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Evaluating appetite/satiety hormones and eating behaviours as predictors of weight loss maintenance with GLP-1RA therapy in adolescents with severe obesity.
Bensignor, MO, Kelly, AS, Kunin-Batson, A, Fox, CK, Freese, R, Clark, J, Rudser, KD, Bomberg, EM, Ryder, J, Gross, AC
Pediatric obesity. 2024;(5):e13105
Abstract
INTRODUCTION Whilst glucagon-like peptide-1 receptor agonists (GLP1-RAs) are effective for treating adolescent obesity, weight loss maintenance (WLM; preventing weight regain) remains a challenge. Our goal was to investigate appetite/satiety hormones and eating behaviours that may predict WLM with exenatide (a GLP1-RA) versus placebo in adolescents with severe obesity. METHODS Adolescents who had ≥5% body mass index (BMI) reduction with meal replacement therapy were randomized to 52 weeks of once-weekly exenatide extended release or placebo. In this secondary analysis, eating behaviours and appetite/satiety regulation hormones post-meal replacement therapy (pre-randomization to exenatide or placebo) were evaluated as possible predictors of WLM. Percent change in BMI from randomization to 52 weeks served as the primary measure of WLM. RESULTS The analysis included 66 adolescents (mean age 16.0 years; 47% female). Lower leptin response to meal testing was associated with greater WLM in terms of BMI percent change in those receiving exenatide compared to placebo (p = 0.007) after adjusting for sex, age and BMI. There were no other significant predictors of WLM. CONCLUSIONS Prior to exenatide, lower leptin response to meals was associated with improved WLM with exenatide compared to placebo. The mostly null findings of this study suggest that GLP1-RA treatment may produce similar WLM for adolescents with obesity regardless of age, BMI, sex and eating behaviours.
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Niacin - a scoping review for Nordic Nutrition Recommendations 2023.
Freese, R, Lysne, V
Food & nutrition research. 2023
Abstract
Niacin is the precursor to pyridine nucleotides NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate). Niacin (vitamin B3) is the common term for nicotinic acid, nicotinamide and derivatives that exhibit the biological activity of nicotinamide. Furthermore, the indispensable amino acid tryptophan is the substrate for de novo synthesis of NAD. Thus, the requirements and intake of niacin are expressed as niacin equivalents (NE). The focus of interest for niacin over the last decade has primarily been on pharmacological doses of nicotinic acid as a lipid-lowering agent and other NAD precursors as potential enhancers of cellular NAD+ concentrations. None of these studies, however, makes a useful contribution to understanding dietary requirements in healthy populations. The requirement for niacin is estimated based on the relationship between intake and biochemical indices of niacin status, primarily urinary excretion of nicotinamide metabolites.
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Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients.
Hovinen, T, Korkalo, L, Freese, R, Skaffari, E, Isohanni, P, Niemi, M, Nevalainen, J, Gylling, H, Zamboni, N, Erkkola, M, et al
EMBO molecular medicine. 2021;13(2):e13492
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Plain language summary
As vegan diets gain popularity amongst families, there is little known about the impact of strict plant-based diets on metabolism and micronutrient status in children, apart from reduced average growth within the norm. This small study looked at 40 Finnish children from one day centre, and compared children following an omnivore or vegetarian diet to those raised on a vegan diet. The diets were analysed, and biomarkers and metabolites were measured. The metabolic profile and nutrient status of children who followed a vegan diet from birth were distinctively different to other diet patterns, including vegetarians. The authors suggest that little animal source foods are enough to shift the metabolism of children. Dietary analysis showed that vegan children had higher folate consumption and lower protein and saturated fats intake. Despite intake appearing adequate, serum markers for fat-soluble vitamins A and D were low. While the fatty acid ALA was higher compared to omnivores, DHA and overall cholesterol were decreased. The authors concluded that the bodies own cholesterol production does not seem to compensate for a lack of dietary cholesterol in this case and it remains to be established whether lower cholesterol in vegan children are negative to health. Furthermore, the circulating amino acids pool was decreased in vegan children, particularly branch chained amino acids. The most distinct difference, however, was seen in the variance of bile acid patterns. The physiological functions of bile acids go beyond digestion, yet the consequences of diverging bile acid profiles in children’s health are unknown. In conclusion, the data shows that a strict vegan diet affects the metabolism of healthy children, but much of the long-term impact on health is currently still unclear. This article highlights some of the differences, risks and uncertainties that come with raising young children on a strictly vegan diet.
