores was the primary outcome. Secondary outcomes included nutritional status, physical performance, and mental health. The measurements were performed at baseline, 3 months, and 6 months. Results Overall, 190 subjects completed the trial. At post-intervention, the intervention group exhibited borderline significant improvements in the frailty scores (P = 0.08) compared to the control. Significant improvements were also observed for grip strength (P = 0.04), working memory (P = 0.02), intakes of whole grains (P = 0.01) and dairy (P < 0.001), and diastolic blood pressure level (P = 0.02). Conclusions Group activities designed for improving geriatric nutrition in community centers showed its efficacy to improve frailty score, handgrip strength, working memory, blood pressure and dietary quality. Funding Sources Health Promotion Agency; Academia Sinica.

The Impact of Suboptimal Diet on Type 2 Diabetes at Global, Regional, National, and Sub-National Levels: A Comparative Risk Assessment Analysis

Abstract Objectives To prioritize dietary factors for reducing the growing burden of type 2 diabetes (T2D) worldwide, we estimated the impact of suboptimal diet on T2D incidence at global, regional, national, and subnational levels between 1990 and 2015. Methods A comparative risk assessment framework estimated T2D incidence attributable to suboptimal diet in strata jointly stratified by year, nation, age, and sex, across 185 countries. We estimated direct (dietary composition) etiologic effects of 8 factors including nuts/seeds, whole grains, yogurt, processed meats, unprocessed red meats, glycemic load (estimated from refined grains), sugar-sweetened beverages (SSBs) and potatoes. Population demographics were from the United Nations; stratum-specific mean dietary intakes and distributions from Global Dietary Database (GDD), diet-T2D etiologic effects from meta-analyses of prospective cohort studies; and T2D incidence from the Global Burden of Disease study. These inputs and their uncertainties were used to calculate the stratum-specific population attributable fraction (PAF) and then absolute attributable cases, with joint effects estimated using multiplicative PAFs. Results In 2015, suboptimal intakes of these 8 factors were jointly estimated to cause 10.9 million T2D cases (95% UI 7.2–15.3), representing 59.6% of all cases (39.3–83.3%) among adults age 25 + y globally. Low intake of whole grains (3.6 million cases (3.4–3.8)) followed by high intake of SSBs (2.7 million cases (2.5–2.9)) had the largest estimated attributable burdens. Across 7 world regions, highest diet-attributable burdens of T2D were in High Income Countries (2516 cases per million (2115, 2870)) and Former Soviet Union (2341 cases per million (1465, 2970)); and lowest in Sub-Saharan Africa (797 cases per million (333, 1435)). The proportion of T2D attributable to suboptimal diet was generally greater in males vs. females and in younger vs. older age groups. Results for specific countries, trends over time, and further sensitivity analyses will be presented. Conclusions These novel findings provide the most updated estimates of diet-attributable T2D globally, helping to inform priorities for targeted healthcare system, policy, industry and public health interventions to reduce T2D. Funding Sources Gates Foundation.

Differential Association of Cereal Intake Patterns with Cardiometabolic Risk Factors Among the Adults in China

Abstract Objectives This study examined the association between cereal intake patterns and major CM risk factors among Chinese adults. Methods We linked the dietary intake and covariates measured in China Health and Nutrition Survey (CHNS) 2011 with CM risk factors measured in CHNS 2015 among 4706 Chinese adults aged ≥18 years. Dietary intake was calculated based on the data collected by consecutive 3 d 24 h recalls combined with the weighing of household seasonings. We performed multivariable logistic regressions to analyze the association of each 2011 cereal and its subtypes intake with the major CM risk factors. Results After we adjusted for potential confounders, intake levels of total cereal, rice and its products and refined grains were associated with the prevalence of elevated TG. Intake levels of wheat and its products were positively associated with the prevalence of abdominal obesity and overweight, whereas were inversely associated with the prevalence of lipid-related factors, elevated BP and elevated FG. Adults with the top tertile of the intake of whole grains showed lower OR of elevated LDL-C (OR 0.64, 95% CI 0.46–0.88), along with the intake of 50.00 to 150.00 g/day (OR 0.69, 95% CI 0.49–0.96). Conclusions Associations with the major CM risk factors varied across cereal subtypes. Rice, wheat and their products, and refined grains were positively associated with elevated TG; Coarse grains and whole grains did not show the similar impacts on major CM risk factors. Funding Sources The CHNS is funded by the National Institute for Nutrition and Health, China Center for Disease Control and Prevention; Carolina Population Center (5 R24 HD050924), the University of North Carolina at Chapel Hill; the National Institutes of Health (R01-HD30880, DK056350, R24 HD050924, R01-HD38700); the Fogarty International Center, National Institutes of Health (5D43TW007709 and 5D43TW009077); and the Ministry of Finance of the People's Republic of China, the China Nutritional Transition Cohort Study (13,103,110,700,015,005).

