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Probiotic improves symptomatic and viral clearance in Covid19 outpatients: a randomized, quadruple-blinded, placebo-controlled trial.
Gutiérrez-Castrellón, P, Gandara-Martí, T, Abreu Y Abreu, AT, Nieto-Rufino, CD, López-Orduña, E, Jiménez-Escobar, I, Jiménez-Gutiérrez, C, López-Velazquez, G, Espadaler-Mazo, J
Gut microbes. 2022;14(1):2018899
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Expert Review
Conflicts of interest:
None
Take Home Message:
- It is advisable for those over 60 years old with a metabolic risk factor (BMI>30, diabetes and/or hypertension) to consult with their clinical practitioners if tested positive for Covid-19.
- Specific probiotic strains are reported to show positive results in reducing the duration and severity of Covid-19 symptoms in adults under 60 years old.
- These probiotics (Lactiplantibacillus plantarum KABP022, KABP023, and KAPB033, plus strain Pediococcus acidilactici KABP021) have also shown a positive effect on reducing inflammation and supporting remission of Covid-19.
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:
A quadruple-blinded, randomized trial was conducted in adults with symptomatic Coronavirus Disease 2019(Covid19) outpatients.
Three hundred subjects between the ages of 18 and 60 years, with a peripheral oxygen saturation (SpO2) ≥ 90% and in whom 42% had known metabolic risk factors for severe Covid19, were randomized to a oral probiotic containing Lactiplantibacillus plantarum KABP022, KABP023, and KAPB033, with Pediococcus acidilactici strain KABP021, totaling 2 x 109 colony-forming units (n=150), or placebo (n=150), for 30 days. At endpoint, 293/300 subjects finished the study.
Primary clinical outcomes were:
- Complete remission was achieved by 78 of 147 (53.1%) in probiotic group compared to 41 of 146 (28.1%) in placebo (P< .001).
- Adverse events were lower in the probiotic group (p=0.008), though not statistically significant in those taking ≥2 medications daily (risk ratio 0.66 (95%CI 0.29-1.48)
- No hospitalizations or deaths occurred during the study.
Secondary clinical outcomes were:
- The probiotic treatment was well-tolerated and reduce the duration of both digestive and non-digestive symptoms, compared to placebo.
- The probiotic treatment was associated with reduce nasopharyngeal viral load compared to placebo (P < .001) and reduce lung infiltrates (P < .001).
Furthermore, the probiotic treatment
- significantly increased specific IgM and IgG against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and
- lower serum levels of high-sensitivity C-reactive protein (hsCRP) (P<00.1) and D-Dimer levels (P,00.1) compared to placebo.
- shortened median recovery time by 5 days (p<0.001).
Clinical practice applications:
- General practitioners, pharmacists, and clinic nurses are generally the first point of contact for patients who are not feeling well. Especially, during a pandemic when hospitals are inundated with patients who need urgent care. It is therefore essential for clinicians to have outpatient treatment protocols available to support the community.
- The microbiome is reported to be the first line of defense and interacts with the human host’s immune system. Therefore, probiotics may be useful as a preventative and supportive measure during a pandemic.
- Based on this study, practitioners could therefore consider a probiotic containing Lactiplantibacillus plantarum and Pediococcus acidilactici strains alone or in combination with other probiotic strains as a supportive measure.
Considerations for future research:
- Future studies are needed to replicate these findings and elucidate its mechanism of action, particularly as fecal microbiome analysis in a subset of n=100 subjects did not detect a difference in fecal microbiome composition between groups at baseline or endpoint.
- Additionally, further studies are needed to identify specific probiotic strains that display immune effects and their required dosage.
- Elevated D-Dimer levels are associated with a higher risk of thrombotic events such as pulmonary embolism and have been associated with Covid19 severity and mortality. Therefore, further investigation of this probiotic formula in helping prevent thrombotic complications in Covid19 is warranted.
- All the subjects in the study were of Hispanic ethnicity, therefore further studies of other ethnicities are required.
- This study was capped at 60-year-olds, thus studies in older subjects are warranted.
- Conflict of interest statement: This study was fully funded by the manufacturer of the provided probiotic, and authors received either speaker fees or institutional support from the manufacturer.
