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"Commercial" Ready-To-Use Therapeutic Foods (RUTFs) are used in acute malnutrition management, but they are not always appropriate being expensive and unfamiliar. Much research has tried to develop alternative RUTF formulations and this work systematically reviewed eight articles discussing the approaches used to assess the children's sensory satisfaction, families' acceptance, and the cultural appropriateness of 13 alternative RUTFs. Different approaches were used by the authors and much research to standardise methodologies and findings is urgent to ensure that food products are culturally appropriate, acceptable and appreciated, with the final aim of completing the development process of alternative RUTFs. This work proposed some indications to follow in alternative RUTF acceptability evaluation processing. Moreover, community engagement and education resulted key aspects in alternative RUTF acceptance. An innovative, multi-disciplinary, multi-stakeholder approach could develop alternative "fit-for-the-purpose" RUTFs to help food-insecure communities acquire sufficient, safe, nutritious food in long-term Community Management of Acute Malnutrition.

Background and aims Post-prandial glycemic response (PPGR) depends on the intrinsic characteristic of the carbohydrate-rich foods as well as on the amount and type of other nutrients. This study aimed to explore whether the addition of condiments can affect the difference in PPGR between a low and a medium–high Glycemic Index (GI) food. Methods and results Spaghetti (S) and rice ® were consumed plain and after adding tomato sauce and extra virgin olive oil (TEVOO), or pesto sauce (P). The GI of R (63 ± 3) was statistically higher than that of S (44 ± 7) (p = 0.003). The Incremental Area Under the Curve (IAUC) for R was significantly greater than S (124.2 ± 12.1 and 82.1 ± 12.9 mmol∗min/L respectively) (p = 0.016) for blood glucose but not for insulin (1192.6 ± 183.6 and 905.2 ± 208.9 mU∗min/L, respectively) (p = 0.076). There were no significant differences after the addition of either TEVOO or P. The postprandial peaks of blood glucose and insulin for R (6.7 ± 0.3 mmol/L and 36.4 ± 4.9 mU/L, respectively) were significantly higher compared to S (6.0 ± 0.2 mmol/L and 26.7 ± 3.6 mU/L, respectively) (p = 0.033 and p = 0.025). The postprandial peak for insulin remained significantly higher with P (36.8 ± 3.7 and 28.6 ± 2.9 mU/L for R + P and S + P, p = 0.045) but not with EVOO (p = 0.963). Postprandial peaks for blood glucose were not significantly different with condiment. Conclusions The differences in PPGR were significant between spaghetti and rice consumed plain, they reduced or disappeared with fat adding, depending on the type of condiment used. Registration number ( www.clinicaltrial.gov ):NCT03104712

Background & aims The effect of pasta consumption within a low-energy Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity. Methods & Results Forty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component. Conclusions Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention. This trial was registered at clinicaltrials.gov as NCT03341650.

It is unclear whether weight loss (WL) achieved by means of lifestyle interventions (LSIs) before bariatric surgery (BS) can improve long-term WL outcomes after surgery. We aimed to assess the impact of a structured LSI on WL% after gastric bypass (GBP). Two groups of patients were selected from a large cohort of participants with obesity who underwent GBP surgery at Santa Maria Nuova Hospital (Reggio Emilia, Italy). The groups were categorized as those who have or have not received LSI prior to GBP. The LSI group included 91 participants (cases) compared to 123 participants (controls) in the non-LSI group. WL% was measured at follow-up times of 1, 3, 6, 12, 24, 36, 48, and 60 months. The LSI group achieved a clinically significant WL% (−7.5%) before BS, and at the time of surgery, the two groups had similar body weights and demographic statuses. At all points, until the 24-month follow-up, the two groups displayed similar WLs%. With regard to the longer follow-ups, the LSI group maintained weight loss until the last timepoint (60 months), whereas the non-LSI group experienced weight regain at 36, 48, and 60 months. In a real-world context, a structured behavioral LSI prior to GBP seems to prevent longer-term weight regain.

The adoption of sustainable dietary models, such as the Mediterranean Diet (MD), can be a valuable strategy to preserve ecosystems and human health. This study aims to investigate in an Italian adult representative sample the adherence to the MD and to what extent it is associated with the self-perceived adoption of a sustainable diet, the consideration of the MD as a sustainable dietary model, and anthropometric and sociodemographic factors. By applying an online survey (n = 838, 18–65 years, 52% female), an intermediate level of MD adherence (median: 4.0, IR: 3.0–4.0) in a 0–9 range was observed. Only 50% of the total sample confirmed the MD as a sustainable dietary model, and 84% declared no or low perception of adopting a sustainable diet. Being female, having a higher income and education level, considering the MD as a sustainable dietary model, as well as the perception of having a sustainable diet were the most relevant factors influencing the probability of having a high score (≥6) of adherence to the MD. This study suggests a gradual shift away from the MD in Italy and supports the need to address efforts for developing intervention strategies tailored to adults for improving diet quality. Furthermore, a public campaign should stress the link between a diet and its environmental impact to foster nutritionally adequate and eco-friendly dietary behaviors.

BACKGROUND: Structure and protein-starch interactions in pasta products can be responsible for lower postprandial glycemic responses compared with other cereal foods.OBJECTIVES: We tested the effect on postprandial glucose metabolism induced by 2 pasta products, couscous, and bread, through their structural changes during mastication and simulated gastric digestion.METHODS: Two randomized controlled trials (n = 30/trial) in healthy, normal-weight adults (mean BMI of 23.9 kg/m2 (study 1) and 23.0 kg/m2 (study 2)) evaluated postprandial glucose metabolism modulation to portions of durum wheat semolina spaghetti, penne, couscous, and bread each containing 50 g available carbohydrate. A mastication trial involving 26 normal-weight adults was conducted to investigate mastication processes and changes in particle size distribution and microstructure (light microscopy) of boluses after mastication and in vitro gastric digestion.RESULTS: Both pasta products resulted in lower areas under the 2-h curve for blood glucose (-40% for spaghetti and -22% for penne compared with couscous; -41% for spaghetti and -30% for penne compared with bread), compared with the other grain products (P < 0.05). Pasta products required more chews (spaghetti: 34 ± 18; penne: 38 ± 20; bread: 27 ± 13; couscous: 24 ± 17) and longer oral processing (spaghetti: 21 ± 13 s; penne: 23 ± 14 s; bread: 18 ± 9 s; couscous: 14 ± 10 s) compared with bread or couscous (P < 0.01). Pastas contained more large particles (46-67% of total particle area) compared with bread (0-30%) and couscous (1%) after mastication and in vitro gastric digestion. After in vitro gastric digestion, pasta samples still contained large areas of nonhydrolyzed starch embedded within the protein network; the protein in bread and couscous was almost entirely digested, and the starch was hydrolyzed.CONCLUSIONS: Preservation of the pasta structure during mastication and gastric digestion explains slower starch hydrolysis and, consequently, lower postprandial glycemia compared with bread or couscous prepared from the same durum wheat semolina flour in healthy adults.The postprandial in vivo trials were registered at clinicaltrials.gov as NCT03098017 and NCT03104686.