Dietary Pattern Indices and Incident Peripheral Arterial Disease in Women: A Prospective Cohort Study

Abstract Objectives We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD. Methods We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes). Results During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend < 0.001), 0.66 (0.55–0.80) for DASH index (P-trend < 0.001), and 0.68 (0.56–0.82) for HEI-2015 (P-trend < 0.001). Among major foods/nutrients contributing to these dietary patterns, intakes of whole grains (top vs. bottom quartile, HR = 0.81; P-trend = 0.01), legumes (HR = 0.77; P-trend = 0.004), dietary fiber (HR = 0.78; P-trend = 0.01), and vegetable protein (HR = 0.76; P-trend = 0.006) were associated with lower risk of PAD, whereas intakes of red meat (HR = 1.38; P-trend = 0.003), processed meat (HR = 1.36; P-trend = 0.004), and regular soft drinks (HR = 1.26; P-trend = 0.01) were associated with higher risk. Conclusions Adherence to various recommended dietary patterns is associated with lower risk of PAD in a nationwide cohort of US postmenopausal women. Our findings may extend the range of cardiovascular diseases that are potentially preventable by adopting a healthy dietary pattern. Funding Sources National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.

Dietary Patterns and Gut Microbiome Composition in a Large Population-Based Cohort

Abstract Objectives Effects of diet on health and disease risk may be mediated by changes in gut microbiome composition. Our aim was to examine associations between intake of food groups and overall diet quality with gut microbiome composition in a large population-based cohort. Methods We analyzed data of 1130 participants (median age 57 years) from the Rotterdam Study, a population-based cohort study in the Netherlands. We measured dietary intake using a 389-item FFQ, and assessed adherence to dietary guidelines for 14 food groups and combined into a diet quality score. We assessed gut microbiome composition using 16S rRNA gene sequencing. Data were available for 11 phyla, 19 classes, 25 orders, 44 families, and 184 genera. Alpha diversity was quantified by Shannon index and Richness, and beta diversity was qualified by Bray-Curtis distance. We used linear models to examine associations with Shannon index and Richness, Adonis function to examine variations of Bray-Curtis distance, and Multivariate Association with Linear Models to examine associations with gut microbial communities. Models were adjusted for technical covariates, energy intake, age, sex, physical activity, education, smoking and BMI. Results After adjustment, higher diet quality was associated with more alpha diversity and explained part of the variation in beta diversity (P < 0.001). Overall diet quality was associated with relative abundance of four families (Erysipelotrichaceae, Ruminococcaceae, Lachnospiraceae, Christensenellaceae), and 15 genera (Torques group, RuminococcaceaeUCG002, RuminococcaceaeUCG003, RuminococcaceaeUCG005, RuminococcaceaeUCG010, Xylanophilum group, Blautia, RuminococcaceaeNK4A214 group, Eligens group, Coprococcus3, Senegalimassilia, Lachnospira, Halliigroup, ChristensenellaceaeR7 group, Ventriosum group) (adjusted p: q < 0.05). Results were not explained by any single food group. Higher intake of fruits, vegetables, whole grains, and tea, and lower intake of red meat and alcohol were all related to microbiome composition. Replication analyses are ongoing. Conclusions Better overall diet quality may improve overall gut microbial diversity. Furthermore, diet quality may influence abundance of certain gut microbial communities, several of which have previously been linked to lower risk of metabolic and inflammatory diseases. Funding Sources N/A.