Abstract
Intestinal bacteria may influence lung homeostasis via the gut-lung axis. We conducted a single-center, quadruple-blinded, randomized trial in adult symptomatic Coronavirus Disease 2019 (Covid19) outpatients. Subjects were allocated 1:1 to probiotic formula (strains Lactiplantibacillus plantarum KABP022, KABP023, and KAPB033, plus strain Pediococcus acidilactici KABP021, totaling 2 × 109 colony-forming units (CFU)) or placebo, for 30 days. Co-primary endpoints included: i) proportion of patients in complete symptomatic and viral remission; ii) proportion progressing to moderate or severe disease with hospitalization, or death; and iii) days on Intensive Care Unit (ICU). Three hundred subjects were randomized (median age 37.0 years [range 18 to 60], 161 [53.7%] women, 126 [42.0%] having known metabolic risk factors), and 293 completed the study (97.7%). Complete remission was achieved by 78 of 147 (53.1%) in probiotic group compared to 41 of 146 (28.1%) in placebo (RR: 1.89 [95 CI 1.40-2.55]; P < .001), significant after multiplicity correction. No hospitalizations or deaths occurred during the study, precluding the assessment of remaining co-primary outcomes. Probiotic supplementation was well-tolerated and reduced nasopharyngeal viral load, lung infiltrates and duration of both digestive and non-digestive symptoms, compared to placebo. No significant compositional changes were detected in fecal microbiota between probiotic and placebo, but probiotic supplementation significantly increased specific IgM and IgG against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) compared to placebo. It is thus hypothesized this probiotic primarily acts by interacting with the host's immune system rather than changing colonic microbiota composition. Future studies should replicate these findings and elucidate its mechanism of action (Registration: NCT04517422).Abbreviations: AE: Adverse Event; BMI: Body Mass Index; CONSORT CONsolidated Standards of Reporting Trials; CFU: Colony-Forming Units; eDRF: Electronic Daily Report Form; GLA: Gut-Lung Axis; GSRS Gastrointestinal Symptoms Rating Scale; hsCRP: High-sensitivity C-Reactive Protein; HR: Hazard Ratio; ICU: Intensive Care Unit; OR: Odds Ratio; PCoA: Principal Coordinate Analysis; RR: Relative Risk; RT-qPCR: Real-Time Quantitative Polymerase Chain Reaction; SARS-CoV2: Severe acute respiratory syndrome coronavirus 2; SpO2: Peripheral Oxygen Saturation; WHO: World Health Organization.
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Impact of α-Linolenic Acid, the Vegetable ω-3 Fatty Acid, on Cardiovascular Disease and Cognition.
Sala-Vila, A, Fleming, J, Kris-Etherton, P, Ros, E
Advances in nutrition (Bethesda, Md.). 2022;13(5):1584-1602
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α-Linolenic acid (ALA) is an omega-3 fatty acid found in seeds and nuts such as flaxseeds, chia seeds, and walnuts and in oils such as canola oil, soybean oil, flaxseed oil and walnut oil. It has been shown to reduce the risk of coronary heart disease and cardiovascular disease. This meta-analysis examined the results of various studies, including epidemiologic studies, randomized controlled trials, and systematic reviews, to evaluate the beneficial effects of ALA in improving cognitive function and reducing the risk of cardiovascular disease and coronary heart disease. The included studies showed a correlation between ALA intake and a decreased risk of cardiovascular disease and coronary heart disease, possibly due to ALA's anti-inflammatory properties, as well as its ability to reduce total cholesterol, LDL cholesterol, triglycerides, and blood pressure. The analysis also found that ALA intake may reduce the risk of type 2 diabetes and cognitive impairment. Healthcare professionals can leverage the findings of this analysis to educate individuals about the benefits of dietary ALA in improving cardiovascular and cognitive outcomes. However, further studies are necessary to establish definitive conclusions and determine therapeutic dosage.