Perinatal (antenatal and postpartum) depression is increasingly becoming a global public health problem. Studies have shown that the presence of depression during the perinatal period impact on a mother's ability to adequately provide nutritional care for herself and her infants and young children. This may thus negatively influence the nutritional status of these vulnerable children resulting in poor growth, such as stunting which is currently a public health problem in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to determine the association between maternal postpartum depression and child growth in LMICs. Electronic databases were systematically reviewed by screening abstracts, titles, full text and additional data sources of eligible papers. Articles were eligible for inclusion if based on children aged 0 to 59 months, if reporting maternal postpartum depression as an exposure, if based on observational studies evaluating the relation between maternal postpartum depression and child growth, if reporting at least one physical growth indicator such as stunting as an outcome, and if published after 2000. Article selection was based on the PRISMA guidelines for reporting systematic reviews. Twelve articles were included in the quantitative synthesis (12 for stunting, 8 for underweight and 2 for wasting). Maternal postpartum depression was observed to be associated with an increased risk of child stunting (1.87 (95% CI: 1.52, 2.30; I

Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth’s main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13–17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects.

Excess intake of energy, sugars, salt and saturated fats is an important causal factor of obesity and related non-communicable diseases. In order to help consumers to make healthy food choices, many European countries have developed proposals for “front-of-pack” food labeling, intended as an integration to the nutritional information provided by the mandatory nutritional declaration. Based on the European strategic program “Farm to Fork”, the intention is to achieve a harmonized front-of-pack label proposal by Q4 2022. Among the different proposals, the one which received most attention by experts and greater feedback by the EU member countries is the Nutri-Score, a tool based on an algorithm whereby a “quality” category ranging from A to E is assigned to each single food on a background colored from dark green to dark orange. As an alternative to Nutri-Score, the NutrInform Battery has been developed by Italy in association with a few other EU member states: this proposal is objectively alternative to the Nutri-Score proposal due to a different underlying philosophy, in particular for its informative and educational intent rather than purchase orientation. The present document, prepared by the Scientific Board and reviewed by the Scientific Council of the Italian Society of Human Nutrition, represents the scientific-based position of the Society in relation to the general theme of front-of-pack labeling and in particular to the dualism created between the Nutri-Score and NutrInform Battery proposals.

Children&rsquo, s energy requirements may vary during school and summer camp days. To evaluate energy balance during these two periods, seventy-eight children (45% females, 8&ndash, 10 years) living in Parma, Italy, were enrolled in this observational study. Participants completed a 3-day food diary and wore an activity tracker for three consecutive days during a school- and a summer camp-week to estimate energy intake (EI) and energy expenditure (TEE). Height and body weight were measured at the beginning of each period to define children&rsquo, s weight status. BMI and EI (school: 1692 &plusmn, 265 kcal/day, summer camp: 1738 &plusmn, 262 kcal/day) were similar during both periods. Both physical activity and TEE (summer camp: 1948 &plusmn, 312, school: 1704 &plusmn, 263 kcal/day) were higher during summer camp compared to school time. Therefore, energy balance was more negative during summer camp (&minus, 209 &plusmn, 366 kcal/day) compared to school time (&minus, 12 &plusmn, 331 kcal/day). Similar results were observed when males and females were analyzed separately but, comparing the sexes, males had a higher TEE and a more negative energy balance than females, during both periods. The results strongly suggest that an accurate evaluation of children&rsquo, s energy balance, that considers both diet and physical activity, is needed when planning adequate diets for different situations.

This study aimed to evaluate the impact of breads made with two different wheat evolutionary populations (EPs), in comparison with a modern variety, on postprandial blood glucose and insulin responses. A randomized controlled crossover postprandial study involving twelve healthy subjects was conducted. Seven non-commercial breads produced with flours from two different bread wheat (T. aestivum L.) EPs (Bio2, ICARDA) and a modern bread wheat variety (Bologna) considered as control, and with two different bread-making processes (S. cerevisiae and sourdough), were specifically formulated for the study. Postprandial incremental curves, Incremental Area Under the Curve (IAUC), maximum postprandial peaks for blood glucose and plasma insulin over 2 hours after administration of isoglucidic portions of breads (50 g of available carbohydrates) were evaluated. The comparison of incremental curves, IAUC, and maximum postprandial peaks after consumption of breads formulated with EPs and control breads showed no differences among samples. Neither the flour nor the leavening technic used for the baking were effective in inducing a different postprandial response compared to the Bologna variety. EPs, being characterized by higher degree of crop genetic diversity, may have a relevant agronomic role to guarantee good and stable yields and quality under low input management in a changing climate, however, future studies are needed to better investigate their potential positive effect on human health.

Inadequate diet, physical activity, and sleep-related behaviors are potential risk factors for overweight and obese, therefore we investigated the relations between body mass index (BMI) and behavioral factors in a sample of Italian adolescents. Four hundred nine Italian secondary school students (46% females, 12.5 &plusmn, 0.6 y.o.) were enrolled in this cross-sectional study. Anthropometric measures, adherence to the Mediterranean Diet (KIDMED), physical activity level (PAQ-C), sleep duration, daytime sleepiness (PDSS), sleep quality, and school achievement data were collected through an online questionnaire. The percentage of overweight adolescents was slightly lower (14%) compared to the regional and the national figures. Approximately 88% of the sample reported a medium/high adherence to the Mediterranean Diet and 77% a moderate/vigorous physical activity level. The average sleep duration was in line with the international sleep recommendation for adolescents and 82% had a medium/high sleep quality. No differences were found between genders except for BMI (lower in females). Unexpectedly, no differences were found among the BMI groups (normal weight vs. overweight vs. obese) for lifestyle variables, in contrast, Mediterranean Diet adherence was associated with sleep habits. Further investigation is required to better explore the associations among behavioral variables involved in adolescents&rsquo, healthy development.

Coffee is an important source of bioactive compounds, including caffeine, trigonelline, and phenolic compounds. Several studies have highlighted the preventive effects of coffee consumption on major cardiometabolic (CM) diseases, but the impact of different coffee dosages on markers of CM risk in a real-life setting has not been fully understood. This study aimed to investigate the effect of coffee and cocoa-based confectionery containing coffee consumption on several CM risk factors in healthy subjects., info:eu-repo/semantics/published

The key role of diet in both human health and environmental sustainability is well known. However, there is a lack of studies investigating the environmental impact of children&rsquo, s dietary behavior. The aim of this observational study was to investigate the dietary environmental impact in a sample of primary school children living in Parma (Italy, n = 172, 8&ndash, 10 years), in relation to their adherence to the Mediterranean diet (MD). Children completed a 3-day food record in both winter and spring. Dietary records were processed to obtain: (i) adherence to the MD and (ii) mean daily carbon and ecological footprints. Adherence to the MD was similar in winter and spring, with almost half of the participants showing a medium MD score. Carbon and ecological footprints were higher during winter, and the main dietary contributors were red and processed meat for both indexes. A small positive correlation was observed between adherence to the MD and total carbon and ecological footprints. This study provided the first analysis of the relationship between adherence to the MD and environmental impact of primary school children. Further research is needed to better investigate the environmental impact of primary school children&rsquo, s diet and the possible relationship between the MD and environmental sustainability.