Abstract
Vegan diets are gaining popularity, also in families with young children. However, the effects of strict plant-based diets on metabolism and micronutrient status of children are unknown. We recruited 40 Finnish children with a median age 3.5 years-vegans, vegetarians, or omnivores from same daycare centers-for a cross-sectional study. They enjoyed nutritionist-planned vegan or omnivore meals in daycare, and the full diets were analyzed with questionnaires and food records. Detailed analysis of serum metabolomics and biomarkers indicated vitamin A insufficiency and border-line sufficient vitamin D in all vegan participants. Their serum total, HDL and LDL cholesterol, essential amino acid, and docosahexaenoic n-3 fatty acid (DHA) levels were markedly low and primary bile acid biosynthesis, and phospholipid balance was distinct from omnivores. Possible combination of low vitamin A and DHA status raise concern for their visual health. Our evidence indicates that (i) vitamin A and D status of vegan children requires special attention; (ii) dietary recommendations for children cannot be extrapolated from adult vegan studies; and (iii) longitudinal studies on infant-onset vegan diets are warranted.
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Low-FODMAP vs regular rye bread in irritable bowel syndrome: Randomized SmartPill® study.
Pirkola, L, Laatikainen, R, Loponen, J, Hongisto, SM, Hillilä, M, Nuora, A, Yang, B, Linderborg, KM, Freese, R
World journal of gastroenterology. 2018;(11):1259-1268
Abstract
AIM: To compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome (IBS) symptoms and to study gastrointestinal conditions with SmartPill®. METHODS Our aim was to evaluate if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, different transit times, and fewer IBS symptoms than regular rye bread. The study was a randomized, double-blind, controlled cross-over meal study. Female IBS patients (n = 7) ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day. Intraluminal pH, transit time, and pressure were measured by SmartPill, an indigestible motility capsule. RESULTS Hydrogen excretion (a marker of colonic fermentation) expressed as area under the curve (AUC)(0-630 min) was [median (range)] 6300 (1785-10800) ppm∙min for low-FODMAP rye bread and 10 635 (4215-13080) ppm∙min for regular bread (P = 0.028). Mean scores of gastrointestinal symptoms showed no statistically significant differences but suggested less flatulence after low-FODMAP bread consumption (P = 0.063). Intraluminal pressure correlated significantly with total symptom score after regular rye bread (ρ = 0.786, P = 0.036) and nearly significantly after low-FODMAP bread consumption (ρ = 0.75, P = 0.052). We found no differences in pH, pressure, or transit times between the breads. Gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only during one measurement (out of 14 measurements in total) and therefore did not follow on par with the rye bread bolus. CONCLUSION Low-FODMAP rye bread reduced colonic fermentation vs regular rye bread. No difference was found in median values of intraluminal conditions of the gastrointestinal tract.
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Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls.
Korkalo, L, Erkkola, M, Heinonen, AE, Freese, R, Selvester, K, Mutanen, M
European journal of nutrition. 2017;(3):1179-1189
Abstract
PURPOSE In low-income settings, dietary diversity scores (DDSs) often predict the micronutrient adequacy of diets, but little is known about whether they predict levels of biochemical indicators of micronutrient status. METHODS In 2010, we studied two samples of non-pregnant 14- to 19-year-old girls in central Mozambique, the first in January-February ('hunger season'; n = 227) and the second in May-June (harvest season; n = 223). In this paper, we examined whether a low Women's Dietary Diversity Score (WDDS) predicts a low concentration of haemoglobin, serum ferritin, zinc, and folate, and plasma retinol in adolescent Mozambican girls. We constructed three scores: WDDS based on 24-h recalls, WDDS15g based on 24-h recall and employing a 15 g limit, and 7dWDDS based on 7-day food frequency questionnaires. Logistic regression models, stratified by season, were used to estimate the odds of having a low concentration of a status indicator (≤25th percentile of the season-specific distribution or cut-off from the literature) in those with a low score compared to those with a higher score. RESULTS In January-February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having low serum zinc compared to having a higher score, regardless of which of the two types of cut-offs for serum zinc was used. These associations were not present in May-June. CONCLUSIONS Our data from Mozambique suggest that dietary diversity is associated with serum zinc, but this association seems to be limited to the hunger season.
