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Background: Statins are used to lower cardiovascular disease risk in part because of their effects on plasma lipid profiles. Dietary whole grains have been reported to improve plasma lipid profiles. Little is known about potential interactions between statins and whole grains.Objective: We aimed to assess the interaction between statin use and whole-grain intake in relation to serum lipid concentrations in adults.Design: In this cross-sectional study, we used data from 4284 adults aged ≥45 y with reliable and complete dietary data who were participating in the NHANES 2003–2006. Usual whole-grain intake was estimated from two 24-h diet recalls by using the MyPyramid Equivalents Database. Participants self-reported statin use. Total cholesterol and HDL-cholesterol concentrations were measured in all adult participants. The non-HDL-cholesterol concentration and total cholesterol:HDL-cholesterol ratio were calculated. Multiple linear and logistic regression models were used for analyses.Results: Statin usage was 24.9% in all participants (n = 1065), and 31.0% of participants (n = 1327) consumed ≥16 g whole grains/d. After adjustment for demographic and lifestyle factors, the non-HDL-cholesterol concentration was significantly lower in statin users than in nonusers. This difference was greater in participants who consumed ≥16 g whole grains/d (difference: 31 mg/dL; P < 0.001) than in those who consumed

Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen–Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss −2.0 kg, p

Some evidence suggests that phytoestrogens, such as soy-derived isoflavones, may have beneficial effects on cardiovascular health and glycemic control. These data are mainly limited to postmenopausal women or individuals at elevated cardiometabolic risk. There is a lack of data for pregnant women who have elevated estrogen levels and physiologically altered glucose and lipid metabolism. We analyzed data from 299 pregnant women who participated in the NHANES 2001–2008 surveys. Multivariable linear regression analyses were used to examine the association between urinary concentrations of isoflavonoids and cardiometabolic risk markers, adjusted for body mass index, pregnancy trimester, total energy intake, dietary intake of protein, fiber, and cholesterol, and demographic and lifestyle factors. Cardiometabolic risk markers were log-transformed, and geometric means were calculated by quartiles of urinary concentrations of isoflavonoids. Comparing women in the highest vs. lowest quartiles of urine total isoflavone concentrations, we observed significant, inverse associations with circulating concentrations of fasting glucose (79 vs. 88 mg/dL, P-trend = 0.0009), insulin (8.2 vs. 12.8 μU/mL, P-trend = 0.03), and triglyceride (156 vs. 185 mg/dL, P-trend = 0.02), and the homeostasis model assessment of insulin resistance (1.6 vs. 2.8, P-trend = 0.01), but not for total, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. The concentrations of individual isoflavonoids, daidzein, equol, and O-desmethylangolensin were inversely associated with some cardiometabolic risk markers, although no clear pattern emerged. These data suggest that there may be a relation between isoflavone intake and cardiometabolic risk markers in pregnant women.

Background and Aims: The association of fatty acids with coronary heart disease (CHD) has been examined, mainly through dietary measurements, and has generated inconsistent results due to measurement error. Large observational studies and randomized controlled trials have shown that plasma phospholipid fatty acids (PL-FA), especially those less likely to be endogenously synthesized, are good biomarkers of dietary fatty acids. Thus, PL-FA profiles may better predict CHD risk with less measurement error. Methods: We performed a matched case-control study of 2428 postmenopausal women nested in the Women&rsquo, s Health Initiative Observational Study. Plasma PL-FA were measured using gas chromatography and expressed as molar percentage (moL %). Multivariable conditional logistic regression was used to calculate odds ratios (95% CIs) for CHD associated with 1 moL % change in PL-FA. Results: Higher plasma PL long-chain saturated fatty acids (SFA) were associated with increased CHD risk, while higher n-3 polyunsaturated fatty acids (PUFA) were associated with decreased risk. No significant associations were observed for very-long-chain SFA, monounsaturated fatty acids (MUFA), PUFA n-6 or trans fatty acids (TFA). Substituting 1 moL % PUFA n-6 or TFA with an equivalent proportion of PUFA n-3 were associated with lower CHD risk. Conclusions: Higher plasma PL long-chain SFA and lower PUFA n-3 were associated with increased CHD risk. A change in diet by limiting foods that are associated with plasma PL long-chain SFA and TFA while enhancing foods high in PUFA n-3 may be beneficial in CHD among postmenopausal women.

OBJECTIVES: Studies regarding whether light to moderate alcohol consumption is associated with a lower risk of cardiovascular diseases (CVD) have generated mixed results. Further, few studies have comprehensively examined the potential impact of alcohol consumption on diverse disease outcomes. The current study aimed to prospectively investigate dose-response association between alcohol consumption and risk of developing major chronic diseases, including CVD, cancers and mortality. METHODS: The study consisted of 83,732 Chinese adults (aged 18–96 y) without history of CVD and cancer from the Kailuan Study, 2006–2007. Participants were categorized into 6 groups based on self-report alcohol consumption (grams of pure ethanol per week): 0, 1–25, 26–150, 151–350, 351–750, and >750 g/wk. Incident cases of CVD (including stroke, myocardial infarction, heart failure and atrial fibrillation), cancers (total and site-specific), and mortality were confirmed by review of medical records. Major chronic disease was defined as the initial occurrence of CVD, cancer, or death during follow-up. RESULTS: During a median follow up of 10.0 years (interquartile range 9.7–10.2 years), there were 6411 incidences of CVDs, 2947 incidences of cancers and 6646 deaths. Compared to zero intake of alcohol, the adjusted hazard ratio (HR) was 0.72 (95% confidence interval (CI): 0.67, 0.78) for consuming 1–25 g/wk, 0.83 (95%CI: 0.76, 0.90) for 26–150 g/wk, and 0.88 (95%CI: 0.81, 0.95) for 151–350 g/wk, after adjusting for age, sex, lifestyle (eg, smoking and obesity), social economic status, blood glucose concentration and medication use. A trend was identified between >750 g ethanol/wk and higher chronic disease risk (adjusted HR = 1.13; 95%CI: 0.95, 1.36), which reached significance for cancer (adjusted HR = 1.51; 95%CI: 1.07, 2.11). Similar results were observed in sub-group analyses alcoholic beverage type, occupation, men, >50 years, and never smokers. CONCLUSIONS: Light to moderate alcohol consumption has an overall beneficial effect for major chronic diseases. FUNDING SOURCES: This research is supported by the start-up grant from the college of health and human development and the department of nutritional sciences, Penn State University and the Institute for CyberScience Seed Grant Program, Penn State University. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