The effect of coffee and cocoa on oxidative damage to macromolecules has been investigated in several studies, often with controversial results. This study aimed to investigate the effect of one-month consumption of different doses of coffee or cocoa-based products containing coffee on markers of DNA damage and lipid peroxidation in young healthy volunteers. Twenty-one volunteers were randomly assigned into a three-arm, crossover, randomized trial. Subjects were assigned to consume one of the three following treatments: one cup of espresso coffee/day (1C), three cups of espresso coffee/day (3C), and one cup of espresso coffee plus two cocoa-based products containing coffee (PC) twice per day for 1 month. At the end of each treatment, blood samples were collected for the analysis of endogenous and H2O2-induced DNA damage and DNA oxidation catabolites, while urines were used for the analysis of oxylipins. On the whole, four DNA catabolites (cyclic guanosine monophosphate (cGMP), 8-OH-2′-deoxy-guanosine, 8-OH-guanine, and 8-NO2-cGMP) were detected in plasma samples following the one-month intervention. No significant modulation of DNA and lipid damage markers was documented among groups, apart from an effect of time for DNA strand breaks and some markers of lipid peroxidation. In conclusion, the consumption of coffee and cocoa-based confectionery containing coffee was apparently not able to affect oxidative stress markers. More studies are encouraged to better explain the findings obtained and to understand the impact of different dosages of these products on specific target groups., This study was partially funded by Soremartec Italia S.r.l. (Alba, Italy). The sponsor approved the final trial protocol but was not involved in any stage of the study as well as in the drafting of the manuscript.

Introduction The aim of this study was evaluating if the presence of a humanoid robot could improve the efficacy of a game-based, nutritional education intervention. Study design This was a controlled, school-based pilot intervention carried out on fourth-grade school children (8–10 years old). A total of 112 children underwent a game-based nutritional educational lesson on the importance of carbohydrates. For one group ( n = 58), the lesson was carried out by a nutritional educator, the Master of Taste (MT), whereas for another group, ( n = 54) the Master of Taste was supported by a humanoid robot (MT + NAO). A third group of children ( n = 33) served as control not receiving any lesson. Methods The intervention efficacy was evaluated by questionnaires administered at the beginning and at the end of each intervention. The nutritional knowledge level was evaluated by the cultural-nutritional awareness factor (AF) score. Results A total of 290 questionnaires were analyzed. Both MT and MT + NAO interventions significantly increased nutritional knowledge. At the end of the study, children in the MT and MT + NAO group showed similar AF scores, and the AF scores of both intervention groups were significantly higher than the AF score of the control group. Conclusions This study showed a significant increase in the nutritional knowledge of children involved in a game-based, single-lesson, educational intervention performed by a figure that has a background in food science. However, the presence of a humanoid robot to support this figure's teaching activity did not result in any significant learning improvement.

Foods consumed and dietary patterns are strong determinants of health status. Diet and nutrition have a key role in health promotion and maintenance during the entire lifetime, but what we choose to eat and drink greatly affects the environmental impact on ecosystems as well as monetary resources. Some studies suggest that a healthy diet with a low environmental impact is not necessarily more expensive. This paper aims to identify a healthy, greener and cheaper diet based on current consumption patterns. Dietary information was collected from 104 young adults in the last year of high school in Parma (Italy). Diet was monitored with 7-day dietary records. Subsequently, food items were decoded to obtain nutritional, economic and environmental impact data. An optimization tool based on mathematical programming (Multi-Objective Linear Programming) was used to identify sustainable diet. Three different 7-day diets were identified, based on nutrition recommendations for the healthy Italian adult population, characterized by different targets and optimizing different impacts: first the diet at the lowest cost (Minimum Cost Diet - MCD), then the Environmentally Sustainable Diet (ESD) obtained by minimizing the three environmental indicators (CO2e emissions, H2O consumption and amount of land to regenerate the resources - m(2)). Finally, the Sustainable Diet (SD) was identified by integrating environmental and economic sustainability objectives. Lastly, suggestions and recommendations for communication campaigns and other interventions to achieve sustainable diet are suggested.

The quantity and quality of dietary fat and/or carbohydrate may alter one or more of the basic components of the insulin-glucose system, which in turn affect the pathways leading to alterations in glucose homeostasis and, possibly, to cardiovascular disease. This viewpoint article, reviewing some of the currently available tools aiming at quantifying the impact of dietary carbohydrates on the glucose-insulin homeostatic loop, highlights the unmet need of a more thorough assessment of the complex interaction between dietary factors and the glucose-insulin system. A novel index, the "β-cell burden index", may turn out to be a valuable tool to quantify the role played by the diet in shaping the risk of type 2 diabetes, cardiovascular disease and other metabolic and degenerative disorders, ideally orienting their prevention with strategies based on dietary modifications.

Nutritional habits modifications have shown an important impact in preventing and ameliorating metabolic alterations, such as nonalcoholic fatty liver disease (NAFLD). Among several dietary approaches that exert positive effects in NAFLD patients, the Mediterranean dietary pattern has shown notable benefits. This review explores the molecular mechanisms through which the Mediterranean diet would improve risk factors associated with metabolic syndrome and NAFLD. The main features of the Mediterranean diet acting on metabolism are represented by its whole-grain and low glycemic index cereal-based items, its fatty acid profile, and its content in phytochemical compounds. Carbohydrate-rich foods high in dietary fiber inducing low glycemic response are able to interact with glucose and insulin metabolism. Unsaturated fatty acids are associated with better hepatic lipid metabolism. Finally, phytochemical compounds, such as dietary polyphenols, are thought to ameliorate inflammation, which is considered one of the mechanisms through which NALFD may evolve into nonalcoholic steatohepatitis (NASH).

