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An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition: An Interim Subgroup Analysis of the PREDIMED-Plus Randomized Clinical Trial.
Konieczna, J, Ruiz-Canela, M, Galmes-Panades, AM, Abete, I, Babio, N, Fiol, M, Martín-Sánchez, V, Estruch, R, Vidal, J, Buil-Cosiales, P, et al
JAMA network open. 2023;6(10):e2337994
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The Mediterranean diet (MedDiet), which focuses on whole grains, lean meat, fruits, vegetables, and low amounts of minimally processed foods has been shown in previous research to improve body composition and decrease fat storage around the middle. This randomised control trial of 1556 older adults aimed to determine the effects of combining a 30% lower energy version of the MedDiet in combination with physical exercise on body composition. After 3 years, the results showed that compared to a normal MedDiet without exercise, the lower energy version in combination with exercise improved body composition by decreasing total fat, and the fat stored around the organs and increasing muscle mass. However, benefits were more pronounced after 1 year and decreased slightly at 3 years. It was concluded that a low energy MedDiet in combination with physical activity may be able to improve the body composition of overweight and older adults with obesity. This study could be used by healthcare professionals to recommend a low energy MedDiet to older adults to promote weight loss, whilst attenuating muscle loss associated with ageing.
Expert Review
Conflicts of interest:
None
Take Home Message:
- The addition of exercise to an energy-reduced diet, which focuses on whole grains, healthy fats, lean protein, and fruits and vegetables can emphasise positive effects on body composition in older adults.
- However, there is a loss of lean mass associated with this type of diet (contrary to author conclusions) and measures should be taken to monitor and increase protein intake to prevent or limit this loss.
Evidence Category:
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X
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:
Introduction
This study aimed to determine the long-term effects of an energy reduced MedDiet in combination with physical activity on body composition.
Methods
- This is a predetermined 3-year interim analysis of a 6-year single-blind, randomised control trial of 1556 individuals aged 55-75 who are overweight or obese with metabolic syndrome.
- 760 individuals on 30% energy reduced MedDiet with limited processed foods, plus 45 minutes walking 6 days per week and behavioural and motivational support. [Intervention group]
- 761 on standard MedDiet without physical activity. [Control]
Results
Within group comparisons showed that individuals in the intervention group lost (P value represents baseline vs year 3):
- Total fat mass percentage (1-year vs baseline, −1.14%; 95% CI, −1.32% to −0.96%; 3-year vs baseline, −0.52%; 95% CI, −0.71% to −0.33% P=<0.001)
- Absolute visceral fat (1-year vs baseline, −154 g; 95% CI, −191 to −116 g; 3-year vs baseline, −75.1 g, 95% CI, −115 to −35.3 g P=<0.001)
- Absolute total fat after 1 year (mean change at 1 year vs baseline, −1677 g; 95% CI, −1930 to −1424 g) but regained some at year 3 (mean change at 3 years vs baseline, −1018 g; 95% CI, −1280 to −756 g P=<0.001)
- Absolute lean mass (mean change at 1 year vs baseline −300 g; 95% CI, −439 to −162 g) with further losses at year 3 (−626 g; 95% CI, −770 to −483 g P=0.001).
Within group comparisons also showed significantly increased:
- Total lean mass percentage, which was greater at year 1 than year 3 (1-year vs baseline, 1.07%; 95%CI, 0.90%-1.25%; 3-year vs baseline, 0.47%; 95% CI, 0.29%-0.65% P=<0.001).
As a result of total fat loss and some lean mass in the intervention group, the lean:fat mass ratio improved and was unchanged in the control group (between group differences (P=<0.001).
Compared to women, men may find the MedDiet + exercise more beneficial as it was shown that body composition changes were slightly more pronounced in men.
Conclusion
An energy-reduced MedDiet plus exercise emphasised positive changes to body composition compared to standard MedDiet in older adults who are overweight or have obesity.
Clinical practice applications:
- The recommendation of a reduced energy MedDiet in combination with physical activity to older people who are overweight or obese may improve body composition.
- Although lean mass loss slowed between years 1 and 3, other practices should be employed to attenuate the loss of lean mass associated with an energy-reduced MedDiet and ageing.
Considerations for future research:
- The research has not yet concluded but when it does, it will address the incidence of cardiovascular disease along with body composition changes.