Abstract
Given the evidence of the health benefits of plant-based diets and long-chain n-3 (ω-3) fatty acids, there is keen interest in better understanding the role of α-linolenic acid (ALA), a plant-derived n-3 fatty acid, on cardiometabolic diseases and cognition. There is increasing evidence for ALA largely based on its major food sources (i.e., walnuts and flaxseed); however, this lags behind our understanding of long-chain n-3 fatty acids. Meta-analyses of observational studies have shown that increasing dietary ALA is associated with a 10% lower risk of total cardiovascular disease and a 20% reduced risk of fatal coronary heart disease. Three randomized controlled trials (RCTs) [AlphaOmega trial, Prevención con Dieta Mediterránea (PREDIMED) trial, and Lyon Diet Heart Study] all showed benefits of diets high in ALA on cardiovascular-related outcomes, but the AlphaOmega trial, designed to specifically evaluate ALA effects, only showed a trend for benefit. RCTs have shown that dietary ALA reduced total cholesterol, LDL cholesterol, triglycerides, and blood pressure, and epidemiologic studies and some trials also have shown an anti-inflammatory effect of ALA, which collectively account for, in part, the cardiovascular benefits of ALA. A meta-analysis reported a trend toward diabetes risk reduction with both dietary and biomarker ALA. For metabolic syndrome and obesity, the evidence for ALA benefits is inconclusive. The role of ALA in cognition is in the early stages but shows promising evidence of counteracting cognitive impairment. Much has been learned about the health benefits of ALA and with additional research we will be better positioned to make strong evidence-based dietary recommendations for the reduction of many chronic diseases.
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Effects of curcumin and/or coenzyme Q10 supplementation on metabolic control in subjects with metabolic syndrome: a randomized clinical trial.
Sangouni, AA, Taghdir, M, Mirahmadi, J, Sepandi, M, Parastouei, K
Nutrition journal. 2022;21(1):62
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Metabolic syndrome (MetS) is a cluster of metabolic disorders such as hyperlipidaemia, hypertension, hyperglycaemia, insulin resistance, and abdominal obesity. MetS is associated with cardiovascular disease (CVD), type 2 diabetes mellitus and non-alcoholic fatty liver disease. The aim of this study was to investigate the effects of curcumin and/or coenzyme Q10 supplementation on metabolic syndrome components in subjects with MetS. This study is a 2×2 factorial, randomised, double-blinded, placebo-controlled study which was conducted for 12 weeks. Eighty-eight subjects were randomly assigned into four groups. All subjects completed the trial. Results show that curcumin supplementation improves lipid profile, but it does not have any effect on body composition, hypertension and fasting plasma glucose. However, supplementation with coenzyme Q10 as well as curcumin plus coenzyme Q10 did not show any significant effects on lipid profile, body composition, hypertension and fasting plasma glucose. Authors conclude that curcumin supplementation (especially by its effects on dyslipidaemia) is more effective than coenzyme Q10 as well as the combination of curcumin and coenzyme Q10 in the management of MetS. However, curcumin, coenzyme Q10 and their combination have no effect on body composition, hypertension and glycaemic control.
Abstract
BACKGROUND Metabolic syndrome (MetS) as a cluster of conditions including hyperlipidemia, hypertension, hyperglycemia, insulin resistance, and abdominal obesity is linked to cardiovascular diseases and type 2 diabetes. Evidence suggested that intake of curcumin and coenzyme Q10 may have therapeutic effects in the management of MetS. AIMS We investigated the effects of curcumin and/or coenzyme Q10 supplementation on metabolic syndrome components including systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-c) and fasting plasma glucose (FPG) as primary outcomes, and total cholesterol (TC), low density lipoprotein-cholesterol (LDL-c) and body mass index (BMI) as secondary outcomes in subjects with MetS. METHODS In this 2 × 2 factorial, randomized, double-blinded, placebo-controlled study, 88 subjects with MetS were randomly assigned into four groups including curcumin plus placebo (CP), or coenzyme Q10 plus placebo (QP), or curcumin plus coenzyme Q10 (CQ), or double placebo (DP) for 12 weeks. RESULTS The CP group compared with the three other groups showed a significant reduction in HDL-c (P = 0.001), TG (P < 0.001), TC (P < 0.001), and LDL-c (P < 0.001). No significant differences were seen between the four groups in terms of SBP, DBP, FPG, WC, BMI and weight. CONCLUSION Curcumin improved dyslipidemia, but had no effect on body composition, hypertension and glycemic control. Furthermore, coenzyme Q10 as well as the combination of curcumin and coenzyme Q10 showed no therapeutic effects in subjects with MetS. The trial was registered on 09/21/2018 at the Iranian clinical trials website (IRCT20180201038585N2), URL: https://www.irct.ir/trial/32518 .