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Essential fatty acid intake and serum fatty acid composition among adolescent girls in central Mozambique.
Freese, R, Korkalo, L, Vessby, B, Tengblad, S, Vaara, EM, Hauta-alus, H, Selvester, K, Mutanen, M
The British journal of nutrition. 2015;(7):1086-95
Abstract
Many African diets are low in fat but are currently changing because of nutrition transition. We studied fat and fatty acid (FA) intake and the essential fatty acid (EFA) status of adolescent girls (aged 14-19 years, n 262) in Zambezia Province, central Mozambique. A cross-sectional study was carried out in a city as well as in the towns and rural villages of a coastal and an inland district. Dietary intake and FA sources were studied in a 24 h dietary recall. FA compositions of cholesteryl esters and phospholipids of non-fasting serum samples were analysed by GLC. Fat intake was low (13-18 % of energy) in all areas. Coconut and palm oil were the main sources of fat, and soyabean oil and maize were the main sources of PUFA. Compared to Food and Agriculture Organization/WHO 2010 recommendations, intake of linoleic acid (LA, 18 : 2n-6) was inadequate in the coastal district, and intakes of n-3 PUFA were inadequate in all areas. FA compositions of serum lipids differed between areas. The proportions of LA tended to be highest in the city and lowest in the rural areas. The phospholipid mead (20 : 3n-9):arachidonic acid (20 : 4n-6) ratio did not indicate EFA insufficiency. LA proportions in phospholipids were low, but those of long-chain n-6 and n-3 PUFA were high in comparison with Western adolescents. To conclude, fat sources, FA intake and EFA status differed between adolescent girls living in different types of communities. Fat intake was low, but EFA insufficiency was not indicated.
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No effect on oxidative stress biomarkers by modified intakes of polyunsaturated fatty acids or vegetables and fruit.
Freese, R, Dragsted, LO, Loft, S, Mutanen, M
European journal of clinical nutrition. 2008;(9):1151-3
Abstract
Diet may both increase and decrease oxidative stress in the body. We compared the effects of four strictly controlled isocaloric diets with different intakes of polyunsaturated fatty acids (PUFA, 11 or 3% of energy) and vegetables and fruit (total amount of vegetables and fruit 516 or 1059 g/10 MJ) on markers associated with oxidative stress in 77 healthy volunteers (19-52 years). Plasma protein carbonyls (2-aminoadipic semialdehyde residues) and whole-body DNA and nucleotide oxidation (urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine excretion) tended to decrease in all treatment groups with no differences between the diets. The diets did not differ in their effects on red blood cell antioxidative enzyme activities, either. The results suggest that in healthy volunteers with adequate nutrient intakes, 6-week diets differing markedly in the amount of PUFA or vegetables and fruit do not differ in their effects on markers associated with oxidative stress.
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Markers of oxidative DNA damage in human interventions with fruit and berries.
Freese, R
Nutrition and cancer. 2006;(1):143-7
Abstract
Diets rich in fruit and vegetables are associated with a decreased risk of several cancers via numerous possible mechanisms. For example, phytochemicals may decrease oxidative DNA damage and enhance DNA repair. Markers of oxidative DNA damage in human dietary intervention trials used most frequently include oxidized nucleosides such as 7-hydro-8-oxo-2'-deoxyguanosine, which can be analyzed from isolated DNA or urine. Single-cell gel electrophoresis has been widely used to measure baseline or H2O2-induced DNA strand breaks or sites of modified bases sensitive to repair enzymes recognizing oxidized purines or pyrimidines. Recently, markers of DNA repair also have been used. Few controlled human dietary interventions have investigated the specific effects of fruit or berries. There are indications that kiwifruit can decrease H2O2 sensitivity of lymphocyte DNA ex vivo and enhance DNA repair. Carefully controlled studies with flavonoid-rich fruit or berry juices found only few significant differences; less rigorously controlled studies gave more optimistic results. Data on the effects of fruit and berries on DNA damage in humans are scarce and inconclusive; adequately controlled studies with validated markers are needed. Because levels of DNA damage are usually low in young healthy volunteers, groups with an enhanced risk of DNA damage should be studied.
