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Effect of a lifestyle intervention in obese infertile women on cardiometabolic health and quality of life: A randomized controlled trial.
van Dammen, L, Wekker, V, van Oers, AM, Mutsaerts, MAQ, Painter, RC, Zwinderman, AH, Groen, H, van de Beek, C, Muller Kobold, AC, Kuchenbecker, WKH, et al
PloS one. 2018;13(1):e0190662
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Obesity is linked to increase in cardiovascular and related disease risk factors. The rate of prevalence of obesity in childbearing women is on the increase. Based on these data one of the largest randomised control multicentre Lifestyle study was conducted. The aim of this study was to look into the effects of lifestyle intervention on cardio metabolic risk factors in childbearing obese women. The intervention goal was weight loss of 5-10% within six month. The intervention included caloric restriction and moderate physical activity. The result from the study showed lifestyle intervention among obese infertile women improved cardio metabolic health and also their physical quality of life. The authors concluded that based on data from this study infertile obese women, especially prior to infertility treatment, should be informed of the positive effects of lifestyle intervention of diet and physical activity.
Abstract
BACKGROUND The prevalence of obesity, an important cardiometabolic risk factor, is rising in women. Lifestyle improvements are the first step in treatment of obesity, but the success depends on factors like timing and motivation. Women are especially receptive to advice about lifestyle before and during pregnancy. Therefore, we hypothesize that the pre-pregnancy period provides the perfect window of opportunity to improve cardiometabolic health and quality of life of obese infertile women, by means of a lifestyle intervention. METHODS AND FINDINGS Between 2009-2012, 577 infertile women between 18 and 39 years of age, with a Body Mass Index of ≥ 29 kg/m2, were randomized to a six month lifestyle intervention preceding infertility treatment, or to direct infertility treatment. The goal of the intervention was 5-10% weight loss or a BMI < 29 kg/m2. Cardiometabolic outcomes included weight, waist- and hip circumference, body mass index, systolic and diastolic blood pressure, fasting glucose and insulin, HOMA-IR, hs-CRP, lipids and metabolic syndrome. All outcomes were measured by research nurses at randomization, 3 and 6 months. Self-reported quality of life was also measured at 12 months. Three participants withdrew their informed consent, and 63 participants discontinued the intervention program. Intention to treat analysis was conducted. Mixed effects regression models analyses were performed. Results are displayed as estimated mean differences between intervention and control group. Weight (-3.1 kg 95% CI: -4.0 to -2.2 kg; P < .001), waist circumference (-2.4 cm 95% CI: -3.6 to -1.1 cm; P < .001), hip circumference (-3.0 95% CI: -4.2 to -1.9 cm; P < .001), BMI (-1.2 kg/m2 95% CI: -1.5 to -0.8 kg/m2; P < .001), systolic blood pressure (-2.8 mmHg 95% CI: -5.0 to -0.7 mmHg; P = .01) and HOMA-IR (-0.5 95% CI: -0.8 to -0.1; P = .01) were lower in the intervention group compared to controls. Hs-CRP and lipids did not differ between groups. The odds ratio for metabolic syndrome in the intervention group was 0.53 (95% CI: 0.33 to 0.85; P < .01) compared to controls. Physical QoL scores were higher in the lifestyle intervention group (2.2 95% CI: 0.9 to 3.5; P = .001) while mental QoL scores did not differ. CONCLUSIONS In obese infertile women, a lifestyle intervention prior to infertility treatment improves cardiometabolic health and self-reported physical quality of life (LIFEstyle study: Netherlands Trial Register: NTR1530).
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Fasting blood glucose, glycaemic control and prostate cancer risk in the Finnish Randomized Study of Screening for Prostate Cancer.