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Longitudinal association of dietary carbohydrate quality with visceral fat deposition and other adiposity indicators.
Zamanillo-Campos, R, Chaplin, A, Romaguera, D, Abete, I, Salas-Salvadó, J, Martín, V, Estruch, R, Vidal, J, Ruiz-Canela, M, Babio, N, et al
Clinical nutrition (Edinburgh, Scotland). 2022;41(10):2264-2274
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Abdominal obesity, measured by waist circumference, a proxy of visceral fat, is increasing at an even greater rate than overall obesity alone. Diet plays a key role in body fat accumulation; however, recent evidence also indicates that, beyond quantity, the quality of certain nutrients may have an independent effect. The aim of this study was to determine the dynamic association between changes in overall dietary carbohydrate quality and changes in objectively measured visceral and overall adiposity distribution This study is a prospective cohort study based on data collected during the first year of the PREDIMED-Plus (PREvencion con DIeta MEDiterranea Plus) randomised controlled trial. In the PREDIMED-Plus trial, a total of 6874 people were randomly allocated in a 1:1 ratio to either the intervention or control group. Results show that a carbohydrate quality index increase was associated with a decrease in regional and overall adiposity. The observed associations were mostly driven by fibre and the wholegrains/total grains ratio. Authors conclude that the promotion of fibre-rich foods, including fruits, vegetables, legumes and nuts, and the substitution of refined grains by wholegrains, may be important dietary recommendations to adopt in clinical practice to promote a healthier body composition.
Expert Review
Conflicts of interest:
None
Take Home Message:
This prospective cohort of older adults with overweight/obesity and MetS, found that improvements in dietary carbohydrate quality over one year was associated with positive changes in visceral and overall fat deposition, largely due to dietary fibre and the wholegrain/total grain ratio.
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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X
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:
Background
Obesity prevalence is increasing worldwide and is associated with a range of metabolic and cardiovascular diseases. Excess visceral fat appears with increasing age but also with unhealthy dietary patterns and lifestyle behaviours, and it contributes to chronic diseases, particularly type 2 diabetes (T2D), insulin resistance, metabolic syndrome (MetS), and cardiovascular diseases (CVD).
Aim
This study determined the association between changes in overall dietary carbohydrate quality and changes in objectively-measured visceral and overall adiposity distribution. Three repeated measurements of diet and adiposity were conducted throughout a 1-year follow-up, using a dual-energy X-ray absorptiometry (DXA) scans for body composition assessment.
The study compared an intensive weight-loss (intervention group) using an energy-reduced Mediterranean Diet (MedDiet), with physical activity (PA), and behavioural support on the prevention of CVD events, compared to usual care and dietary counselling only.
This prospective cohort study analysed a subgroup of 1476 participants (men aged 55-75 years and women aged 60-75 years) enrolled in the PREDIMED-Plus randomized controlled trial. Participants were overweight or obese (BMI>27 kg/m2 and <40 kg/m2) with no previous cardiovascular events and at least three characteristics of metabolic syndrome (MetS): hypertension, hyper-triglyceridemia, lower high-density lipoprotein (HDL) cholesterol, hyperglycemia, or central obesity.
Dietary intake was measured at baseline, 6- and 12-months using a Spanish version of the validated 143-item semi-quantitative food-frequency questionnaire, via face-to-face interviews by trained dietitian-nutritionists. Carbohydrate quality index (CQI) was calculated using four criteria: total dietary fibre, glycemic index, wholegrain/total grain carbohydrate ratio, and solid/total carbohydrate ratio.
Results
Improvements in body composition and lifestyle factors were observed compared to baseline data (both study arms combined) (p < 0.05 for all). A higher Carbohydrate Quality Index CQI (p = 0.024) was observed at both the 6 and 12 month follow-up.
A 3-point increment in CQI over 12-month follow-up was associated with a decrease in visceral fat (β 0.067 z-score, 95% CI -0.088 to -0.046, p<0.001), android-to-gynoid fat ratio* (β -0.038, 95% CI -0.059 to -0.017, p<0.001) (*calculated by dividing the fat mass (g) from the specific regions), and total fat (β -0.064, 95% CI -0.080 to -0.047, p<0.001).