OBJECTIVES: Despite extensive works on the cardioprotective effects of fish oil containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the distinct mechanisms by which DHA and EPA modulate inflammation and plasma lipids are not well characterized. We compared the effects of DHA and EPA supplementation on serum cytokines and blood monocyte inflammatory response and on blood lipids in subjects with chronic inflammation. METHODS: Twenty-one subjects (9 men and 12 women, 50–75 y) with chronic inflammation (CRP > 2 µg/mL) were enrolled in a randomized, controlled crossover trial consisting of a 4-week lead-in control phase (high oleic sunflower oil, 3 g/d) followed by two sequential 10-week supplementation phases with pure DHA or EPA (3 g/d each) with a 10-week washout in between. Serum concentrations of cytokines were determined by electrochemiluminescence (ECL) assay. Following lipopolysaccharides (LPS) stimulation of blood monocytes, gene expression and secretion of cytokines were assessed by qPCR and ECL. Plasma lipid concentrations were measured by enzymatic assays. RESULTS: Relative to the control phase, DHA reduced the LPS-induced gene expression of pro-inflammatory TNFA (median % change: −45%, P

OBJECTIVES: The role of n-3 fatty acid-derived specialized pro-resolving mediators (SPMs), including the novel docosapentaenoic acid (DPA) products, in reducing inflammation in humans has not been determined. We evaluated the differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on plasma SPMs and the resulting impact on the inflammatory response of peripheral blood monocytes. METHODS: In a randomized, controlled, crossover trial, 21 subjects (9 men and 12 women, 50–75 y) with chronic inflammation (C-reactive protein > 2 µg/mL) entered a 4-week lead-in control phase (high oleic sunflower oil, 3 g/d) and then two sequential 10-week supplementation phases with pure EPA or DHA (3 g/d each), separated by a 10-week washout phase. Plasma phospholipid (PL) fatty acid composition and SPMs, including their precursors, were measured at the end of each phase. Following lipopolysaccharides (LPS) stimulation, the inflammatory response of blood monocytes was assessed by inflammatory gene expression. RESULTS: EPA increased PL EPA (P

The purpose of this study was to examine associations between the Walk Score and physical activity in young, overweight/obese urban women. Project Health included 45 White or African American women (BMI 31.5±3.9 kg/m2; age 26.5±4.6 years; 62% African American) living in the Boston area. An accelerometer estimated steps/day and mins/day in light physical activity (100–2019 counts-per-minute) and moderate-to-vigorous-physical activity (≥2020 cpm). Walk Score was used to estimate the walkability of home address by analyzing proximity to nearby amenities. General linear regression models estimated associations between total Walk Score and physical activity (light physical activity, moderate-to-vigorous-physical activity, steps, total activity counts, METs), adjusting for body mass index, age, race/ethnicity, seasonality, wear time, employment and student status. For physical activity variables that had significant associations with Walk Score (steps/day and steps/min), regression models were estimated for Walk Score sub-scores (parks, grocery, errands, shopping, dining/drinking, culture/entertainment and schools). Logistic regression models estimated the odds of meeting the guidelines for steps (≥10,000/day) and moderate-to-vigorous-physical activity (≥150mins MVPA/week) based on Walk Score. Participants had a Walk Score of 63.9±26.4, took 14,143±3,934 steps/day, and spent 206.2±66.0 mins/day in light physical activity and 46.7±17.5 mins/day in moderate-to-vigorous- physical activity. Walk Score was significantly and positively associated with steps/day (β = 51.4, p = 0.01) and steps/min (β = 0.06, p = 0.009) but was not associated with mins/day of light physical activity, moderate-to-vigorous-physical activity, total activity counts or METs. Parks, grocery, errands, shopping, dining/drinking, and culture/entertainment Walk Score sub-scores were significantly associated with steps and steps/min (all p

Public interest in popular diets is increasing, in particular whole-food plant-based (WFPB) and vegan diets. Whether these diets, as theoretically implemented, meet current food-based and nutrient-based recommendations has not been evaluated in detail. Self-identified WFPB and vegan diet followers in the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey reported their most frequently used sources of information on nutrition and cooking. Thirty representative days of meal plans were created for each diet. Weighted mean food group and nutrient levels were calculated using the Nutrition Data System for Research (NDSR) and data were compared to DRIs and/or USDA Dietary Guidelines/MyPlate meal plan recommendations. The calculated HEI-2015 scores were 88 out of 100 for both WFPB and vegan meal plans. Because of similar nutrient composition, only WFPB results are presented. In comparison to MyPlate, WFPB meal plans provide more total vegetables (180%), green leafy vegetables (238%), legumes (460%), whole fruit (100%), whole grains (132%), and less refined grains (&minus, 74%). Fiber level exceeds the adequate intakes (AI) across all age groups. WFPB meal plans failed to meet the Recommended Dietary Allowances (RDA)s for vitamin B12 and D without supplementation, as well as the RDA for calcium for women aged 51&ndash, 70. Individuals who adhere to WFBP meal plans would have higher overall dietary quality as defined by the HEI-2015 score as compared to typical US intakes with the exceptions of calcium for older women and vitamins B12 and D without supplementation. Future research should compare actual self-reported dietary intakes to theoretical targets.

What is not to like about fruits and vegetables? For decades, the data have been relatively consistent: Individuals who report eating more fruits and vegetables have lower rates of cardiovascular disease, stroke, cancer, diabetes mellitus, heart failure, and all-cause mortality.1–6 Fruits and vegetables come in lots of colors, shapes, sizes, flavors, and textures. They can be eaten raw or prepared by baking, stewing, sauteing, frying, grilling, steaming, or microwaving. They are available in multiple forms: fresh, frozen, canned, or dried. They can be served whole, sliced, diced, mashed, pureed, or any combination thereof. Yet consistently, the majority of us are not eating the recommended amounts. When intensive efforts are made to get people to increase their intakes of fruits and vegetables, they inevitably fall short of the goal.7,8 Article see p 1990 In this issue of Circulation , we have new data from the Coronary Artery Risk Development in Young Adults (CARDIA) study supporting the beneficial effects of diets high in fruits and vegetables. Miedema et al9 based this conclusion on data collected between 1985 and 1986 and coronary artery calcium scores measured 20 years later. Participants included black and white women and men who ranged in age from 18 to 30 years at baseline. They were recruited from 4 urban sites within the US states of Alabama, Illinois, Minnesota, and California. After 20 years of follow-up, the CARDIA study had an impressive retention rate of 72%. Dietary intake was assessed with an interviewer-administered CARDIA Diet History questionnaire. All fruits and vegetables …

Background: Cardiovascular disease (CVD) and osteoporosis are 2 major public health problems that share common pathophysiological mechanisms. It is possible that strategies to reduce CVD risk may also benefit bone health. Objective: We tested the hypothesis that adherence to the 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) is associated with bone health. Design: We previously developed a unique diet and lifestyle score (American Heart Association Diet and Lifestyle Score; AHA-DLS) to assess adherence to the AHA-DLR. In a cross-sectional study of 933 Puerto Ricans aged 47–79 y, we modified the AHA-DLS to test associations with bone health. Bone mineral density (BMD) at the femoral neck, trochanter, total hip, and lumbar spine (L2–L4) was measured by using dual-energy X-ray absorptiometry. Results: For every 5-unit increase in the modified AHA-DLS, BMD at the femoral neck, trochanter, total hip, and lumbar spine (L2–L4) was associated with a 0.005–0.008-g/cm2 (P < 0.05) higher value. No component of the AHA-DLR alone was responsible for the observed positive associations. For every 5-unit increase in the modified AHA-DLS, the odds for osteoporosis or osteopenia at the trochanter, total hip, and lumbar spine (L2–L4) were lower by 14% (OR: 0.86; 95% CI: 0.79, 0.92), 17% (OR: 0.83; 95% CI: 0.76, 0.92), and 9% (OR: 0.91; 95% CI: 0.84, 0.99), respectively. Conclusions: Dietary guidelines for CVD risk reduction may also benefit bone health in this Hispanic cohort. Synchronizing dietary guidelines for these 2 common diseases may provide a simplified public health message. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT01231958","term_id":"NCT01231958"}}NCT01231958.