Murtola, TJ, Vihervuori, VJ, Lahtela, J, Talala, K, Taari, K, Tammela, TL, Auvinen, A
British journal of cancer. 2018;118(9):1248-1254
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Studies have shown that people with diabetes mellitus have lower risk of developing prostate cancer compared with non-diabetics. Glucose metabolism (the process by which simple sugars found in food are processed and used to produce energy) may have an independent role in prostate cancer development and progression. The aim of this study was to investigate the associations between fasting blood glucose and glycaemic control and prostate cancer risk. The study recruited 80,144 men who were randomly assigned either to be screened with PSA at four-year intervals (the screening arm, 31,866 men) or to control arm with no intervention and followed through national registries (48,278 men). Results indicate an association between fasting blood glucose level and elevated prostate cancer risk. This association was more noticeable in the screening arm, and concerned both poorly and well-differentiated cancers. Furthermore, compared to the normoglycemic men, overall prostate cancer risk was elevated in diabetic, but not in pre-diabetic men. Authors conclude that diabetic fasting blood glucose level is associated with elevated prostate cancer risk in a population-based cohort of Finnish men.
Abstract
BACKGROUND Diabetic men have lowered overall risk of prostate cancer (PCa), but the role of hyperglycaemia is unclear. In this cohort study, we estimated PCa risk among men with diabetic fasting blood glucose level. METHODS Participants of the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) were linked to laboratory database for information on glucose measurements since 1978. The data were available for 17,860 men. Based on the average yearly level, the men were categorised as normoglycaemic, prediabetic, or diabetic. Median follow-up was 14.7 years. Multivariable-adjusted Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for prostate cancer overall and separately by Gleason grade and metastatic stage. RESULTS In total 1,663 PCa cases were diagnosed. Compared to normoglycaemic men, those men with diabetic blood glucose level had increased risk of PCa (HR 1.52; 95% CI 1.31-1.75). The risk increase was observed for all tumour grades, and persisted for a decade afterwards. Antidiabetic drug use removed the risk association. Limitations include absence of information on lifestyle factors and limited information on BMI. CONCLUSIONS Untreated diabetic fasting blood glucose level may be a prostate cancer risk factor.
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A Pilot Study To Investigate the Immune-Modulatory Effects of Fasting in Steroid-Naive Mild Asthmatics.
Han, K, Nguyen, A, Traba, J, Yao, X, Kaler, M, Huffstutler, RD, Levine, SJ, Sack, MN
Journal of immunology (Baltimore, Md. : 1950). 2018;201(5):1382-1388
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Previous studies have shown that caloric restriction and fasting may modulate immune function and have positive effects in asthmatics. The aim of this pilot study was to evaluate the effects of fasting on specific inflammatory markers that might mediate such benefits. 18 mild asthmatics, 5 of whom were not on steroid inhalers, fasted for 24 hours. Lung function and immune parameters were evaluated at baseline and 2.5 hours after the first meal following the fast. There were significant differences between subjects who were and were not on steroid inhalers. Whilst one day of fasting did not affect lung function, a number of inflammatory parameters were improved by fasting in those not taking steroid inhalers, but not in those who were taking steroids. The authors conclude that caloric restriction might be considered as a strategy to improve systemic and pulmonary inflammation in asthma.
Abstract
A fasting mimetic diet blunts inflammation, and intermittent fasting has shown ameliorative effects in obese asthmatics. To examine whether canonical inflammatory pathways linked with asthma are modulated by fasting, we designed a pilot study in mild asthmatic subjects to assess the effect of fasting on the NLRP3 inflammasome, Th2 cell activation, and airway epithelial cell cytokine production. Subjects with documented reversible airway obstruction and stable mild asthma were recruited into this study in which pulmonary function testing (PFT) and PBMCextraction was performed 24 h after fasting, with repeated PFT testing and blood draw 2.5 h after refeeding. PFTs were not changed by a prolonged fast. However, steroid-naive mild asthmatics showed fasting-dependent blunting of the NLRP3 inflammasome. Furthermore, PBMCs from these fasted asthmatics cocultured with human epithelial cells resulted in blunting of house dust mite-induced epithelial cell cytokine production and reduced CD4+ T cell Th2 activation compared with refed samples. This pilot study shows that prolonged fasting blunts the NLRP3 inflammasome and Th2 cell activation in steroid-naive asthmatics as well as diminishes airway epithelial cell cytokine production. This identifies a potential role for nutrient level-dependent regulation of inflammation in asthma. Our findings support the evaluation of this concept in a larger study as well as the potential development of caloric restriction interventions for the treatment of asthma.
