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Interactions between Mediterranean Diet Supplemented with Dairy Foods and the Gut Microbiota Influence Cardiovascular Health in an Australian Population.
Choo, JM, Murphy, KJ, Wade, AT, Wang, Y, Bracci, EL, Davis, CR, Dyer, KA, Woodman, RJ, Hodgson, JM, Rogers, GB
Nutrients. 2023;15(16)
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Diet is a fundamental determinant of metabolic health and immune regulation. Long-term dietary patterns also play an important role in shaping the intestinal commensal microbiota. The aim of this study was to explore the effects of an-8 week Mediterranean Diet enriched with dairy foods on the gut microbiome of Australian adults at risk of cardiovascular disease. This study was a randomised controlled trial with a 2 × 2 cross-over design. Participants followed a Mediterranean diet with 3–4 daily serves of dairy foods of 1000–1300mg per day (MedDairy) or low-fat diet (LFD) diet intervention for 8 weeks, separated by an 8-week washout phase where participants returned to their habitual diet. Participants (n= 43) were randomly assigned to their first dietary phase. Results showed that compared to the LFD (control), the MedDairy diet did not result in broad changes to the gut microbiota but significantly altered the relative abundance of selected bacterial taxa. Furthermore, microbial changes, including an increase in Butyricicoccus, were inversely correlated with changes in systolic blood pressure. Authors conclude that an 8-week MedDiet supplemented with dairy foods results in relative abundance changes in bacterial taxa.
Abstract
The impact of a Mediterranean diet on the intestinal microbiome has been linked to its health benefits. We aim to evaluate the effects of a Mediterranean diet supplemented with dairy foods on the gut microbiome in Australians at risk of cardiovascular disease. In a randomised controlled cross-over study, 34 adults with a systolic blood pressure ≥120 mmHg and with risk factors for cardiovascular disease were randomly allocated to a Mediterranean diet with 3-4 daily serves of dairy foods (Australian recommended daily intake (RDI) of 1000-1300 mg per day (MedDairy)) or a low-fat (LFD) control diet. Between each 8-week diet, participants underwent an 8-week washout period. Microbiota characteristics of stool samples collected at the start and end of each diet period were determined by 16S rRNA amplicon sequencing. MedDairy-associated effects on bacterial relative abundance were correlated with clinical, anthropometric, and cognitive outcomes. No change in the overall faecal microbial structure or composition was observed with either diet (p > 0.05). The MedDairy diet was associated with changes in the relative abundance of several bacterial taxa, including an increase in Butyricicoccus and a decrease in Colinsella and Veillonella (p < 0.05). Increases in Butyricicoccus relative abundance over 8 weeks were inversely correlated with lower systolic blood pressure (r = -0.38, p = 0.026) and positively correlated with changes in fasting glucose levels (r = 0.39, p = 0.019), specifically for the MedDairy group. No significant associations were observed between the altered taxa and anthropometric or cognitive measures (p > 0.05). Compared to a low-fat control diet, the MedDairy diet resulted in changes in the abundance of specific gut bacteria, which were associated with clinical outcomes in adults at risk of CVD.
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Gut microbiome modulates the effects of a personalised postprandial-targeting (PPT) diet on cardiometabolic markers: a diet intervention in pre-diabetes.
Ben-Yacov, O, Godneva, A, Rein, M, Shilo, S, Lotan-Pompan, M, Weinberger, A, Segal, E
Gut. 2023;72(8):1486-1496
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Diet is a major contributor to cardiometabolic health and plays a fundamental role in the prevention, management and even reversal of many chronic diseases. The gut microbiota has a central role in human health and disease. Specifically, its role in cardiometabolic health has been studied extensively in recent years. The aim of this study was to evaluate the interplay between dietary modifications, microbiome composition and cardiometabolic health outcomes. This study was a randomised controlled trial of a 6-month dietary intervention comparing a personalised postprandial-targeting (PPT) diet versus Mediterranean (MED) diet in 200 adults with pre-diabetes. Results showed that: - PPT intervention induced greater changes in multiple dietary features compared with MED intervention. - PPT intervention increased microbiome diversity and richness and exerted specific microbiome species changes that associate with clinical outcomes. - Changes in specific gut microbiome species partially mediated the effects of dietary modifications on clinical outcomes. Authors conclude that the PPT diet prompted greater changes in gut microbiota composition, consistent with overall greater dietary modifications, as compared with the MED intervention.
