67 results on '"Cyril W C, Kendall"'
Search Results
2. The Portfolio Diet and HbA1c in Adults Living with Type 2 Diabetes Mellitus: A Patient-Level Pooled Analysis of Two Randomized Dietary Trials
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Meaghan E. Kavanagh, Songhee Back, Victoria Chen, Andrea J. Glenn, Gabrielle Viscardi, Zeinab Houshialsadat, John L. Sievenpiper, Cyril W. C. Kendall, David J. A. Jenkins, and Laura Chiavaroli
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Portfolio Diet ,dietary portfolio ,diabetes ,glycemic index ,glycaemic index ,glucose control ,Nutrition. Foods and food supply ,TX341-641 - Abstract
(1) Background: The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is also rich in low glycemic index (GI) foods. While strong evidence supports clinically meaningful reductions in cholesterol, evidence on the relationship between the Portfolio Diet and diabetes management is lacking. (2) Objective: To evaluate the relationship between the Portfolio Diet and glycated hemoglobin (HbA1c) as a determinant of glycemic control among adults living with type 2 diabetes mellitus (T2DM). (3) Methods: Patient-level data was pooled from two randomized dietary trials of low glycemic index interventions compared to high cereal fibre control diets in adults living with T2DM where HbA1c was collected (clinicaltrials.gov identifiers: NCT00438698, NCT00438698). Dietary exposure was assessed using weighed 7-day diet records. Adherence to the Portfolio Diet and its pillars (nuts and seeds, plant protein, viscous fibre, plant sterols, monounsaturated fatty acid [MUFA] oils) was determined using the validated clinical Portfolio Diet Score (c-PDS). Multiple linear regression was used to assess the association between change in the c-PDS and change in HbA1c over 6-months with covariate adjustments. (4) Results: A total of 267 participants, predominantly White (67%) and male (63%), were included, with a mean ± standard error age of 62 ± 0.5 years, baseline BMI of 30.2 ± 0.3 kg/m2, HbA1c of 7.08 ± 0.03%, and a c-PDS of 4.1 ± 0.3 points out of 25. Change in the c-PDS was significantly associated with a change in HbA1c (β: −0.04% per point, 95% CI: −0.07, −0.02, p = 0.001). A 7.5-point (30%) increase in the c-PDS was associated with a 0.3% reduction in HbA1c. Of the individual pillars, a 1-point change in nut and seeds intake (β: −0.07%, 95% CI: −0.12, −0.02, p = 0.009) or in plant protein intake (β: −0.11%, 95% CI: −0.18, −0.03, p = 0.009) was associated with a change in HbA1c. Further analysis of plant protein intake revealed that an increase in dietary pulse intake, a particularly low-GI food, was significantly associated with a reduction in HbA1c (β: −0.24% per 1-cup points cooked pulses (226 g) or 2 c-PDS points, 95% CI: −0.45, −0.03, p = 0.028). (5) Conclusions: Among adults living with T2DM, the Portfolio Diet was associated with lower HbA1c over a 6-month period, predominantly driven by two pillars: nuts and seeds and plant protein, particularly dietary pulses. These data have implications for including the Portfolio Diet in dietary recommendations for glycemic control in T2DM. A trial demonstrating the direct causal effect of the Portfolio Diet in a diverse group is warranted.
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- 2024
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3. Effect of oats and oat ß-glucan on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials
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Tauseef A Khan, Fei Au-Yeung, Sonia Blanco Mejia, Lawrence A Leiter, John L Sievenpiper, Cyril W C Kendall, David J A Jenkins, Laura Chiavaroli, Amna Ahmed, Victoria Chen, and Andreea Zurbau
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Introduction Current health claims recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to update the evidence on the effect of oats and oat ß-glucan on glycemic control in individuals with diabetes.Research design and methods MEDLINE, EMBASE and Cochrane were searched (June 2021) for RCTs of ≥2 weeks investigating the effect of oat ß-glucan on glycemic control in diabetes. The outcomes were hemoglobin A1c (HbA1c), fasting glucose, 2-hour postprandial glucose (2h-PG) from a 75 g oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin. Independent reviewers extracted the data and assessed the risk of bias. Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q) and quantified (I2). Pooled estimates were expressed as mean difference (MD) with 95% CI. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach.Results Eight trial comparisons (n=407) met the eligibility criteria. All trials were in adults with type 2 diabetes who were predominantly middle-aged, overweight and treated by antihyperglycemic medications or insulin. A median dose of 3.25 g of oat ß-glucan for a median duration of 4.5 weeks improved HbA1c (MD, −0.47% (95% CI −0.80 to −0.13), pMD=0.006), fasting glucose (−0.75 mmol/L (−1.20 to –0.31), pMD
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- 2022
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4. Rationale, Design and Participants Baseline Characteristics of a Crossover Randomized Controlled Trial of the Effect of Replacing SSBs with NSBs versus Water on Glucose Tolerance, Gut Microbiome and Cardiometabolic Risk in Overweight or Obese Adult SSB Consumer: Strategies to Oppose SUGARS with Non-Nutritive Sweeteners or Water (STOP Sugars NOW) Trial and Ectopic Fat Sub-Study
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Sabrina Ayoub-Charette, Néma D. McGlynn, Danielle Lee, Tauseef Ahmad Khan, Sonia Blanco Mejia, Laura Chiavaroli, Meaghan E. Kavanagh, Maxine Seider, Amel Taibi, Chuck T. Chen, Amna Ahmed, Rachel Asbury, Madeline Erlich, Yue-Tong Chen, Vasanti S. Malik, Richard P. Bazinet, D. Dan Ramdath, Caomhan Logue, Anthony J. Hanley, Cyril W. C. Kendall, Lawrence A. Leiter, Elena M. Comelli, and John L. Sievenpiper
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low- and no-calorie sweeteners ,sweetening agents ,sugar-sweetened beverages ,water ,randomized controlled trial ,type 2 diabetes ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Health authorities are near universal in their recommendation to replace sugar-sweetened beverages (SSBs) with water. Non-nutritive sweetened beverages (NSBs) are not as widely recommended as a replacement strategy due to a lack of established benefits and concerns they may induce glucose intolerance through changes in the gut microbiome. The STOP Sugars NOW trial aims to assess the effect of the substitution of NSBs (the “intended substitution”) versus water (the “standard of care substitution”) for SSBs on glucose tolerance and microbiota diversity. Design and Methods: The STOP Sugars NOW trial (NCT03543644) is a pragmatic, “head-to-head”, open-label, crossover, randomized controlled trial conducted in an outpatient setting. Participants were overweight or obese adults with a high waist circumference who regularly consumed ≥1 SSBs daily. Each participant completed three 4-week treatment phases (usual SSBs, matched NSBs, or water) in random order, which were separated by ≥4-week washout. Blocked randomization was performed centrally by computer with allocation concealment. Outcome assessment was blinded; however, blinding of participants and trial personnel was not possible. The two primary outcomes are oral glucose tolerance (incremental area under the curve) and gut microbiota beta-diversity (weighted UniFrac distance). Secondary outcomes include related markers of adiposity and glucose and insulin regulation. Adherence was assessed by objective biomarkers of added sugars and non-nutritive sweeteners and self-report intake. A subset of participants was included in an Ectopic Fat sub-study in which the primary outcome is intrahepatocellular lipid (IHCL) by 1H-MRS. Analyses will be according to the intention to treat principle. Baseline results: Recruitment began on 1 June 2018, and the last participant completed the trial on 15 October 2020. We screened 1086 participants, of whom 80 were enrolled and randomized in the main trial and 32 of these were enrolled and randomized in the Ectopic Fat sub-study. The participants were predominantly middle-aged (mean age 41.8 ± SD 13.0 y) and had obesity (BMI of 33.7 ± 6.8 kg/m2) with a near equal ratio of female: male (51%:49%). The average baseline SSB intake was 1.9 servings/day. SSBs were replaced with matched NSB brands, sweetened with either a blend of aspartame and acesulfame-potassium (95%) or sucralose (5%). Conclusions: Baseline characteristics for both the main and Ectopic Fat sub-study meet our inclusion criteria and represent a group with overweight or obesity, with characteristics putting them at risk for type 2 diabetes. Findings will be published in peer-reviewed open-access medical journals and provide high-level evidence to inform clinical practice guidelines and public health policy for the use NSBs in sugars reduction strategies. Trial registration: ClinicalTrials.gov identifier, NCT03543644.
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- 2023
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5. Nuts and Cardiovascular Disease Outcomes: A Review of the Evidence and Future Directions
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Andrea J. Glenn, Dagfinn Aune, Heinz Freisling, Noushin Mohammadifard, Cyril W. C. Kendall, Jordi Salas-Salvadó, David J. A. Jenkins, Frank B. Hu, and John L. Sievenpiper
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tree nuts ,peanuts ,nutrition ,cardiovascular diseases ,review ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Nuts are nutrient-rich foods that contain many bioactive compounds that are beneficial for cardiovascular health. Higher consumption of nuts has been associated with a reduced risk of several cardiovascular diseases (CVD) in prospective cohort studies, including a 19% and 25% lower risk of CVD incidence and mortality, respectively, and a 24% and 27% lower risk of coronary heart disease incidence and mortality, respectively. An 18% lower risk of stroke mortality, a 15% lower risk of atrial fibrillation, and a 19% lower risk of total mortality have also been observed. The role of nuts in stroke incidence, stroke subtypes, peripheral arterial disease and heart failure has been less consistent. This narrative review summarizes recommendations for nuts by clinical practice guidelines and governmental organizations, epidemiological evidence for nuts and CVD outcomes, nut-containing dietary patterns, potential mechanisms of nuts and CVD risk reduction, and future research directions, such as the use of biomarkers to help better assess nut intake. Although there are still some uncertainties around nuts and CVD prevention which require further research, as summarized in this review, there is a substantial amount of evidence that supports that consuming nuts will have a positive impact on primary and secondary prevention of CVD.
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- 2023
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6. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis
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Roselyn Zhang, Jarvis C. Noronha, Tauseef A. Khan, Néma McGlynn, Songhee Back, Shannan M. Grant, Cyril W. C. Kendall, and John L. Sievenpiper
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non-nutritive sweetened beverages ,sugar-sweetened beverages ,postprandial ,glucose ,insulin ,GLP-1 ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: There has been an emerging concern that non-nutritive sweeteners (NNS) can increase the risk of cardiometabolic disease. Much of the attention has focused on acute metabolic and endocrine responses to NNS. To examine whether these mechanisms are operational under real-world scenarios, we conducted a systematic review and network meta-analysis of acute trials comparing the effects of non-nutritive sweetened beverages (NNS beverages) with water and sugar-sweetened beverages (SSBs) in humans. Methods: MEDLINE, EMBASE, and The Cochrane Library were searched through to January 15, 2022. We included acute, single-exposure, randomized, and non-randomized, clinical trials in humans, regardless of health status. Three patterns of intake were examined: (1) uncoupling interventions, where NNS beverages were consumed alone without added energy or nutrients; (2) coupling interventions, where NNS beverages were consumed together with added energy and nutrients as carbohydrates; and (3) delayed coupling interventions, where NNS beverages were consumed as a preload prior to added energy and nutrients as carbohydrates. The primary outcome was a 2 h incremental area under the curve (iAUC) for blood glucose concentration. Secondary outcomes included 2 h iAUC for insulin, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), peptide YY (PYY), ghrelin, leptin, and glucagon concentrations. Network meta-analysis and confidence in the network meta-analysis (CINeMA) were conducted in R-studio and CINeMA, respectively. Results: Thirty-six trials involving 472 predominantly healthy participants were included. Trials examined a variety of single NNS (acesulfame potassium, aspartame, cyclamate, saccharin, stevia, and sucralose) and NNS blends (acesulfame potassium + aspartame, acesulfame potassium + sucralose, acesulfame potassium + aspartame + cyclamate, and acesulfame potassium + aspartame + sucralose), along with matched water/unsweetened controls and SSBs sweetened with various caloric sugars (glucose, sucrose, and fructose). In uncoupling interventions, NNS beverages (single or blends) had no effect on postprandial glucose, insulin, GLP-1, GIP, PYY, ghrelin, and glucagon responses similar to water controls (generally, low to moderate confidence), whereas SSBs sweetened with caloric sugars (glucose and sucrose) increased postprandial glucose, insulin, GLP-1, and GIP responses with no differences in postprandial ghrelin and glucagon responses (generally, low to moderate confidence). In coupling and delayed coupling interventions, NNS beverages had no postprandial glucose and endocrine effects similar to controls (generally, low to moderate confidence). Conclusions: The available evidence suggests that NNS beverages sweetened with single or blends of NNS have no acute metabolic and endocrine effects, similar to water. These findings provide support for NNS beverages as an alternative replacement strategy for SSBs in the acute postprandial setting.