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Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study.
Rapaport, MH, Nierenberg, AA, Schettler, PJ, Kinkead, B, Cardoos, A, Walker, R, Mischoulon, D
Molecular psychiatry. 2016;21(1):71-9
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This study investigated whether Omega 3 (n-3) fatty acids had a clinical effect on five inflammatory biomarkers on individuals diagnosed with Major Depressive Disorder (MDD). Individuals were randomised into 3 groups, each of which took 8 weeks of double blind treatment with either eicosapentaenoic acid enriched n-3 fatty acids (EPA), docosahexaenoic acid enriched n-3 fatty acids (DHA), or placebo. There were no significant differences in the outcomes of the groups. However, it was noted that individuals with higher levels of inflammatory markers who took EPA improved more than those on placebo, and less on DHA than placebo. he larger the number of high inflammatory markers, the wider the gap between the improvements of the EPA versus placebo. Individuals with high hs-CRP, IL-6 or leptin responded less well to placebo than those with lower levels of these biomarkers. EPA was less effective than placebo or DHA if subjects had low levels of all 5 biomarkers. The five biomarkers were strongly influenced by gender and weight. The majority of obese women and men had at least one high marker of inflammation, and many of these had 2 high markers. There was no difference in treatment patterns for men and women. This is consistent with literature that suggests that inflammation is associated with obesity. Results suggest that it is important to look at more than one marker of inflammation, and that subjects with a specific combination inflammation markers were more likely to respond to EPA treatment. The authors concluded that anti-inflammation therapy was only beneficial for those with inflammation related MDD, and not helpful and possibly harmful for those with physiologically derived MDD.
Abstract
This study explores whether inflammatory biomarkers act as moderators of clinical response to omega-3 (n-3) fatty acids in subjects with major depressive disorder (MDD). One hundred fifty-five subjects with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) MDD, a baseline 17-item Hamilton Depression Rating Scale (HAM-D-17) score ⩾ 15 and baseline biomarker data (interleukin (IL)-1ra, IL-6, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin) were randomized between 18 May 2006 and 30 June 2011 to 8 weeks of double-blind treatment with eicosapentaenoic acid (EPA)-enriched n-3 1060 mg day(-1), docosahexaenoic acid (DHA)-enriched n-3 900 mg day(-1) or placebo. Outcomes were determined using mixed model repeated measures analysis for 'high' and 'low' inflammation groups based on individual and combined biomarkers. Results are presented in terms of standardized treatment effect size (ES) for change in HAM-D-17 from baseline to treatment week 8. Although overall treatment group differences were negligible (ES=-0.13 to +0.04), subjects with any 'high' inflammation improved more on EPA than placebo (ES=-0.39) or DHA (ES=-0.60) and less on DHA than placebo (ES=+0.21); furthermore, EPA-placebo separation increased with increasing numbers of markers of high inflammation. Subjects randomized to EPA with 'high' IL-1ra or hs-CRP or low adiponectin ('high' inflammation) had medium ES decreases in HAM-D-17 scores vs subjects 'low' on these biomarkers. Subjects with 'high' hs-CRP, IL-6 or leptin were less placebo-responsive than subjects with low levels of these biomarkers (medium to large ES differences). Employing multiple markers of inflammation facilitated identification of a more homogeneous cohort of subjects with MDD responding to EPA vs placebo in our cohort. Studies are needed to replicate and extend this proof-of-concept work.
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Probiotic With or Without Fiber Controls Body Fat Mass, Associated With Serum Zonulin, in Overweight and Obese Adults-Randomized Controlled Trial.