Abstract
OBJECTIVE To explore the interplay between dietary modifications, microbiome composition and host metabolic responses in a dietary intervention setting of a personalised postprandial-targeting (PPT) diet versus a Mediterranean (MED) diet in pre-diabetes. DESIGN In a 6-month dietary intervention, adults with pre-diabetes were randomly assigned to follow an MED or PPT diet (based on a machine-learning algorithm for predicting postprandial glucose responses). Data collected at baseline and 6 months from 200 participants who completed the intervention included: dietary data from self-recorded logging using a smartphone application, gut microbiome data from shotgun metagenomics sequencing of faecal samples, and clinical data from continuous glucose monitoring, blood biomarkers and anthropometrics. RESULTS PPT diet induced more prominent changes to the gut microbiome composition, compared with MED diet, consistent with overall greater dietary modifications observed. Particularly, microbiome alpha-diversity increased significantly in PPT (p=0.007) but not in MED arm (p=0.18). Post hoc analysis of changes in multiple dietary features, including food-categories, nutrients and PPT-adherence score across the cohort, demonstrated significant associations between specific dietary changes and species-level changes in microbiome composition. Furthermore, using causal mediation analysis we detect nine microbial species that partially mediate the association between specific dietary changes and clinical outcomes, including three species (from Bacteroidales, Lachnospiraceae, Oscillospirales orders) that mediate the association between PPT-adherence score and clinical outcomes of hemoglobin A1c (HbA1c), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Finally, using machine-learning models trained on dietary changes and baseline clinical data, we predict personalised metabolic responses to dietary modifications and assess features importance for clinical improvement in cardiometabolic markers of blood lipids, glycaemic control and body weight. CONCLUSIONS Our findings support the role of gut microbiome in modulating the effects of dietary modifications on cardiometabolic outcomes, and advance the concept of precision nutrition strategies for reducing comorbidities in pre-diabetes. TRIAL REGISTRATION NUMBER NCT03222791.
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Gut Microbiota-Derived Metabolites and Cardiovascular Disease Risk: A Systematic Review of Prospective Cohort Studies.
Sanchez-Gimenez, R, Ahmed-Khodja, W, Molina, Y, Peiró, OM, Bonet, G, Carrasquer, A, Fragkiadakis, GA, Bulló, M, Bardaji, A, Papandreou, C
Nutrients. 2022;14(13)
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Cardiovascular disease (CVD) remains a major public health issue. Identification of circulating biomarkers with prognostic value may help to both identify pathophysiological processes relevant to CVD development and improve preventive cardiovascular risk reduction efforts. The aim of this study was to identify the association of circulating levels of microbial metabolites with CVD incidence. This study is a systematic review of twenty-one studies of which 19 were prospective cohort studies, one study included one nested case-control study and one study included two nested case–control studies. Results show that: - associations of trimethylamine N-oxide (TMAO) [molecular metabolite derived from the gut flora] and subsequent risk of CV outcomes were supported by some but not all prospective studies. - inconsistent results were also obtained for secondary bile acids in relation to CVD and related outcomes, and CVD/all-cause mortality. - with regards to branched-chain amino acids (BCAAs), their associations with CV outcomes were robust amongst most of the studies. Authors conclude that their findings show inconsistent results for TMAO and bile acids but robust ones for the relationships between BCAAs and CVD. Thus, further studies are needed to investigate whether circulating microbial metabolites could be an intervention target for CVD.