- It will also look at long-term effects of the diet to determine longevity.
- Future research could focus on how to limit lean mass loss through the possibility of changing the type of exercise that accompanies the MedDiet.
Abstract
IMPORTANCE Strategies targeting body composition may help prevent chronic diseases in persons with excess weight, but randomized clinical trials evaluating lifestyle interventions have rarely reported effects on directly quantified body composition. OBJECTIVE To evaluate the effects of a lifestyle weight-loss intervention on changes in overall and regional body composition. DESIGN, SETTING, AND PARTICIPANTS The ongoing Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) randomized clinical trial is designed to test the effect of the intervention on cardiovascular disease prevention after 8 years of follow-up. The trial is being conducted in 23 Spanish research centers and includes men and women (age 55-75 years) with body mass index between 27 and 40 and metabolic syndrome. The trial reported herein is an interim subgroup analysis of the intermediate outcome body composition after 3-year follow-up, and data analysis was conducted from February 1 to November 30, 2022. Of 6874 total PREDIMED-Plus participants, a subsample of 1521 individuals, coming from centers with access to a dual energy x-ray absorptiometry device, underwent body composition measurements at 3 time points. INTERVENTION Participants were randomly allocated to a multifactorial intervention based on an energy-reduced Mediterranean diet (MedDiet) and increased physical activity (PA) or to a control group based on usual care, with advice to follow an ad libitum MedDiet, but no physical activity promotion. MAIN OUTCOMES AND MEASURES The outcomes (continuous) were 3-year changes in total fat and lean mass (expressed as percentages of body mass) and visceral fat (in grams), tested using multivariable linear mixed-effects models. Clinical relevance of changes in body components (dichotomous) was assessed based on 5% or more improvements in baseline values, using logistic regression. Main analyses were performed in the evaluable population (completers only) and in sensitivity analyses, multiple imputation was performed to include data of participants lost to follow-up (intention-to-treat analyses). RESULTS A total of 1521 individuals were included (mean [SD] age, 65.3 [5.0] years; 52.1% men). In comparison with the control group (n=761), participants in the intervention arm (n=760) showed greater reductions in the percentage of total fat (between group differences after 1-year, -0.94% [95% CI, -1.19 to -0.69]; 3 years, -0.38% [95% CI, -0.64 to -0.12] and visceral fat storage after 1 year, -126 g [95% CI, -179 to -73.3 g]; 3 years, -70.4 g [95% CI, -126 to -15.2 g] and greater increases in the percentage of total lean mass at 1 year, 0.88% [95% CI, 0.63%-1.12%]; 3-years 0.34% [95% CI, 0.09%-0.60%]). The intervention group was more likely to show improvements of 5% or more in baseline body components (absolute risk reduction after 1 year, 13% for total fat mass, 11% for total lean mass, and 14% for visceral fat mass; after 3-years: 6% for total fat mass, 6% for total lean mass, and 8% for visceral fat mass). The number of participants needed to treat was between 12 and 17 to attain at least 1 individual with possibly clinically meaningful improvements in body composition. CONCLUSIONS AND RELEVANCE The findings of this trial suggest a weight-loss lifestyle intervention based on an energy-reduced MedDiet and physical activity significantly reduced total and visceral fat and attenuated age-related losses of lean mass in older adults with overweight or obesity and metabolic syndrome. Continued follow-up is warranted to confirm the long-term consequences of these changes on cardiovascular clinical end points. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN89898870.
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Oligofructose-Enriched Inulin Consumption Acutely Modifies Markers of Postexercise Appetite.
Hamilton, CC, Bomhof, MR
Nutrients. 2023;15(24)
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Exercise is commonly used to manage weight but longer-term studies show that actual weight loss corresponds to only a fraction of energy expenditure from exercise, which is likely due to a compensatory increase in energy intake. Inulin-type prebiotics have shown to reduce appetite through affecting various hormones involved in appetite regulation. The aim of this randomised crossover study was to evaluate the acute effects of oligofructose-enriched inulin (OI) consumption after exercise on appetite-regulating hormones, self-reported appetite and energy intake over the following 2 days. 14 adults received sweetened milk either with (SM+OI) or without OI (SM) following a 45 min workout session. Total energy intake over the 3 days did not differ between the groups although the SM group had a significantly higher energy intake on the day after the exercise compared to the day of the exercise. Exercise-related effects on hunger hormones and subjective appetite perception were seen in both groups with no statistically significant difference between groups. The SM+OI group experienced significant increases in abdominal discomfort, flatulence and rumbling, which were not observed in the control SM group. The authors conclude that OI may induce subtle reductions in appetite but that longer term outcomes require further research.