Dietary modification alters plasma lipoprotein profiles and atherosclerotic lesion progression in humans and some animal models. Variability in response to diet induced atherosclerosis has been reported in hamsters. Assessed was the interaction between background diet composition and dietary fat type on aortic cholesterol accumulation, lipoprotein profiles, hepatic lipids and selected genes. F1B Golden Syrian hamsters (20/group) were fed (12 weeks) semi-purified or non-purified diets containing either 10 % (w/w) coconut oil or safflower oil and 0.15 % (w/w) cholesterol. The non-purified diets relative to semi-purified diets resulted in significantly higher TC (72 % [percent difference] and 38 %, coconut oil and safflower oil, respectively) and nHDL-C (84 and 61 %, coconut oil and safflower oil, respectively), and lower HDL-C (−47 and −45 %, coconut oil and safflower oil, respectively) concentrations. Plasma triacylglycerol concentrations in the hamsters fed the non-purified coconut oil-supplemented diets were three- to fourfold higher than non-purified safflower oil-supplemented, and both semi-purified diets. With the exception of HDL-C, a significant effect of fat type was observed in TC, nHDL-C and triacylglycerol (all P < 0.05) concentrations. Regardless of diet induced differences in lipoprotein profiles, there was no significant effect on aortic cholesterol accumulation. There was an inverse relationship between plasma nHDL-C and triacylglycerol, and hepatic cholesteryl ester content (P < 0.001). Diet induced differences in hepatic gene transcription (LDL receptor, apoB-100, microsomal transfer protein) were not reflected in protein concentrations. Although hamsters fed non-purified and/or saturated fatty acid-supplemented diets had more atherogenic lipoprotein profiles compared to hamsters fed semi-purified and/or polyunsaturated fatty acid-supplemented diets these differences were not reflected in aortic cholesterol accumulation.

Background: Previous studies have reported beneficial effects of a Mediterranean diet rich in monounsaturated fatty acids (MUFAs) on coronary artery disease (CAD) risk. However, these findings remain inconsistent because some experimental studies have suggested atherogenic and lipotoxicity effects of long-chain and very-long-chain MUFAs on cardiomyocytes. Objective: We examined whether red blood cell (RBC) long-chain and very-long-chain MUFAs are associated with risk of CAD in the Physicians’ Health Study. Design: The ancillary study used a prospective nested case-control design to select 1000 cases of incident CAD and 1000 control subjects matched for age, year of birth, and time of blood collection. RBC MUFAs were measured by using gas chromatography, and CAD was validated by an endpoint committee. Conditional logistic regression was used to estimate RRs. Results: The mean (±SD) age was 68.7 ± 8.7 y. In a multivariable model that was controlled for matching factors and established CAD risk factors and RBC saturated and omega-3 (n−3) fatty acids, ORs for CAD associated with each SD increase of 20:1n−9 and log 22:1n−9 were 0.89 (95% CI: 0.80, 1.00; P = 0.0441) and 0.83 (95% CI: 0.72, 0.95; P = 0.0086). However, only the 22:1n−9–CAD relation remained statistically significant after Bonferroni correction (P < 0.0125). RBC cis 18:1n−9 and 24:1n−9 were not associated with CAD risk. Conclusion: Our data suggest an inverse association of RBC 22:1n−9 but not 20:1n−9, 18:1n−9, or 24:1n−9 with CAD risk after Bonferroni correction in the Physicians’ Health Study.

ObjectiveTo evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage.DesignTwo independent reviewers analysed the newspaper articles. The key report findings cited, proportion of sentences describing the IOM report and proportion of sentences describing critical viewpoints on the report were calculated. The content of articles written by reporters with a history of pre-report vitamin D-related articles was compared with that of articles written by reporters without such a history.SettingFactiva and LexisNexis searches of the top thirty US and three English-language Canadian print newspapers, by circulation.SubjectsArticles on the IOM report published from 30 November to 21 December 2010 and previous vitamin D-related articles written by the same reporters.ResultsOnly ten articles met inclusion/exclusion criteria. Articles inconsistently cited the key findings in the IOM report. Reporters with a history of pre-report articles highlighting the benefits of vitamin D dedicated a greater proportion of sentences to viewpoints critical of the IOM report (P < 0·01). There was no significant difference between pre-report publication history and proportion of sentences focused on the IOM report. A borderline-significant difference (P = 0·058) was observed between pre-report articles highlighting the benefits of vitamin D and the absence of reference to potential risks of vitamin D overconsumption.ConclusionOur findings suggest that newspaper articles did not consistently or comprehensively report the IOM recommendations and that pre-report publication history of reporters was related to post-report article content.

The objective of this study is to empirically compare alternative meta-analytic methods for combining dose-response data from epidemiological studies. We identified meta-analyses of epidemiological studies that analyzed the association between a single nutrient and a dichotomous outcome. For each topic, we performed meta-analyses of odds ratios with five approaches: using extreme exposure categories only, two-step approach (first calculated study-specific effects then combined across studies) using unadjusted data, two-step approach using adjusted data, one-step approach (analyzed all data in one regression model) using unadjusted data, and one-step approach using adjusted data. Meta-analyses including only extreme exposure categories gave consistently bigger effects and wider confidence intervals than meta-analyses using all data. Confidence intervals of effect sizes were generally wider in meta-analyses with the two-step approach, compared with the one-step approach. Meta-analyses using unadjusted data and adjusted data differed, with no consistent pattern of discordance in direction, statistical significance, or magnitude of effect. We discourage using meta-analysis approaches that only use data from extreme exposure categories. The one step approach generally has higher precision than the two-step approach. Sensitivity analysis comparing results between meta-analyses of adjusted and unadjusted data may be useful in indicating the presence of confounding.