Current evidence accounts for the role of (poly)phenolic compounds in the prevention of non-communicable diseases. Detailed information on population-level intakes is required to translate these findings into recommendations. This work aimed to estimate (poly)phenol intake in the UK population using data from a nationally representative survey.Data from 9374 participants (4636 children aged 1.5-18 years and 4738 adults aged 19 years and over) from the National Diet and Nutrition Survey Rolling Programme (NDNS RP) 2008-2014 was used. (Poly)phenol content of foods consumed in the NDNS RP was identified using Phenol-Explorer and through literature searches. Data on flavonoids, phenolic acids, and stilbenes were collected. Total (poly)phenol content was also assessed.Mean total (poly)phenol intake ranged from 266.6 ± 166.1 mg/day in children aged 1.5-3 years to 1035.1 ± 544.3 mg/day in adults aged 65 years and over, with flavan-3-ols and hydroxycinnamic acids being the most consumed (poly)phenols across all age groups. (Poly)phenol intake was higher in males in all age groups except for adults aged 19-34 and 50-64 years, where intakes were marginally higher in females. Energy-adjusted intakes accounted for the pattern of increasing (poly)phenol intakes with age and a higher intake was observed in females across all age groups, with the exception of children aged 1.5-3 years. The main food sources were non-alcoholic beverages and fruits, being the main compounds flavan-3-ols and caffeoylquinic acids.This analysis provides estimates of (poly)phenol intake from a representative sample of the UK general population, which can help inform the health implications of (poly)phenol intake.

Background Regular breakfast consumption is associated with better health status and healthier food intake throughout the day, but this association is a complex interaction of several factors. Objective This study aimed to investigate the effect of nutritional and cognitive-perceived characteristics of breakfast on metabolic and behavioral variables related to food intake. Methods The study was a randomized, crossover, controlled trial, with 4 experimental conditions consisting of 3 iso-energetic breakfasts and 1 energy-free control meal. Breakfasts had similar nutritional profiles but differed for glycemic index (GI), glycemic load (GL), and perceived healthiness, satiety, palatability, or energy content. Fifteen healthy normal-weight men [means ± SDs; age: 24 ± 2 y; body mass index (BMI; kg/m2) 23.4 ± 1.6] underwent each experimental condition in random order during 4 different weeks, separated by ≥1-wk washout. On the third day of each intervention week, postprandial blood variables (with insulin as primary outcome), satiety ratings, and food intake during an ad libitum lunch consumed 4 h after breakfast (secondary outcomes) were measured for each experimental condition. Results A main effect of time, treatment, and time × treatment was found for postprandial insulin, glucose, and nonesterified fatty acids (P

Breakfast foods with lower glycaemic responses are associated with better body weight control. Glycaemic index (GI) values of some commonly consumed breakfast foods in Italy were determined and compared, along with macronutrients. Cakes/pastries were low-medium GI (44-60), with high-sugar and saturated fat and low-fibre. Generally, mueslis and breads were medium GI (62-66 and 59-76, respectively) with higher fibre and lower saturated fat and sugar. The addition of spreads to bread lowered GI (47-66) but increased sugar and saturated fat.

The physicochemical (volume, crumb grain and color), sensory and starch in vitro digestion properties were investigated in four gluten-free breads, produced using gluten-free commercial mixes. Different mixes' formulations and processing parameters led to the production of breads with different crumb grain, specific volume, crust and crumb color, which affected product's sensory acceptability. Generally, more heterogeneous and coarser crumb grain and darker color were more appreciated by the judges. Nutritional composition of gluten-free breads differed mainly for starch and lipids contents, due to a wide variety of ingredients used in breads formulations. Starch availability to hydrolytic enzymes in the gluten-free breads was not influenced by variation in ingredients and nutritional composition, but it was related to the physical structure in terms of specific volume. The higher was the specific volume, the higher was the starch-digested fraction.

The prevalence of overweight and obesity in children has risen greatly worldwide. Diet and poor physical activity are the two risk factors usually examined, but epidemiological evidence exists suggesting a link between sleep duration and overweight/obesity in children. The aim of this study was to describe the relationship among body mass index (BMI), diet quality, physical activity level, and sleep duration in 690 children attending the 5th grade in primary schools (9–11 years old) in the city of Parma (Italy) involved in the Giocampus educational program. This was achieved through (i) measuring anthropometric data to compute body mass index; (ii) administering a food questionnaire to evaluate adherence to the Mediterranean Diet (KIDMED score); and (iii) administering a lifestyle questionnaire to classify children physical activity level (PAL), sleep duration, and school achievement. A highly significant negative association was found between BMI and sleep hours. Moreover, there was a significant positive association between PAL and KIDMED scores. No evidence was found of association between BMI and PAL, nor between BMI and KIDMED score. Data from this study established that BMI is correlated to gender and sleep duration, defining sleep habits as one of the factors linked to overweight and obesity.

Food and beverage consumption has a great impact on the environment, although there is a lack of information concerning the whole diet. The environmental impact of 153 Italian adults (51 omnivores, 51 ovo-lacto-vegetarians, 51 vegans) and the inter-individual variability within dietary groups were assessed in a real-life context. Food intake was monitored with a 7-d dietary record to calculate nutritional values and environmental impacts (carbon, water, and ecological footprints). The Italian Mediterranean Index was used to evaluate the nutritional quality of each diet. The omnivorous choice generated worse carbon, water and ecological footprints than other diets. No differences were found for the environmental impacts of ovo-lacto-vegetarians and vegans, which also had diets more adherent to the Mediterranean pattern. A high inter-individual variability was observed through principal component analysis, showing that some vegetarians and vegans have higher environmental impacts than those of some omnivores. Thus, regardless of the environmental benefits of plant-based diets, there is a need for thinking in terms of individual dietary habits. To our knowledge, this is the first time environmental impacts of three dietary regimens are evaluated using individual recorded dietary intakes rather than hypothetical diet or diets averaged over a population.

Background and aims No data exist in the current literature on the glycemic index (GI) and glycemic load (GL) of the diet of phenylketonuric (PKU) children. The aims of this study were to examine the dietary GI and GL in PKU children on a low-phenylalanine (Phe)-diet and to evaluate whether an association may exist between the carbohydrate quality and the metabolic profile. Methods Twenty-one PKU children (age 5–11 years) and 21 healthy children, gender and age matched, were enrolled. Dietary (including GI and GL) and blood biochemical assessments were performed. Results No difference was observed for daily energy intake between PKU and healthy children. Compared to healthy controls, PKU children consumed less protein ( p = 0.001) and fat ( p = 0.028), and more carbohydrate (% of total energy, p = 0.004) and fiber ( p = 0.009). PKU children had higher daily GI than healthy children (mean difference (95% confidence interval), 13.7 (9.3–18.3)) and higher GL (31.7 (10.1–53.2)). PKU children exhibited lower blood total and low density lipoprotein cholesterol (LDL) levels ( p p = 0.014) than healthy children, while glucose and insulin concentrations did not differ. In PKU children the dietary GL was associated with triglyceride glucose index (Spearman's correlation coefficient = 0.515, p = 0.034). Conclusion In PKU children a relationship of the dietary treatment with GI and GL, blood triglycerides and triglyceride glucose index may exist. Improvement towards an optimal diet for PKU children could include additional attention to the management of dietary carbohydrate quality.