Abstract
Gut microbiota-derived metabolites have recently attracted considerable attention due to their role in host-microbial crosstalk and their link with cardiovascular health. The MEDLINE-PubMed and Elsevier's Scopus databases were searched up to June 2022 for studies evaluating the association of baseline circulating levels of trimethylamine N-oxide (TMAO), secondary bile acids, short-chain fatty acids (SCFAs), branched-chain amino acids (BCAAs), tryptophan and indole derivatives, with risk of cardiovascular disease (CVD). A total of twenty-one studies were included in the systematic review after evaluating 1210 non-duplicate records. There were nineteen of the twenty-one studies that were cohort studies and two studies had a nested case-control design. All of the included studies were of high quality according to the "Newcastle-Ottawa Scale". TMAO was positively associated with adverse cardiovascular events and CVD/all-cause mortality in some, but not all of the included studies. Bile acids were associated with atrial fibrillation and CVD/all-cause mortality, but not with CVD. Positive associations were found between BCAAs and CVD, and between indole derivatives and major adverse cardiovascular events, while a negative association was reported between tryptophan and all-cause mortality. No studies examining the relationship between SCFAs and CVD risk were identified. Evidence from prospective studies included in the systematic review supports a role of microbial metabolites in CVD.
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Impact of wheat aleurone on biomarkers of cardiovascular disease, gut microbiota and metabolites in adults with high body mass index: a double-blind, placebo-controlled, randomized clinical trial.
Fava, F, Ulaszewska, MM, Scholz, M, Stanstrup, J, Nissen, L, Mattivi, F, Vermeiren, J, Bosscher, D, Pedrolli, C, Tuohy, KM
European journal of nutrition. 2022;61(5):2651-2671
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Cross-sectional studies have shown that whole grain cereal consumption can reduce the risk of cardiovascular disease (CVD, as well as reduce systemic inflammation, which is linked to many chronic diet associated diseases. Aleurone is a wheat grain fraction composed of a single cell layer that constitutes the outermost portion of the endosperm and contains many of the beneficial substances. The primary aim of this study was to investigate the effect of aleurone consumption on plasma homocysteine concentrations in overweight/ obese subjects. Secondary aim was to measure the impact of chronic aleurone supplementation on markers of CVD risk and on the human gut microbiota and its metabolic output. This study is a placebo-controlled, randomised, double-blind parallel trial with 2 test foods, wheat aleurone-rich foods or placebo foods (cellulose). Participants (n=74) were randomised to receive the active supplementation (aleurone 27 g per day) or placebo for 4 consecutive weeks. Results show that although average plasma homocysteine levels decreased upon wheat aleurone supplementation treatment, this change was not statistically significant, and homocysteine levels did not differ between groups after intervention. Furthermore, there was a significant increase in bifidobacteria both over time and compared to the placebo. Several significant and useful biomarkers of wheat aleurone intake, all related to wheat polyphenol metabolism by the gut microbiota, were identified. Authors conclude that wheat aleurone supplementation has the potential to modulate the gut microbial metabolic output and increase faecal bifidobacterial abundance, but it does not impact plasma homocysteine or other CVD biomarkers.
Abstract
PURPOSE Aleurone is a cereal bran fraction containing a variety of beneficial nutrients including polyphenols, fibers, minerals and vitamins. Animal and human studies support the beneficial role of aleurone consumption in reducing cardiovascular disease (CVD) risk. Gut microbiota fiber fermentation, polyphenol metabolism and betaine/choline metabolism may in part contribute to the physiological effects of aleurone. As primary objective, this study evaluated whether wheat aleurone supplemented foods could modify plasma homocysteine. Secondary objectives included changes in CVD biomarkers, fecal microbiota composition and plasma/urine metabolite profiles. METHODS A parallel double-blind, placebo-controlled and randomized trial was carried out in two groups of obese/overweight subjects, matched for age, BMI and gender, consuming foods supplemented with either aleurone (27 g/day) (AL, n = 34) or cellulose (placebo treatment, PL, n = 33) for 4 weeks. RESULTS No significant changes in plasma homocysteine or other clinical markers were observed with either treatment. Dietary fiber intake increased after AL and PL, animal protein intake increased after PL treatment. We observed a significant increase in fecal Bifidobacterium spp with AL and Lactobacillus spp with both AL and PL, but overall fecal microbiota community structure changed little according to 16S rRNA metataxonomics. Metabolomics implicated microbial metabolism of aleurone polyphenols and revealed distinctive biomarkers of AL treatment, including alkylresorcinol, cinnamic, benzoic and ferulic acids, folic acid, fatty acids, benzoxazinoid and roasted aroma related metabolites. Correlation analysis highlighted bacterial genera potentially linked to urinary compounds derived from aleurone metabolism and clinical parameters. CONCLUSIONS Aleurone has potential to modulate the gut microbial metabolic output and increase fecal bifidobacterial abundance. However, in this study, aleurone did not impact on plasma homocysteine or other CVD biomarkers. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT02067026) on the 17th February 2014.