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- 2023
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7. Nuts in the Prevention and Management of Type 2 Diabetes
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Stephanie K. Nishi, Effie Viguiliouk, Cyril W. C. Kendall, David J. A. Jenkins, Frank B. Hu, John L. Sievenpiper, Alessandro Atzeni, Anoop Misra, and Jordi Salas-Salvadó
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nuts ,diabetes ,glycemic control ,insulin resistance ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Diabetes is a continuously growing global concern affecting >10% of adults, which may be mitigated by modifiable lifestyle factors. Consumption of nuts and their inclusion in dietary patterns has been associated with a range of beneficial health outcomes. Diabetes guidelines recommend dietary patterns that incorporate nuts; however, specific recommendations related to nuts have been limited. This review considers the epidemiological and clinical evidence to date for the role of nut consumption as a dietary strategy for the prevention and management of type 2 diabetes (T2D) and related complications. Findings suggest nut consumption may have a potential role in the prevention and management of T2D, with mechanistic studies assessing nuts and individual nut-related nutritional constituents supporting this possibility. However, limited definitive evidence is available to date, and future studies are needed to elucidate better the impact of nuts on the prevention and management of T2D.
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- 2023
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8. A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study
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Meaghan E Kavanagh, Laura Chiavaroli, Andrea J Glenn, Genevieve Heijmans, Shannan M Grant, Chi-Ming Chow, Robert G Josse, Vasanti S Malik, William Watson, Aisha Lofters, Candice Holmes, Julia Rackal, Kristie Srichaikul, Diana Sherifali, Erna Snelgrove-Clarke, Jacob A Udell, Peter Juni, Gillian L Booth, Michael E Farkouh, Lawrence A Leiter, Cyril W C Kendall, David J A Jenkins, and John L Sievenpiper
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Medical technology ,R855-855.5 - Abstract
BackgroundThe Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. ObjectiveThe main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). MethodsWe undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. ResultsA total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. ConclusionsBy undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool.
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- 2022
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9. Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study
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Andrea J. Glenn, Kenneth Lo, David J. A. Jenkins, Beatrice A. Boucher, Anthony J. Hanley, Cyril W. C. Kendall, JoAnn E. Manson, Mara Z. Vitolins, Linda G. Snetselaar, Simin Liu, and John L. Sievenpiper
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cardiovascular disease ,dietary patterns ,dietary portfolio ,plant‐based ,prospective cohort study ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The plant‐based Dietary Portfolio combines established cholesterol‐lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low‐density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78–0.95), and heart failure (HR, 0.83; 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87–1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87–1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.
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- 2021
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10. Effect of Important Food Sources of Fructose-Containing Sugars on Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Controlled Feeding Trials
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XinYe Qi, Laura Chiavaroli, Danielle Lee, Sabrina Ayoub-Charette, Tauseef A. Khan, Fei Au-Yeung, Amna Ahmed, Annette Cheung, Qi Liu, Sonia Blanco Mejia, Vivian L. Choo, Russell J. de Souza, Thomas M. S. Wolever, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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inflammation ,CRP ,fructose ,sugars ,food sources ,fruit ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Fructose-containing sugars as sugar-sweetened beverages (SSBs) may increase inflammatory biomarkers. Whether this effect is mediated by the food matrix at different levels of energy is unknown. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials on the effect of different food sources of fructose-containing sugars on inflammatory markers at different levels of energy control. Methods: MEDLINE, Embase, and the Cochrane Library were searched through March 2022 for controlled feeding trials ≥ 7 days. Four trial designs were prespecified by energy control: substitution (energy matched replacement of sugars); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced). The primary outcome was C-reactive protein (CRP). Secondary outcomes were tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Independent reviewers extracted data and assessed risk of bias. GRADE assessed certainty of evidence. Results: We identified 64 controlled trials (91 trial comparisons, n = 4094) assessing 12 food sources (SSB; sweetened dairy; sweetened dairy alternative [soy]; 100% fruit juice; fruit; dried fruit; mixed fruit forms; sweetened cereal grains and bars; sweets and desserts; added nutritive [caloric] sweetener; mixed sources [with SSBs]; and mixed sources [without SSBs]) at 4 levels of energy control over a median 6-weeks in predominantly healthy mixed weight or overweight/obese adults. Total fructose-containing sugars decreased CRP in addition trials and had no effect in substitution, subtraction or ad libitum trials. No effect was observed on other outcomes at any level of energy control. There was evidence of interaction/influence by food source: substitution trials (sweetened dairy alternative (soy) and 100% fruit juice decreased, and mixed sources (with SSBs) increased CRP); and addition trials (fruit decreased CRP and TNF-α; sweets and desserts (dark chocolate) decreased IL-6). The certainty of evidence was moderate-to-low for the majority of analyses. Conclusions: Food source appears to mediate the effect of fructose-containing sugars on inflammatory markers over the short-to-medium term. The evidence provides good indication that mixed sources that contain SSBs increase CRP, while most other food sources have no effect with some sources (fruit, 100% fruit juice, sweetened soy beverage or dark chocolate) showing decreases, which may be dependent on energy control. Clinicaltrials.gov: (NCT02716870).
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- 2022
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11. Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials
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Danielle Lee, Laura Chiavaroli, Sabrina Ayoub-Charette, Tauseef A. Khan, Andreea Zurbau, Fei Au-Yeung, Annette Cheung, Qi Liu, Xinye Qi, Amna Ahmed, Vivian L. Choo, Sonia Blanco Mejia, Vasanti S. Malik, Ahmed El-Sohemy, Russell J. de Souza, Thomas M. S. Wolever, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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alanine aminotransferase ,aspartate aminotransferase ,intrahepatocellular lipid ,non-alcoholic fatty liver disease ,sugars ,sugar-sweetened beverages ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.
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- 2022
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12. Low-carbohydrate vegan diets in diabetes for weight loss and sustainability: a randomized controlled trial
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David J A, Jenkins, Peter J H, Jones, Mohammad M H, Abdullah, Benoit, Lamarche, Dorothea, Faulkner, Darshna, Patel, Sandhya, Sahye-Pudaruth, Melanie, Paquette, Balachandran, Bashyam, Sathish C, Pichika, Meaghan E, Kavanagh, Pooja, Patel, Fred, Liang, Ramon, Brown, Tiffany, Zhao, Mila, Phan, Gajuna, Mathiyalagan, Shilpa, Tandon, Vladmir, Vuksan, Elena, Jovanovski, John L, Sievenpiper, Cyril W C, Kendall, Lawrence A, Leiter, and Robert G, Josse
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Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Low-carbohydrate, high animal fat and protein diets have been promoted for weight loss and diabetes treatment. We therefore tested the effect of a low-carbohydrate vegan diet in diabetes as a potentially healthier and more ecologically sustainable low-carbohydrate option.We sought to compare the effectiveness of a low-carbohydrate vegan diet with a moderate-carbohydrate vegetarian diet on weight loss and metabolic measures in diabetes.One hundred and sixty-four male and female participants with type 2 diabetes were randomly assigned to advice on either a low-carbohydrate vegan diet, high in canola oil and plant proteins, or a vegetarian therapeutic diet, for 3 mo, with both diets recommended at 60% of calorie requirements. Body weight, fasting blood, blood pressure, and 7-d food records, to estimate potential greenhouse gas emissions, were obtained throughout the study with tests of cholesterol absorption undertaken at baseline and end of study on 50 participants.Both low-carbohydrate vegan and vegetarian diets similarly but markedly reduced body weight (-5.9 kg; 95% CI: -6.5, -5.28 kg; and -5.23 kg; 95% CI: -5.84, -4.62 kg), glycated hemoglobin (-0.99%; 95% CI: -1.07, -0.9%; and -0.88%; 95% CI: -0.97, -0.8%), systolic blood pressure (-4 mmHg; 95% CI: -7, -2 mmHg; and -6 mmHg; 95% CI: -8, -3 mmHg), and potential greenhouse gas emissions, but only for potential greenhouse gas emissions was there a significant treatment difference of -0.63 kgCO2/d (95% CI: -0.99, -0.27 kgCO2/d) favoring the low-carbohydrate vegan diet.Low-carbohydrate vegan and vegetarian diets reduced body weight, improved glycemic control and blood pressure, but the more plant-based diet had greater potential reduction in greenhouse gas emissions.Trial registration number: clinicaltrials.gov identifier NCT02245399.
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- 2022
13. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta‐Analysis of Prospective Cohort Studies
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Andreea Zurbau, Fei Au‐Yeung, Sonia Blanco Mejia, Tauseef A. Khan, Vladimir Vuksan, Elena Jovanovski, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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cardiovascular outcomes ,cohort ,fruit ,nutrition ,vegetables ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta‐analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle‐Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane‐Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty‐one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89–0.96]; 0.91 [0.88–0.95]; and 0.94 [0.90–0.97], respectively), coronary heart disease (0.88 [0.83–0.92]; 0.88 [0.84–0.92]; and 0.92 [0.87–0.96], respectively), and stroke (0.82 [0.77–0.88], 0.82 [0.79–0.85]; and 0.88 [0.83–0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85–0.93]; 0.88 [0.86–0.91]; and 0.87 [0.85–0.90], respectively), coronary heart disease (0.81 [0.72–0.92]; 0.86 [0.82–0.90]; and 0.86 [0.83–0.89], respectively), and stroke (0.73 [0.65–0.81]; 0.87 [0.84–0.91]; and 0.94 [0.90–0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was “very low” to “moderate,” with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339.
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- 2020
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14. Prospective Association of the Portfolio Diet with All-Cause and Cause-Specific Mortality Risk in the Mr. OS and Ms. OS Study
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Kenneth Lo, Andrea J. Glenn, Suey Yeung, Cyril W. C. Kendall, John L. Sievenpiper, David J. A. Jenkins, and Jean Woo
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Portfolio Diet ,Asian population ,mortality ,cardiovascular disease ,cancer ,prospective cohort ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.