Breakfast consumption can entail nutritional advantages positively affecting food choices. This study investigated the effect of minor changes in breakfast composition on the perceived attributes of foods, both at breakfast and at lunchtime. Four breakfasts were defined considering nutritional and perceptual factors. Three breakfasts varied just for a single cereal-based chocolate-containing food item, while a control breakfast mimicked fasting conditions. Breakfast perception was assessed before and after consumption. Subjects rated breakfast energy content on the basis of single items, while judged breakfast healthiness as a whole, suggesting that the combination of different ingredients can modify the perceived health value of foods. Additionally, 4 h after breakfast, a perceptual evaluation of lunch-related food images was performed, without differences among breakfasts. This study extends current knowledge on the relationship between subjective perceptual attributes and objective energy value and food composition, as well as on breakfast impact on food perception at lunchtime.

The Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico is a five-century institution that, besides the unique clinical role in the center of Milan, may rely on benefactor donations such as fields and farming houses not far from the city, for a total of 8500 ha, all managed by the "Sviluppo Ca' Granda' Foundation". Presently, the main products of these fields are represented by rice and cow's milk. During the latest years, farmers and managers have developed a model of sustainable food production, with great attention to the product quality based on compositional analysis and functional nutritional characteristics. This experience represents a new holistic model of food production and consumption, taking great care of both sustainability and health.

cope This work aimed at investigating absorption, metabolism, and bioavailability of phenolic compounds after consumption of wholegrain bread or bread enriched with an aleurone fraction. Methods and results Two commercially available breads were consumed by 15 participants on three occasions and matched for either the amount of ferulic acid in the bread or the amount of bread consumed. Urine was collected for 48 h from all the volunteers for phenolic metabolite quantification. Blood samples were collected for 24 h following bread consumption in five participants. A total of 12 and 4 phenolic metabolites were quantified in urine and plasma samples, respectively. Metabolites were sulfate and glucuronic acid conjugates of phenolic acids, and high concentrations of ferulic acid-4’-O-sulfate, dihydroferulic acid-4’-O-sulfate, and dihydroferulic acid-O-glucuronide were observed. The bioavailability of ferulic acid was significantly higher from the aleurone-enriched bread when all ferulic acid metabolites were accounted for. Conclusions The study shows that low amounts of aleurone-enriched bread resulted in equivalent plasma levels of ferulic acid as wholegrain bread. This could suggest that, if the absorbed phenolic metabolites after wholegrain product intake exert health benefits, equal levels could be reached through the consumption of lower doses of refined products enriched in aleurone fraction.

Wheat aleurone, due to its potentially higher bioaccessibility and bioavailability of micronutrients and phenolic acids, could represent a useful ingredient in the production of commonly consumed cereal-based food. The aim of the present study was to investigate the in vitro bioaccessibility of phenolic acids both from an aleurone-enriched bread and from a whole grain bread. The two bread samples were firstly characterized for the phenolic acid content. An in vitro digestion was then performed in order to evaluate the release of phenolic acids. The results obtained suggest that the bioaccessibility of the phenolic acids in the aleurone-enriched bread is higher than in the whole grain bread. These in vitro results suggest the potential use of aleurone in the production of foods, and this may represent an attractive possibility to vehicle nutritionally interesting components to consumers.

To improve nutritional knowledge of children, single-group educational interventions with pre/post knowledge assessment were performed in primary schools in Parma, Italy, participating to the Giocampus Program. A total of 8165 children (8–11 years old) of 3rd, 4th and 5th grades of primary school were involved in 3 hours per class nutritional lessons, with specifically designed games and activities for each school grade. To evaluate children learning, a questionnaire was administered before and after three months of educational intervention. A total of 16330 questionnaires were analysed. Children nutritional knowledge significantly increased (p< 0.001) in all school grades. The integrated "learning through playing" approach, including the educational figures, tools and games, was successful in improving children's nutritional knowledge. A stable integration of this method in primary school settings could prepare a new generation of citizens, better educated on health-promotion lifestyles.

Oxidative stress has been advocated as a major cause for cardiovascular disease (CVD), and low plasma antioxidant concentrations are associated with endothelial dysfunction, the first step towards atherosclerosis. However, although the antioxidant content in fruits and vegetables may explain at least in part their protective effect against CVD, supplementation with antioxidant vitamins fails to improve endothelial function and reduce CVD risk. The aim of this study was to investigate the impact of a diet rich in antioxidants on endothelial function measured by flow-mediated dilatation (FMD) in volunteers at low cardiovascular risk.In a crossover trial, 24 subjects (13 women, mean age 61 ± 3 years), received, in a randomised order, a 14-day high (HT) and a 14-day low (LT) antioxidant diets, with a 2-week wash-out (WO) in between. Both diets were comparable in daily portions of fruits and vegetables, and in alcohol, fibre and macronutrient intake, but differed in their total antioxidant capacity. Before and after each diet, anthropometrics, blood pressure, fasting plasma glucose, lipid profile, hepatic enzymes, circulating antioxidant concentrations, high sensitivity C-reactive protein (hs-CRP) and FMD were assessed. FMD increased significantly during the HT diet compared to the LT (p 0.000). FMD values were 2.3% higher after HT compared with LT (p 0.001) after adjustment for age, gender and diet order. α-tocopherol increased significantly (p 0.05) and hs-CRP and of γ-glutamyltranspeptidase decreased significantly (p 0.05 and p 0.01, respectively) during the HT diet, compared with the LT diet.A short-term HT diet improves endothelial function in volunteers at low cardiovascular risk, which may further reduce their risk of CVD.

Background and aim The glycemic index (GI) and glycemic load (GL) are useful parameters in the nutritional classification of carbohydrate foods. Diets characterized by a low GI and/or a low GL have been repeatedly and independently associated with decreased risk of diabetes and other chronic diseases. The aim of this study is to report the GI and GL value of carbohydrate-rich foods available on the Italian market and mostly consumed in Italy. Methods and results GI values were determined according to FAO/WHO (1997) and ISO (2010). Overall, the 141 commercial foods that were analyzed represent food categories that are the source of >80% carbohydrate intake in Italy. The food items chosen were based mainly on the market share of the brand within each food category and grouped into 13 food categories: 1) beverages: fermented milk drink, juice, smoothie, soft drink; 2) biscuits; 3) breads; 4) bread substitutes; 5) breakfast cereals; 6) cakes and snacks; 7) candy and confectionery; 8) cereals; 9) desserts and ice-creams; 10) marmalade and jam; 11) pasta; 12) pizza; 13) sugar and sweetener. Conclusion This database of commercial Italian foods partly overcomes the lack of information on GI and GL of local foods, contributing to a better understanding of the association between GI/GL and health and providing a more informed choice to Italian consumers and health practitioners.