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Combined berberine and probiotic treatment as an effective regimen for improving postprandial hyperlipidemia in type 2 diabetes patients: a double blinded placebo controlled randomized study.
Wang, S, Ren, H, Zhong, H, Zhao, X, Li, C, Ma, J, Gu, X, Xue, Y, Huang, S, Yang, J, et al
Gut microbes. 2022;14(1):2003176
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Hyperlipidaemia is a major risk factor for atherosclerotic cardiovascular diseases particularly when combined with hyperglycaemia and type 2 diabetes (T2D). Current diagnostic criteria and treatment targets are based on evaluating fasting lipidaemia (FL). However, increasing evidence has supported that a high level of non-fasting lipidaemia, mainly constituted by post-prandial lipidaemia (PL), is also an important CVD risk factor. The aim of this study was to investigate how the combination treatment of berberine (BBR) and probiotics (Prob), or either one could exert benefit on lowering PL, and whether their impact on gut microbiota could contribute to this effect. This study is based on the PREMOTE trial, which was a randomised, double-blind, placebo-controlled clinical trial in 20 medical centres in China and enrolled newly diagnosed T2D patients. This lipidomic study included 365 of the 409 participants enrolled for the PREMOTE trial. Results showed that: - Prob+BBR combined therapy exerted a similar effect on reducing fasting lipidaemia with BBR alone but a superior effect on the levels of postprandial plasma total cholesterol and post-prandial low-density lipoprotein cholesterol compared to either BBR or Prob alone. - a substantial decrease in various lipid species after Prob+BBR treatment. Authors conclude that their findings proved the therapeutic effect of a combined treatment of oral administration of probiotics with berberine on improving PL in patients newly diagnosed with T2D and proposed a new gut microbiome related remedy for managing dyslipidaemia, covering both PL and FL, in patients with T2D.
Abstract
Non-fasting lipidemia (nFL), mainly contributed by postprandial lipidemia (PL), has recently been recognized as an important cardiovascular disease (CVD) risk as fasting lipidemia (FL). PL serves as a common feature of dyslipidemia in Type 2 Diabetes (T2D), albeit effective therapies targeting on PL were limited. In this study, we aimed to evaluate whether the therapy combining probiotics (Prob) and berberine (BBR), a proven antidiabetic and hypolipidemic regimen via altering gut microbiome, could effectively reduce PL in T2D and to explore the underlying mechanism. Blood PL (120 min after taking 100 g standard carbohydrate meal) was examined in 365 participants with T2D from the Probiotics and BBR on the Efficacy and Change of Gut Microbiota in Patients with Newly Diagnosed Type 2 Diabetes (PREMOTE study), a random, placebo-controlled, and multicenter clinical trial. Prob+BBR was superior to BBR or Prob alone in improving postprandial total cholesterol (pTC) and low-density lipoprotein cholesterol (pLDLc) levels with decrement of multiple species of postprandial lipidomic metabolites after 3 months follow-up. This effect was linked to the changes of fecal Bifidobacterium breve level responding to BBR alone or Prob+BBR treatment. Four fadD genes encoding long-chain acyl-CoA synthetase were identified in the genome of this B. breve strain, and transcriptionally activated by BBR. In vitro BBR treatment further decreased the concentration of FFA in the culture medium of B. breve compared to vehicle. Thus, the activation of fadD by BBR could enhance FFA import and mobilization in B. breve and diliminish the intraluminal lipids for absorption to mediate the effect of Prob+BBR on PL. Our study confirmed that BBR and Prob (B. breve) could exert a synergistic hypolipidemic effect on PL, acting as a gut lipid sink to achieve better lipidemia and CVD risk control in T2D.
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Intake and adequacy of the vegan diet. A systematic review of the evidence.