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- 2021
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15. Systematic review and meta-analysis examining the relationship between postprandial hypotension, cardiovascular events, and all-cause mortality
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David J A, Jenkins, Sandhya, Sahye-Pudaruth, Khosrow, Khodabandehlou, Fred, Liang, Maaria, Kasmani, Jessica, Wanyan, Maggie, Wang, Keishini, Selvaganesh, Melanie, Paquette, Darshna, Patel, Andrea J, Glenn, Korbua, Srichaikul, Cyril W C, Kendall, and John L, Sievenpiper
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Stroke ,Cross-Sectional Studies ,Nutrition and Dietetics ,Cardiovascular Diseases ,Humans ,Medicine (miscellaneous) ,Prospective Studies ,Hypotension ,Aged - Abstract
Postprandial hypotension (PPH) has been reported to be associated with syncope, falls, adverse cardiovascular outcomes, and increased all-cause mortality. It has been reported to have an incidence as high as 30% in the elderly and persons with diabetes. We therefore performed a meta-analysis to determine the relation of PPH with cardiovascular disease (CVD) events and all-cause mortality.Our objective was to conduct a systematic review and meta-analysis of cohort and cross-sectional studies to determine the association of PPH with CVD and all-cause mortality.We searched the databases MEDLINE, EMBASE, and Cochrane library up to 13 April 2022 for prospective cohort and cross-sectional studies that examined the association of PPH with CVD outcomes and all-cause mortality. Data were analyzed using the generic inverse variance method with a random-effects model. Grading of Recommendations, Assessment, Development, and Evaluation approach assessed the certainty of evidence.Seven studies that included 2389 participants met our inclusion criteria. PPH was associated with each outcome individually, including increased all-cause mortality, total CVD, CVD mortality, and stroke. CVD outcomes and all-cause mortality combined were also associated with PPH (RR: 1.52; 95% CI: 1.05, 2.18; P = 0.03; I2 = 77%). The certainty of evidence was graded as very low due to significant heterogeneity and the limited number of studies.This assessment indicates an association of PPH with CVD and all-cause mortality. Further studies are required to improve CVD and mortality estimates, but the potential seriousness of CVD and all-cause mortality as outcomes of PPH justifies more screening, diagnosis, and research.
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- 2022
16. Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials
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Paraskevi Massara, Andreea Zurbau, Andrea J. Glenn, Laura Chiavaroli, Tauseef A. Khan, Effie Viguiliouk, Sonia Blanco Mejia, Elena M. Comelli, Victoria Chen, Ursula Schwab, Ulf Risérus, Matti Uusitupa, Anne-Marie Aas, Kjeld Hermansen, Inga Thorsdottir, Dario Rahelić, Hana Kahleová, Jordi Salas-Salvadó, Cyril W. C. Kendall, and John L. Sievenpiper
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Randomised controlled trial ,Inflammation ,Nutrition and Dietetics ,Nordic diet ,Endocrinology, Diabetes and Metabolism ,Cholesterol, HDL ,Body Weight ,Insulins ,Cholesterol, LDL ,Prospective cohort ,Cardiovascular disease ,Näringslära ,Stroke ,Meta-analysis ,Cholesterol ,Apolipoproteins ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Systematic review ,Internal Medicine ,Humans ,Prospective Studies ,Obesity ,Randomized Controlled Trials as Topic - Abstract
Aims/hypothesis Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. Methods We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle–Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. Results We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with ‘small important’ reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQpp<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] −0.26 mmol/l [95% CI −0.52, −0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQp<0.05). For the other outcomes there were ‘trivial’ reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. Conclusions/interpretation Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. Registration ClinicalTrials.gov NCT04094194. Funding Diabetes and Nutrition Study Group of the EASD Clinical Practice. Graphical abstract
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- 2022
17. Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire
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Andrea J. Glenn, Beatrice A. Boucher, Chloe C. Kavcic, Tauseef A. Khan, Melanie Paquette, Cyril W. C. Kendall, Anthony J. Hanley, David J. A. Jenkins, and John L. Sievenpiper
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portfolio diet ,validity ,diet index ,dietary pattern ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The Portfolio Diet, a plant-based portfolio of cholesterol-lowering foods, has been shown to reduce low-density lipoprotein cholesterol (LDL-C), and other cardiovascular risk factors, in randomized controlled trials (RCTs). It is not known if these beneficial effects translate to a lower incidence of cardiovascular disease (CVD). To support examinations between Portfolio Diet adherence and disease, a Portfolio Diet score (PDS) was developed and its predictive and concurrent validity was assessed within the Toronto Healthy Diet Study, a six-month RCT in overweight adults. Predictive validity was assessed using change in the PDS measured by food frequency questionnaire (FFQ) and concomitant change in LDL-C from baseline to six months using multiple linear regression, adjusted for potential confounders (n = 652). Concurrent validity was assessed in a subset of participants (n = 50) who completed the FFQ and a 7-day diet record (7DDR) at baseline. The PDS determined from each diet assessment method was used to derive correlation coefficients and Bland–Altman plots to assess the between-method agreement. The change in PDS was inversely associated with change in LDL-C (β coefficients: −0.01 mmol/L (95% confidence intervals (CIs): −0.02, −0.002; p = 0.02). The correlation between the PDS from the FFQ and 7DDR was 0.69 (95% CIs: 0.48, 0.85). The Bland–Altman plot showed reasonable agreement between the score from the FFQ and 7DDR. These findings indicate predictive validity of the PDS with lower LDL-C, and reasonable concurrent validity of the PDS as assessed by an FFQ against a 7DDR.
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- 2021
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18. Cumulative Meta‐Analysis of the Soy Effect Over Time
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David J. A. Jenkins, Sonia Blanco Mejia, Laura Chiavaroli, Effie Viguiliouk, Siying S. Li, Cyril W. C. Kendall, Vladmir Vuksan, and John L. Sievenpiper
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cholesterol reduction ,US Food and Drug Administration heart health claim ,soy protein ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Soy protein foods have attracted attention as useful plant protein foods with mild cholesterol‐lowering effects that are suitable for inclusion in therapeutic diets. But on the basis of the lack of consistency in significant cholesterol reduction by soy in 46 randomized controlled trials, the US Food and Drug Administration (FDA) is reassessing whether the 1999 heart health claim for soy protein should be revoked. Methods and Results We have, therefore, performed a cumulative meta‐analysis on the 46 soy trials identified by the FDA to determine if at any time, since the 1999 FDA final rule that established the soy heart health claim, the soy effect on serum cholesterol lost significance. The cumulative meta‐analysis for both total cholesterol and low‐density lipoprotein cholesterol demonstrated preservation of the small, but significant, reductions seen both before and during the subsequent 14 years since the health claim was originally approved. For low‐density lipoprotein cholesterol, the mean reduction in 1999 was −6.3 mg/dL (95% CI, −8.7 to −3.9 mg/dL; P=0.00001) and remained in the range of −4.2 to −6.7 mg/dL (P=0.0006 to P=0.0002, respectively) in the years after 1999. At no time point did the total cholesterol or low‐density lipoprotein cholesterol reductions lose significance or were the differences at individual time points in the cumulative meta‐analysis significantly different from those seen in 1999 when the health claim was approved. Conclusions A cumulative meta‐analysis of the data selected by the FDA indicates continued significance of total cholesterol and low‐density lipoprotein cholesterol reduction after soy consumption and supports the rationale behind the original soy FDA heart health claim.
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- 2019
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19. Relation of Vegetarian Dietary Patterns With Major Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
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Andrea J. Glenn, Effie Viguiliouk, Maxine Seider, Beatrice A. Boucher, Tauseef A. Khan, Sonia Blanco Mejia, David J. A. Jenkins, Hana Kahleová, Dario Rahelić, Jordi Salas-Salvadó, Cyril W. C. Kendall, and John L. Sievenpiper
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vegetarian dietary patterns ,vegetarian diets ,cardiovascular disease ,prospective cohort studies ,systematic review ,meta-analysis ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Vegetarian dietary patterns are recommended for cardiovascular disease (CVD) prevention and management due to their favorable effects on cardiometabolic risk factors, however, the role of vegetarian dietary patterns in CVD incidence and mortality remains unclear.Objective: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we undertook a systematic review and meta-analysis of the association of vegetarian dietary patterns with major cardiovascular outcomes in prospective cohort studies that included individuals with and without diabetes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Methods: MEDLINE, EMBASE, and Cochrane databases were searched through September 6th, 2018. We included prospective cohort studies ≥1 year of follow-up including individuals with or without diabetes reporting the relation of vegetarian and non-vegetarian dietary patterns with at least one cardiovascular outcome. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). The pre-specified outcomes included CVD incidence and mortality (total CVD, coronary heart disease (CHD) and stroke). Risk ratios for associations were pooled using inverse variance random effects model and expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2-statistic). The overall certainty of the evidence was assessed using GRADE.Results: Seven prospective cohort studies (197,737 participants, 8,430 events) were included. A vegetarian dietary pattern was associated with reduced CHD mortality [RR, 0.78 (CI, 0.69, 0.88)] and incidence [0.72 (0.61, 0.85)] but were not associated with CVD mortality [0.92 (0.84, 1.02)] and stroke mortality [0.92 (0.77, 1.10)]. The overall certainty of the evidence was graded as “very low” for all outcomes, owing to downgrades for indirectness and imprecision.Conclusions: Very low-quality evidence indicates that vegetarian dietary patterns are associated with reductions in CHD mortality and incidence but not with CVD and stroke mortality in individuals with and without diabetes. More research, particularly in different populations, is needed to improve the certainty in our estimates.Clinical Trial Registration:Clinicaltrials.gov, identifier: NCT03610828.
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- 2019
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20. Relation of fruit juice with adiposity and diabetes depends on how fruit juice is defined: a re-analysis of the EFSA draft scientific opinion on the tolerable upper intake level for dietary sugars
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Victoria Chen, Tauseef A. Khan, Laura Chiavaroli, Amna Ahmed, Danielle Lee, Cyril W. C. Kendall, and John L. Sievenpiper
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
21. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis
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Amna Ahmed, Zujaja Tul-Noor, Danielle Lee, Shamaila Bajwah, Zara Ahmed, Shanza Zafar, Maliha Syeda, Fakeha Jamil, Faizaan Qureshi, Fatima Zia, Rumsha Baig, Saniya Ahmed, Mobushra Tayyiba, Suleman Ahmad, Dan Ramdath, Rong Tsao, Steve Cui, Cyril W C Kendall, Russell J de Souza, Tauseef A Khan, and John L Sievenpiper
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Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Context Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy. Objective The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Data Sources MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease. Data Extraction Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE. Data Analysis A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol. Conclusion Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence. Systematic Review Registration PROSPERO registration number CRD42015023580.
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- 2022
22. Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC)
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Livia S. A. Augustin, Anne-Marie Aas, Arnie Astrup, Fiona S. Atkinson, Sara Baer-Sinnott, Alan W. Barclay, Jennie C. Brand-Miller, Furio Brighenti, Monica Bullo, Anette E. Buyken, Antonio Ceriello, Peter R. Ellis, Marie-Ann Ha, Jeyakumar C. Henry, Cyril W. C. Kendall, Carlo La Vecchia, Simin Liu, Geoffrey Livesey, Andrea Poli, Jordi Salas-Salvadó, Gabriele Riccardi, Ulf Riserus, Salwa W. Rizkalla, John L. Sievenpiper, Antonia Trichopoulou, Kathy Usic, Thomas M. S. Wolever, Walter C. Willett, and David J. A. Jenkins
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dietary fibre ,labelling ,carbohydrate quality ,ICQC ,consensus ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Dietary fibre is a generic term describing non-absorbed plant carbohydrates and small amounts of associated non-carbohydrate components. The main contributors of fibre to the diet are the cell walls of plant tissues, which are supramolecular polymer networks containing variable proportions of cellulose, hemicelluloses, pectic substances, and non-carbohydrate components, such as lignin. Other contributors of fibre are the intracellular storage oligosaccharides, such as fructans. A distinction needs to be made between intrinsic sources of dietary fibre and purified forms of fibre, given that the three-dimensional matrix of the plant cell wall confers benefits beyond fibre isolates. Movement through the digestive tract modifies the cell wall structure and may affect the interactions with the colonic microbes (e.g., small intestinally non-absorbed carbohydrates are broken down by bacteria to short-chain fatty acids, absorbed by colonocytes). These aspects, combined with the fibre associated components (e.g., micronutrients, polyphenols, phytosterols, and phytoestrogens), may contribute to the health outcomes seen with the consumption of dietary fibre. Therefore, where possible, processing should minimise the degradation of the plant cell wall structures to preserve some of its benefits. Food labelling should include dietary fibre values and distinguish between intrinsic and added fibre. Labelling may also help achieve the recommended intake of 14 g/1000 kcal/day.