Can Curricular Intervention Increase Health Awareness and Produce Healthier Outcomes Among University Students?

Abstract Objectives Significance and objectives of this study is to (1) investigate influences of curricular intervention on student lifestyle choices using self reporting assessment tools including CCAPS instrument and (2) determine if a correlation exist between curricular intervention and an increase in healthy self reported evaluations and outcomes. Methods A Health Behavior Study was conducted by Healthy Campus 2020® a campus-wide comprehensive wellness intervention program. IRB approved health behavior surveys were disseminated to students (N = 645) investigating (co-) curricular intervention to assist with increasing health awareness among students. Counselors evaluated students (N = 101) using Counseling Center Assessment of Psychological Symptoms (CCAPS) a high-quality multi-dimensional assessment tool with distinct subscales related to psychological and distress symptoms. Among the 8 subscales measured, responses to eating concerns were highlighted. Correlation between mental wellness and nutrition were observed. Coded responses were obtained and analyzed. Results Descriptive analytics and correlation coefficient are used to analyze data responses. Students enrolled in courses embedded with 8 STANDOUT® health principles (sunlight, temperance, rest, nutrition, water, outdoors, physical activity and trust) increased in the number of positive health behavior responses after one month. Responding to healthy # of steps an increase of 78% students indicated “yes” compared to one month prior and 90% of students achieved 2500 + steps/day. An 11% increase of students reported consuming healthier diets including recommended daily intake of fruits, vegetables and whole grains. CCAPS-62 results showed 44.5% of students reported positive responses to body image. A high % of students reported they do not engage in eating disorders including purging (92%) or refrain from eating (93.1%) to control their weight or feel better about themselves, respectively. Conclusions (Co-) Curricular intervention may have the ability to increase health awareness and produce healthier outcomes among university students. CCAPS can be used to assess students experiencing forms of depression or anxiety that may negatively impact their academic success. Funding Sources Funding for research conducted through HC2020® was provided by The Dept of Education Title III.

Personalized Nutrition Recommendations Improve Plasma Metabolite Concentrations Related to Dietary Intake

Abstract Objectives The objectives of our proof-of-concept study was to assess the efficacy of personalized nutrition interventions on diet and chronic disease risk. Methods Fasting plasma samples were collected at day 1 and day 100 of a cohort of 148 adults (aged 23–65y) volunteers with a median (range) BMI of 25.8 (17.2–48.3). At both time points 119 metabolites were quantitated using LC-MS/MS. Based on their metabolite concentrations and dietary preferences, each participant received their own personalized nutrition recommendations through an AI-assisted online platform and were advised to follow the recommendations for 100 days. Plasma metabolite concentrations from Day 1 and Day 100 were compared using a paired t-test with Holm-Bonferroni correction (P < 0.05). Results After 100 days, statistically significant changes in acylcarnitine, phosphatidylcholine and amino acid concentrations indicated participants had increased their intakes of omega-3 fats and whole grains and decreased their intakes of saturated fat. For example, Betaine, a biomarker of whole grain intake, increased significantly in concentration from Day 1 to Day 100 [mean (SD): 34.3 (13.2) to 45.3 (15.6) umol/l]. Overall, 55 of the analyzed 119 metabolites’ (46%) concentrations had previously been linked to dietary intake according to a systematic literature search that was used to generate evidence-based personalized nutrition recommendations. Concentrations of 33 (60%) of these 55 metabolites changed significantly. The majority [26 (79%)] of the metabolite concentrations changed in a predicted manner consistent with the literature, particularly those metabolites associated to chronic disease risk. For example, a significant decrease in asymmetric dimethylarginine concentration [mean (SD): 0.54 (0.15) to 0.48 (0.12) umol/L] which is understood to result in a decreased cardiovascular disease risk. Conclusions Adherence with an evidence-based personalized nutrition plan based on a panel of serum metabolomic data can significantly modify serum metabolite concentrations in a direction that can reduce the risk of chronic disease. Further analysis in how these changes relate to chronic disease risk is warranted. Funding Sources This study was supported by Mitacs and Molecular You.