Prior studies assessing the metabolic effects of different types of carbohydrates have focused on their glycaemic response. However, the response of postprandial cardiometabolic risk indicators has not been considered in these studies. The present study assessed postprandial lipid responses to two forms of carbohydrates used as reference foods for glycaemic index determinations, white bread (50 g available carbohydrate) and glucose (50 g), under controlled conditions and with intra-individual replicate determinations. A total of twenty adults (20–70 years) underwent two cycles of challenges with each pair of reference foods (four challenges/person), administered in a random order on separate days under standard conditions. Serum lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, TAG and NEFA), glucose and insulin were monitored for 5 h post-ingestion. Oral glucose resulted in greater glycaemic and insulinaemic responses than white bread for the first 90 min and a greater subsequent decline after 120 min (P =0·0001). The initial decline in serum NEFA concentrations was greater after the oral glucose than after the white bread challenge, as was the rebound after 150 min (P =0·001). Nevertheless, the type of carbohydrate had no significant effect on postprandial total cholesterol, LDL-cholesterol and HDL-cholesterol concentrations. Following an initial modest rise in TAG concentrations in response to both challenges, the values dropped below the fasting values for oral glucose but not for the white bread challenge. These data suggest that the type of carbohydrate used to determine the glycaemic index, bread or glucose, has little or modest effects on postprandial plasma cholesterol concentrations. Differences in TAG and NEFA concentrations over the 5 h time period were modest, and their clinical relevance is unclear.

Despite a considerable amount of data available on the relationship between dietary glycemic index (GI) or load (GL) and cardiovascular disease (CVD) risk factors, in aggregate, the area remains unsettled. The aim of the present review was to summarize the effect of diets differing in GI/GL on CVD risk factors, by examining randomized controlled-feeding trials that provided all food and beverages to adult participants. The studies included a low and high GI/GL diet phase for a minimum of four weeks duration, and reported at least one outcome related to CVD risk; glucose homeostasis, lipid profile or inflammatory status. Ten publications representing five trials were identified. The low GI/GL compared to the high GI/GL diet unexpectedly resulted in significantly higher fasting glucose concentrations in two of the trials, and a lower area under the curve for glucose and insulin in one of the two studies during an oral glucose tolerance test. Response of plasma total, low density lipoprotein and high density lipoprotein cholesterol concentrations was conflicting in two of the studies for which data were available. There was either weak or no effect on inflammatory markers. The results of the five randomized controlled trials satisfying the inclusion criteria suggest inconsistent effects of the GI/GL value of the diet on CVD risk factors.

Linoleic acid (LA) and α-linolenic acid (ALA) are essential fatty acids that play an important role in modulation of T cell proliferation. The effects of consuming novel soybean oils varying in LA:ALA ratios on T cell proliferation and inflammatory responses were assessed in older adults. Eighteen participants (>50 y old) with elevated cholesterol concentrations (3.37-4.14 mmol/L LDL cholesterol) consumed 5 experimental diets in random order for periods of 35 d. Each diet contained 30% of energy as fat, two-thirds of which was high-oleic acid soybean oil (HiOleic-SO), soybean oil (SO), low-SFA soybean oil (LoSFA-SO), hydrogenated soybean oil (Hydrog-SO), or low-ALA soybean oil (LoALA-SO), resulting in LA:ALA ratios of 2.98, 8.70, 9.69, 15.2, and 18.3, respectively. Participants had higher proliferative responses to phytohemagglutinin (PHA) compared with baseline following consumption of SO (26%; P 10 (Hydrog-SO and LoALA-SO). Post-diet intervention, LA:ALA ratios correlated with proliferative responses to PHA (r = -0.87; P = 0.05). An optimal proliferative response was observed at an LA:ALA ratio of 8.70, with an inverse correlation between proliferative response and LA:ALA ratios >8.70. These effects were independent of changes in the production of PGE(2), inflammatory cytokines, or cytokines involved in growth of lymphocytes. These data suggest that the LA:ALA ratio modulates the proliferative ability of T lymphocytes, which may be due to subtle changes in fatty acid composition of the phospholipids in immune cells.

Background: Complex interplays of diet and metabolism influence circulating fatty acids (FAs), possibly constituting FA patterns related to cardiovascular disease (CVD) risk. Objectives: We aimed to derive FA patterns from circulating FAs, relate the patterns to CVD incidence, and extend the derived patterns to atherosclerosis progression in another independent cohort. Design: We used principal component analysis (PCA) to derive FA patterns from 38 plasma phospholipid FAs in 2972 older adults in the Cardiovascular Health Study (CHS). Identified patterns were evaluated for prospective associations with 14-y incidence of CVD [ischemic heart disease (IHD) or stroke]. In another independent cohort of postmenopausal women with IHD, we evaluated associations of the CHS-derived patterns with 3.2-y progression of angiographically defined coronary atherosclerosis. Results: Three distinct patterns were identified, characterized by higher proportions of trans FAs, de novo lipogenesis (DNL) FAs, and long-chain MUFAs (LCMUFAs). During 32,265 person-years, 780 incident CVD events occurred. The trans FA pattern was associated with higher CVD risk (multivariable-adjusted HR for the highest compared with the lowest quintiles = 1.58; 95% CI: 1.17, 2.12; P-trend = 0.006), primarily attributable to higher risk of stroke (HR: 2.46; 95% CI: 1.54, 3.92; P-trend = 0.005). The DNL and LCMUFA patterns were not associated with CVD incidence or with IHD or stroke (P-trend . 0.11 each). In the second cohort, the trans FA pattern, but not the other 2 patterns, was positively associated with progression of coronary atherosclerosis (P-trend , 0.05). Conclusions: PCA appears to provide informative circulating FA patterns. A pattern driven mainly by trans FA levels related to greater CVD risk in older adults and coronary atherosclerosis progression in women with IHD. Am J Clin Nutr 2012;96:1252‐ 61.

In 2013, the American Heart Association and American College of Cardiology published the “Guideline on Lifestyle Management to Reduce Cardiovascular Risk,” which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association’s 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015–2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.

Objectives To examine the association between diet and executive function, episodic memory and global verbal cognition in the Einstein Aging Study (EAS) cohort and determine whether race modifies this relationship. Design Cross-sectional. Setting Community. Participants EAS participants without dementia who completed the Rapid Eating and Activity Assessment for Patients (REAP) (N = 492). Measurements The previously validated REAP is based on the 2000 U.S. dietary guidelines. REAP scores were dichotomized as less-healthy (