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- 2020
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23. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
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Siying S. Li, Sonia Blanco Mejia, Lyubov Lytvyn, Sarah E. Stewart, Effie Viguiliouk, Vanessa Ha, Russell J. de Souza, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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animal protein ,cholesterol ,dyslipidemia ,lipids ,meta‐analysis ,protein ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThere is a heightened interest in plant‐based diets for cardiovascular disease prevention. Although plant protein is thought to mediate such prevention through modifying blood lipids, the effect of plant protein in specific substitution for animal protein on blood lipids remains unclear. To assess the effect of this substitution on established lipid targets for cardiovascular risk reduction, we conducted a systematic review and meta‐analysis of randomized controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation system. Methods and ResultsMEDLINE, EMBASE, and the Cochrane Registry were searched through September 9, 2017. We included randomized controlled trials of ≥3 weeks comparing the effect of plant protein in substitution for animal protein on low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, and apolipoprotein B. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences with 95% confidence intervals. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality (certainty) of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. One‐hundred twelve randomized controlled trials met the eligibility criteria. Plant protein in substitution for animal protein decreased low‐density lipoprotein cholesterol by 0.16 mmol/L (95% confidence interval, −0.20 to −0.12 mmol/L; P
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- 2017
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24. Relation of change or substitution of low-and no-calorie sweetened beverages with cardiometabolic outcomes: A systematic review and meta-analysis of prospective cohort studies
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John L. Sievenpiper, Cyril W. C. Kendall, Jordi Salas-Salvadó, Hana Kahleová, Dario Rahelić, Per Bendix Jeppesen, Lawrence A. Leiter, James O. Hill, Vasanti S. Malik, Nema McGlynn, Tauseef A. Khan, and Jennifer J. Lee
- Abstract
Background: Adverse associations of low-and no-calorie sweetened beverages (LNCSBs) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding. Purpose: To address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSBs with cardiometabolic outcomes. Study Selection: MEDLINE, EMBASE, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies ≥1-year follow-up duration in adults. Outcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, diabetes, cardiovascular disease, and total mortality. Data Extraction: Two independent reviewers extracted data, assessed study quality, and certainty of evidence using GRADE. Data was pooled using random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI. Data Synthesis: Fourteen cohorts (416,830 participants) met the eligibility criteria. Change in LNCSB intake was associated with lower weight (5 cohorts, 136,206 participants; MD, -0.008 [95% CI: -0.014, -0.002] kg/y). Substitution of LNCSBs for sugar-sweetened beverages (SSBs) was associated with lower weight (3 cohorts, 165,579 participants; MD, -0.12 [95% CI: -0.14, -0.01] kg/y) and lower incidence of obesity (1 cohort, 15,765 participants; RR, 0.88 [0.88, 0.89]), coronary heart disease (6 cohorts, 233,676 participants; RR, 0.89 [95% CI: 0.81, 0.98]), CVD mortality (1 cohort, 118,363 participants; RR, 0.95 [95% CI: 0.90, 0.99]), and total mortality (1 cohort, 118,363 participants; RR, 0.96 [95% CI: 0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSBs showed lower weight (3 cohorts, 165,579 participants; MD, -0.10 [95% CI: -0.13, -0.06] kg/y), lower waist circumference (1 cohort, 173 participants; MD, -2.71[95% CI: -4.27, -1.15] cm/y) and percent body fat (1 cohort, 173 participants; MD, -1.51 [95% CI: -2.61, -0.42] %/y), and lower incidence of obesity (1 cohort, 15,765 participants; RR, 0.85 [95% CI: 0.75, 0.97]) and diabetes (3 cohorts, 281,855 participants; RR, 0.96 [95% CI: 95% CI: 0.94, 0.98]). Substitution of LNCSBs for water showed no adverse associations. Limitations: The evidence was low to very low certainty owing downgrades for imprecision, indirectness and/or inconsistency. Conclusions: LNCSBs were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSBs in their intended substitution for SSBs may be associated with cardiometabolic benefit, comparable to the standard of care, water.
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- 2022
25. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: Assessment of Causal Relations
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Geoffrey Livesey, Richard Taylor, Helen F. Livesey, Anette E. Buyken, David J. A. Jenkins, Livia S. A. Augustin, John L. Sievenpiper, Alan W. Barclay, Simin Liu, Thomas M. S. Wolever, Walter C. Willett, Furio Brighenti, Jordi Salas-Salvadó, Inger Björck, Salwa W. Rizkalla, Gabriele Riccardi, Carlo La Vecchia, Antonio Ceriello, Antonia Trichopoulou, Andrea Poli, Arne Astrup, Cyril W. C. Kendall, Marie-Ann Ha, Sara Baer-Sinnott, and Jennie C. Brand-Miller
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causation ,diabetes ,glycemic index ,glycemic load ,dietary fiber ,alcohol ,cohort studies ,epidemiology ,meta-analysis ,public health ,Nutrition. Foods and food supply ,TX341-641 - Abstract
While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neither dietary fiber nor cereal fiber nor wholegrain were found to be reliable or effective surrogate measures of GI or GL. Finally, our cost−benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sufficient to consider inclusion of GI and GL in food and nutrient-based recommendations.
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- 2019
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26. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies
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Geoffrey Livesey, Richard Taylor, Helen F. Livesey, Anette E. Buyken, David J. A. Jenkins, Livia S. A. Augustin, John L. Sievenpiper, Alan W. Barclay, Simin Liu, Thomas M. S. Wolever, Walter C. Willett, Furio Brighenti, Jordi Salas-Salvadó, Inger Björck, Salwa W. Rizkalla, Gabriele Riccardi, Carlo La Vecchia, Antonio Ceriello, Antonia Trichopoulou, Andrea Poli, Arne Astrup, Cyril W. C. Kendall, Marie-Ann Ha, Sara Baer-Sinnott, and Jennie C. Brand-Miller
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glycemic index ,glycemic load ,dietary fiber ,protein ,alcohol ,type 2 diabetes ,cohort studies ,epidemiology ,meta-analysis ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Published meta-analyses indicate significant but inconsistent incident type-2 diabetes (T2D)-dietary glycemic index (GI) and glycemic load (GL) risk ratios or risk relations (RR). It is now over a decade ago that a published meta-analysis used a predefined standard to identify valid studies. Considering valid studies only, and using random effects dose−response meta-analysis (DRM) while withdrawing spurious results (p < 0.05), we ascertained whether these relations would support nutrition guidance, specifically for an RR > 1.20 with a lower 95% confidence limit >1.10 across typical intakes (approximately 10th to 90th percentiles of population intakes). The combined T2D−GI RR was 1.27 (1.15−1.40) (p < 0.001, n = 10 studies) per 10 units GI, while that for the T2D−GL RR was 1.26 (1.15−1.37) (p < 0.001, n = 15) per 80 g/d GL in a 2000 kcal (8400 kJ) diet. The corresponding global DRM using restricted cubic splines were 1.87 (1.56−2.25) (p < 0.001, n = 10) and 1.89 (1.66−2.16) (p < 0.001, n = 15) from 47.6 to 76.1 units GI and 73 to 257 g/d GL in a 2000 kcal diet, respectively. In conclusion, among adults initially in good health, diets higher in GI or GL were robustly associated with incident T2D. Together with mechanistic and other data, this supports that consideration should be given to these dietary risk factors in nutrition advice. Concerning the public health relevance at the global level, our evidence indicates that GI and GL are substantial food markers predicting the development of T2D worldwide, for persons of European ancestry and of East Asian ancestry.
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- 2019
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27. The Effect of Small Doses of Fructose and Its Epimers on Glycemic Control: A Systematic Review and Meta-Analysis of Controlled Feeding Trials
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Jarvis C. Noronha, Catherine R. Braunstein, Sonia Blanco Mejia, Tauseef A. Khan, Cyril W. C. Kendall, Thomas M. S. Wolever, Lawrence A. Leiter, and John L. Sievenpiper
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fructose ,allulose ,tagatose ,sorbose ,catalytic dose ,glycemia ,HbA1c ,glucose ,insulin ,meta-analysis ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Objective: Contrary to the concerns that fructose may have adverse metabolic effects, an emerging literature has shown that small doses (≤10 g/meal) of fructose and its low-caloric epimers (allulose, tagatose, and sorbose) decrease the glycemic response to high glycemic index meals. Whether these acute reductions manifest as sustainable improvements in glycemic control is unclear. Our objective was to synthesize the evidence from controlled feeding trials that assessed the effect of small doses of fructose and its low-caloric epimers on glycemic control. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library through April 18, 2018. We included controlled feeding trials of ≥1 week that investigated the effect of small doses (≤50 g/day or ≤10% of total energy intake/day) of fructose and its low-caloric epimers on HbA1c, fasting glucose, and fasting insulin. Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the Cochran Q statistic and quantified using the I2 statistic. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessed the certainty of the evidence. Results: We identified 14 trial comparisons (N = 337) of the effect of fructose in individuals with and without diabetes, 3 trial comparisons (N = 138) of the effect of allulose in individuals without diabetes, 3 trial comparisons (N = 376) of the effect of tagatose mainly in individuals with type 2 diabetes, and 0 trial comparisons of the effect of sorbose. Small doses of fructose and tagatose significantly reduced HbA1c (MD = −0.38% (95% CI: −0.64%, −0.13%); MD = −0.20% (95% CI: −0.34%, −0.06%)) and fasting glucose (MD = −0.13 mmol/L (95% CI: −0.24 mmol/L, −0.03 mmol/L)); MD = −0.30 mmol/L (95% CI: −0.57 mmol/L, −0.04 mmol/L)) without affecting fasting insulin (p > 0.05). Small doses of allulose did not have a significant effect on HbA1c and fasting insulin (p > 0.05), while the reduction in fasting glucose was of borderline significance (p = 0.05). The certainty of the evidence of the effect of small doses of fructose and allulose on HbA1c, fasting glucose, and fasting insulin was graded as low. The certainty of the evidence of the effect of tagatose on HbA1c, fasting glucose, and fasting insulin was graded as moderate. Conclusions: Our results indicate that small doses of fructose and tagatose may improve glycemic control over the long term. There is a need for long-term randomized controlled trials for all four sugars to improve our certainty in the estimates.