Cost-Effective Options for Increasing Consumption of Underconsumed Food Groups in the United States

Abstract Objectives Current intakes of fruits, vegetables and whole grains are lower than recommended levels with cost often cited as a barrier to increasing intake. This study evaluated current contributors to these food groups to determine the most cost-effective options within each food group. Analyses were also done to determine cost-effective contributors to underconsumed nutrients among foods and beverages contributing to these underconsumed food groups. Methods The National Health and Nutrition Examination Survey (NHANES) 2013–2016 (N = 10,112 adults 19 + y) was analyzed for current contributors to fruit, vegetable and whole grain intakes. Prices of these foods and beverages were then calculated per cup (fruits and vegetables) or ounce equivalent (whole grains) using the USDA National Food Prices Database after adjustment for inflation. Prices for each food/beverage were also calculated for underconsumed micronutrients (vitamin A, vitamin C, vitamin E, magnesium, iron, choline, zinc). Results The top five most cost-effective contributors to whole grain intakes were oatmeal, popcorn, rice, yeast breads and pasta/noodles/cooked grains; oatmeal was also a top 10 cost-effective contributor to vitamin A, magnesium, iron and zinc while rice was a top 10 cost-effective contributor to iron and zinc. For fruit the most cost-effective options were 100% apple juice, 100% citrus juice, bananas, apples and melons. Both 100% apple juice and 100% citrus juice were also in the top five cost-effective contributors to vitamin C. The five most cost-effective contributors to vegetables were white potatoes, mashed potatoes, lettuce/lettuce salads, carrots and string beans; carrots were also the top cost-effective contributor to vitamin A. Conclusions These data highlight the lowest cost contributors to underconsumed food groups in adults, most of which are rich in underconsumed micronutrients. These results should be communicated to the public to promote intake of fruits, vegetables and whole grains at minimal cost in order to improve overall diet quality. Funding Sources Financial support for this study was provided by PepsiCo, Inc. The views expressed in this abstract are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc.

Replacing Red Meat with Alternative Food Sources of Protein on Risk of Type 2 Diabetes - Modeling Dietary Changes in a Causal Framework

Abstract Objectives We investigated whether decreasing the intake of red meat and simultaneously increasing the intake of alternative food sources of protein affects the risk of type 2 diabetes compared with no changes in the substituted foods. We also examined interaction with the age at which participants changed their diet. Methods We used the Danish Diet, Cancer and Health cohort including men and women, two measures of diet taken roughly 5 years apart using food frequency questionnaires and information on incident type 2 diabetes derived from the Danish National Diabetes Register (n = 39,349; aged 55 to 72 years at the second diet measure; n cases = 3759). The pseudo-observation method was used to estimate the average exposure effect of decreasing the intake of red meat (processed and unprocessed) while increasing the intake of either poultry, fish, cheese, eggs or whole grains compared with no changes in the substituted foods on the subsequent 10-year risk of development type 2 diabetes. Results In multivariable adjusted models, we found that replacing 1 serving/day (100 g) of red meat with 1 serving/day of eggs (50 g) (risk difference −2.4%, 95% confidence interval −3.7 to −1.1%) or whole grains (30 g) (−1.4%, −2.2 to −0.6%) was associated with a reduced risk of type 2 diabetes. No effects were observed for other replacements. In general, the lowest risk was observed for replacements at age 55 years compared with older ages (up to 70 years) for all replacements. Conclusions Replacing red meat with eggs or whole grains may reduce the risk of type 2 diabetes compared with no changes in the substituted foods. Changing red meat intake in midlife may be more beneficial than at older ages. Funding Sources Aarhus University.

Whole-Grain Processing and Glycemic Control in Type 2 Diabetes: A Randomized Crossover Trial.