Stenman, LK, Lehtinen, MJ, Meland, N, Christensen, JE, Yeung, N, Saarinen, MT, Courtney, M, Burcelin, R, Lähdeaho, ML, Linros, J, et al
EBioMedicine. 2016;13:190-200
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The gut microbiota is associated with obesity but direct evidence of effects of its modulation on body fat mass is meagre. To investigate the effects of a probiotic and a prebiotic intervention on weight management on adult obese between the ages of 16-65. This is a randomized, double-blind, placebo-controlled clinical intervention trial in overweight and obese adults looking extensively into the clinical markers to assess the potential benefits of the probiotics and prebiotics. This clinical trial demonstrates that a probiotic product with or without dietary fiber may help in managing body fat mass and may also reduce waist circumference but prebiotics on its own had no effect on the measured outcomes.
Abstract
BACKGROUND The gut microbiota is interlinked with obesity, but direct evidence of effects of its modulation on body fat mass is still scarce. We investigated the possible effects of Bifidobacterium animalisssp. lactis 420 (B420) and the dietary fiber Litesse® Ultra polydextrose (LU) on body fat mass and other obesity-related parameters. METHODS 225 healthy volunteers (healthy, BMI 28-34.9) were randomized into four groups (1:1:1:1), using a computer-generated sequence, for 6months of double-blind, parallel treatment: 1) Placebo, microcrystalline cellulose, 12g/d; 2) LU, 12g/d; 3) B420, 1010CFU/d in microcrystalline cellulose, 12g/d; 4) LU+B420, 12g+1010CFU/d. Body composition was monitored with dual-energy X-ray absorptiometry, and the primary outcome was relative change in body fat mass, comparing treatment groups to Placebo. Other outcomes included anthropometric measurements, food intake and blood and fecal biomarkers. The study was registered in Clinicaltrials.gov (NCT01978691). FINDINGS There were marked differences in the results of the Intention-To-Treat (ITT; n=209) and Per Protocol (PP; n=134) study populations. The PP analysis included only those participants who completed the intervention with >80% product compliance and no antibiotic use. In addition, three participants were excluded from DXA analyses for PP due to a long delay between the end of intervention and the last DXA measurement. There were no significant differences between groups in body fat mass in the ITT population. However, LU+B420 and B420 seemed to improve weight management in the PP population. For relative change in body fat mass, LU+B420 showed a-4.5% (-1.4kg, P=0.02, N=37) difference to the Placebo group, whereas LU (+0.3%, P=1.00, N=35) and B420 (-3.0%, P=0.28, N=24) alone had no effect (overall ANOVA P=0.095, Placebo N=35). A post-hoc factorial analysis was significant for B420 (-4.0%, P=0.002 vs. Placebo). Changes in fat mass were most pronounced in the abdominal region, and were reflected by similar changes in waist circumference. B420 and LU+B420 also significantly reduced energy intake compared to Placebo. Changes in blood zonulin levels and hsCRP were associated with corresponding changes in trunk fat mass in the LU+B420 group and in the overall population. There were no differences between groups in the incidence of adverse events. DISCUSSION This clinical trial demonstrates that a probiotic product with or without dietary fiber controls body fat mass. B420 and LU+B420 also reduced waist circumference and food intake, whereas LU alone had no effect on the measured outcomes.
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Randomized trial of peanut consumption in infants at risk for peanut allergy.
Du Toit, G, Roberts, G, Sayre, PH, Bahnson, HT, Radulovic, S, Santos, AF, Brough, HA, Phippard, D, Basting, M, Feeney, M, et al
The New England journal of medicine. 2015;372(9):803-13
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Children with peanut allergies are at a higher risk of death and anaphylaxis. This randomised, open-label, controlled study investigated whether reducing peanut exposure or eliminating peanuts is a better strategy to prevent peanut allergy development. Six hundred and forty infants between the ages of four months and eleven months old were randomly assigned to different cohorts depending on whether they had a pre-existing sensitivity to peanut extract. The study also assessed the proportion of infants with peanut allergies at 60 months. The introduction of peanuts at an early age significantly reduced peanut allergies in infants at high risk. Those who consumed peanuts had elevated peanut-specific IgG4 antibody levels whereas those who avoided peanuts had elevated peanut-specific IgE antibody levels. At the age of sixty months, the proportion of infants in the intention-to-treat group that developed peanut allergy was higher in the infants who avoided peanuts than in those who consumed them. As this study only included low-risk infants, future robust studies will be required to prove the benefits of peanuts’ early introduction. These results can be used by healthcare professionals to develop potential strategies to reduce the prevalence of peanut allergy in children.