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- 2018
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28. Effect of oats and oat ß-glucan on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials
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Victoria Chen, Andreea Zurbau, Amna Ahmed, Tauseef A Khan, Fei Au-Yeung, Laura Chiavaroli, Sonia Blanco Mejia, Lawrence A Leiter, David J A Jenkins, Cyril W C Kendall, and John L Sievenpiper
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Endocrinology, Diabetes and Metabolism - Abstract
IntroductionCurrent health claims recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to update the evidence on the effect of oats and oat ß-glucan on glycemic control in individuals with diabetes.Research design and methodsMEDLINE, EMBASE and Cochrane were searched (June 2021) for RCTs of ≥2 weeks investigating the effect of oat ß-glucan on glycemic control in diabetes. The outcomes were hemoglobin A1c (HbA1c), fasting glucose, 2-hour postprandial glucose (2h-PG) from a 75 g oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin. Independent reviewers extracted the data and assessed the risk of bias. Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q) and quantified (I2). Pooled estimates were expressed as mean difference (MD) with 95% CI. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach.ResultsEight trial comparisons (n=407) met the eligibility criteria. All trials were in adults with type 2 diabetes who were predominantly middle-aged, overweight and treated by antihyperglycemic medications or insulin. A median dose of 3.25 g of oat ß-glucan for a median duration of 4.5 weeks improved HbA1c (MD, −0.47% (95% CI −0.80 to −0.13), pMD=0.006), fasting glucose (−0.75 mmol/L (−1.20 to –0.31), pMDMD=0.003) and HOMA-IR (−0.88 (−1.55 to –0.20), pMD=0.011). There was a non-significant reduction in fasting insulin (−4.30 pmol/L (−11.96 to 3.35), pMD=0.271). The certainty of evidence was high for fasting glucose, moderate for HOMA-IR and fasting insulin (downgraded for imprecision), and low for HbA1c and 2h-PG (downgraded for imprecision and inconsistency).ConclusionsConsumption of oats and oat ß-glucan results in generally small improvements in established markers of fasting and postprandial glycemic control beyond concurrent therapy in adults with type 2 diabetes. The current evidence provides a very good indication for reductions in fasting glucose and less of an indication for reductions in HbA1c, 2h-PG, fasting insulin and HOMA-IR in this population.Trial registration numberNCT04631913.
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- 2022
29. Acute effects of raisin consumption on glucose and insulin reponses in healthy individuals
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Amin Esfahani, Joanne Lam, and Cyril W. C. Kendall
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Raisins ,Dried fruit ,Glycaemic index ,Glycaemic load ,Nutrition. Foods and food supply ,TX341-641 ,Medicine - Abstract
Raisins are popular snacks with a favourable nutrient profile, being high in dietary fibre, polyphenols and a number of vitamins and minerals, in addition to being rich in fructose. In light of evidence demonstrating improvements in glycaemic control with moderate fructose intake and low-glycaemic index (GI) fruits, our aim was to determine the GI, insulin index (II) and postprandial responses to raisins in an acute feeding setting. A total of ten healthy participants (four male and six female) consumed breakfast study meals on four occasions over a 2- to 8-week period: meal 1: white bread (WB) (108 g WB; 50 g available carbohydrate) served as the control and was consumed on two separate occasions; meal 2: raisins (R50) (69 g raisins; 50 g available carbohydrate); and meal 3: raisins (R20) (one serving, 28 g raisins; 20 g available carbohydrate). Postprandial glucose and insulin were measured over a 2 h period for the determination of GI, glycaemic load (GL) and II. The raisin meals, R50 and R20, resulted in significantly reduced postprandial glucose and insulin responses when compared with WB (P
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- 2014
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30. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials.
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Effie Viguiliouk, Cyril W C Kendall, Sonia Blanco Mejia, Adrian I Cozma, Vanessa Ha, Arash Mirrahimi, Viranda H Jayalath, Livia S A Augustin, Laura Chiavaroli, Lawrence A Leiter, Russell J de Souza, David J A Jenkins, and John L Sievenpiper
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Medicine ,Science - Abstract
Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent.To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes.MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014.Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR.Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2).Twelve trials (n = 450) were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003) and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03) compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.Majority of trials were of short duration and poor quality.Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates.ClinicalTrials.gov NCT01630980.
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- 2014
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31. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk
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Néma D. McGlynn, Tauseef Ahmad Khan, Lily Wang, Roselyn Zhang, Laura Chiavaroli, Fei Au-Yeung, Jennifer J. Lee, Jarvis C. Noronha, Elena M. Comelli, Sonia Blanco Mejia, Amna Ahmed, Vasanti S. Malik, James O. Hill, Lawrence A. Leiter, Arnav Agarwal, Per B. Jeppesen, Dario Rahelić, Hana Kahleová, Jordi Salas-Salvadó, Cyril W. C. Kendall, and John L. Sievenpiper
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Adult ,Male ,Sugar-Sweetened Beverages ,Cardiovascular Diseases ,Body Weight ,Diabetes Mellitus ,Humans ,Water ,Female ,Obesity ,General Medicine ,Overweight - Abstract
Importance: There are concerns that low- and no-calorie sweetened beverages (LNCSBs) do not have established benefits, with major dietary guidelines recommending the use of water and not LNCSBs to replace sugar-sweetened beverages (SSBs). Whether LNCSB as a substitute can yield similar improvements in cardiometabolic risk factors vs water in their intended substitution for SSBs is unclear.Objective: To assess the association of LNCSBs (using 3 prespecified substitutions of LNCSBs for SSBs, water for SSBs, and LNCSBs for water) with body weight and cardiometabolic risk factors in adults with and without diabetes.Data Sources: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through December 26, 2021.Study Selection: Randomized clinical trials (RCTs) with at least 2 weeks of interventions comparing LNCSBs, SSBs, and/or water were included.Data Extraction and Synthesis: Data were extracted and risk of bias was assessed by 2 independent reviewers. A network meta-analysis was performed with data expressed as mean difference (MD) or standardized mean difference (SMD) with 95% CIs. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the certainty of the evidence.Main Outcomes and Measures: The primary outcome was body weight. Secondary outcomes were other measures of adiposity, glycemic control, blood lipids, blood pressure, measures of nonalcoholic fatty liver disease, and uric acid.Results: A total of 17 RCTs with 24 trial comparisons were included, involving 1733 adults (mean [SD] age, 33.1 [6.6] years; 1341 women [77.4%]) with overweight or obesity who were at risk for or had diabetes. Overall, LNCSBs were a substitute for SSBs in 12 RCTs (n = 601 participants), water was a substitute for SSBs in 3 RCTs (n = 429), and LNCSBs were a substitute for water in 9 RCTs (n = 974). Substitution of LNCSBs for SSBs was associated with reduced body weight (MD, -1.06 kg; 95% CI, -1.71 to -0.41 kg), body mass index (MD, -0.32; 95% CI, -0.58 to -0.07), percentage of body fat (MD, -0.60%; 95% CI, -1.03% to -0.18%), and intrahepatocellular lipid (SMD, -0.42; 95% CI, -0.70 to -0.14). Substituting water for SSBs was not associated with any outcome. There was also no association found between substituting LNCSBs for water with any outcome except glycated hemoglobin A1c (MD, 0.21%; 95% CI, 0.02% to 0.40%) and systolic blood pressure (MD, -2.63 mm Hg; 95% CI, -4.71 to -0.55 mm Hg). The certainty of the evidence was moderate (substitution of LNCSBs for SSBs) and low (substitutions of water for SSBs and LNCSBs for water) for body weight and was generally moderate for all other outcomes across all substitutions.Conclusions and Relevance: This systematic review and meta-analysis found that using LNCSBs as an intended substitute for SSBs was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution. The evidence supports the use of LNCSBs as an alternative replacement strategy for SSBs over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.
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- 2022
32. Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment: JACC Focus Seminar
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David J A, Jenkins, J David, Spence, Edward L, Giovannucci, Young-In, Kim, Robert G, Josse, Reinhold, Vieth, Sandhya, Sahye-Pudaruth, Melanie, Paquette, Darshna, Patel, Sonia, Blanco Mejia, Effie, Viguiliouk, Stephanie K, Nishi, Meaghan, Kavanagh, Tom, Tsirakis, Cyril W C, Kendall, Sathish C, Pichika, and John L, Sievenpiper
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Stroke ,Cardiovascular Diseases ,Diet, Vegetarian ,Dietary Supplements ,Vitamin B Complex ,Humans - Abstract
This is an update of the previous 2018 systematic review and meta-analysis of vitamin and mineral supplementation on cardiovascular disease outcomes and all-cause mortality. New randomized controlled trials and meta-analyses were identified by searching the Cochrane library, Medline, and Embase, and data were analyzed using random effects models and classified by the Grading of Recommendations Assessment Development and Evaluation approach. This updated review shows similar findings to the previous report for preventive benefits from both folic acid and B vitamins for stroke and has been graded with moderate quality. No effect was seen for the commonly used multivitamins, vitamin D, calcium, and vitamin C, and an increased risk was seen with niacin (with statin) for all-cause mortality. Conclusive evidence for the benefit of supplements across different dietary backgrounds, when the nutrient is sufficient, has not been demonstrated.
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- 2020
33. Supplemental Vitamins and Minerals for CVD Prevention and Treatment
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Effie Viguiliouk, Atherai Maran, Darshna Patel, Awad Chowdhury, Taylor McKay, Edward Giovannucci, Anisa Hajizadeh, Sandy Mitchell, Amy E. Jenkins, Ramsha Shahid, Sandhya Sahye-Pudaruth, David J.A. Jenkins, Tina Qutta, Sathish C. Pichika, Stephanie K. Nishi, Julieta Correa-Betanzo, Cleo Villegas, Robert G. Josse, Gabriella Del Principe, Daniel Bernstein, Ruben Kalaichandran, Narmada Umatheva, John L. Sievenpiper, Gelaine Trinidad, Sonia Blanco Mejia, Lina Bachiri, Geithayini Kirupaharan, Rohit Jayaraman, Meaghan Kavanagh, Young-In Kim, Cyril W. C. Kendall, Tom Tsirakis, Wendy M. Jenkins, Alexis Silver, Jessica White, Reinhold Vieth, Melanie Paquette, Preveena Manisekaran, and J. David Spence
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medicine.medical_specialty ,Disease outcome ,030204 cardiovascular system & hematology ,law.invention ,supplements ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Randomized Controlled Trials as Topic ,Cvd prevention ,business.industry ,Vitamins ,Trace Elements ,meta-analysis ,Treatment Outcome ,Cardiovascular Diseases ,Meta-analysis ,Dietary Supplements ,all-cause mortality ,Diet, Healthy ,Cardiology and Cardiovascular Medicine ,business ,All cause mortality - Abstract
The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.
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- 2018
34. Relation of Total Sugars, Sucrose, Fructose, and Added Sugars With the Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies
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Tauseef A, Khan, Mobushra, Tayyiba, Arnav, Agarwal, Sonia Blanco, Mejia, Russell J, de Souza, Thomas M S, Wolever, Lawrence A, Leiter, Cyril W C, Kendall, David J A, Jenkins, and John L, Sievenpiper
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Sucrose ,Cardiovascular Diseases ,Sweetening Agents ,Humans ,Fructose ,Sugars - Abstract
To determine the association of total and added fructose-containing sugars on cardiovascular (CVD) incidence and mortality.MEDLINE, EMBASE and Cochrane Library were searched from January 1, 1980, to July 31, 2018. Prospective cohort studies assessing the association of reported intakes of total, sucrose, fructose and added sugars with CVD incidence and mortality in individuals free from disease at baseline were included. Risk estimates were pooled using the inverse variance method, and dose-response analysis was modeled.Eligibility criteria were met by 24 prospective cohort comparisons (624,128 unique individuals; 11,856 CVD incidence cases and 12,224 CVD mortality cases). Total sugars, sucrose, and fructose were not associated with CVD incidence. Total sugars (risk ratio, 1.09 [95% confidence interval, 1.02 to 1.17]) and fructose (1.08 [1.01 to 1.15]) showed a harmful association for CVD mortality, there was no association for added sugars and a beneficial association for sucrose (0.94 [0.89 to 0.99]). Dose-response analyses showed a beneficial linear dose-response gradient for sucrose and nonlinear dose-response thresholds for harm for total sugars (133 grams, 26% energy), fructose (58 grams, 11% energy) and added sugars (65 grams, 13% energy) in relation to CVD mortality (P.05). The certainty of the evidence using GRADE was very low for CVD incidence and low for CVD mortality for all sugar types.Current evidence supports a threshold of harm for intakes of total sugars, added sugars, and fructose at higher exposures and lack of harm for sucrose independent of food form for CVD mortality. Further research of different food sources of sugars is needed to define better the relationship between sugars and CVD. REGISTRATION: clinicaltrials.gov, NCT01608620.