Bakaloudi, DR, Halloran, A, Rippin, HL, Oikonomidou, AC, Dardavesis, TI, Williams, J, Wickramasinghe, K, Breda, J, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2021;40(5):3503-3521
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This systematic review investigated vegan diets in the European populations and their adequacy of macro-and micronutrient intake, compared to the recommendations of the World Health Organization. Included were 48 studies and their outcomes regarding protein, carbohydrates, fats and micronutrients summarized. The overall results and their impact on health are discussed in the later sections of the paper. Adequate intake amongst vegans was seen with carbohydrates, fats, Vitamin A, B1, В6, C, E, iron, phosphorus, magnesium, copper and folate. Sodium exceeded recommended intake, whilst protein, Vitamin B2, B3, B12, D, iodine, zinc, calcium, potassium, selenium was of low consumption in a vegan diet. The bioavailability of some nutrients was also acknowledged. In summary, following a vegan diet appears to have positive and negative aspects. A vegan diet profile can contribute to disease prevention with lower incidence rates of obesity, Type 2 diabetes, and cardiovascular disease. Yet veganism appears to increase the risk for mental health conditions, bone fractures, immune system impairments, anaemias and deficiencies from low nutrient intake. This review yields a comprehensive overview of the positive and negative health consequences of a vegan diet. It may be a useful reference for those looking to support vegans or individuals considering adopting a vegan diet pattern.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Vegan diets in European populations tend to be lower in protein intake, particularly amino acids lysine, methionine and tryptophan.
- Other micronutrients that tend to lower in vegan diets are Vitamin B12, zinc, calcium and selenium.
- Healthcare practitioners should be aware of these potential deficiencies when working with vegan clients.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Vegan diets have become increasingly popular in the last ten years. This systematic review of 48 studies investigated the adequacy of vegan diets in European populations. It compared their macro- and micronutrient intakes compared to World Health Organization recommendations. It found that vegan diets tend to be lower in protein and in essential amino acids (lysine, methionine and tryptophan). They can also be lower in micronutrients especially vitamin B12, zinc, calcium and selenium. However, the lower intakes are not always associated with health impairments.
Clinical practice applications:
Practitioners should be aware of the potential deficiencies in a vegan diet.
Considerations for future research:
More research is needed to determine whether lower nutrient intakes in vegans correlated with poor health outcomes.
Abstract
BACKGROUND Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. METHODS A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. RESULTS Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24-0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. CONCLUSIONS Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.
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Improvement in Gastrointestinal Quality of Life Index (GIQLI) following meditation: An open-trial pilot study in India.
Kanchibhotla, D, Sharma, P, Subramanian, S
Journal of Ayurveda and integrative medicine. 2021;12(1):107-111
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Gut health is a complex phenomenon, consisting of micro and macro integrity of various gastrointestinal organs from oesophagus to the rectum, allowing us to eat and digest without discomfort. The aim of this study was to investigate the improvement in gut health and gastrointestinal quality of life with the regular practice of a novel meditation called the Vaishvanara Agni meditation (VAM). This study was an open-trial single-arm, pre-post pilot study. Of all the 80 participants enrolled for the study, 54 participants completed the assessments at all three time points, and were considered for data analysis. Results indicate an overall improvement in the quality of life with regular practice of Vaishvanara Agni meditation. In fact, regular practice of VAM not only improved the physical strength and digestion of the individual, but also contributed to their mental, emotional and social health. Authors conclude that meditation practices which focus on improving digestion can be an effective tool for improving gut health.
Abstract
BACKGROUND Medical science is increasingly recognizing the role of gut health in achieving optimal wellbeing. A healthy gut improves digestion. Additionally, it has a positive impact on multiple physiological networks such as immune system, central nervous system and hepato-endocrine system, thus contributing to the overall quality of life. Functional gastrointestinal disorders: also known as disorders of gut-brain interaction, such as irritable bowel syndrome are increasing worldwide. Conditions like stress, anxiety and mental disorders are correlated with these disorders. Mind-body interventions have been shown to ameliorate stress, anxiety and related conditions that may aggravate functional gastrointestinal disorders. OBJECTIVE The present study aims to investigate the benefits of a novel meditation technique called the Vaishvanara Agni meditation (VAM) on the gastrointestinal quality of life. MATERIALS AND METHODS 54 subjects participated in the study and practiced VAM for 50 days. During the Vaishvanara Agni meditation (VAM), attention is directed to the navel region and the digestive system. The effect of the meditation was evaluated using the gastrointestinal quality of life (GI-QoL) questionnaire, which was administered to subjects at three different time points i.e. day 0, day 24 and day 50. RESULTS GI-QoL was significantly improved with the practice of VAM. Additionally, significant improvements were noticed in all sub domains especially core symptoms, physical strength and the psychological domain. CONCLUSION Meditation practices that focus on improving digestion can be an effective tool for improving gut health.