Abstract
Enhancing the effectiveness of exercise for long-term body weight management and overall health benefits may be aided through complementary dietary strategies that help to control acute postexercise energy compensation. Inulin-type fructans (ITFs) have been shown to induce satiety through the modified secretion of appetite-regulating hormones. This study investigated the acute impact of oligofructose-enriched inulin (OI) consumption after exercise on objective and subjective measures of satiety and compensatory energy intake (EI). In a randomized crossover study, following the completion of a 45 min (65-70% VO2peak) evening exercise session, participants (BMI: 26.9 ± 3.5 kg/m2, Age: 26.8 ± 6.7 yrs) received one of two beverages: (1) sweetened milk (SM) or (2) sweetened milk + 20 g OI (SM+OI). Perceived measures of hunger were reduced in SM+OI relative to SM (p = 0.009). Within SM+OI, but not SM, plasma concentrations of GLP-1 and PYY were increased and acyl-ghrelin reduced from pre-exercise to postexercise. EI during the ad libitum breakfast in the morning postexercise tended to be lower in SM+OI (p = 0.087, d = 0.31). Gastrointestinal impacts of OI were apparent with increased ratings of flatulence (p = 0.026, d = 0.57) in participants the morning after the exercise session. Overall, the ingestion of a single dose of OI after an exercise session appears to induce subtle reductions in appetite, although the impact of these changes on acute and prolonged EI remains unclear.
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Physical Exercise and Dietary Supplementation in Middle-Aged and Older Women: A Systematic Review.
Sánchez-García, JC, López Hernández, D, Piqueras-Sola, B, Cortés-Martín, J, Reinoso-Cobo, A, Menor-Rodríguez, MJ, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;12(23)
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Menopause is a process that marks the end of the reproductive phase in women. Menopause means both that the ovaries stop producing eggs and that there is a sharp decline in the production of female hormones such as progesterone and oestrogen. The aim of this study was to discuss the benefits of exercise and dietary supplements during menopause. This study was a systematic review of ten articles. Results showed that: - both strength and aerobic training, as well as supplementation with calcium and vitamin D, increase bone mineral density. - combined strength and resistance training provide cardiovascular benefits, increase strength and muscle mass, and reduce the risk of sarcopenia. - physical exercise has a synergistic effect with some supplements, enhancing their effectiveness. Authors concluded that physical exercise can help combat many of the symptoms associated with menopause, providing benefits for a more vital menopause and a more vital old age.
Abstract
UNLABELLED With the aging of the population in developed countries, the number of middle-aged and older women is progressively increasing. During this stage, women suffer from a number of signs and symptoms that could be reduced or treated with physical exercise and dietary supplements. The main objective of this study was to analyse the benefits of exercise and dietary supplements during menopause. MATERIALS AND METHODS A systematic review of the scientific literature was performed according to the PRISMA 2020 protocol, searching the PubMed, Cochrane, Scopus, and WOS databases. Studies that met the inclusion criteria were assessed for methodological quality using the PEDro or AMSTAR-2 scales. RESULTS The searches yielded a total of 104 results, of which 10 were selected, with methodological quality ranging from fair to excellent. Each article examined the combination of a dietary supplement plan versus a placebo; plus an exercise routine versus another routine or a sedentary lifestyle. The results showed the benefits of combining a nutritional supplementation plan with an exercise routine during menopause. CONCLUSIONS The practice of weekly strength and endurance exercises, together with the consumption of certain dietary supplements, may be a good resource for coping with menopause in a healthy way.
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Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence.