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- 2018
35. Long-term effects of a plant-based dietary portfolio of cholesterol-lowering foods on blood pressure
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E. Vidgen, Karen G. Lapsley, Robert G. Josse, Azadeh Emam, Cyril W. C. Kendall, Elke A. Trautwein, Thomas Kemp, Julia M W Wong, R. J. de Souza, Tri H. Nguyen, David J.A. Jenkins, Lawrence A. Leiter, Augustine Marchie, William Singer, and Dorothea Faulkner
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Dietary Fiber ,Male ,medicine.medical_specialty ,Diastole ,Medicine (miscellaneous) ,Blood lipids ,Hemodynamics ,Blood Pressure ,Hyperlipidemias ,Diet Records ,Cholesterol, Dietary ,chemistry.chemical_compound ,Animal science ,Weight loss ,Internal medicine ,Weight Loss ,medicine ,Humans ,Obesity ,Nutrition and Dietetics ,Cholesterol ,business.industry ,Body Weight ,Weight change ,Phytosterols ,Middle Aged ,Blood pressure ,Endocrinology ,chemistry ,Hypertension ,Soybean Proteins ,Female ,Prunus ,medicine.symptom ,business - Abstract
To determine the effect on blood pressure of dietary advice to consume a combination of plant-based cholesterol-lowering foods (dietary portfolio).For 1 year, 66 hyperlipidemic subjects were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal) and almonds (22.5 g/1000 kcal). There was no control group. Seven-day diet record, blood pressure and body weight were monitored initially monthly and later at 2-monthly intervals throughout the study.Fifty subjects completed the 1-year study. When the last observation was carried forward for non-completers (n=9) or those who changed their blood pressure medications (n=7), a small mean reduction was seen in body weight 0.7+/-0.3 kg (P=0.036). The corresponding reductions from baseline in systolic and diastolic blood pressure at 1 year (n=66 subjects) were -4.2+/-1.3 mm Hg (P=0.002) and -2.3+/-0.7 mm Hg (P=0.001), respectively. Blood pressure reductions occurred within the first 2 weeks, with stable blood pressures 6 weeks before and 4 weeks after starting the diet. Diastolic blood pressure reduction was significantly related to weight change (r=0.30, n=50, P=0.036). Only compliance with almond intake advice related to blood pressure reduction (systolic: r=-0.34, n=50, P=0.017; diastolic: r=-0.29, n=50, P=0.041).A dietary portfolio of plant-based cholesterol-lowering foods reduced blood pressure significantly, related to almond intake. The dietary portfolio approach of combining a range of cholesterol-lowering plant foods may benefit cardiovascular disease risk both by reducing serum lipids and also blood pressure.
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- 2007
36. The effect of a dietary portfolio compared to a DASH-type diet on blood pressure
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Jiri Frohlich, C. Pellini, Robert G. Josse, Balachandran Bashyam, Patrick Couture, Christopher Ireland, Lawrence A. Leiter, R. J. de Souza, Benoît Lamarche, Arash Mirrahimi, P. Galange, Cyril W. C. Kendall, Vanu Ramprasath, Viranda H. Jayalath, John L. Sievenpiper, Dorothea Faulkner, Peter B. Jones, L. S. A. Augustin, David J.A. Jenkins, Korbua Srichaikul, and Stephanie K. Nishi
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Adult ,Male ,medicine.medical_specialty ,Mean arterial pressure ,Canada ,Mediterranean diet ,Endocrinology, Diabetes and Metabolism ,Diastole ,Medicine (miscellaneous) ,Hyperlipidemias ,Diet, Mediterranean ,Diet Records ,Risk Assessment ,Plant protein ,Animal science ,Internal medicine ,Hyperlipidemia ,medicine ,Humans ,Diet, Fat-Restricted ,Aged ,Nutrition and Dietetics ,business.industry ,Sodium ,Coronary heart disease risk ,Blood Pressure Determination ,Diet, Sodium-Restricted ,Middle Aged ,Cardiovascular disease ,medicine.disease ,3. Good health ,Blood pressure ,Endocrinology ,Treatment Outcome ,Cardiovascular Diseases ,Decreased blood pressure ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business ,Energy Intake ,Vegetable protein ,Follow-Up Studies - Abstract
Background and aim Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatments from the same study to assess the effect over time on systolic, diastolic and mean arterial pressure (MAP), and the relation to sodium (Na + ), potassium (K + ), and portfolio components. Methods and results 241 participants with hyperlipidemia, from four academic centers across Canada were randomized and completed either a DASH-type diet (control n = 82) or a dietary portfolio that included, soy protein, viscous fibers and nuts (n = 159) for 24 weeks. Fasting measures and 7-day food records were obtained at weeks 0, 12 and 24, with 24-h urines at weeks 0 and 24. The dietary portfolio reduced systolic, diastolic and mean arterial blood pressure compared to the control by 2.1 mm Hg (95% CI, 4.2 to −0.1 mm Hg) (p = 0.056), 1.8 mm Hg (CI, 3.2 to 0.4 mm Hg) (p = 0.013) and 1.9 mm Hg (CI, 3.4 to 0.4 mm Hg) (p = 0.015), respectively. Blood pressure reductions were small at 12 weeks and only reached significance at 24 weeks. Nuts, soy and viscous fiber all related negatively to change in mean arterial pressure (ρ = −0.15 to −0.17, p ≤ 0.016) as did urinary potassium (ρ = −0.25, p = 0.001), while the Na + /K + ratio was positively associated (ρ = 0.20, p = 0.010). Conclusions Consumption of a cholesterol-lowering dietary portfolio also decreased blood pressure by comparison with a healthy DASH-type diet. Clinical Trial Reg. No. NCT00438425, clinicaltrials.gov.
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- 2015
37. Direct comparison of dietary portfolio vs statin on C-reactive protein
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Robert G. Josse, Tina Parker, Philip W. Connelly, Andrea R. Josse, Cyril W. C. Kendall, Augustine Marchie, Dorothea Faulkner, T J Li, Azadeh Emam, Lawrence A. Leiter, Julia M W Wong, R. J. de Souza, William Singer, and David J.A. Jenkins
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Adult ,Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Diet therapy ,Saturated fat ,Medicine (miscellaneous) ,Hyperlipidemias ,soy protein ,030204 cardiovascular system & hematology ,Article ,plant sterols ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Diet, Fat-Restricted ,Aged ,Inflammation ,Nutrition and Dietetics ,national cholesterol education program diet ,biology ,business.industry ,Cholesterol ,C-reactive protein ,almonds ,Middle Aged ,low saturated fat ,3. Good health ,C-Reactive Protein ,Endocrinology ,chemistry ,Cardiovascular Diseases ,viscous dietary fiber ,Saturated fatty acid ,biology.protein ,Female ,Lovastatin ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Biomarkers ,medicine.drug ,Lipoprotein - Abstract
Background: 3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) markedly reduce serum cholesterol and have anti-inflammatory effects. The effect of cholesterol-lowering diets on inflammatory biomarkers is less well known. Objective: To compare the efficacy of a dietary combination (portfolio) of cholesterol-lowering foods vs a statin in reducing C-reactive protein (CRP) as a biomarker of inflammation linked to increased cardiovascular disease risk. Methods: In all, 34 hyperlipidemic subjects completed three 1-month treatments as outpatients in random order: a very low-saturated fat diet (control); the same diet with 20 mg lovastatin (statin); and a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (portfolio). Fasting blood samples were obtained at weeks 0, 2, and 4. Results: Using the complete data, no treatment reduced serum CRP. However, when subjects with CRP levels above the 75th percentile for previously reported studies (>3.5 mg/l) were excluded, CRP was reduced similarly on both statin, −16.3±6.7% (n=23, P=0.013) and dietary portfolio, −23.8±6.9% (n=25, P=0.001) but not the control, 15.3±13.6% (n=28, P=0.907). The percentage CRP change from baseline on the portfolio treatment (n=25) was greater than the control (n=28, P=0.004) but similar to statin treatment (n=23, P=0.349). Both statin and portfolio treatments were similar in reducing CRP and numerically more effective than control but only the change in portfolio was significant after the Bonferroni adjustment. Conclusions: A combination of cholesterol-lowering foods reduced C-reactive protein to a similar extent as the starting dose of a first-generation statin.
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- 2005
38. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants1–3
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Azadeh Emam, Russell J. de Souza, Lawrence A. Leiter, Karen G. Lapsley, William Singer, Robert G. Josse, Dorothea Faulkner, Philip W. Connelly, Augustine Marchie, Edward Vidgen, Cyril W. C. Kendall, Elke A. Trautwein, David J.A. Jenkins, Tina Parker, and Julia M W Wong
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,Statin ,biology ,medicine.drug_class ,business.industry ,Cholesterol ,Medicine (miscellaneous) ,Blood lipids ,Psyllium ,Crossover study ,chemistry.chemical_compound ,Animal science ,Endocrinology ,chemistry ,Internal medicine ,HMG-CoA reductase ,medicine ,biology.protein ,lipids (amino acids, peptides, and proteins) ,Lovastatin ,business ,Soy protein ,medicine.drug - Abstract
Background: 3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMGCoA)reductaseinhibitorsreduceserumcholesterolandareincreasinglyadvocatedinprimarypreventiontoachievereductionsinLDL cholesterol. Newer dietary approaches combining cholesterolloweringfoodsmayofferanotheroption,buttheseapproacheshave not been compared directly with statins in the same persons. Objective: The objective was to compare, in the same subjects, the cholesterol-loweringpotentialofadietaryportfoliowiththatofastatin. Design:Thirty-fourhyperlipidemicparticipantsunderwentallthree 1-mo treatments in random order as outpatients: a very-lowsaturated-fat diet (control diet), the same diet plus 20 mg lovastatin (statin diet), and a diet high in plant sterols (1.0 g/1000 kcal), soyprotein foods (including soy milks and soy burgers, 21.4 g/1000 kcal), almonds (14 g/1000 kcal), and viscous fibers from oats, barley, psyllium, and the vegetables okra and eggplant (10 g/1000 kcal) (portfolio diets). Fasting blood samples were obtained at 0, 2, and 4 wk. Results:LDL-cholesterol concentrations decreased by 8.51.9%, 33.3 1.9%, and 29.6 1.3% after 4 wk of the control, statin, and portfolio diets, respectively. Although the absolute difference between the statin and the portfolio treatments was significant at 4 wk (P 0.013), 9 participants (26%) achieved their lowest LDLcholesterol concentrations with the portfolio diet. Moreover, the statin (n 27) and the portfolio (n 24) diets did not differ significantly (P 0.288) in their ability to reduce LDL cholesterol below the 3.4-mmol/L primary prevention cutoff. Conclusions: Dietary combinations may not differ in potency from first-generation statins in achieving current lipid goals for primary prevention.Theymay,therefore,bridgethetreatmentgapbetweencurrent therapeutic diets and newer statins. Am J Clin Nutr 2005;81
- Published
- 2005
39. Soy Consumption and Phytoestrogens: Effect on Serum Prostate Specific Antigen When Blood Lipids and Oxidized Low-Density Lipoprotein are Reduced in Hyperlipidemic Men
- Author
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Edward Vidgen, David J.A. Jenkins, John Honey, Neil Fleshner, Chung-Ja C. Jackson, Cyril W. C. Kendall, William Singer, Laurence Klotz, George Koumbridis, Jason A. Silverman, Mario A. D’Costa, and A. Venket Rao
- Subjects
medicine.medical_specialty ,Cholesterol ,business.industry ,Urology ,Blood lipids ,Isoflavones ,urologic and male genital diseases ,medicine.disease ,chemistry.chemical_compound ,Prostate-specific antigen ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Prostate ,Internal medicine ,Hyperlipidemia ,medicine ,Phytoestrogens ,business ,Soy protein - Abstract
Purpose: Herbal remedies high in phytoestrogens have been shown to reduce serum prostate specific antigen (PSA) and have been proposed as a treatment for prostate cancer. Soy proteins used to lower serum cholesterol are rich sources of phytoestrogens. Therefore, we assessed the effect of soy consumption on serum PSA in men who had participated in cholesterol lowering studies.Materials and Methods: For 3 to 4 weeks 46 healthy middle-aged men with a range of starting PSA values took soy (mean 44 gm. soy protein daily, 116 mg. isoflavones daily) or control foods, and a subgroup of men took a lower level of soy supplements for 3 months. PSA was measured at the start and end of each treatment.Results: Soy had no significant effect on serum total or free PSA, independent of PSA starting value or isoflavone intake. The lack of effect on PSA was seen, although soy intake was sufficient to reduce low-density lipoprotein cholesterol (5.8 ± 2.2%, p = 0.012), the estimated coronary heart disease risk (6.1 ± 2.8% for ...