The aim of this study was observing and improving children’s eating habits through an edutainment technological platform. A single-group education intervention was carried out in primary schools in Parma and Milano, Italy. A total of 76 children (32 females and 44 males, 8–10 years old) were involved in a 3-month nutritional program including lessons and educational videogames. Intakes of fruits, vegetables, juices and dietary total antioxidant capacity (TAC) were measured using 3-day food diaries before and after the intervention. The daily total consumption of fruit and vegetables increased from 421.8 (320.3) to 484.3 (337.2) g/day (p = 0.016). Consequently, daily dietary TAC increased by 26%, rising from 1.4 (1.3) to 1.6 (1.3) mmol of Trolox equivalents (p = 0.006). The methods and, particularly, the use of technological tools proved to be effective in conducting an educational intervention in children aged 8–10 years old.

Gluten-free products present major challenges for the food industry in terms of organoleptic, technological and nutritional characteristics. The absence of gluten has been shown to affect starch digestibility, thus increasing the postprandial glycaemic response. However, in recent years, gluten-free technologies have been improved, thus possibly modifying this quality parameter. We investigated the glycaemic index (GI) of 10 commercial foods aiming to update the GI values of the most common gluten-free products consumed in Italy. The in vivo GI was evaluated for six bakery products and four types of pasta. The postprandial glucose response was obtained in two groups with 10 healthy volunteers each. The overall GI values ranged from 37.5 for breakfast biscuits to 66.7 for puffed multigrain cake. Breads and pasta had GI values consistently lower than those previously reported in the literature. The present study showed that several commercial GF products exhibited low and medium GI values, not confirming the previous observations on the high GI of GF. However, considering the multiple formulations and processes for preparation of these products, further studies are recommended.

Background: Insulin resistance (IR) and liver steatosis (LS) are interlinked metabolic derangements whose prevalence is rapidly increasing, but the effect of dietary carbohydrate quality on LS is unknown. Objective: The objective was to describe the relation of IR and LS tototalcarbohydrate,totaldietaryfiber,andtheglycemicindex(GI) and glycemic load of the diet. Design: The study was a cross-sectional evaluation of 247 apparently healthy subjects who had no evidence of viral, toxic, or autoimmune hepatitis and who were unselected for alcohol intake. The homeostasis model assessment index was used as a surrogate measureofIR,andaliverechographywasusedasaproxyforLSgrading. Dietary data were collected by using 3-d food records. Total carbohydrate intake, total dietary fiber, GI, and glycemic load were calculated by using a semiquantitative food-frequency questionnaire concerning the dietary sources of carbohydrates. Results: The prevalence of high-grade LS (HG-LS) increased significantly across quartiles of dietary GI (P for trend 0.034): HG-LS in the 4th quartile (high GI) was twice that in the first 3 quartiles (low to medium GIs), whereas no relation was observed with total carbohydrates, total dietary fiber, or glycemic load. In insulin-sensitive subjects (first 3 quartiles of homeostasis model assessment index of IR), the prevalence of HG-LS did not differ significantly between GI groups, but, in insulin-resistant subjects (4th quartile of homeostasis model assessment index of IR), it was twice as high in those with high GI as in those with low to medium GIs (P 0.005). Conclusions: High-GI dietary habits are associated with HG-LS, particularly in insulin-resistant subjects. Dietary advice on the quality of carbohydrate sources therefore may be a complementary tool for preventing or treating LS of metabolic origin. Am J Clin Nutr 2006;84:136–42.

We tested the possibility to prepare a hyperproteic and hyperenergetic supplementary food for malnutrition rehabilitation in children starting from available ingredients in popular markets in Sierra Leone. Twelve residents in Paediatrics from University of Parma, Italy, prepared in a hospital near the capital Freetown with modest technology a mixture of peanut flour, palm oil, milk powder, sugar and vitamins to which they gave the name of "Parma pap". Three hundred and thirty-two malnourished children (mean age 14±6.3 months) who were receiving Feeding Program Supplementations (FPS), were enrolled in the study: 177 participants received randomly FSP portions only (Group 1), and 159 participants were treated with FSP regimen plus a supplement of "Parma pap" (Group 2). Outcomes of the study were computed as WHZ-score increment (Δ value) by subtracting the discharge WHZ-score from the admission WHZ-score. The best Δ-WHZ-scores (gt;+4) were recorded among participants of Group 2 (64%) rather than in Group 1 (21%; p=0.040). The children receiving FSP portions plus "Parma pap" recovered faster (5.54 week on average) than those treated with FSP regimen only (8.16 on average). The percentage of children who did not recover was higher in Group 1 (25.3%) than in Group 2 (; 13%; p=0.05). A slight positive correlation has been found between WHZ-scores at admission and at the end of the study (r=0.19; p=0.045). During the experience in Sierra Leone we have had the chance to give "Parma pap" to twenty one malnourished children admitted to Xaverian Mission in Makeni, northern Sierra Leone, not taking other supplementary food. Sixteen of these children recovered in 4.9 week on average and five in 6 to 8 weeks. Mean Δ-WHZ-scores ranged between + 1 and + 5. The data from the present study suggest that "Parma pap" could be an effective additional food to FPS regimen in malnutrition recovering. Further researches are needed on the contrary to prove if "Parma pap" could be defined as a veritable ready to use therapeutic food, although this characteristic seems already to result from the experience in Makeni Mission.

The aim of this study was to evaluate the efficacy of a campaign promoting breakfast in primary school-children from the city of Parma, Italy, where 22 % of peer school-children had reported in 2005 to skip breakfast. Two groups of children were interviewed by a multiple choice questionnaire on their breakfast habits. Group 1 counted only the children who underwent the intensive campaign (n. 341), and Group 2 a number of matched peers who did not attend any breakfast-promoting program (n. 291). Children who did not eat breakfast were found to be more numerous in Group 2 (17.5 %) than in Group 1 (8.0 %; p=0.0001). In the Group 2 the percentage of overweight (18.4 %) was higher compared to Group 1 patients (11.7 %; p=0.022). No significant difference in obesity percentage (8.9 vs 5.0 %; p=0.071). Seventy five percent of children in Group I and the 25% of children in Group 2 (p=0.031) had one or two parents who had reported to skip routinely breakfast. Children with one or both parents used to skip breakfast had a greater odds ratio of 3.04 and 3 respectively of skipping breakfast compared to the children with parents who had regularly breakfast (p=0.0002). Compared to the children tested in 2005, children admitted to the Giocampus program showed: a significant decrease in breakfasting (22 vs 8 %; p=0.0001), a significant decrease in overweight (18.5 vs 11.7 %; p=0.003) but not in obesity (7.5 vs 5.0 %; p=0.138) status; a significant increase in consumption of cereals (p=0.0001) and fruit (p=0.0001). In conclusion, an intensive breakfast-centred strategy seems to be effective in breakfast promotion and in overweight risk decrease.