Fibre intake and the ratio of whole grain/total grain showed the strongest inverse associations with all adiposity indicators. Statistically significant differences were observed over time in all CQI components. The most relevant changes were the increase in consumption of carbohydrates from whole-grains and a decrease in refined grains, and an increase in dietary fibre intake. After evaluating each CQI component separately, the study found that fibre intake and the ratio of whole grain/total grain presented the strongest and statistically significant negative associations with all adiposity indicators (all p-values <0.01).
Limitations
Due to the observational nature of the study, causality cannot be inferred. The study population is based on older people with overweight/obesity and MetS from a Mediterranean area, which can limit the generalisability of findings to the general population.
The use of self-reported dietary data is subject to measurement error, where self-reports may be affected by a tendency to respond in a manner to avoid criticism or judgement and to seek social approval.
Clinical practice applications:
Evidence has shown that the quality of dietary carbohydrates, rather than the quantity, may have a greater impact on health and overall mortality.
While visceral fat constitutes only a small proportion of total fat, the available evidence indicates that it plays an important role in certain chronic diseases, such as T2D, MetS, CVD and cancer.
Findings from this study suggest a better CQI via the manipulation of carbohydrate quality may be associated with a decrease in visceral fat, which are independent of changes in total body fat.
Considerations for future research:
Future strategies to decrease visceral fat are warranted.
Robust reference ranges are needed for the interpretation of visceral fat in clinical practice and research settings.
Abstract
BACKGROUND & AIMS The quality of dietary carbohydrates rather than total carbohydrate intake may determine the accumulation of visceral fat; however, to date, few studies have examined the impact of diet on adiposity using specific imaging techniques. Thus, the aim of this prospective study was to investigate the association between concurrent changes in carbohydrate quality index (CQI) and objectively-quantified adiposity distribution over a year. METHODS We analyzed a cohort of 1476 participants aged 55-75 years with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus randomized controlled trial. Dietary intake information was obtained at baseline, 6- and 12-months from a validated 143-item semi-quantitative food-frequency questionnaire, and CQI (range: 4 to 20) was calculated based on four dietary criteria: total dietary fibre, glycemic index, wholegrain/total grain carbohydrate ratio, and solid/total carbohydrate ratio. Overall and regional adiposity (total body fat, visceral fat and android-to-gynoid fat ratio) was quantified using dual-energy X-ray absorptiometry at all three time points. Multiple adjusted linear mixed-effects models were used to assess associations between concurrent changes in repeatedly measured CQI and adiposity over time. RESULTS After controlling for potential confounding factors, a 3-point increment in CQI over 12-month follow-up was associated with a decrease in visceral fat (β -0.067 z-score, 95% CI -0.088; -0.046, p < 0.001), android-to-gynoid fat ratio (-0.038, -0.059; -0.017, p < 0.001), and total fat (-0.064, -0.080; -0.047, p < 0.001). Fibre intake and the ratio of wholegrain/total grain showed the strongest inverse associations with all adiposity indicators. CONCLUSIONS In this prospective cohort of older adults with overweight/obesity and MetS, we found that improvements in dietary carbohydrate quality over a year were associated with concurrent favorable changes in visceral and overall fat deposition. These associations were mostly driven by dietary fibre and the wholegrain/total grain ratio. TRIAL REGISTRATION The trial was registered at the International Standard Randomized. CONTROLLED TRIAL (ISRCTN http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.
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Effects of inulin supplementation on body composition and metabolic outcomes in children with obesity.