OBJECTIVETo consider the effects of whole-grain processing, specifically milling, on glycemic control in free-living adults with type 2 diabetes.RESEARCH DESIGN AND METHODSParticipants of this crossover trial were randomized to two interventions of 2 weeks, separated by washout. They were advised to replace the grain foods they normally consumed with intervention foods. Intervention foods were nutrient-matched whole-grain products of wheat, oats, and brown rice that differed in their degree of processing. No other lifestyle advice was given. Continuous glucose monitoring systems were worn. Other cardiometabolic risk factors and alkylresorcinols (a biomarker of whole-grain intake) were measured pre- and postintervention.RESULTSThirty-one adults with type 2 diabetes (63 ± 13 years old, BMI 32.4 ± 7 kg/m2, HbA1c 7.5 ± 3.4% [59 ± 14 mmol/mol]) commenced the trial; 28 (90%) completed both interventions. The increase in alkylresorcinols did not differ between interventions, and there was no difference in reported energy intake. Postprandial responses were 9% (95% CI 3–15) lower following breakfast and 6% (1–10) lower following all meals of less-processed whole grains when compared with finely milled grains. Day-long glycemic variability also was reduced when measured by 24-h SD (−0.16 mmol/L [95% CI −0.25 to −0.06]) and mean amplitude of glycemic excursion (−0.36 [95% CI −0.65 to −0.08]). Mean change in body weight differed by 0.81 kg (95% CI 0.62–1.05) between interventions, increasing during the finely milled intervention and decreasing during the less-processed whole-grain intervention. This was not a mediating factor for the glycemic variables considered.CONCLUSIONSConsuming less-processed whole-grain foods over 2 weeks improved measures of glycemia in free-living adults with type 2 diabetes compared with an equivalent amount of whole-grain foods that were finely milled. Dietary advice should promote the consumption of minimally processed whole grains.

Simplified method for the measurement of plasma alkylresorcinols: Biomarkers of whole-grain intake.

Consumption of whole grains is negatively associated with cardiovascular disease (CVD) risk but quantification of whole-grain intake is challenging. Alkylresorcinols (ARs) are biomarkers of whole-grain intake. Current methods for AR quantification involve a time-consuming multi-step separation process that hampers applicability in large-scale studies. We developed a streamlined method to quantify ARs in human plasma based on protein precipitation and direct injection into an ultra-high-performance liquid chromatograph coupled to a quadrupole time-of-flight mass spectrometer operating in atmospheric pressure chemical ionization negative ion mode. Separation of five major ARs was achieved, with linearity in the 5 to 550 nmol/L range and a lower limit of detection (LOD) of 0.5 nmol/L and quantification (LOQ) of 5 nmol/L. The within-run and between-run precision and accuracy were below 15%, and recoveries above 90%. Once validated, the method was applied to measure concentrations of plasma ARs in subjects who participated in a randomized, crossover trial evaluating the effect of carbohydrate type on CVD risk factors. The unrefined carbohydrate diet with the highest fiber content resulted in the highest plasma AR concentration (93 ± 78 nmol/L), and was significantly different (p <0.01) from lower fiber diets (18 ± 26 nmol/L and 19 ± 26 nmol/L, simple and unrefined carbohydrate, respectively). This method offers a simplified approach to measure concentrations of plasma ARs as an objective biomarker of whole-grain intake that can be applied to large-scale cohort studies.

The Role of Diet in Osteoporotic Fracture Risk

Introduction: Osteoporosis-related fractures constitute a considerable public health burden and nutrition is an important modifiable factor influencing bone health. Numerous micronutrients, macronutrients, and dietary components influence bone health, as well as dietary patterns. This short review describes the role of diet on osteoporosis fracture risk, investigating those dietary factors which improve bone health. Materials and Methods: Searching Pubmed and Web of Science, we performed a review of current literature. Results: This review reported the beneficial effects of micronutrients (e.g. calcium, vitamin D, potassium, magnesium, vitamin K, and vitamin B12), macronutrients (e.g. protein and carbohydrates), and foods (e.g. fish and seafood, fruits and vegetables) on osteoporotic fracture risk. A healthy diet, such as the Mediterranean diet, is important for decreasing osteoporotic fracture risk. A potential benefit on fracture risk is attributed to the “Healthy” and “Milk/dairy” dietary patterns which emphasise the intake of fruit, vegetables, whole grains, poultry and fish, nuts and legumes, and low-fat dairy products. By contrast, the unhealthy “Meat/Western” dietary pattern, characterised by high consumption of soft drinks, fried foods, meat and processed products, sweets and desserts, and refined grains, increased osteoporosis fracture risk. Conclusions: Diet plays an important role in bone health. A healthy diet prevents osteoporosis and reduces osteoporotic fracture risk.