Background: In cross-sectional studies and short-term clinical trials, it has been suggested that there is a positive dose-response relation between alcohol consumption and HDL concentrations. However, prospective data have been limited.Objective: We sought to determine the association between total alcohol intake, the type of alcohol-containing beverage, and the 6-y (2006-2012) longitudinal change in HDL-cholesterol concentrations in a community-based cohort.Design: A total of 71,379 Chinese adults (mean age: 50 y) who were free of cardiovascular diseases and cancer and did not use cholesterol-lowering agents during follow-up were included in the study. Alcohol intake was assessed via a questionnaire in 2006 (baseline), and participants were classified into the following categories of alcohol consumption: never, past, light (women: 0-0.4 servings/d; men: 0-0.9 servings/d), moderate (women: 0.5-1.0 servings/d; men: 1-2 servings/d), and heavy (women: >1.0 servings/d; men: >2 servings/d). HDL-cholesterol concentrations were measured in 2006, 2008, 2010, and 2012. We used generalized estimating equation models to examine the associations between baseline alcohol intake and the change in HDL-cholesterol concentrations with adjustment for age, sex, smoking, physical activity, obesity, hypertension, diabetes, liver function, and C-reactive protein concentrations.Results: An umbrella-shaped association was observed between total alcohol consumption and changes in HDL-cholesterol concentrations. Compared with never drinkers, past, light, moderate, and heavy drinkers experienced slower decreases in HDL cholesterol of 0.012 mmol · L-1 · y-1 (95% CI: 0.008, 0.016 mmol · L-1 · y-1), 0.013 mmol · L-1 · y-1 (95% CI: 0.010, 0.016 mmol · L-1 · y-1), 0.017 mmol · L-1 · y-1 (95% CI: 0.009, 0.025 mmol · L-1 · y-1), and 0.008 mmol · L-1 · y-1 (95% CI: 0.005, 0.011 mmol · L-1 · y-1), respectively (P < 0.0001 for all), after adjustment for potential confounders. Moderate alcohol consumption was associated with the slowest increase in total-cholesterol:HDL-cholesterol and triglyceride:HDL-cholesterol ratios. We observed a similar association between hard-liquor consumption and the HDL-cholesterol change. In contrast, greater beer consumption was associated with slower HDL-cholesterol decreases in a dose-response manner.Conclusion: Moderate alcohol consumption was associated with slower HDL-cholesterol decreases; however, the type of alcoholic beverage had differential effects on the change in the HDL-cholesterol concentration.

Background: Alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), lowers plasma low-density lipoprotein (LDL) cholesterol and apolipoprotein B100 (apoB). Although studies in mice and cells have identified increased hepatic LDL receptors as the basis for LDL lowering by PCSK9 inhibitors, there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism. In particular, it is not known whether inhibition of PCSK9 has any effects on very low-density lipoprotein or intermediate-density lipoprotein (IDL) metabolism. Inhibition of PCSK9 also results in reductions of plasma lipoprotein (a) levels. The regulation of plasma Lp(a) levels, including the role of LDL receptors in the clearance of Lp(a), is poorly defined, and no mechanistic studies of the Lp(a) lowering by alirocumab in humans have been published to date. Methods: Eighteen (10 F, 8 mol/L) participants completed a placebo-controlled, 2-period study. They received 2 doses of placebo, 2 weeks apart, followed by 5 doses of 150 mg of alirocumab, 2 weeks apart. At the end of each period, fractional clearance rates (FCRs) and production rates (PRs) of apoB and apo(a) were determined. In 10 participants, postprandial triglycerides and apoB48 levels were measured. Results: Alirocumab reduced ultracentrifugally isolated LDL-C by 55.1%, LDL-apoB by 56.3%, and plasma Lp(a) by 18.7%. The fall in LDL-apoB was caused by an 80.4% increase in LDL-apoB FCR and a 23.9% reduction in LDL-apoB PR. The latter was due to a 46.1% increase in IDL-apoB FCR coupled with a 27.2% decrease in conversion of IDL to LDL. The FCR of apo(a) tended to increase (24.6%) without any change in apo(a) PR. Alirocumab had no effects on FCRs or PRs of very low-density lipoproteins-apoB and very low-density lipoproteins triglycerides or on postprandial plasma triglycerides or apoB48 concentrations. Conclusions: Alirocumab decreased LDL-C and LDL-apoB by increasing IDL- and LDL-apoB FCRs and decreasing LDL-apoB PR. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition. The increase in apo(a) FCR during alirocumab treatment suggests that increased LDL receptors may also play a role in the reduction of plasma Lp(a). Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01959971.

The Dietary Guidelines for Americans (DGA) is published every 5 y jointly by the Department of Health and Human Services (HHS) and the USDA and provides a framework for US-based food and nutrition programs, health promotion and disease prevention initiatives, and research priorities. Summarized in this report are the methods, major conclusions, and recommendations of the Scientific Report of the 2015 US Dietary Guidelines Advisory Committee (DGAC). Early in the process, the DGAC developed a conceptual model and formulated questions to examine nutritional risk and determinants and impact of dietary patterns in relation to numerous health outcomes among individuals aged ≥2 y. As detailed in the report, an expansive, transparent, and comprehensive process was used to address each question, with multiple opportunities for public input included. Consensus was reached on all DGAC's findings, including each conclusion and recommendation, and the entire report. When research questions were answered by original systematic literature reviews and/or with existing, high-quality expert reports, the quality and strength of the evidence was formally graded. The report was organized around the following 5 themes: 1) food and nutrient intakes and health: current status and trends; 2) dietary patterns, foods and nutrients, and health outcomes; 3) diet and physical activity behavior change; 4) food and physical activity environments; and 5) food sustainability and food safety. The following 3 cross-cutting topics were addressed: 1) sodium, 2) saturated fat, and 3) added sugars. Physical activity recommendations from recent expert reports were endorsed. The overall quality of the American diet was assessed to identify overconsumed and underconsumed nutrients of public health concern. Common food characteristics of healthy dietary patterns were determined. Features of effective interventions to change individual and population diet and physical activity behaviors in clinical, public health, and community settings were identified. The report was used by the HHS and the USDA to develop the 2015 DGA.

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.

Introduction: The 2013 AHA/ACC Guideline recommended limiting saturated fatty acids (SFA) and substituting SFA with monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) in diet. Dietary intake data derived from self-reports is prone to measurement error and studies have been criticized for this reason. An objective alternative approach to examining the role of different dietary fatty acids on coronary heart disease (CHD) risk is to measure plasma phospholipid fatty acid (PL-FA) profiles, which reflect both dietary intake and endogenous metabolism, hence are proximal to the pathophysiologic processes of CHD. Our aim was to evaluate the role of plasma PL-FA profiles on CHD risk both directly and by estimating the theoretical effects of plasma “substitution” of various fatty acids for each other on CHD risk, and evaluate the consistence with the AHA/ACC Guideline. Hypothesis: Plasma SFA is associated with increased CHD risk, and “substituting” plasma SFA with MUFA, PUFA n-6 or n-3 is associated with lower CHD risk. Methods: We performed a nested case-control study with 2428 postmenopausal women in Women’s Health Initiative Observational Study (1214 CHD cases-controls pairs matched for baseline age, enrollment date, ethnicity and hysterectomy). Plasma PL-FA profiles were measured using gas chromatography methodology and expressed as molar percentage (mol%). Multivariate conditional logistic regression was used to calculate ORs for CHD risk associated with 1 mol% PL-FA increase, and “substitutions” of various fatty acids for each other, adjusting for matching factors, physical activity, body mass index (BMI), smoking, family history of diabetes, anticoagulant medication, hormone therapy, hypertension, diabetes mellitus, dyslipidemia and alternative healthy eating index. In addition, we tested the interactions of BMI and hormone therapy with PL-FAs. Results: In multivariate conditional logistic regression analysis, plasma PL SFA was associated with increased CHD risk (OR=1.16, 95% CI 1.09 to 1.24) and PUFA n-3 was associated with decreased CHD risk (OR=0.92, 95% CI 0.86 to 0.97). No significant associations were observed for MUFA, PUFA n-6 and trans -fatty acids. “Substituting” 1 mol% SFA with an equivalent proportion of MUFA, PUFA n-6, or n-3 were associated with lower CHD risk (OR=0.81, 95% CI 0.74 to 0.88; OR=0.77, 95% CI 0.70 to 0.84;and OR=0.85, 95%CI 0.80 to 0.92, respectively). “Substituting” PUFA n-6 with n-3 was associated with lower CHD risk (OR=0.92, 95% CI 0.86 to 0.98) while no significant effect was found for “substituting” PUFA n-6 with MUFA. No significant interactions were obtained of BMI and hormone therapy with PL-FAs. Conclusion: This plasma PL-FA “substitution” analysis is consistent with the AHA/ACC Guideline and suggests that “substituting” PL SFA with MUFA, PUFA n-6 or n-3, and “substituting” PUFA n-6 with n-3 is associated with lower CHD risk.