Visuthranukul, C, Chamni, S, Kwanbunbumpen, T, Saengpanit, P, Chongpison, Y, Tepaamorndech, S, Panichsillaphakit, E, Uaariyapanichkul, J, Nonpat, N, Chomtho, S
Scientific reports. 2022;12(1):13014
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The prevalence of overweight and obesity among children and adolescents has risen dramatically. Overweight and obese children are at risk of developing co-morbidities such as type 2 diabetes mellitus, hypertension, dyslipidaemia, metabolic syndrome, non-alcohol fatty liver disease and premature cardiovascular diseases. Furthermore, obese children are highly prone to become obese adults. The aim of this study was to determine the effects of prebiotic (as inulin) supplementation on body weight, adiposity, and metabolic profiles in obese Thai children. This study is a randomised double-blinded placebo-controlled trial. Participants (n=165) were randomly allocated to 3 groups: inulin, placebo, and dietary fibre advice group. Results show that the intensive behavioural modification and frequent follow-up are effective strategies to reduce body mass index and adiposity in obese children. Furthermore, even though inulin supplementation did not demonstrate considerable effect on adiposity and metabolic outcomes, it can increase fat-free mass in these children. Authors conclude that further research regarding the change of gut microbiota composition and their metabolites are needed to determine inulin’s impact on host microbe interaction in obese paediatric population.
Abstract
Inulin might improve body composition in obese children. We aimed to determine the effects of inulin supplementation on body composition and metabolic outcomes in obese children. A randomized, double-blinded placebo-controlled study was conducted in obese Thai children aged 7-15 years. Participants were assigned to 3 treatment groups for 6 months: 13 g of extracted inulin powder from Thai Jerusalem artichoke, isocaloric maltodextrin, and dietary fiber advice groups. Body composition was assessed by bioelectrical impedance analysis. One-hundred and fifty-five children completed the study (mean age 10.4 ± 2.2 years, BMI z-score 3.2 ± 1.0, 59% male). The drop-out rate was 6%. The inulin extract yielded more than 90% compliance without significant gastrointestinal side effects. All three groups demonstrated a significant decrease in BMI z-score, fat mass index (FMI), and trunk FMI, but the differences between groups were not observed. Fat-free mass index significantly increased only in the inulin group (16.18 ± 1.90 vs. 16.38 ± 1.98 kg/m2, P = 0.009). There were no significant differences in the metabolic profiles between groups. Despite showing no substantial effect on adiposity, inulin may increase fat-free mass in obese children. Further research in the change of gut microbiota composition is needed to determine inulin's impact on host-microbe interaction in pediatric obesity.
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Comparison of dietary and physical activity behaviors in women with and without polycystic ovary syndrome: a systematic review and meta-analysis of 39 471 women.
Kazemi, M, Kim, JY, Wan, C, Xiong, JD, Michalak, J, Xavier, IB, Ganga, K, Tay, CT, Grieger, JA, Parry, SA, et al
Human reproduction update. 2022;28(6):910-955
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Polycystic ovary syndrome (PCOS) is a heritable, prevalent and complex endocrine disorder. Besides reproductive manifestations of increased risk of infertility and pregnancy complications, women with PCOS often exhibit cardio-metabolic aberrations and are at risk for developing metabolic syndrome, type 2 diabetes and sleep disturbance. The aim of this study was to test the hypothesis that reproductive-aged women with PCOS would exhibit worse dietary and physical activity (PA) behaviours versus their counterparts without PCOS. This study was a systematic review and meta-analysis of 54 studies (61 publications). The studies included a total of 39,471 participants and 116 experimental arms (n = 8736 PCOS [59 arms]). Results showed that women with PCOS exhibit an overall adverse lifestyle behaviour, specifically poorer dietary intakes (lower diet quality, higher cholesterol, lower magnesium, tendency for lower zinc), and lower total PA compared to those without PCOS, despite lower alcohol intakes. Furthermore, compared to women without PCOS, the women with PCOS consumed worse or similar consumption of core food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy). Authors conclude that providing education on lifestyle modification is crucial for women with PCOS to improve their short- and long-term reproductive, metabolic, and psychological health.
Abstract
BACKGROUND Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. OBJECTIVE AND RATIONALE We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. SEARCH METHODS Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (<18 years), pregnant or menopausal-aged women (>50 years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). OUTCOMES Fifty-four studies (N = 39 471 participants; [n = 8736 PCOS; 30 735 Controls]) were eligible (96%; [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day; P = 0.03; I2 = 19%), lower magnesium (MD: -21.46, 95% CI: -41.03 to -1.91 mg/day; P = 0.03; I2 = 76%), and a tendency for lower zinc (MD: -1.08, 95% CI: -2.19 to -0.03 mg/day; P = 0.05; I2 = 96%) intake, despite lower alcohol consumption (MD: -0.95, 95% CI: -1.67 to 0.22 g/day; P = 0.02; I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: -0.38, 95% CI: -0.72 to 0.03; P = 0.03; I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. WIDER IMPLICATIONS Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
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Linoleic Acid-Rich Oil Alters Circulating Cardiolipin Species and Fatty Acid Composition in Adults: A Randomized Controlled Trial.