Sánchez-García, JC, Saraceno López-Palop, I, Piqueras-Sola, B, Cortés-Martín, J, Mellado-García, E, Muñóz Sánchez, I, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;13(1)
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Gestational Diabetes Mellitus (GDM) causes hyperglycaemia due to the deficit of insulin during pregnancy. Dietary and lifestyle management plays a vital role in maintaining glycaemic control in women with GDM to avoid health risks to the mother and baby. Therefore, this systematic review of fourteen randomised controlled trials evaluated the latest research advancements to identify effective nutritional strategies for managing hyperglycaemia in women with GDM. Among all the dietary strategies implemented in the included randomised controlled trials, probiotic supplementation and supplementation of probiotics and vitamin D were most effective in GDM. Further robust studies are required to evaluate the potential effectiveness of different nutritional strategies for managing GDM. Healthcare professionals can use the results of this systematic review to understand the latest evidence supporting nutritional strategy for women with GDM and the need for personalised support for managing hyperglycaemia in GDM.
Abstract
Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.
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The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial.
Soares, ALS, Machado-Lima, A, Brech, GC, Greve, JMD, Dos Santos, JR, Inojossa, TR, Rogero, MM, Salles, JEN, Santarem-Sobrinho, JM, Davis, CL, et al
International journal of environmental research and public health. 2023;20(10)
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Type 2 Diabetes Mellitus (T2DM) is a common metabolic disease and the prevalence of T2DM is increasing among older adults. Resistance training is known to be an effective therapeutic strategy as it can positively influence the mechanisms of T2DM pathophysiology. Previous research suggests that whey protein supplementation can positively influence the different mechanisms of T2DM pathophysiology and improve muscle mass and glycaemic control. This triple-blinded, randomised controlled parallel-arm trial included twenty-eight male older adults to assess the effect of whey protein supplementation combined with resistance training for twelve weeks on glycaemic control, functional tasks, muscle strength, and body composition. The control group was supplemented with maltodextrin. All participants followed resistance training and were given nutritional guidance. Twelve weeks of resistance training improved muscle strength significantly. However, 20g whey protein supplementation did not improve performance in functional tasks, glycaemic control, or body composition in the test group of older adults with T2DM. Whey protein supplementation showed no significant synergetic effects when combined with resistance training in the test group. Due to the heterogeneity of the present study, further robust studies are warranted to investigate the effects of whey protein supplementation and resistance training. However, healthcare professionals can use the results of this study to understand the effect of resistance training alone and the safety profile of whey protein supplementation in older adults with T2DM.
Abstract
OBJECTIVES To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
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Prevalence of Female and Male Vegan and Non-Vegan Endurance Runners and the Potential Associations of Diet Type and BMI with Performance-Results from the NURMI Study (Step 1).
Wirnitzer, K, Tanous, D, Motevalli, M, Wirnitzer, G, Leitzmann, C, Pichler, R, Rosemann, T, Knechtle, B
Nutrients. 2022;14(18)
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Endurance running is a popular sport around the world and has increased in popularity by 57% in the last decade. Nutrition is an important variable to consider but recommendations on what athletes should eat are inconsistent among major sports and nutritional bodies. The popularity of plant-based diets is spreading fast and vegan/vegetarian diets are currently booming in recreational and competitive sports. There have been several studies looking at endurance performance and vegan/vegetarian diets but the results are inconclusive. It is therefore important to provide data to support training and nutritional strategies and to examine the associations between diet type and running-related characteristics in a large sample of vegan and non-vegan endurance runners. The purpose of this study is to investigate vegetarian and mixed diet type prevalence among distance runners at running events and associations with running-related patterns and performance. 2864 runners took part from around the world and completed an online questionnaire. The results show that vegan and vegetarian diets may be appropriate for participating in distance running activities. However, significant associations were identified between omnivore diet participants and best average time to finish across a range of disciplines. Findings from this investigation may provide beneficial evidence for sport scientists, trainers, coaches, and nutrition specialists when advising vegan and vegetarian distance runners, however more detailed research is needed.