Correction to: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

HomeCirculationVol. 141, No. 16Correction to: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Originally published20 Apr 2020https://doi.org/10.1161/CIR.0000000000000771Circulation. 2020;141:e774This article corrects the following2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice GuidelinesIn the article by Arnett et al, “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” which published ahead of print on March 17, 2019, and appeared in the September 10, 2019, issue of the journal (Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678), several corrections were needed.On page e597, in the Top 10 Take-home Messages section, second column, item No. 4 read, “4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein,….” To provide clarity in the wording regarding a healthy diet, it has been updated to read, “4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable protein or animal protein,….”On page e605, in the Recommendation-Specific Supportive Text section, second column at the bottom, item No. 1 read, “1. Plant-based and Mediterranean diets, along with increased fruit, nut, vegetable, legume, and lean vegetable or animal protein….” To provide clarity in the wording regarding a healthy diet, it had been updated to read, “1. Plant-based and Mediterranean diets, along with increased fruit, nut, vegetable, legume, and lean vegetable protein or animal protein….”These corrections have been made to the current online version of the article, which is available at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678.Footnoteshttps://www.ahajournals.org/journal/circ Previous Back to top Next FiguresReferencesRelatedDetailsRelated articles2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice GuidelinesDonna K. Arnett, et al. Circulation. 2019;140:e596-e646 April 21, 2020Vol 141, Issue 16 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIR.0000000000000771PMID: 32310693 Originally publishedApril 20, 2020 PDF download Advertisement

Abstract B12: Cross-sectional analysis of grain, gluten, and fiber intakes and gut microbiota in the Food and Microbiome Longitudinal Investigation (FAMiLI) Study

Abstract Whole grains are recommended as part of a healthy dietary pattern for the prevention of chronic diseases, including colorectal cancer. Greater whole grain consumption may beneficially alter gut microbiota, and it is unclear if gluten, a protein component of grains, is also associated with altered microbiota. To examine the association between grain, gluten, and fiber intake with gut microbiota, we analyzed data from the ongoing prospective Food and Microbiome Longitudinal Investigation Study. This cross-sectional analysis included 300 men and 501 women of White, Black, Hispanic, and Asian race/ethnicity who completed a 137-item semiquantitative food frequency questionnaire. Gluten intake was estimated using the protein content of grain products. Bacterial 16S rRNA genes from stool samples collected via RNAlater tubes were amplified, sequenced, and assigned to bacterial taxa. We examined associations of whole and refined grain, gluten, and dietary fiber intakes with gut microbiota diversity and composition using multivariable-adjusted linear regression models and permutational multivariate analysis of variance, respectively, and with microbial taxa abundance using analysis of composition of microbiomes (ANCOM). In this diverse study population, the highest quartiles of energy-adjusted refined grain and gluten intake, when compared to the lowest quartiles, were associated with lower Shannon diversity (P-trend=0.03 and P-trend=0.01, respectively), but no other associations with alpha- or beta-diversity measures were observed. The highest quartile of dietary fiber was not associated with alpha-diversity measures but was associated with shifts in overall gut microbial composition (P-trend=0.02). Whole grain intake was not statistically significantly associated with these microbiome parameters. However, the highest quartile of whole grain intake, compared to the lowest quartile, was associated with greater abundance of several gut taxa, including classes Erysipelotrichi (family Erysipelotrichaceae), Clostridia (genus Faecalibacterium and Lachnospira), and Bacteroidia (Bacteroides plebeius). Higher whole grain intake was also associated with lower abundance of classes Bacteroidia (family Rikenellaceae and Bacteroides uniformis) and Clostridia (genus Oscillospira and Ruminococcus). Similarly, the highest quartile of dietary fiber intake was associated with greater abundance of classes Erysipelotrichi (family Erysipelotrichaceae) and Clostridia (genus Lachnospira) and lower abundance of class Bacteroidia (family Rikenellaceae). Higher intakes of refined grain and gluten were not statistically significantly associated with altered abundance of gut taxa. Though this study is cross-sectional, identification of gut microbes associated with higher intakes of whole grain and fiber may expand our understanding of how these nutritional factors lower risk for colorectal cancer. Citation Format: Caroline Y. Um, Brandilyn A. Peters, Emilia N. Cobbs, Hee Sun Choi, Dia B. Beggs, Richard B. Hayes, Marjorie L. McCullough, Susan M. Gapstur, Jiyoung Ahn. Cross-sectional analysis of grain, gluten, and fiber intakes and gut microbiota in the Food and Microbiome Longitudinal Investigation (FAMiLI) Study [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr B12.