- Published
- 2003
40. Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women
- Author
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Dorothea Faulkner, Robert G. Josse, Chung-Ja C. Jackson, Stephen C. Cunnane, David J.A. Jenkins, Tina Parker, Cyril W. C. Kendall, Lawrence A. Leiter, Edward Vidgen, and Philip W. Connelly
- Subjects
Male ,medicine.medical_specialty ,Apolipoprotein B ,Saturated fat ,Medicine (miscellaneous) ,Hemodynamics ,Blood lipids ,Blood Pressure ,Coronary Disease ,Hyperlipidemias ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Homocysteine ,Soy protein ,Cross-Over Studies ,Nutrition and Dietetics ,Dose-Response Relationship, Drug ,biology ,Chemistry ,Cholesterol ,Middle Aged ,Isoflavones ,Lipids ,Postmenopause ,Endocrinology ,Blood pressure ,Soybean Proteins ,biology.protein ,Female ,lipids (amino acids, peptides, and proteins) ,Dietary Proteins - Abstract
BACKGROUND Many of the benefits of soy have been attributed to soy isoflavones. OBJECTIVE The objective was to determine the effects of high- and low-isoflavone soy-protein foods on both lipid and nonlipid risk factors for coronary artery disease (CAD). METHODS Forty-one hyperlipidemic men and postmenopausal women participated in a study with three 1-mo diets: a low-fat dairy food control diet and high- (50 g soy protein and 73 mg isoflavones daily) and low- (52 g soy protein and 10 mg isoflavones daily) isoflavone soyfood diets. All 3 diets were very low in saturated fat (< 5% of energy) and cholesterol (< 50 mg/d). Fasting blood samples were drawn and blood pressure was measured at the start and end of each diet. RESULTS No significant differences were seen between the high- and low-isoflavone soy diets. Compared with the control diet, however, both soy diets resulted in significantly lower total cholesterol, estimated CAD risk, and ratios of total to HDL cholesterol, LDL to HDL cholesterol, and apolipoprotein B to A-I. No significant sex differences were observed, except for systolic blood pressure, which in men was significantly lower after the soy diets than after the control diet. On the basis of blood lipid and blood pressure changes, the calculated CAD risk was significantly lower with the soy diets, by 10.1 +/- 2.7%. CONCLUSION Substitution of soyfoods for animal products, regardless of isoflavone concentration, reduces the CAD risk because of both modest reductions in blood lipids and reductions in oxidized LDL, homocysteine, and blood pressure.
- Published
- 2002
41. Effects of high- and low-isoflavone (phytoestrogen) soy foods on inflammatory biomarkers and proinflammatory cytokines in middle-aged men and women
- Author
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Cyril W. C. Kendall, David J.A. Jenkins, Tina Parker, Dorothea Faulkner, Chung-Ja C. Jackson, Philip W. Connelly, and Edward Vidgen
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Male ,medicine.medical_specialty ,Diet therapy ,Endocrinology, Diabetes and Metabolism ,Saturated fat ,Hypercholesterolemia ,Administration, Oral ,Phytoestrogens ,Proinflammatory cytokine ,Cholesterol, Dietary ,chemistry.chemical_compound ,Sex Factors ,Endocrinology ,Internal medicine ,Humans ,Medicine ,Estrogens, Non-Steroidal ,Serum amyloid A ,Soy protein ,Serum Amyloid A Protein ,Inflammation ,Dose-Response Relationship, Drug ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,Cholesterol ,Middle Aged ,Dietary Fats ,Isoflavones ,Diet ,Apolipoproteins ,C-Reactive Protein ,chemistry ,Cytokines ,Female ,Plant Preparations ,Soybeans ,business ,Biomarkers - Abstract
This study sought to determine effects of high- and low-isoflavone soy protein foods on acute-phase proteins and proinflammatory cytokines and whether isoflavone phytoestrogens might act as estrogens, which enhance the immune response. Forty-one hypercholesterolemic men and postmenopausal women underwent three 1-month diets consisting of a low-fat dairy food control phase and high- and low-isoflavone soy food test phases (50 g/d and 52g/d soy protein, respectively, and 73 mg/d and 10 mg/d isoflavone, respectively). Diets were low in saturated fat (
- Published
- 2002
42. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial
- Author
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Cyril W. C. Kendall, David J.A. Jenkins, Dorothea Faulkner, Mary Ann Ryan, Tina Parker, Edward Vidgen, Vladimir Vuksan, Christine C. Mehling, Giulio Testolin, Paul Corey, Stephen C. Cunnane, and Marcella Garsetti
- Subjects
Adult ,Dietary Fiber ,Male ,medicine.medical_specialty ,Health Status ,Population ,Medicine (miscellaneous) ,Blood Pressure ,Risk Assessment ,Gastroenterology ,Psyllium ,chemistry.chemical_compound ,Framingham Heart Study ,Risk Factors ,Internal medicine ,Humans ,Medicine ,education ,Drug Approval ,Glucans ,Completely randomized design ,Aged ,Aged, 80 and over ,education.field_of_study ,Cross-Over Studies ,Nutrition and Dietetics ,Framingham Risk Score ,Dose-Response Relationship, Drug ,business.industry ,Cholesterol ,Middle Aged ,Lipids ,Crossover study ,Apolipoproteins ,Endocrinology ,Blood pressure ,Solubility ,chemistry ,Cardiovascular Diseases ,Female ,business ,medicine.drug - Abstract
BACKGROUND The US Food and Drug Administration (FDA) approved health claims for 2 dietary fibers, beta-glucan (0.75 g/serving) and psyllium (1.78 g/serving), on the assumption that 4 servings/d would reduce cardiovascular disease risk. OBJECTIVE We assessed the efficacy of this dose of fibers in reducing serum lipid risk factors for cardiovascular disease. DESIGN Sixty-eight hyperlipidemic adults consumed a test (high-fiber) and a control low-fat (25% of energy), low-cholesterol (
- Published
- 2002
43. Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds
- Author
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Darshna Patel, Russell J. de Souza, Peter B. Jones, Shahad Abdulnour, Benoît Lamarche, Korbua Srichaikul, Jiri Frohlich, Christopher Ireland, Cyril W. C. Kendall, Robert G. Josse, Balachandran Bashyam, Lawrence A. Leiter, Luba Cermakova, David J.A. Jenkins, Vanu Ramprasath, Patrick Couture, Edward Vidgen, Dorothea Faulkner, Philip W. Connelly, and University of Manitoba
- Subjects
Dietary Fiber ,Male ,Fat soluble vitamins ,030309 nutrition & dietetics ,Medicine (miscellaneous) ,Blood lipids ,Tocopherols ,030204 cardiovascular system & hematology ,Portfolio diet ,chemistry.chemical_compound ,0302 clinical medicine ,Lycopene ,Hyperlipidemia ,Nuts ,Single-Blind Method ,Food science ,Vitamin A ,0303 health sciences ,Nutrition and Dietetics ,Retinol ,Phytosterols ,Vitamins ,Middle Aged ,beta Carotene ,3. Good health ,Cholesterol ,Biochemistry ,Intestinal cholesterol absorption ,lipids (amino acids, peptides, and proteins) ,Female ,Adult ,Canada ,Campesterol ,education ,Hyperlipidemias ,Clinical nutrition ,Plant sterols ,03 medical and health sciences ,medicine ,Humans ,Triglycerides ,business.industry ,Research ,Cholesterol, HDL ,Lutein ,Cholesterol, LDL ,Feeding Behavior ,medicine.disease ,Carotenoids ,Sitosterols ,Diet ,Fat-Soluble Vitamin ,chemistry ,business ,Follow-Up Studies - Abstract
Background Consumption of a cholesterol lowering dietary portfolio including plant sterols (PS), viscous fibre, soy proteins and nuts for 6 months improves blood lipid profile. Plant sterols reduce blood cholesterol by inhibiting intestinal cholesterol absorption and concerns have been raised whether PS consumption reduces fat soluble vitamin absorption. Objective The objective was to determine effects of consumption of a cholesterol lowering dietary portfolio on circulating concentrations of PS and fat soluble vitamins. Methods Using a parallel design study, 351 hyperlipidemic participants from 4 centres across Canada were randomized to 1 of 3 groups. Participants followed dietary advice with control or portfolio diet. Participants on routine and intensive portfolio involved 2 and 7 clinic visits, respectively, over 6 months. Results No changes in plasma concentrations of α and γ tocopherol, lutein, lycopene and retinol, but decreased β-carotene concentrations were observed with intensive (week 12:p = 0.045; week 24:p = 0.039) and routine (week 12:p = 0.031; week 24:p = 0.078) portfolio groups compared to control. However, cholesterol adjusted β-carotene and fat soluble compound concentrations were not different compared to control. Plasma PS concentrations were increased with intensive (campesterol:p = 0.012; β-sitosterol:p = 0.035) and routine (campesterol: p = 0.034; β-sitosterol: p = 0.080) portfolio groups compared to control. Plasma cholesterol-adjusted campesterol and β-sitosterol concentrations were negatively correlated (p
- Published
- 2014
44. Health benefits of nuts in prevention and management of diabetes
- Author
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Cyril W C, Kendall, Amin, Esfahani, Jennifer, Truan, Korbua, Srichaikul, and David J A, Jenkins
- Subjects
Blood Glucose ,Diabetes Complications ,Diabetes Mellitus, Type 2 ,Species Specificity ,Cardiovascular Diseases ,Hyperglycemia ,Humans ,Nuts ,Lipids ,Nutritive Value - Abstract
The effects of tree nuts on risk factors for coronary heart disease (CHD), in particular blood lipids, have been investigated in a number of studies and the beneficial effects are now recognized. The beneficial effects of nuts on CHD in cohort studies have also been clearly demonstrated. However, while there is also reason to believe the unique micro- and macronutrient profiles of nuts may help to control blood glucose levels, relatively few studies have investigated their role in diabetes control and prevention. Nuts are low in available carbohydrate, have a healthy fatty acid profile, and are high in vegetable protein, fiber and magnesium. Acute feeding studies indicate that when eaten alone nuts have minimal effects on raising postprandial blood glucose levels. In addition, when nuts are consumed with carbohydrate rich foods, they blunt the postprandial glycemic response of the carbohydrate meal. Despite the success of these acute studies, only a limited number of trials have been conducted with nuts in type 2 diabetes. These studies have either been of insufficient duration to observe changes in HbA1c, as the standard measure of glycemic control, or have been underpowered. Therefore, more long-term clinical trials are required to examine the role of nuts on glycemic control in patients with prediabetes and diabetes. Overall, there are good reasons to justify further exploration of the use of nuts in the prevention of diabetes and its micro- and macrovascular complications.