Abstract
This study aims to investigate vegetarian and mixed diet type prevalences among distance runners at running events around the world and associations with running-related patterns and performance. Following a cross-sectional approach, linear regression analyses were carried out to identify potential associations among body mass index (BMI), diet type, and average best performance times of half-marathon and marathon events for males and females. From a sample of 3835 runners who completed an online questionnaire, 2864 all-distance runners (age: 37 years; 57% females) were included in inferential analyses and categorized into dietary subgroups according to self-reports: 994 vegans (34.7%), 598 vegetarians (20.9%), and 1272 omnivores (44.4%). Significant associations were identified between kind of diet and best average time to finish (i) half-marathons in females where vegans (p = 0.001) took longer than omnivores, (ii) half-marathons in males where vegans (p < 0.001) and vegetarians (p = 0.002) took longer than omnivores, and (iii) marathons in males where vegans (p < 0.001) and vegetarians (p = 0.043) averaged slower than omnivores. Increased units of BMI (+1.0) in males influenced best runtimes: 2.75 (3.22-2.27) min slower for HM and 5.5 (5.69-4.31) min slower for M. The present study did not take detailed confounders into account such as runner motives or training behaviors; however, the results may provide valuable insight for running event organizers, nutrition experts, coaches, and trainers advising runners who adhere to a general diet type regarding the basic question of who participates in running events around the world.
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Polyphenol Intake in Pregnant Women on Gestational Diabetes Risk and Neurodevelopmental Disorders in Offspring: A Systematic Review.
Salinas-Roca, B, Rubió-Piqué, L, Montull-López, A
Nutrients. 2022;14(18)
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In Europe, gestational diabetes affects approximately 10.9% of pregnant women. According to previous research, the cardiometabolic health of the mother and the mother's dietary habits during pregnancy may affect the foetus' neurodevelopment. Taking polyphenol supplements and eating foods rich in polyphenols is beneficial for promoting health across generations. In this systematic review, fourteen studies were included in order to evaluate the effects of polyphenols on gestational diabetes and mental health in the offspring. A higher prevalence of neurodevelopmental diseases in offspring is associated with gestational diabetes. The results of this systematic review revealed that polyphenol intake during pregnancy might have a beneficial effect on improving cardiometabolic health, reducing inflammation, DNA methylation and oxidative stress, thus reducing the risk of developing fetal neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder and learning disorders. There is a need for further robust research, as the existing evidence regarding the safety of long-term polyphenol supplementation and its effects on gestational diabetes and fetal neurodevelopment is very limited. In spite of this, healthcare professionals can use the findings of this systematic review to learn more about the positive health benefits of polyphenols in pregnant women.
Abstract
The intake of foods containing polyphenols can have a protective role to avoid comorbidities during pregnancy and, at the same time, promote transgenerational health. This review aims to describe the effect of polyphenol intake through supplements or polyphenol-rich foods during pregnancy on the incidence and evolution of gestational diabetes mellitus (GDM), as well as the link with the neurodevelopment of the fetus. Using PRISMA procedures, a systematic review was conducted by searching in biomedical databases (PubMed, Cinahl and Scopus) from January to June 2022. Full articles were screened (n = 419) and critically appraised. Fourteen studies were selected and were divided into two different thematic blocks considering (i) the effect of polyphenols in GDM and (ii) the effect of GDM to mental disorders in the offspring. A positive relationship was observed between the intake of polyphenols and the prevention and control of cardiometabolic complications during pregnancy, such as GDM, which could be related to thwarted inflammatory and oxidative processes, as well as neuronal factors. GDM is related to a greater risk of suffering from diseases related to neurodevelopment, such as attention deficit hyperactivity disorder, autism spectrum disorder and learning disorder. Further clinical research on the molecule protective mechanism of polyphenols on pregnant women is required to understand the transgenerational impact on fetal neurodevelopment.
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Effect of Peanut Consumption on Cardiovascular Risk Factors: A Randomized Clinical Trial and Meta-Analysis.
Parilli-Moser, I, Hurtado-Barroso, S, Guasch-Ferré, M, Lamuela-Raventós, RM
Frontiers in nutrition. 2022;9:853378
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Peanuts contain bioactive substances that are beneficial for cardiovascular health. This three-arm, parallel-group randomised controlled trial (ARISTOTLE) and meta-analysis evaluated the beneficial effects of high-oleic peanuts and peanut butter in improving cardiometabolic health. Participants in the randomised controlled trial consumed 25 g of skin-roasted peanuts or 32 g of peanut butter, or a control butter made with peanut oil without fibre and polyphenols for six months. The skin-roasted peanuts group showed a reduction in total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios. The meta-analysis was highly heterogeneous in participant ethnicity, health status, peanut intervention dosage and duration. The dosage of peanuts, peanut butter and high oleic peanuts used was between 25 and 200 g/day. The participants were healthy, with metabolic syndrome (MeS), or at risk of MeS. There was a significant increase in body weight among those with or at risk of MeS. In addition, healthy participants showed reduced triglycerides, total cholesterol, and LDL-cholesterol/HDL-cholesterol ratios. Healthcare professionals can use the results of this research to understand the beneficial impact of peanut consumption on the lipid profile. However, further robust studies are required due to the high heterogeneity of the included studies in the meta-analysis.