Introduction: Fatty acids (FAs) are essential components of cell membranes and play an integral role in membrane fluidity. The lipophilic index (LI, defined as the sum of the products between FA percentage and melting points (°C) of each FA, divided by the total percentage of FAs) is a novel index that captures the overall FA profile and reflects lipoprotein fluidity. Limited studies have evaluated the relationship between plasma LI and CHD risk, and none has assessed this association among postmenopausal women. Hypothesis: Higher plasma LI is associated with increased CHD risk among postmenopausal women. Methods: In a nested case-control study in Women’s Health Initiative Observational Study, we measured levels of plasma phospholipid FAs, expressed as molar percentage (mol%), in 1214 matched CHD cases (including myocardial infarction and coronary death) and controls. Multivariate conditional logistic regression was used to calculate ORs for CHD risk between each quartiles (based on controls) of LI after adjusting for confounders. Results: The mean age of the women was 67.8±6.8 years, average BMI was 27.6±6.0, 89.5% were White, 6.6% were current smokers, 41.2% were hypertensive, and 15.2% had dyslipidemia. The median plasma LI among cases and controls were 22.5 and 22.1, respectively. Palmitic acid (16:0) and stearic acid (18:0), oleic acid (18:1), linoleic acid (18:2), and docosahexaenoic acid (22:6) were the most common saturated, monounsaturated, n-6 and n-3 polyunsaturated FAs, respectively. The association between quartiles of LI and CHD risk are shown in Table below. After multivariate adjustment in the parsimonious model, plasma LI was significantly associated with an increased risk of CHD: OR=1.61 (95% CI 1.25-2.07, P for trendP for trend Conclusion: Our study indicated that higher plasma LI, which represents lower FA fluidity, was associated with higher risk of CHD among postmenopausal women.

Purpose: Adipocytokines and vitamin D (vitD) concentrations may contribute to cardiometabolic risk profiles in obese populations. To address this potential relationship we assessed levels of adipocytokines and vitD concentrations between young metabolically healthy obese (MHO) and metabolically abnormal obese (MAO) black and white women. Methods: Project Health included 46 overweight/obese young women (BMI ≥25 kg/m2, age=19-35 years, 61% Black). Women were classified as MHO ( Results: Compared to MAO (n=9, 20%), MHO (n=37; 80%) had significantly lower BMI values (MHO: 30.5±3.5; MAO: 34.3±3.9 kg/m2, p=0.004), but there was no significant difference in body fat (mean in total sample: 45.3±6.2%). CRP concentration was significantly associated with higher body fat (%) in MAO (r=0.78, p=0.007), but this relationship was not significant in MHO. IL-6, TNF-α and vitD were not significantly correlated with percent body fat in either MHO or MAO. Compared to MHO, MAO had significantly higher CRP levels (log mg/L MHO: 0.82±1.2 vs. MAO 1.8±0.9, p=0.01); and significantly lower adiponectin levels (log ng/mL MHO: 9.7±0.5 vs. MAO 9.0±0.3; p=0.0004). These differences remained significant after adjusting for race and body fat. There were no significant differences between MHO and MAO for IL-6, TNF-α or VitD levels. Conclusion: Compared to MHO, young women who are MAO have higher levels of CRP and lower levels of adiponectin even after controlling for potential confounders. Our findings suggest that chronic inflammation may play an important role in the mechanism of abnormal cardiometabolic risk as it differentiates young MHO and MAO women.

Intake of marine-basedn-3 fatty acids (EPA, docosapentaenoic acid and DHA) is recommended to prevent CHD. Stearidonic acid (SDA), a plant-basedn-3 fatty acid, is a precursor of EPA and may be more readily converted to EPA than α-linolenic acid (ALA). While transgenic soyabeans might supply SDA at low cost, it is unclear whether SDA is associated with CHD risk. Furthermore, associations of othern-3 fatty acids with CHD risk remain inconsistent. The present ancillary study examined the association of erythrocyte SDA as well as othern-3 fatty acids with the risk of CHD. In a prospective nested case–control study of the Physicians' Health Study, we randomly selected 1000 pairs of incident CHD with matching controls. Erythrocyte fatty acids were measured using GC. We used conditional logistic regression to estimate relative risks. Mean age was 68·7 (sd8·7) years. In a multivariable model controlling for matching factors and established CHD risk factors, OR for CHD for each standard deviation increase of log-SDA was 1·03 (95 % CI 0·90, 1·18). Corresponding values for log-ALA and log-marinen-3 fatty acids were 1·04 (95 % CI 0·94, 1·16) and 0·97 (95 % CI 0·88, 1·07), respectively. In conclusion, the present data did not show an association among erythrocyte SDA, ALA or marinen-3 fatty acids and the risk of CHD in male physicians.

Alkylresorcinols (AR) are phenolic lipids found in the bran fraction of whole-grain wheat, rye, and barley. In intervention studies, plasma AR concentration increased in response to greater intakes of whole grain, wheat, and rye. This study examined the cross-sectional associations between plasma AR and habitual whole-grain intake, BMI, and metabolic risk factors in 407 free-living older adults (166 men and 241 women; aged 60-81y; median BMI: 27 kg/m(2)). Plasma AR were measured by liquid chromatography-tandem MS, and whole-grain intakes were estimated by using an FFQ. After adjustment for fasting TG concentrations, median plasma AR concentrations across quartile categories of AR were 5, 14, 27, and 62 nmol/L, respectively. Spearman correlation coefficients between plasma AR and whole-grain wheat-rich foods and total bran intake were 0.31 and 0.27, respectively (both P < 0.0001). After adjustment for multiple covariates, the geometric means of BMI in the lowest and highest quartile category of plasma AR were 27.6 and 26.7 kg/m(2), respectively (P-trend = 0.04). No associations were observed between plasma AR and glucose and insulin. Our study shows a dose-dependent relationship between whole-grain intake and plasma AR and confirms the previously observed inverse relationship between whole-grain intake and BMI using an independent biomarker of whole-grain wheat intake.