Cole, RM, Angelotti, A, Sparagna, GC, Ni, A, Belury, MA
Molecular nutrition & food research. 2022;66(15):e2101132
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Dietary polyunsaturated fatty acid intake is associated with reduced cardiometabolic disease risk. In addition, higher linoleic acid (LA) biomarkers have been associated with a reduced risk for cardiometabolic diseases and conditions. The main aim of this study was to determine whether a modest addition of an oil rich in LA could change the LA content in plasma, erythrocytes, and peripheral blood mononuclear cells (PBMCs). The secondary aim was to determine if the LA-rich oil could alter cardiolipin species in PBMCs. This study is a randomised double-masked placebo-controlled study of 84 participants who were randomly assigned to one of the two groups: either the high-oleate-cookie (n = 42) or LA-cookie groups (n = 42). Results show that dietary supplementation with less than one serving of LA-rich oil per day increases LA in PBMC cardiolipin as well as LA levels. Authors conclude that patients with obesity, cardiometabolic disease, and other conditions related to mitochondrial dysfunction could be a future cohort that should be studied.
Abstract
SCOPE Higher circulating linoleic acid (LA) and muscle-derived tetralinoleoyl-cardiolipin (LA4 CL) are each associated with decreased cardiometabolic disease risk. Mitochondrial dysfunction occurs with low LA4 CL. Whether LA-rich oil fortification can increase LA4 CL in humans is unknown. The aims of this study are to determine whether dietary fortification with LA-rich oil for 2 weeks increases: 1) LA in plasma, erythrocytes, and peripheral blood mononuclear cells (PBMC); and 2) LA4 CL in PBMC in adults. METHODS AND RESULTS In this randomized controlled trial, adults are instructed to consume one cookie per day delivering 10 g grapeseed (LA-cookie, N = 42) or high oleate (OA) safflower (OA-cookie, N = 42) oil. In the LA-cookie group, LA increases in plasma, erythrocyte, and PBMC by 6%, 7%, and 10% respectively. PBMC and erythrocyte OA increase by 7% and 4% in the OA-cookie group but is unchanged in the plasma. PBMC LA4 CL increases (5%) while LA3 OA1 CL decreases (7%) in the LA-cookie group but are unaltered in the OA-cookie group. CONCLUSIONS LA-rich oil fortification increases while OA-oil has no effect on LA4 CL in adults. Because LA-rich oil fortification reduces cardiometabolic disease risk and increases LA4 CL, determining whether mitochondrial dysfunction is repaired through dietary fortification is warranted.
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The association between the metabolic syndrome and iron status in pre- and postmenopausal women: Korean National Health and Nutrition Examination Survey (KNHANES) in 2012.
Yun, S, Nguyen, HD, Park, JS, Oh, C, Kim, MS
The British journal of nutrition. 2022;127(4):630-640
Abstract
We aim to determine the association between Fe status and the metabolic syndrome (MetS) during menopause. Records of 1069 premenopausal and 703 postmenopausal Korean women were retrieved from the database of the fifth Korean National Health and Nutrition Examination Survey (KNHANES V 2012) and analysed. The association between the MetS and Fe status was performed using multivariable-adjusted analyses, subsequently develop a prediction model for the MetS by margin effects. We found that the risk of Fe depletion among postmenopausal women was lower than premenopausal women (PR = 0·813, 95 % CI 0·668, 0·998, P = 0·038). The risk of the MetS was 2·562-fold lower among premenopausal women with than without Fe depletion (PR = 0·390, 95 % CI 0·266, 0·571, P < 0·001). In contrast, the risk of the MetS tended to be higher among postmenopausal women with than without Fe depletion (PR = 1·849, 95 % CI 1·406, 2·432, P < 0·001). When the serum ferritin levels increased, the risk of the MetS increased in both premenopausal women and postmenopausal women. The margin effects showed that an increase in serum Hb and ferritin was associated with an increase in the risk of the MetS according to menopausal status and age group. Therefore, ferritin is the most validated and widely used Fe marker, could be a potential clinical value in predicting and monitoring the MetS during menopause. Further prospective or longitudinal studies, especially, clinically related studies on menopause and Fe status, are needed to clarify the causality between serum ferritin levels and the MetS that could offer novel treatments for the MetS.