As bread is the most relevant source of available carbohydrates in the diet and as lowering dietary glycaemic index (GI) is considered favourable to health, many studies have been carried out in order to decrease the GI of bread. The most relevant strategy that has been applied so far is the addition of fibre-rich flours or pure dietary fibre. However, the effectiveness of dietary fibre in bread in reducing the GI is controversial. The purpose of the present review was to discuss critically the effects obtained by adding different kinds of fibre to bread in order to modulate its glycaemic response. The studies were selected because they analysedin vivowhether or not dietary fibre, naturally present or added during bread making, could improve the glucose response. The reviewed literature suggests that the presence of intact structures not accessible to human amylases, as well as a reduced pH that may delay gastric emptying or create a barrier to starch digestion, seems to be more effective than dietary fibrepersein improving glucose metabolism, irrespective of the type of cereal. Moreover, the incorporation of technologically extracted cereal fibre fractions, the addition of fractions from legumes or of specifically developed viscous or non-viscous fibres also constitute effective strategies. However, when fibres or wholemeal is included in bread making to affect the glycaemic response, the manufacturing protocol needs to reconsider several technological parameters in order to obtain high-quality and consumer-acceptable breads.

Dietary polyphenolic compounds are poorly absorbed in the small intestine. The absorbed fraction follows the common metabolic pathway of drugs, undergoing phase II enzymatic detoxification with the conjugation of glucuronic acid, sulfate, and methyl groups. However, the unabsorbed fraction can reach the colon, becoming available for the wide array of enzymes produced by the local commensal microbiota. Gut bacteria can hydrolyze glycosides, glucuronides, sulfates, amides, esters, and lactones and are able to break down the polyphenolic skeleton and perform reactions of reduction, decarboxylation, demethylation, and dehydroxylation. These complex modifications generate several low-molecular-weight metabolites that can be efficiently absorbed in situ, subsequently undergoing further phase II metabolism, locally and/or at the liver level, before entering the systemic blood circulation and finally being excreted in urine in substantial quantities that exceed the excretion of phenolic metabolites formed in the upper gastrointestinal tract. This brief work focuses on the phenolic composition and colonic microbial transformation of 2 of the most polyphenol-rich dietary sources, namely, green tea and coffee, and a new interesting and innovative ingredient, hazelnut skin, recently evaluated as one of the richest edible sources of polyphenolic compounds.

The aim of this research was to evaluate β-glucan-enriched flours, obtained from barleys with either normal or waxy starch, for their effects on the glycaemic index (GI) and the quality of bread. Rheological results confirmed that when barley flour was included in the dough the overall quality of bread slightly worsened. However, positive consequences on glycaemia were obtained with the normal starch barley: the GI of all-wheat bread (82.8 ± 7.2) was significantly reduced (57.2 ± 7.9) when 40% of wheat flour was substituted with β-glucan-enriched barley flour (6.0% ± 0.1 β-glucan in the final flour blend). In contrast, this positive effect was significantly reduced (GI: 70.1 ± 9.1) when 40% of wheat flour was substituted with the β-glucan-enriched flour of a waxy barley (CDC Alamo; 6.6 ± 0.2 β-glucan in the final flour blend), suggesting that the ability of β-glucans to lower the GI was affected by the barley starch-type.

Background and aims There are theoretical reasons for suspecting that a high glycemic index (GI) or glycemic load (GL) diet may increase breast cancer risk, perhaps via an effect on the insulin-like growth factor (IGF) axis. However observational studies have produced inconsistent findings and it is controversial whether breast cancer risk is influenced by the carbohydrate characteristics of the diet. We prospectively investigated the association between dietary GI and GL and breast cancer in the Italian section of the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods and results Women were recruited from 1993 to 1998 at five centers: Varese and Turin (north Italy), Florence (central Italy), and Ragusa and Naples (south Italy). Participants completed validated food frequency questionnaires from which GI and GL were estimated. Multivariable Cox proportional hazard regression models quantified the association between breast cancer risk and total carbohydrate intake, GI, and GL. During 11 years of follow-up, 879 breast cancer (797 invasive and 82 in situ) cases were indentified. High dietary GL was associated with increased breast cancer risk (RR 1.45, 95% CI = 1.06–1.99; highest vs. lowest quintile; p-trend 0.029), whereas dietary GI and total carbohydrate had no influence. The association was not modified by menopausal status or body mass index. Conclusion Our data indicate that, in a Mediterranean population characterized by traditionally high and varied carbohydrate intake, a diet high in GL plays a role in the development of breast cancer.

Glycemic index (GI) and Glycemic Load (GL) are parameters of carbohydrate bioavailability able to influence risk of chronic diseases. GL can be lowered either by reducing carbohydrate intake or by reducing the GI of the carbohydrate moiety of a mixed meal. These two approaches might have a different impact on Dietary-Induced Thermogenesis (DIT) and preferential substrate oxidation in the postprandial period, which are variables known to be involved in the regulation of body weight and body composition. This dietary, crossover intervention trial was designed to evaluate the effect on DIT and Respiratory Quotient (RQ) of three isocaloric breakfasts different in GI and/or GL (high GI and high GL [HGI-HGL] vs. low GI and low GL [LGI-LGL]; vs. high GI and low GL [HGI-LGL]) followed by a standard meal.RQ and DIT were measured in 16 lean young males by indirect calorimetry for 8h. DIT resulted significantly higher after the LGI-LGL compared to the HGI-HGL breakfast (p0.05). Postprandial changes in RQ differed among all breakfasts (p0.001). RQ increased from baseline after the two breakfasts with highest carbohydrate content and significantly more after the HGI-HGL than after the LGI-LGL (p0.02), whereas it decreased after the HGI-LGL breakfast, which contained a higher amount of fat.Reducing the GL of a meal by reducing GI seems an effective strategy to increase energy expenditure while maintaining a good rate of lipid oxidation. This might be related to different profiles of postprandial hormones affecting substrate oxidation.

Objective Because consumption of teas may be associated with potential health benefits due to its content in polyphenols and in Western countries the consumption of tea is equally divided between the hot and the ready-to-drink (RTD) cold versions of this typical beverage, the aim of this work was to study the absorption and metabolism of flavan-3-ols in human volunteers after the ingestion of a commercial RTD tea. Methods A feeding study was carried out in 20 healthy human volunteers and urine samples were collected for 24 h after tea ingestion. Flavan-3-ols–derived molecules were identified and quantified in urine samples by high-performance liquid chromatography with tandem mass spectrometric detection. Results Eight relevant metabolites were identified in urine, all modified flavan-3-ols with the exception of unmetabolized gallic acid. The urinary excretion of flavan-3-ols was equal to 7.2% of the intake with tea. Gallic acid, which was abundant in the RTD tea used in this study, reached a 4.5% of the drunken amount. Conclusions The bioavailability values observed are in agreement with previous reports, although the dosage of polyphenols ingested in this study is remarkably lower. Moreover, the use of a group of 20 volunteers, more than the average number of subjects used for usual human acute-feeding studies involving polyphenols, provides additional credibility to the results. After drinking the RTD ice tea used in this study, the internal compartments are exposed to non-marginal doses of flavanols and flavanol metabolites up to 24 h.