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No difference in platelet activation or inflammation markers after diets rich or poor in vegetables, berries and apple in healthy subjects.
Freese, R, Vaarala, O, Turpeinen, AM, Mutanen, M
European journal of nutrition. 2004;(3):175-82
Abstract
BACKGROUND High intake of vegetables and fruits is associated with decreased risk of coronary heart disease. Part of these cardioprotective effects may be mediated via the antithrombotic effects of compounds found in vegetables and fruits, such as flavonoids. AIM OF THE STUDY To study the effects of high and low intake of vegetables, berries and apple on platelet function and inflammatory markers. METHODS The study was a randomised, controlled parallel human dietary intervention with healthy female and male volunteers (n = 77, 19-52 y). Nineteen healthy volunteers served as controls. The volunteers consumed one of four strictly controlled isocaloric 6-week diets containing either 810 or 196 g/10 MJ of vegetables, berries and apple and rich either in linoleic acid (11% of energy, en%) or oleic acid (12 en%). Blood and three 24-hour urine samples were collected at the beginning and at the end of the study period for analyses of various markers of platelet function and inflammation. RESULTS No differences between the treatment groups were seen in platelet count or volume, markers of platelet activation ( ex vivo aggregation to ADP and thrombin receptor activating peptide, protein kinase C activity, urinary 2,3-dinor-thromboxane B2 excretion, plasma P-selectin), plasma intercellular adhesion molecule-1, sensitive C-reactive protein, or antiphospholipid antibodies. CONCLUSIONS The results indicate that in healthy volunteers 6-week diets differing markedly in the amounts of vegetables, berries and apple do not differ in their effects on platelets or inflammation.
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High intakes of vegetables, berries, and apples combined with a high intake of linoleic or oleic acid only slightly affect markers of lipid peroxidation and lipoprotein metabolism in healthy subjects.
Freese, R, Alfthan, G, Jauhiainen, M, Basu, S, Erlund, I, Salminen, I, Aro, A, Mutanen, M
The American journal of clinical nutrition. 2002;(5):950-60
Abstract
BACKGROUND A high consumption of vegetables and fruit is associated with decreased risk of ischemic heart disease and several cancers. The pathophysiology of these diseases involves free radical mechanisms. Diet may either enhance or diminish oxidative stress in the body. OBJECTIVE We studied the effects of high and low intakes of vegetables, berries, and apples on markers of lipid peroxidation and lipoprotein metabolism in subjects consuming diets high in linoleic or oleic acid. DESIGN For 6 wk, healthy men and women (n = 77; aged 19-52 y) consumed 1 of 4 controlled isoenergetic diets rich in either linoleic acid (11% of energy) or oleic acid (12% of energy) and containing either 815 or 170 g vegetables, berries, and apples/10 MJ. Nineteen healthy volunteers served as control subjects. Several markers of dietary compliance (plasma fatty acids, vitamin C, carotenoids, and quercetin), lipid peroxidation [ex vivo LDL oxidation, plasma and LDL thiobarbituric acid-reactive substances, paraoxonase (EC 3.1.8.1), and urinary 8-iso-prostaglandin F(2)(alpha)], and lipoprotein metabolism (plasma lipids, apolipoproteins, and lipid transfer protein activities) were measured from samples collected before and at the end of the experimental period. RESULTS Plasma fatty acid composition and antioxidant concentrations showed that compliance with the diets was good. However, there were no significant differences between the diets in the markers of lipid peroxidation and lipoprotein metabolism. CONCLUSIONS In healthy volunteers with adequate vitamin intakes, 6-wk diets differing markedly in the amounts of linoleic and oleic acid and vegetables, berries, and apples did not differ in their effects on lipid peroxidation or lipoprotein metabolism.