Abstract
BACKGROUND The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy. CONCLUSIONS The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
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Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study.
Bamia, C, Lagiou, P, Jenab, M, Trichopoulou, A, Fedirko, V, Aleksandrova, K, Pischon, T, Overvad, K, Olsen, A, Tjønneland, A, et al
International journal of cancer. 2015;136(8):1899-908
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The most investigated risk factors for Hepatocellular carcinoma (HCC) (Liver cancer) are alcohol, diet and obesity. This cohort study looks at tea and coffee (caffeinated and decaffeinated) consumption with HCC risk using data from the European Prospective Investigation into Cancer and nutrition study (EPIC). The EPIC study recruited 521,000 apparently healthy participants, aged 25-70 years, from 10 European countries between 1992 and 2000. Their diets were assessed by questionnaire alongside biometric data and other lifestyle factors. The researchers were able to identify 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. Some data had to be excluded based on cultural tea and coffee drinking habits (particularly lack of data from certain nationalities). There was coffee data from 163,672 participants drinking an overall median of 354 ml/d among men and 290 ml/d among women. The results found that increased coffee intake in participants in the highest compared to the lowest quintile had a lower HCC risk by 72%. There was no significant data for decaffeinated coffee. Tea drinkers represented just 66% of the total cohort and median intakes were 107 ml/d for men and 190 ml/d for women. Tea intake was also inversely associated with HCC incidence with 60% lower HCC risk. The study concludes that intakes of coffee and, to a lesser extent, tea are associated with lower HCC incidence. The incidence of HCC in participants was low so further studies are necessary.
Abstract
Inverse associations of coffee and/or tea in relation to hepatocellular carcinoma (HCC) risk have been consistently identified in studies conducted mostly in Asia where consumption patterns of such beverages differ from Europe. In the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. We calculated adjusted hazard ratios (HRs) for HCC incidence in relation to quintiles/categories of coffee/tea intakes. We found that increased coffee and tea intakes were consistently associated with lower HCC risk. The inverse associations were substantial, monotonic and statistically significant. Coffee consumers in the highest compared to the lowest quintile had lower HCC risk by 72% [HR: 0.28; 95% confidence intervals (CIs): 0.16-0.50, p-trend < 0.001]. The corresponding association of tea with HCC risk was 0.41 (95% CI: 0.22-0.78, p-trend = 0.003). There was no compelling evidence of heterogeneity of these associations across strata of important HCC risk factors, including hepatitis B or hepatitis C status (available in a nested case-control study). The inverse, monotonic associations of coffee intake with HCC were apparent for caffeinated (p-trend = 0.009), but not decaffeinated (p-trend = 0.45) coffee for which, however, data were available for a fraction of subjects. Results from this multicentre, European cohort study strengthen the existing evidence regarding the inverse association between coffee/tea and HCC risk. Given the apparent lack of heterogeneity of these associations by HCC risk factors and that coffee/tea are universal exposures, our results could have important implications for high HCC risk subjects.
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The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial.