Background and aims It has been suggested that lignan intake may decrease the risk for cardiovascular disease (CVD) by modifying traditional risk factors as well as aortic stiffness. However, the role of dietary lignans on the vascular system is largely unknown. The objective was to investigate whether dietary intake of plant lignans in a free-living population was associated with markers of vascular inflammation and function. Methods and Results We performed a cross-sectional study in 242 (151 males) men and post-menopausal women. Anthropometric characteristics and lignan intake were evaluated. Soluble intercellular adhesion molecule-1 (sICAM-1), insulin, high-sensitive C-reactive protein, glucose, total cholesterol, HDL-cholesterol and triacylglycerols were measured in fasting blood samples. Brachial flow-mediated dilation (FMD) measurements were available for 101 subjects (56 males). Median (interquartile range) daily intake of matairesinol (MAT), secoisolariciresinol (SECO), pinoresinol (PINO), lariciresinol (LARI), and total lignans was 20.9 μg (17.4), 335.3 μg (289.1), 96.7 μg (91.1), 175.7 μg (135.8), and 665.5 μg (413.7), respectively, as assessed by 3-day weighed food record. Plasma concentrations of sICAM-1 (whole sample) significantly decreased (mean (95%CI) = 358 μg/L (320–401), 276 μg/L (252–303), 298 μg/L (271–326), and 269 μg/L (239–303), P per trend 0.013) and FMD values (FMD sub-group) significantly increased (4.1% (2.2–6.0), 5.7% (4.3–7.2), 6.4% (4.9–7.8), and 8.1% (6.3–10.0), P per trend 0.016) across quartiles of energy-adjusted MAT intake, even after adjustment for relevant clinical and dietary variables. Intake of SECO was also inversely related to plasma sICAM-1 ( P per trend 0.018), but not to FMD values. No relationship between intake of PINO, LARI or total lignans and either sICAM-1 or FMD values was observed. Conclusions Higher MAT intakes in the context of a typical Northern Italian diet are associated to lower vascular inflammation and endothelial dysfunction, which could have some implications in CVD prevention.

It is unknown whether diets with a high dietary total antioxidant capacity (TAC) can modify oxidative stress, low-grade inflammation, or liver dysfunction, all of which are risk factors for type 2 diabetes and cardiovascular disease.We studied the effect of high- and low-TAC (HT and LT, respectively) diets on markers of antioxidant status, systemic inflammation, and liver dysfunction.In a crossover intervention, 33 healthy adults (19 men, 14 women) received the HT and LT diets for 2 wk each. Dietary habits were checked with a 3-d food record during both diet periods and the washout period.Fruit and vegetable, macronutrient, dietary fiber, and alcohol intakes did not differ significantly between the 2 diets, whereas dietary TAC, alpha-tocopherol, and ascorbic acid were significantly (P0.001) higher during the HT diet. Plasma alpha-tocopherol rose during the HT and decreased during the LT diet (P0.02 for difference) without changes in markers of oxidative stress except plasma malondialdehyde, which decreased unexpectedly during the LT diet (P0.05). Plasma high-sensitivity C-reactive protein, alanine aminotransferase, gamma-glutamyltranspeptidase, and alkaline phosphatase concentrations decreased during the HT compared with the LT diet (mean +/- SEM for pre-post changes: -0.72 +/- 0.37 compared with 1.05 +/- 0.60 mg/L, P0.01; -1.73 +/- 1.02 compared with 2.33 +/- 2.58 U/L, P0.01; -2.12 +/- 1.45 compared with 5.15 +/- 2.98 U/L, P0.05; and 1.36 +/- 1.34 compared with 5.06 +/- 2.00 U/L, P0.01, respectively).Selecting foods according to their TAC markedly affects antioxidant intake and modulates hepatic contribution to systemic inflammation without affecting traditional markers of antioxidant status.

Background Low postprandial blood glucose is associated with low risk of metabolic diseases. A meal's ability to diminish the glucose response to carbohydrates eaten during the following meal is known as the "second-meal effect" (SME). The reduced glycemia elicited by low-glycemic-index (LGI) foods consumed during the first meal has been suggested as the main mechanism for SME. However, LGI foods often increase colonic fermentation because of the presence of fiber and resistant starch. Objective The objective was to study the SME of greater fermentation of high-glycemic-index (HGI) and LGI carbohydrates eaten during a previous meal. Design Ten healthy volunteers ate 3 breakfast test meals consisting of sponge cakes made with rapidly digestible, nonfermentable amylopectin starch plus cellulose (HGI meal), amylopectin starch plus the fermentable disaccharide lactulose (HGI-Lac meal), or slowly digestible, partly fermentable amylose starch plus cellulose (LGI meal). Five hours later, subjects were fed the same standard lunch containing 93 g available carbohydrates. Blood was collected for measurement of glucose, insulin, and nonesterified fatty acids (NEFAs). Breath hydrogen was measured as a marker of colonic fermentation. Postlunch gastric emptying was measured by using ultrasonography. Results Both the HGI-Lac and LGI meals improved glucose tolerance at lunch. In the case of the HGI-Lac meal, this effect was concomitant with low NEFA concentrations and delayed gastric emptying. Conclusion Fermentable carbohydrates, independent of their effect on a food's glycemic index, have the potential to regulate postprandial responses to a second meal by reducing NEFA competition for glucose disposal and, to a minor extent, by affecting intestinal motility.

Background: Many laboratories offer glycemic index (GI) services. Objective: We assessed the performance of the method used to measure GI. Design: The GI of cheese-puffs and fruit-leather (centrally provided) was measured in 28 laboratories (n = 311 subjects) by using the FAO/WHO method. The laboratories reported the results of their calculations and sent the raw data for recalculation centrally. Results: Values for the incremental area under the curve (AUC) reported by 54% of the laboratories differed from central calculations. Because of this and other differences in data analysis, 19% of reported food GI values differed by > 5 units from those calculated centrally. GI values in individual subjects were unrelated to age, sex, ethnicity, body mass index, or AUC but were negatively related to within-individual variation (P = 0.033) expressed as the CV of the AUC for repeated reference food tests (refCV). The between-laboratory GI values (mean +/- SD) for cheese-puffs and fruit-leather were 74.3 +/- 10.5 and 33.2 +/- 7.2, respectively. The mean laboratory GI was related to refCV (P = 0.003) and the type of restrictions on alcohol consumption before the test (P = 0.006, r(2) = 0.509 for model). The within-laboratory SD of GI was related to refCV (P < 0.001), the glucose analysis method (P = 0.010), whether glucose measures were duplicated (P = 0.008), and restrictions on dinner the night before (P = 0.013, r(2) = 0.810 for model). Conclusions: The between-laboratory SD of the GI values is approximate to 9. Standardized data analysis and low within-subject variation (refCV < 30%) are required for accuracy. The results suggest that common misconceptions exist about which factors do and do not need to be controlled to improve precision. Controlled studies and cost-benefit analyses are needed to optimize GI methodology. The trial was registered at clinicaltrials.gov as NCT00260858.