Whole-grain intake and its inverse relationships with fatty acids intake among multiethnic Malaysian schoolchildren.

Little is known about the relationship of whole-grain intake with dietary fatty acids intake. The present study aimed to assess the whole-grain intake and its relationships with dietary fatty acids intake among multiethnic schoolchildren in Kuala Lumpur, Malaysia. This cross-sectional study was conducted among 392 schoolchildren aged 9-11years, cluster sampled from five randomly selected schools in Kuala Lumpur. Whole-grain and fatty acids intakes were assessed by 3-day, 24-h diet recalls. All whole-grain foods were considered irrespective of the amount of whole grain they contained. In total, 55.6% (n=218) were whole-grain consumers. Mean (SD) daily intake of whole grain in the total sample was 5.13 (9.75) gday-1 . In the whole-grain consumer's only sample, mean (SD) intakes reached 9.23 (11.55) gday-1 . Significant inverse associations were found between whole-grain intake and saturated fatty acid (SAFA) intake (r=-0.357; P<0.001), monosaturated fatty acid (MUFA) (r=-0.373; P<0.001) and polyunsaturated fatty acid (PUFA) (r=-0.307; P<0.001) intake. Furthermore, whole-grain intake was a significant predictor of SAFA (β=-0.077; P=0.004), MUFA (β=-0.112; P=<0.001) and PUFA (β=-0.202; P=<0.001) intakes, after controlling for sex, age and ethnicity. Whole-grain intake in Malaysia was well below recommendations. Schoolchildren who consumed higher whole grain tend to reduce fat intake; however, it would also reduce the SAFA, MUFA and PUFA intakes. Future collaboration may be conducted between industry, government and universities to promote unsaturated fatty acids-rich foods and whole-grain food, although not to promote processed whole-grain foods with a high sugar and salt content.

Risk Factor Profiles Differ for Cancers of Different Regions of the Colorectum

The molecular features of colorectal tumors differ with their anatomic location. Colorectal tumors are usually classified as proximal or distal. We collected data from 3 cohorts to identify demographic, clinical, anthropometric, lifestyle, and dietary risk factors for colorectal cancer (CRC) at 7 anatomic subsites. We examined whether the associations differ among refined subsites and whether there are trends in associations from cecum to rectum. We collected data from the Nurses' Health Study, Nurses' Health Study 2, and Health Professionals Follow-up Study (45,351 men and 178,016 women, followed for a median 23 years) on 24 risk factors in relation to risk of cancer in cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectosigmoid junction, and rectum. Hazard ratios were estimated using Cox proportional hazards regression. We tested for linear and nonlinear trends in associations with CRC among subsites and within proximal colon, distal colon, and rectum. We documented 3058 cases of CRC (474 in cecum, 633 in ascending colon, 250 in transverse colon, 221 in descending colon, 750 in sigmoid colon, 202 in rectosigmoid junction, and 528 in rectum). The positive associations with cancer risk decreased, from cecum to rectum, for age and family history of CRC. In contrast, the inverse associations with cancer risk increased, from cecum to rectum, for endoscopic screening and intake of whole grains, cereal fiber, and processed red meat. There was a significant nonlinear trend in the association between CRC and female sex, with hazard ratios ranging from 1.73 for ascending colon cancer to 0.54 for sigmoid colon cancer. For proximal colon cancers, the association with alcohol consumption and smoking before age 30 years increased from the cecum to transverse colon. For distal colon cancers, the positive association with waist circumference in men was greater for descending vs sigmoid colon cancer. In an analysis of 3058 cases of CRC, we found that risk factor profiles differed for cancers along the colorectum. Proximal vs distal classifications are not sufficient to encompass the regional variations in colorectal tumor features and risk factors.