A 2009 American Heart Association scientific statement titled “Dietary Sugars Intake and Cardiovascular Health”1 concluded that current intake of added sugars among Americans greatly exceeds discretionary calorie allowances based on the 2005 US Dietary Guidelines.2 For this reason, the American Heart Association Nutrition Committee recommended population-wide reductions in added sugars intake. The present statement from the American Heart Association and the American Diabetes Association addresses the potential role of nonnutritive sweeteners (NNS) in helping Americans to adhere to this recommendation in the context of current usage and health perspectives. By definition, NNS, otherwise referred to as very low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners, have a higher intensity of sweetness per gram than caloric sweeteners such as sucrose, corn syrups, and fruit juice concentrates. As a caloric sweetener replacement, they are added in smaller quantities; hence, they provide no or few calories. In our current food supply, NNS are widely used in thousands of beverages and other food products such as diet soft drinks, yogurts, desserts, and gum. Food manufacturers often use a blend of NNS or use a blend of sugar and NNS to improve the flavor acceptability of NNS. In developing this scientific statement, the writing group reviewed issues pertaining to NNS in the context of data on consumer attitudes, consumption patterns, appetite, hunger and energy intake, body weight, and components of cardiometabolic syndrome. The objective was to review the literature to determine whether there were adequate data to provide guidance for the use of NNS. The focus of the statement is on the 6 NNS that are described in Table 1. Aspartame, acesulfame-K, neotame, saccharin, and sucralose are regulated as food additives by the US Food and Drug Administration and therefore had to be approved as safe before being marketed. Regarding stevia, …

SummaryIn osteoarthritis (OA) the synovium is often inflamed and inflammatory cytokines contribute to cartilage damage. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have anti-inflammatory effects whereas omega-6 polyunsaturated fatty acids (n-6 PUFAs) have, on balance, proinflammatory effects. The goal of our study was to assess the association of fasting plasma phospholipid n-6 and n-3 PUFAs with synovitis as measured by synovial thickening on contrast enhanced (CE) knee MRI and cartilage damage among subjects in the Multicenter Osteoarthritis Study (MOST).MOST is a cohort study of individuals who have or are at high risk of knee OA. An unselected subset of participants who volunteered obtained CE 1.5T MRI of one knee. Synovitis was scored in six compartments and a summary score was created. This subset also had fasting plasma, analyzed by gas chromatography for phospholipid fatty acid content, and non-CE MRI, read for cartilage morphology according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) method. The association between synovitis and cartilage morphology and plasma PUFAs was assessed using logistic regression after controlling for the effects of age, sex, and BMI.472 out of 535 subjects with CE MRI had complete data on synovitis, cartilage morphology and plasma phospholipids. Mean age was 60 years, mean BMI 30, and 50% were women. We found an inverse relation between total n-3 PUFAs and the specific n-3, docosahexaenoic acid with patellofemoral cartilage loss, but not tibiofemoral cartilage loss or synovitis. A positive association was observed between the n-6 PUFA, arachidonic acid, and synovitis.In conclusion, systemic levels of n-3 and n-6 PUFAs which are influenced by diet, may be related to selected structural findings in knees with or at risk of OA. Future studies manipulating the systemic levels of these fatty acids may be warranted to determine the effects on structural damage in knee OA.

This study examined the relative influence of genetic versus environmental factors on specific aspects of eating behavior. Adult monozygotic twins (22 pairs and 3 singleton reared apart, 38 pairs and 9 singleton reared together, age 18-76 years, BMI 17-43 kg/m 2 ) completed the Three Factor Eating Questionnaire. Genetic and environmental variance components were determined for the three eating behavior constructs and their subscales using model-fitting univariate and multivariate analyses. Unique environmental factors had a substantial influence on all eating behavior variables (ex- plaining 45-71% of variance), and most strongly influenced external locus for hunger and strategic dieting behavior of re- straint (explaining 71% and 69% of variance, respectively). Genetic factors had a statistically significant influence on only 4 variables: restraint, emotional susceptibility to disinhibition, situational susceptibility to disinhibition, and internal locus for hunger (heritabilities were 52%, 55%, 38% and 50%, respectively). Common environmental factors did not statisti- cally significantly influence any variable assessed in this study. In addition, multivariate analyses showed that disinhibi- tion and hunger share a common influence, while restraint appears to be a distinct construct. These findings suggest that the majority of variation in eating behavior variables is associated with unique environmental factors, and highlights the importance of the environment in facilitating specific eating behaviors that may promote excess weight gain.

Coronary heart disease (CHD) is the leading cause of death in women. A nested case-control study tested whether dietary patterns predicted CHD events among 1224 participants in the Women's Health Initiative-Observational Study (WHI-OS) with centrally confirmed CHD, fatal or nonfatal myocardial infarct compared to 1224 WHI-OS controls matched for age, enrollment date, race/ethnicity, and absence of CHD at baseline or follow-up. The first six principal components explained >75% of variation in dietary intakes and K-mean analysis based on these six components produced three clusters. Diet cluster 1 was rich in carbohydrate, vegetable protein, fiber, dietary vitamin K, folate, carotenoids, α-linolenic acid [18:3(n-3)], linoleic acid [18:2(n-6)], and supplemental calcium and vitamin D. Diet cluster 2 was rich in total and animal protein, arachidonic acid [20:4(n-6)], DHA [22:6(n-3)], vitamin D, and calcium. Diet cluster 3 was rich in energy, total fat, and trans fatty acids (all P < 0.01). Conditional logistic regression analysis demonstrated diet cluster 1 was associated with lower CHD risk than diet cluster 2 (reference group) adjusted for smoking, education, and physical activity [OR = 0.79 (95% CI = 0.64, 0.99); P = 0.038]. This difference was not significant after adjustment for BMI and systolic blood pressure. Diet cluster 3 was associated with higher CHD risk than diet cluster 2 [OR = 1.28 (95% CI = 1.04, 1.57); P = 0.019], but this difference did not remain significant after adjustment for smoking, education, and physical activity. Within this WHI-OS cohort, distinct dietary patterns may be associated with subsequent CHD outcomes.

There are several examples in nutrition of discordance between the results of observational studies and randomized controlled trials (RCTs). We hypothesized that this discordance is attributable to differences in the translational paths of nutrient-disease associations. Translational paths can be assessed using citation analysis.We compared the characteristics of citation networks using examples, where RCTs and observational studies agreed (long-chain n-3 polyunsaturated fatty acids [n-3 PUFA]) or disagreed (vitamin E). We performed systematic reviews in each example, constructed citation networks, and compared them with respect to the number of articles and citation relationships between them, as well as the distribution of articles' hub and authority scores.For n-3 PUFA, meta-analyses of 14 RCTs and 10 observational studies both suggested that higher intake was associated with lower cardiovascular mortality. For vitamin E, the meta-analysis of 14 RCTs excluded a clinically significant effect, whereas 14 observational studies reported a significant inverse association. The respective citation networks consisted of 392 (n-3 PUFA) and 351 (vitamin E) articles. No differences between the characteristics of the two networks were identified. There was no evidence that the observational studies predated RCTs in the translational process in either example.In the two examples, citation network characteristics do not predict concordance in the results of observational studies and RCTs.