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Yogurt, cultured fermented milk, and health: a systematic review.
Savaiano, DA, Hutkins, RW
Nutrition reviews. 2021;79(5):599-614
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Many fermented foods are associated with health benefits, including fermented dairy products. Whereby diary itself is part of many nutritional guidelines, the guidances rarely distinguish between dairy and fermented dairy. This qualitative, systematic review sought to capture how consumption of fermented milk products influences health. The review included 108 studies, with over 70% reporting beneficial health outcomes. A small number of studies reported insignificant or neutral results and four unfavourable ones. The aspects of health that were considered included lactose digestion and tolerance, gut health and disease, diarrhoea and constipation, irritable bowel syndrome, cardiovascular health and disease, hypertension, blood lipids, cancer risk, colorectal/breast/prostate cancer, weight and body composition, diabetes risk and metabolic syndrome and bone health. The authors concluded that eating fermented dairy products aided lactose digestion and showed a consistent link with reduced risk of breast and colorectal cancer, type 2 diabetes, and improved weight maintenance, cardiovascular, bone, and gastrointestinal health. As dairy appears to increase the risk for prostate cancer, fermented dairy seems to be no different here to unfermented dairy at increasing the risk. Some potential mechanisms are proposed in the discussion section, how fermented dairy may elicit its health benefits. Given the predominant health benefits of fermented dairy, the authors encouraged to include fermented dairy into national nutrition guidelines and stress distinction between dairy and fermented dairy products. This review captures current evidence of the widespread health benefits of fermented dairy consumption worthwhile considering in clinical practice. In the absence of more clear findings in relation to prostate cancer and prevention, a cautious approach to dairy and fermented dairy consumption may be warranted.
Abstract
Consumption of yogurt and other fermented products is associated with improved health outcomes. Although dairy consumption is included in most dietary guidelines, there have been few specific recommendations for yogurt and cultured dairy products. A qualitative systematic review was conducted to determine the effect of consumption of fermented milk products on gastrointestinal and cardiovascular health, cancer risk, weight management, diabetes and metabolic health, and bone density using PRISMA guidelines. English language papers in PubMed were searched, with no date restrictions. In total, 1057 abstracts were screened, of which 602 were excluded owing to lack of appropriate controls, potential biases, and experimental design issues. The remaining 455 papers were independently reviewed by both authors and 108 studies were included in the final review. The authors met regularly to concur, through consensus, on relevance, methods, findings, quality, and conclusions. The included studies were published between 1979 and 2017. From the 108 included studies, 76 reported a favorable outcome of fermented milks on health and 67 of these were considered to be positive or neutral quality according to the Academy of Nutrition and Dietetics' Quality Criteria Checklist. Of the 32 remaining studies, the study outcomes were either not significant (28) or unfavorable (4), and most studies (18) were of neutral quality. A causal relationship exists between lactose digestion and tolerance and yogurt consumption, and consistent associations exist between fermented milk consumption and reduced risk of breast and colorectal cancer and type 2 diabetes, improved weight maintenance, and improved cardiovascular, bone, and gastrointestinal health. Further, an association exists between prostate cancer occurrence and dairy product consumption in general, with no difference between fermented and unfermented products. This article argues that yogurt and other fermented milk products provide favorable health outcomes beyond the milk from which these products are made and that consumption of these products should be encouraged as part of national dietary guidelines. Systematic review registration: PROSPERO registration no. CRD42017068953.
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Short- and potential long-term adverse health outcomes of COVID-19: a rapid review.