Abstract
UNLABELLED Although numerous studies have reported the protective effect of nut consumption on cardiovascular risk, evidence for the role of peanuts in maintaining cardiometabolic health is inconclusive. Presented here are the results from the ARISTOTLE study, a parallel randomized controlled trial evaluating the impact of regular peanut intake on anthropometric, biochemical, and clinical measurements. The 63 healthy subjects that completed the study consumed their habitual diet plus either: a) 25 g/day of skin roasted peanuts (SRP, n = 21), b) two tablespoons (32 g)/day of peanut butter (PB, n = 23) or c) two tablespoons (32 g)/day of a control butter based on peanut oil (CB, n = 19) for 6 months. In addition, a meta-analysis of clinical trials, including data from the ARISTOTLE study, was carried out to update the evidence for the effects of consuming peanuts, including high-oleic peanuts, and peanut butter on healthy subjects and those at high cardiometabolic risk. After a systematic search on PubMed, Web of Science, Cochrane Library and Scopus databases up to July 2021, 11 studies were found to meet the eligibility criteria. In the ARISTOTLE study, lower total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios were found in the SRP group compared to the CB group (p = 0.019 and p = 0.008). The meta-analysis of clinical trials revealed that peanut consumption is associated with a decrease in triglycerides (MD: -0.13; 95% CI, -0.20 to -0.07; p < 0.0001) and that healthy consumers had lower total cholesterol and LDL-cholesterol/HDL-cholesterol ratios compared to the control groups (MD: -0.40; 95% CI, -0.71 to -0.09; p = 0.01 and MD: -0.19; 95% CI, -0.36 to -0.01; p = 0.03, respectively). However, individuals at high cardiometabolic risk experienced an increase in body weight after the peanut interventions (MD: 0.97; 95% CI, 0.54 to 1.41; p < 0.0001), although not in body fat or body mass index. According to the dose-response analyses, body weight increased slightly with higher doses of peanuts. In conclusion, a regular consumption of peanuts seems to modulate lipid metabolism, reducing triglyceride blood levels. SYSTEMATIC REVIEW REGISTRATION https://osf.io/jx34y/, identifier: 10.17605/OSF.IO/MK35Y.
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Associations between circulating obesity-related biomarkers and prognosis in female breast cancer survivors: a systematic review of observational data in women enrolled in lifestyle intervention trials.
Meyer, D, Pastor-Villaescusa, B, Michel, S, Hauner, H, Hauner, D
BMC cancer. 2022;22(1):1187
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Overweight and obesity play a role in the development and potential outcomes in breast cancer. Several factors have been implicated linking cancer and obesity including hormones imbalances and inflammation, however exact links have yet to be elucidated. This systematic review of 4 randomised control trials containing 5234 women aimed to examine obesity related blood factors such as hormones, fats and sugar and their relationship with prognosis in individuals with breast cancer. The results showed that higher levels of testosterone were associated with an increased risk of recurrence of breast cancer. The female sex hormones, oestradiol and sex hormone binding globulin were not associated with breast cancer recurrence. Blood sugar levels and insulin resistance were not associated with breast cancer recurrence. There were certain growth factors, which are molecules responsible for stimulating cellular processes, that were responsible for an increased chance of recurrence of breast cancer and insulin-like growth factor and platelet derived growth factor were shown to increase risk but only when increased in combination with each other. Inconsistent results were seen with C-reactive protein, which is an inflammatory marker. It was concluded that testosterone may be associated with an increased risk of breast cancer recurrence, however the evidence from the other blood factor was unreliable due to poor quality trials. More trials are needed to investigate these factors further. This study could be used by healthcare professionals to understand that weight loss is the key to the prevention of recurrence of breast cancer in those who are overweight and that testosterone levels could be used to identify those who are at an increased risk.