Dietary fatty acid type alters atherosclerotic lesion progression and macrophage lipid accumulation. Incompletely elucidated are the mechanisms by which fatty acids differing in double-bond geometric or positional configuration alter arterial lipid accumulation. The objective of this study was to evaluate the suitability of using Tamm-Horsfall protein 1 (THP-1) macrophages as a model for human monocytes/macrophages to address this issue. Our hypothesis was that THP-1 macrophages pretreated with ω-3 polyunsaturated fatty acids (PUFA) or fatty acid containing a cis double bond would accumulate less lipid, particularly cholesteryl ester, compared with ω-6 polyunsaturated fatty acids or a fatty acid containing a trans double bond, respectively. THP-1 monocytes were differentiated into macrophages and then incubated with fatty acids for 48 hours. There was an increase in intracellular lipid in response to all the fatty acids assessed, and by response was similar among the fatty acids. The increase in lipid accumulation was contributed to triglyceride and to a lesser extent cholesterol, primarily free cholesterol. These data suggest that free fatty acids bound to bovine serum albumin, regardless of double-bond geometric or positional configuration, induce triglyceride accumulation but had only a modest effect on cholesterol accumulation in THP-1 macrophages. The cells appeared to respond similarly to the assessed fatty acids in terms of amount and type of lipid accumulated. Hence, the THP-1 cell line was not appropriate to test the hypotheses of interest.

Background: Cross-sectional data indicate that central adiposity is associated with cardiovascular disease risk, independent of total adiposity. The use of longitudinal data to investigate the relation between changes in fat distribution and the emergence of risk factors is limited. Objective: We tested the hypothesis that age-related change in waist circumference (to reflect central adiposity) during adolescence is a significant predictor of longitudinal change in cardiovascular disease risk, after adjustment for change in body mass index (BMI) z score (to reflect total adiposity) in a cohort of postmenarcheal adolescent females. We also tested whether race modified this relation. Design: We analyzed publicly available data from the National Heart, Lung, and Blood Institute Growth and Health Study. Longitudinal regression models were fitted to investigate the independent effects of changes in waist circumference on cardiovascular disease risk factors. Results: Steeper age-related increases in waist circumference over time were associated with a greater increase in LDL-cholesterol concentrations, systolic blood pressure, diastolic blood pressure, and homeostasis model assessment of insulin resistance, after adjustment for BMI z score, in white but not in black females. Change in waist circumference was not a statistically significant predictor of age-related changes in HDL-cholesterol, triglyceride, insulin, and glucose concentrations, after adjustment for changes in BMI z score, in either white or black females. Conclusions: Our research suggests that monitoring waist circumference in addition to BMI z score has the potential to identify adolescents at risk of the emergence of cardiovascular disease risk factors, at least in white females. The data also suggest that race may modify the relation between fat distribution pattern and cardiovascular disease risk factors.

We investigated the effects of eicosapentaenoic acid (EPA) on prevention (P) and reversal (R) of high saturated-fat (HF) diet-induced obesity and glucose-insulin homeostasis. Male C57BL/6J mice were fed low-fat (LF; 10% energy from fat), HF (45% energy from fat), or a HF-EPA-P (45% energy from fat; 36 g/kg EPA) diet for 11 wk. A 4th group was initially fed HF for 6 wk followed by the HF-EPA-R diet for 5 wk. As expected, mice fed the HF diet developed obesity and glucose intolerance. In contrast, mice fed the HF-EPA-P diet maintained normal glucose tolerance despite weight gain compared with the LF group. Whereas the HF group developed hyperglycemia and hyperinsulinemia, both HF-EPA groups (P and R) exhibited normal glycemia and insulinemia. Further, plasma adiponectin concentration was lower in the HF group but was comparable in the LF and HF-EPA groups, suggesting a role of EPA in preventing and improving insulin resistance induced by HF feeding. Further analysis of adipose tissue adipokine levels and proteomic studies in cultured adipocytes indicated that dietary EPA supplementation of HF diets was associated with reduced adipose inflammation and lipogenesis and elevated markers of fatty acid oxidation. In C57BL/6J mice, EPA minimized saturated fat-induced insulin resistance and this is in part mediated by its effects on fatty acid oxidation and inflammation.

Fatty acid profiles of biological specimens from epidemiological/clinical studies can serve as biomarkers to assess potential relationships between diet and chronic disease risk. However, data are limited regarding fatty acid stability in archived specimens following long-term storage, a variable that could affect result validity. Our objective was to determine the effect of prolonged storage at -80 degrees C on the fatty acid profiles of serum cholesteryl ester (CE), triglyceride (TG), and phospholipid (PL) fractions. This was accomplished by determining the fatty acid profile of frozen, archived, previously unthawed serum samples from 22 subjects who participated in a controlled feeding trial. Initial analysis was performed after trial completion and the repeat analysis after 8-10 years of storage using GC. No significant differences were observed among the majority of fatty acids regardless of lipid fraction. Reliability coefficients were high for the fatty acid classes (saturated fatty acid : 0.70, MUFA : 0.90, PUFA : 0.80). When differences were identified, they were limited to low abundance fatty acids (or=1.5 mol%). These differences were quantitatively small and likely attributable to technical improvements in GC methodology rather than sample degradation. Thus, our data demonstrate that storage at -80 degrees C up to 10 years does not significantly influence serum CE, TG, or PL fatty acid profiles.

Approximately 79 400 000 American adults, or 1 in 3, have cardiovascular disease (CVD).1 CVD accounts for 36.3% or 1 of every 2.8 deaths in the United States and is the leading cause of death among both men and women in the United States, killing an average of 1 American every 37 seconds.1 Older adults, some ethnic minority populations, and socioeconomically disadvantaged individuals have an increased prevalence of CVD and vascular/metabolic risk factors such as hypertension, dyslipidemia, and diabetes; are more likely to have ≥2 risk factors; and are at increased risk of being sedentary, overweight or obese, and having unhealthy dietary habits.2–10 Black and Hispanic immigrants are initially at lower risk for vascular/metabolic risk factors and CVD than US-born black and Hispanic individuals,2 but as they adapt to the diet and activity habits of this country, the prevalence of vascular/metabolic risk factors increases.3 Each of these issues emphasizes the importance of interventions to promote physical activity (PA) and healthy diets in all American adults. Even modest sustained lifestyle changes can substantially reduce CVD morbidity and mortality. Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits. Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance.4 Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals. According to the National Center for Health Statistics, life expectancy could increase by almost 7 years if all forms of major CVD were eliminated.5 Improvements in morbidity and quality of life would also be substantial. In order to achieve these goals, healthcare providers must focus on reducing CVD risk factors such as overweight and obesity, …