Leung, TYM, Chan, AYL, Chan, EW, Chan, VKY, Chui, CSL, Cowling, BJ, Gao, L, Ge, MQ, Hung, IFN, Ip, MSM, et al
Emerging microbes & infections. 2020;9(1):2190-2199
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The Coronavirus pandemic (Covid-19) has infected millions of people worldwide and there is evidence that it affects many systems in the human body. This rapid review summarises the current evidence on short-term negative health outcomes of Covid-19. It also assesses the risk of potential long-term negative effects by looking at data from the other coronaviruses; Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The burden for caring for Covid-19 survivors is likely to be huge and so policy makers need suitable data to put the appropriate care strategies in place. The review is divided into sections as per body system affected: Immune, respiratory, cardiovascular, gastrointestinal, hepatic and renal, neurological, dermatological, mental health, pregnancy and prenatal exposure. The evidence (short-term and long-term) is then reviewed by experts in those fields. Further large-scale studies are needed to monitor the adverse effects and to measure the long-term health consequences.
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.
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Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial.
Koutsos, A, Riccadonna, S, Ulaszewska, MM, Franceschi, P, Trošt, K, Galvin, A, Braune, T, Fava, F, Perenzoni, D, Mattivi, F, et al
The American journal of clinical nutrition. 2020;111(2):307-318
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Apples contain naturally occurring substances, called polyphenols, which in combination with fibre may be beneficial in preventing heart disease in a number of different ways. However, high quality research on this is lacking. This randomised control crossover trial of 40 individuals with slightly elevated cholesterol, aimed to assess the effects of consuming two apples a day for 20 weeks, on indicators for heart disease and in particular cholesterol levels. The results showed that consuming two apples per day resulted in decreased cholesterol and improved indicators for heart disease. It was concluded that the consumption of 2 apples per day decreased heart disease risk, attributed to the polyphenols and fibre they contain. Health professionals could use this study to recommend 2 apples per day in patients with slightly raised cholesterol in order to decrease their risk of heart disease.
Abstract
BACKGROUND Apples are rich in bioactive polyphenols and fiber. Evidence suggests that consumption of apples or their bioactive components is associated with beneficial effects on lipid metabolism and other markers of cardiovascular disease (CVD). However, adequately powered randomized controlled trials are necessary to confirm these data and explore the mechanisms. OBJECTIVE We aimed to determine the effects of apple consumption on circulating lipids, vascular function, and other CVD risk markers. METHODS The trial was a randomized, controlled, crossover, intervention study. Healthy mildly hypercholesterolemic volunteers (23 women, 17 men), with a mean ± SD BMI 25.3 ± 3.7 kg/m2 and age 51 ± 11 y, consumed 2 apples/d [Renetta Canada, rich in proanthocyanidins (PAs)] or a sugar- and energy-matched apple control beverage (CB) for 8 wk each, separated by a 4-wk washout period. Fasted blood was collected before and after each treatment. Serum lipids, glucose, insulin, bile acids, and endothelial and inflammation biomarkers were measured, in addition to microvascular reactivity, using laser Doppler imaging with iontophoresis, and arterial stiffness, using pulse wave analysis. RESULTS Whole apple (WA) consumption decreased serum total (WA: 5.89 mmol/L; CB: 6.11 mmol/L; P = 0.006) and LDL cholesterol (WA: 3.72 mmol/L; CB: 3.86 mmol/L; P = 0.031), triacylglycerol (WA: 1.17 mmol/L; CB: 1.30 mmol/L; P = 0.021), and intercellular cell adhesion molecule-1 (WA: 153.9 ng/mL; CB: 159.4 ng/mL; P = 0.028), and increased serum uric acid (WA: 341.4 μmol/L; CB: 330 μmol/L; P = 0.020) compared with the CB. The response to endothelium-dependent microvascular vasodilation was greater after the apples [WA: 853 perfusion units (PU), CB: 760 PU; P = 0.037] than after the CB. Apples had no effect on blood pressure or other CVD markers. CONCLUSIONS These data support beneficial hypocholesterolemic and vascular effects of the daily consumption of PA-rich apples by mildly hypercholesterolemic individuals.This trial was registered at clinicaltrials.gov as NCT01988389.