Whole grain and cereal fibre intake in the Australian Health Survey: associations to CVD risk factors.

To explore associations of whole grain and cereal fibre intake to CVD risk factors in Australian adults. Cross-sectional analysis. Intakes of whole grain and cereal fibre were examined in association to BMI, waist circumference (WC), blood pressure (BP), serum lipid concentrations, C-reactive protein, systolic BP, fasting glucose and HbA1c. Australian Health Survey 2011-2013. A population-representative sample of 7665 participants over 18 years old. Highest whole grain consumers (T3) had lower BMI (T0 26·8 kg/m2, T3 26·0 kg/m2, P < 0·0001) and WC (T0 92·2 cm, T3 90·0 cm, P = 0·0005) compared with non-consumers (T0), although only WC remained significant after adjusting for dietary and lifestyle factors, including cereal fibre intake (P = 0·03). Whole grain intake was marginally inversely associated with fasting glucose (P = 0·048) and HbA1c (P = 0·03) after adjusting for dietary and lifestyle factors, including cereal fibre intake. Cereal fibre intake was inversely associated with BMI (P < 0·0001) and WC (P < 0·0008) and tended to be inversely associated with total cholesterol, LDL-cholesterol and apo-B concentrations, although associations were attenuated after further adjusting for BMI and lipid-lowering medication use. The extent to which cereal fibre is responsible for the CVD-protective associations of whole grains may vary depending on the mediators involved. Longer-term intervention studies directly comparing whole grain and non-whole grain diets of similar cereal fibre contents (such as through the use of bran or added-fibre refined grain products) are needed to confirm independent effects.

Whole grain intake compared with cereal fibre intake in association to CVD risk factors: a cross-sectional analysis of the National Diet and Nutrition Survey (UK).

To investigate how intakes of whole grains and cereal fibre were associated to risk factors for CVD in UK adults. Cross-sectional analyses examined associations between whole grain and cereal fibre intakes and adiposity measurements, serum lipid concentrations, C-reactive protein, systolic blood pressure, fasting glucose, HbA1c, homocysteine and a combined CVD relative risk score. The National Diet and Nutrition Survey (NDNS) Rolling Programme 2008-2014. A nationally representative sample of 2689 adults. Participants in the highest quartile (Q4) of whole grain intake had lower waist-hip ratio (Q1 0·872; Q4 0·857; P = 0·04), HbA1c (Q1 5·66 %; Q4 5·47 %; P = 0·01) and homocysteine (Q1 9·95 µmol/l; Q4 8·76 µmol/l; P = 0·01) compared with participants in the lowest quartile (Q1), after adjusting for dietary and lifestyle factors, including cereal fibre intake. Whole grain intake was inversely associated with C-reactive protein using multivariate analysis (P = 0·02), but this was not significant after final adjustment for cereal fibre. Cereal fibre intake was also inversely associated with waist-hip ratio (P = 0·03) and homocysteine (P = 0·002) in multivariate analysis. Similar inverse associations between whole grain and cereal fibre intakes to CVD risk factors suggest the relevance of cereal fibre in the protective effects of whole grains. However, whole grain associations often remained significant after adjusting for cereal fibre intake, suggesting additional constituents may be relevant. Intervention studies are needed to compare cereal fibre intake from non-whole grain sources to whole grain intake.