Abstract
Obesity plays an important role in the development and progression of breast cancer via various oncogenic pathways. However, the biological mechanisms underlying this relationship are not fully understood. Moreover, it is unclear whether obesity-related and further associated biomarkers could be suitable targets for lifestyle interventions. This systematic review was conducted to examine relationships between obesity-related blood parameters and prognosis for breast cancer survivors enrolled in lifestyle intervention studies. A systematic, computerized literature search was conducted from inception through August 26th, 2020 in PubMed, EMBASE, and CENTRAL. The focus was on observational data from randomized controlled lifestyle intervention trials investigating associations between selected baseline biomarkers, measured in remission, and breast cancer recurrence, breast cancer mortality and/or all-cause mortality. Four studies with data from 5234 women met the inclusion criteria.Studies herein provide moderate evidence that bioavailable or serum testosterone may be positively linked to breast cancer recurrence and inversely linked to disease-free survival. Limited evidence suggests no associations with circulating estradiol or insulin levels on prognosis outcomes, whereas HDL cholesterol was inversely associated with breast cancer recurrence. For some other biomarkers, such as growth factors, adipokines, and CRP, the evidence for associations with disease prognosis was too weak to draw conclusions.Overall, despite potential candidates, there is insufficient evidence to confirm or refute that obesity-related biomarkers and sex hormones have a prognostic value for breast cancer survival. More longitudinal studies in breast cancer survivors to examine the clinical utility of obesity-related biomarkers are needed.
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Effects of the Treatment with Flavonoids on Metabolic Syndrome Components in Humans: A Systematic Review Focusing on Mechanisms of Action.
Gouveia, HJCB, Urquiza-Martínez, MV, Manhães-de-Castro, R, Costa-de-Santana, BJR, Villarreal, JP, Mercado-Camargo, R, Torner, L, de Souza Aquino, J, Toscano, AE, Guzmán-Quevedo, O
International journal of molecular sciences. 2022;23(15)
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Metabolic syndrome is a condition characterised by at least three of the five risk factors, such as abdominal obesity, elevated fasting glucose, blood pressure and triglycerides and reduced high-density lipoprotein cholesterol (HDL-c). There is a strong link between metabolic syndrome and the development of cardiovascular disease and Type 2 diabetes. Research suggests that increasing consumption of flavonoid-rich foods can be beneficial in reducing cardiovascular morbidity and mortality. Flavonoids are bioactive compounds that possess antioxidative, anti-inflammatory, anti-cancerous, anti-mutagenic, and enzymatic properties. This systematic review of 29 randomised controlled trials evaluated the beneficial effects of long-term flavonoid supplementation in reducing the risk factors of metabolic syndrome. This review included a variety of flavonoid supplements, such as anthocyanin, hesperidin, quercetin, epigallocatechin gallate (egcg), genistein, theaflavin, catechin, and eriocitrin. Additionally, this research investigated the mechanisms behind the beneficial effects of flavonoid supplementation. Results showed that flavonoid supplementation for at least three weeks improved metabolic parameters and inflammatory markers, with hesperidin showing the greatest improvements in metabolic parameters. Healthcare professionals can use these findings to understand the potential benefits of long-term flavonoid supplementation in improving metabolic parameters. However, more robust studies are needed to determine the therapeutic dosages of different flavonoids.
Abstract
Diets high in bioactive compounds, such as polyphenols, have been used to mitigate metabolic syndrome (MetS). Polyphenols are a large group of naturally occurring bioactive compounds, classified into two main classes: non-flavonoids and flavonoids. Flavonoids are distributed in foods, such as fruits, vegetables, tea, red wine, and cocoa. Studies have already demonstrated the benefits of flavonoids on the cardiovascular and nervous systems, as well as cancer cells. The present review summarizes the results of clinical studies that evaluated the effects of flavonoids on the components of the MetS and associated complications when offered as supplements over the long term. The results show that flavonoids can significantly modulate several metabolic parameters, such as lipid profile, blood pressure, and blood glucose. Only theaflavin and catechin were unable to affect metabolic parameters. Moreover, only body weight and body mass index were unaltered. Thus, the evidence presented in this systematic review offers bases in support of a flavonoid supplementation, held for at least 3 weeks, as a strategy to improve several metabolic parameters and, consequently, reduce the risk of diseases associated with MetS. This fact becomes stronger due to the rare side effects reported with flavonoids.