Mortensen, SA, Rosenfeldt, F, Kumar, A, Dolliner, P, Filipiak, KJ, Pella, D, Alehagen, U, Steurer, G, Littarru, GP
JACC. Heart failure. 2014;2(6):641-9
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Optimal therapy of heart failure (HF) is a considerable challenge. Standard treatments are administered to block rather than to enhance cellular processes. Coenzyme Q10 (CoQ10) is a powerful lipid-soluble antioxidant. This study is a prospective, randomized, double-blind, placebo-controlled, multi-centre trial of CoQ10 as adjunctive treatment of chronic HF focusing on changes in symptoms, biomarker status, and long-term outcome. A total of 420 patients were randomly assigned to active treatment with CoQ10 (n = 202) or placebo (n = 218). Results show that supplementation with CoQ10 significantly reduced major adverse cardiovascular events and cardiovascular death by 43% and all-cause mortality by 42%. Furthermore, CoQ10 supplementation improved the patients’ symptoms according to the New York Heart Association functional classification after 2 years. Authors conclude that treatment with CoQ10 in addition to standard therapy for patients with moderate to severe HF is safe, well tolerated, and associated with a reduction in symptoms and major adverse cardiovascular events.
Abstract
OBJECTIVES This randomized controlled multicenter trial evaluated coenzyme Q10 (CoQ10) as adjunctive treatment in chronic heart failure (HF). BACKGROUND CoQ10 is an essential cofactor for energy production and is also a powerful antioxidant. A low level of myocardial CoQ10 is related to the severity of HF. Previous randomized controlled trials of CoQ10 in HF were underpowered to address major clinical endpoints. METHODS Patients with moderate to severe HF were randomly assigned in a 2-year prospective trial to either CoQ10 100 mg 3 times daily or placebo, in addition to standard therapy. The primary short-term endpoints at 16 weeks were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide. The primary long-term endpoint at 2 years was composite major adverse cardiovascular events as determined by a time to first event analysis. RESULTS A total of 420 patients were enrolled. There were no significant changes in short-term endpoints. The primary long-term endpoint was reached by 15% of the patients in the CoQ10 group versus 26% in the placebo group (hazard ratio: 0.50; 95% confidence interval: 0.32 to 0.80; p = 0.003) by intention-to-treat analysis. The following secondary endpoints were significantly lower in the CoQ10 group compared with the placebo group: cardiovascular mortality (9% vs. 16%, p = 0.026), all-cause mortality (10% vs. 18%, p = 0.018), and incidence of hospital stays for HF (p = 0.033). In addition, a significant improvement of NYHA class was found in the CoQ10 group after 2 years (p = 0.028). CONCLUSIONS Long-term CoQ10 treatment of patients with chronic HF is safe, improves symptoms, and reduces major adverse cardiovascular events. (Coenzyme Q10 as adjunctive treatment of chronic heart failure: a randomised, double-blind, multicentre trial with focus on SYMptoms, BIomarker status [Brain-Natriuretic Peptide (BNP)], and long-term Outcome [hospitalisations/mortality]; ISRCTN94506234).
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The effects of oats on the function of gut microflora in children with coeliac disease.
Tjellström, B, Stenhammar, L, Sundqvist, T, Fälth-Magnusson, K, Hollén, E, Magnusson, KE, Norin, E, Midtvedt, T, Högberg, L
Alimentary pharmacology & therapeutics. 2014;39(10):1156-60
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Oats have been allowed in the gluten-free diet of patients with coeliac disease (CD), however concerns have been raised that they may not be safe to eat in a subset of these patients. Short chain fatty acids (SFCAs) have been identified as a marker of inflammation and gut metabolism. Recent studies have found that children with CD often have elevated SCFA levels, indicating a disturbance in the gut microflora. The aim of this study was to identify the effect of consuming oats in children recently diagnosed with CD by examining faecal SCFAs. 116 children were treated with or without oats in their gluten-free diet for one year to see if oats affect the gut microflora. The findings of this study indicate that the children consuming oats had higher faecal SCFA concentration after one year than those not consuming oats. Based on this study, the authors’ conclude that oats do affect the gut microflora metabolism and that some coeliac children consuming oats may develop gut mucosal inflammation, leading to further future complications.