- Published
- 2010
45. Session 4: CVD, diabetes and cancer: A dietary portfolio for management and prevention of heart disease
- Author
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Amin, Esfahani, David J A, Jenkins, and Cyril W C, Kendall
- Subjects
Dietary Fiber ,Male ,Phytosterols ,Coronary Disease ,Diet ,Cholesterol ,Risk Factors ,Neoplasms ,Vegetables ,Diabetes Mellitus ,Humans ,Nuts ,Female ,Dietary Proteins ,Phytotherapy ,Plant Proteins - Abstract
CHD is the leading cause of worldwide mortality. The prevalence of heart disease has been linked to the adoption of a sedentary lifestyle and the increased dietary dependence on saturated fats from animal sources and the intake of refined foods. Elevated blood cholesterol level is one of the major risk factors for CHD. While cholesterol-lowering drug therapy (statins) has been effective in reducing the risk of heart disease, there are those individuals who are unwilling or because of muscle pains or raised levels of liver or muscle enzymes are unable to take cholesterol-lowering medication. Fortunately, there is evidence linking a number of dietary components to CHD risk reduction. The strength of this evidence has prompted various regulatory bodies to advocate diet as the first line of defence for primary prevention of heart disease. It was therefore decided to combine four dietary components that have been shown to lower blood cholesterol concentrations (nuts, plant sterols, viscous fibre and vegetable protein) in a dietary portfolio in order to determine whether the combined effect is additive. In a metabolically-controlled setting this dietary portfolio has proved to be as effective as a starting dose of a first-generation statin cholesterol-lowering medication in reducing the risk of CHD. The dietary portfolio has also been shown to be effective in sustaining a clinically-significant effect in the long term under a 'real-world' scenario. However, success of the diet depends on compliance and despite the accessibility of the foods adherence has been found to vary greatly. Overall, the evidence supports the beneficial role of the dietary portfolio in reducing blood cholesterol levels and CHD risk.
- Published
- 2009
46. Heterogeneous effects of fructose on blood lipids in individuals with type 2 diabetes: systematic review and meta-analysis of experimental trials in humans
- Author
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John L, Sievenpiper, Amanda J, Carleton, Sheena, Chatha, Henry Y, Jiang, Russell J, de Souza, Joseph, Beyene, Cyril W C, Kendall, and David J A, Jenkins
- Subjects
Clinical Trials as Topic ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Reviews/Commentaries/ADA Statements ,Sweetening Agents ,Meta-analyses ,Humans ,Fructose ,Lipid Metabolism ,Lipids ,Triglycerides - Abstract
OBJECTIVE Because of blood lipid concerns, diabetes associations discourage fructose at high intakes. To quantify the effect of fructose on blood lipids in diabetes, we conducted a systematic review and meta-analysis of experimental clinical trials investigating the effect of isocaloric fructose exchange for carbohydrate on triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol in type 1 and 2 diabetes. RESEARCH DESIGN AND METHODS We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for relevant trials of ≥7 days. Data were pooled by the generic inverse variance method and expressed as standardized mean differences with 95% CI. Heterogeneity was assessed by χ2 tests and quantified by I2. Meta-regression models identified dose threshold and independent predictors of effects. RESULTS Sixteen trials (236 subjects) met the eligibility criteria. Isocaloric fructose exchange for carbohydrate raised triglycerides and lowered total cholesterol under specific conditions without affecting LDL cholesterol or HDL cholesterol. A triglyceride-raising effect without heterogeneity was seen only in type 2 diabetes when the reference carbohydrate was starch (mean difference 0.24 [95% CI 0.05–0.44]), dose was >60 g/day (0.18 [0.00–0.37]), or follow-up was ≤4 weeks (0.18 [0.00–0.35]). Piecewise meta-regression confirmed a dose threshold of 60 g/day (R2 = 0.13)/10% energy (R2 = 0.36). A total cholesterol–lowering effect without heterogeneity was seen only in type 2 diabetes under the following conditions: no randomization and poor study quality (−0.19 [−0.34 to −0.05]), dietary fat >30% energy (−0.33 [−0.52 to −0.15]), or crystalline fructose (−0.28 [−0.47 to −0.09]). Multivariate meta-regression analyses were largely in agreement. CONCLUSIONS Pooled analyses demonstrated conditional triglyceride-raising and total cholesterol–lowering effects of isocaloric fructose exchange for carbohydrate in type 2 diabetes. Recommendations and large-scale future trials need to address the heterogeneity in the data.
- Published
- 2009
47. Possible benefit of nuts in type 2 diabetes
- Author
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David J A, Jenkins, Frank B, Hu, Linda C, Tapsell, Andrea R, Josse, and Cyril W C, Kendall
- Subjects
Blood Glucose ,Arachis ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Humans ,Nuts ,Postprandial Period ,Life Style ,Nutritive Value ,Diet - Abstract
Nuts, including peanuts, are now recognized as having the potential to improve the blood lipid profile and, in cohort studies, nut consumption has been associated with a reduced risk of coronary heart disease (CHD). More recently, interest has grown in the potential value of including nuts in the diets of individuals with diabetes. Data from the Nurses Health Study indicates that frequent nut consumption is associated with a reduced risk of developing diabetes and cardiovascular disease. Randomized controlled trials of patients with type 2 diabetes have confirmed the beneficial effects of nuts on blood lipids also seen in nondiabetic subjects, but the trials have not reported improvement in A1c or other glycated proteins. Acute feeding studies, however, have demonstrated the ability of nuts, when eaten with carbohydrate (bread), to depress postprandial glycemia. Furthermore, there was evidence of reduced postprandial oxidative stress associated with nut consumption. In terms of dietary composition, nuts have a good nutritional profile, are high in monounsaturated fatty acids (MUFA) and PUFA, and are good sources of vegetable protein. Incorporation of nuts in the diet may therefore improve the overall nutritional quality of the diet. We conclude that there is justification to consider the inclusion of nuts in the diets of individuals with diabetes in view of their potential to reduce CHD risk, even though their ability to influence overall glycemic control remains to be established.
- Published
- 2008
48. The glycemic index: methodology and use
- Author
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Cyril W C, Kendall, Livia S A, Augustin, Azadeh, Emam, Andrea R, Josse, Nishta, Saxena, and David J A, Jenkins
- Subjects
Blood Glucose ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Food ,Glycemic Index ,Neoplasms ,Dietary Carbohydrates ,Humans ,Insulin ,Obesity ,Fatty Acids, Nonesterified ,Lipid Metabolism - Abstract
The glycemic index concept owes much to the dietary fiber hypothesis that fiber would reduce the rate of nutrient absorption and increase the value of carbohydrate foods in the maintenance of health and treatment of disease. However, properties and components of food other than its fiber content contribute to the glycemic and endocrine responses postprandially. The aim of the glycemic index classification of foods was therefore to assist in the physiological classification of carbohydrate foods which, it was hoped, would be of relevance in the prevention and treatment of chronic diseases such as diabetes. Over the past two decades low glycemic index diets have been reported to improve glycemic control in diabetic subjects, to reduce serum lipids in hyperlipidemic subjects and possibly to aid in weight control. In large cohort studies, low glycemic index or glycemic load diets (glycemic index multiplied by total carbohydrate) have also been associated with higher levels of high-density lipoprotein cholesterol, reduced C-reactive protein concentrations and with a decreased risk of developing diabetes and cardiovascular disease. More recently, some case-control and cohort studies have also found positive associations between the dietary glycemic index and the risk of colon, breast and other cancers. While the glycemic index concept continues to be debated and there remain inconsistencies in the data, sufficient positive findings have emerged to suggest that the glycemic index is an aspect of diet of potential importance in the treatment and prevention of chronic diseases.
- Published
- 2006
49. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia
- Author
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Robert G. Josse, Tri H. Nguyen, Candice Holmes, William Singer, Dorothea Faulkner, Cyril W. C. Kendall, Edward Vidgen, Augustine Marchie, Julia M W Wong, Elke A. Trautwein, Thomas Kemp, David J.A. Jenkins, Russell J. de Souza, Karen G. Lapsley, Lawrence A. Leiter, Azadeh Emam, and Philip W. Connelly
- Subjects
Adult ,Dietary Fiber ,Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Saturated fat ,Hypercholesterolemia ,Medicine (miscellaneous) ,Blood lipids ,Cholesterol, Dietary ,chemistry.chemical_compound ,Metabolic diet ,Internal medicine ,medicine ,Humans ,Aged ,Aged, 80 and over ,Nutrition and Dietetics ,business.industry ,Cholesterol ,Anticholesteremic Agents ,Cholesterol lowering ,Phytosterols ,Cholesterol, LDL ,Middle Aged ,Combined Modality Therapy ,Endocrinology ,Treatment Outcome ,chemistry ,Saturated fatty acid ,Soybean Proteins ,Portfolio ,Patient Compliance ,lipids (amino acids, peptides, and proteins) ,Female ,Prunus ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business - Abstract
Background: Cholesterol-lowering foods may be more effective when consumed as combinations rather than as single foods. Objectives: Our aims were to determine the effectiveness of consuming a combination of cholesterol-lowering foods (dietary portfolio) under real-world conditions and to compare these results with published data from the same participants who had undergone 4-wk metabolic studies to compare the same dietary portfolio with the effects of a statin. Design: For 12 mo, 66 hyperlipidemic participants were prescribed dietshighinplantsterols(1.0g/1000kcal),soyprotein(22.5g/1000 kcal),viscousfibers(10g/1000kcal),andalmonds(23g/1000kcal). Fifty-five participants completed the 1-y study. The 1-y data were also compared with published results on 29 of the participants who had also undergone separate 1-mo metabolic trials of a diet and a statin. Results: At 3 mo and 1 y, mean (SE) LDL-cholesterol reductions appeared stable at 14.0 1.6% (P 0.001) and 12.8 2.0% (P 0.001), respectively (n66). These reductions were less than those observed after the 1-mo metabolic diet and statin trials. Nevertheless, 31.8% of the participants (n 21 of 66) had LDL-cholesterol reductions of 20% at 1y( x SE: 29.7 1.6%). The LDLcholesterol reductions in this group were not significantly different from those seen after their respective metabolically controlled portfolio or statin treatments. A correlation was found between total dietary adherence and LDL-cholesterol change (r 0.42, P 0.001). Only 2 of the 26 participants with 55% compliance achieved LDL-cholesterol reductions 20% at 1 y. Conclusions: More than 30% of motivated participants who ate the dietary portfolio of cholesterol-lowering foods under real-world conditions were able to lower LDL-cholesterol concentrations 20%, which was not significantly different from their response to a first-generation statin taken under metabolically controlled conditions. Am J Clin Nutr 2006;83:582–91.
- Published
- 2006
50. Assessment of the Longer Term Effects of a Dietary Portfolio of Cholesterol Lowering Foods in Hypercholesterolemia
- Author
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David J.A. Jenkins, Cyril W. C. Kendall, and Dorothea Faulkner
- Subjects
business.industry ,Environmental health ,Genetics ,Medicine ,Portfolio ,Cholesterol lowering ,business ,Molecular Biology ,Biochemistry ,Biotechnology ,Term (time) - Published
- 2006
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