Abstract
BACKGROUND Faecal short chain fatty acids (SCFAs) are produced by the gut microflora. We have previously reported high faecal SCFA levels in children with coeliac disease (CD), indicating alteration in gut microfloral metabolism. Data accumulated over recent decades by us and others suggest that wheat-free oats can safely be included in a gluten-free diet (GFD). However, concerns have been raised with respect to the safety of oats in a subset of coeliacs. AIM: To describe faecal SCFA patterns in children with newly diagnosed CD treated for 1 year with a GFD with or without oats. METHODS This report is part of a randomised, double-blind study on the effect of a GFD containing oats (GFD-oats) vs. a standard GFD (GFD-std). Faecal samples were received from 34 children in the GFD-oats group and 37 in the GFD-std group at initial diagnosis and/or after 1 year on a GFD. Faecal SCFAs were analysed. RESULTS The GFD-std group had a significantly lower total faecal SCFA concentration at 12 months compared with 0 months (P < 0.05). In contrast, total SCFA in the GFD-oats group remained high after 1 year on the GFD. The children in the GFD-oats group had significantly higher acetic acid (P < 0.05), n-butyric acid (P < 0.05) and total SCFA concentration (P < 0.01) after 1-year diet treatment compared to the GFD-std group. CONCLUSIONS Our results indicate that oats do affect the gut microflora function, and that some coeliac children receiving oats may develop gut mucosal inflammation, that may present a risk for future complications.
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Mediterranean dietary pattern and depression: the PREDIMED randomized trial.
Sánchez-Villegas, A, Martínez-González, MA, Estruch, R, Salas-Salvadó, J, Corella, D, Covas, MI, Arós, F, Romaguera, D, Gómez-Gracia, E, Lapetra, J, et al
BMC medicine. 2013;11:208
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The role of diet in preventing mental disorders has been increasingly explored in the past few years. Few observational studies have associated the traditional Mediterranean diet (MD) with a reduced risk of depression, however this available information is limited and inconclusive. The aim of this trial was to compare the efficacy of two variations of the MD on depression among patients at high risk of cardiovascular disease. The diets included MD supplemented with extra-virgin olive oil or mixed nuts, and a control group advised to follow a low-fat diet. The study included 3923 participants aged 55-80 the median follow-up was 5.4 years. The findings of this trial did not show a significant decrease in depression risk among participants assigned to either MD group compared with the control. However when the specific cohort of subjects with type 2 diabetes was analysed, the depression risk was significantly reduced compared with the control group. Based on this study, the authors suggest a beneficial effect of the MD on depression for patients with type 2 diabetes though further investigation is required.
Abstract
BACKGROUND A few observational studies have found an inverse association between adherence to a Mediterranean diet and the risk of depression. Randomized trials with an intervention based on this dietary pattern could provide the most definitive answer to the findings reported by observational studies. The aim of this study was to compare in a randomized trial the effects of two Mediterranean diets versus a low-fat diet on depression risk after at least 3 years of intervention. METHODS This was a multicenter, randomized, primary prevention field trial of cardiovascular disease (Prevención con Dieta Mediterránea (PREDIMED Study)) based on community-dwelling men aged 55 to 80 years and women aged 60 to 80 years at high risk of cardiovascular disease (51% of them had type 2 diabetes; DM2) attending primary care centers affiliated with 11 Spanish teaching hospitals. Primary analyses were performed on an intention-to-treat basis. Cox regression models were used to assess the relationship between the nutritional intervention groups and the incidence of depression. RESULTS We identified 224 new cases of depression during follow-up. There was an inverse association with depression for participants assigned to a Mediterranean diet supplemented with nuts (multivariate hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.55 to 1.10) compared with participants assigned to the control group, although this was not significant. However, when the analysis was restricted to participants with DM2, the magnitude of the effect of the intervention with the Mediterranean diet supplemented with nuts did reach statistical significance (multivariate HR = 0.59; 95% CI 0.36 to 0.98). CONCLUSIONS The result suggest that a Mediterranean diet supplemented with nuts could exert a beneficial effect on the risk of depression in patients with DM2. TRIAL REGISTRATION This trial has been registered in the Current Controlled Trials with the number ISRCTN 35739639.