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The association between environmental exposures to chlordanes, adiposity and diabetes-related features: a systematic review and meta-analysis.
Mendes, V, Ribeiro, C, Delgado, I, Peleteiro, B, Aggerbeck, M, Distel, E, Annesi-Maesano, I, Sarigiannis, D, Ramos, E
Scientific reports. 2021;11(1):14546
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Plain language summary
Chlordane is a synthetic organochlorine pesticide used for several decades in agriculture, but also in housing for pest control. Chlordane compounds are endocrine disrupting chemicals (EDCs), which means that they may affect the natural function of hormones by blocking, mimicking, displacing, or acting to subvert their roles. The aim of this study was to investigate whether exposure to chlordane compounds increases the risk of adiposity and diabetes in humans. This study is a systematic review and meta-analysis of 31 publications. Results demonstrate that there is no association between chlordane compounds and adiposity. However, there are higher odds of having diabetes-related features with increasing levels of all the chlordane compounds evaluated. Authors conclude that an international agreement on methods to measure both exposure and outcome variables and to conduct epidemiological studies could increase the knowledge on how adverse effects of exposure to various stressors (exposome) can influence human health.
Abstract
Chlordane compounds (CHLs) are components of technical chlordane listed in the Stockholm convention on persistent organic pollutants identified as endocrine disrupting chemicals (EDCs) and may interfere with hormone biosynthesis, metabolism or action resulting in an unbalanced hormonal function. There is increasing scientific evidence showing EDCs as risk factors in the pathogenesis and development of obesity and obesity-related metabolic syndromes such as type 2 diabetes, but there is no systematized information on the effect of CHLs in humans. Our aim is to identify the epidemiological data on the association between CHLs with adiposity and diabetes using a systematic approach to identify the available data and summarizing the results through meta-analysis. We searched PubMed and Web of Science from inception up to 15 February 2021, to retrieve original data on the association between chlordanes, and adiposity or diabetes. For adiposity, regression coefficients and Pearson or Spearman correlation coefficients were extracted and converted into standardized regression coefficients. Data were combined using fixed effects meta-analyses to compute summary regression coefficients and corresponding 95% confidence intervals (95% CI). For the association between chlordanes and diabetes, Odds ratios (ORs) were extracted and the DerSimonian and Laird method was used to compute summary estimates and respective 95% CI. For both, adjusted estimates were preferred, whenever available. Among 31 eligible studies, mostly using a cross-sectional approach, the meta-analysis for adiposity was possible only for oxychlordane and transchlordane, none of them were significantly associated with adiposity [(β = 0.04, 95% CI 0.00; 0.07, I2 = 89.7%)] and (β = 0.02, 95% CI - 0.01; 0.06), respectively. For diabetes, the estimates were positive for all compounds but statistically significant for oxychlordane [OR = 1.96 (95% CI 1.19; 3.23)]; for trans-nonachlor [OR = 2.43 (95% CI 1.64; 3.62)] and for heptachlor epoxide [OR = 1.88 (95% CI 1.42; 2.49)]. Our results support that among adults, the odds of having diabetes significantly increase with increasing levels of chlordanes. The data did not allow to reach a clear conclusion regarding the association with adiposity.
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Targeting body composition in an older population: do changes in movement behaviours matter? Longitudinal analyses in the PREDIMED-Plus trial.
Galmes-Panades, AM, Konieczna, J, Varela-Mato, V, Abete, I, Babio, N, Fiol, M, Antonio de Paz, J, Casas, R, Olbeyra, R, Ruiz-Canela, M, et al
BMC medicine. 2021;19(1):3
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Expert Review
Conflicts of interest:
None
Take Home Message:
- The importance of including daily physical activity in place of sedentary behaviour.
- The additional benefits of moderate-to vigorous physical activity.
- The importance of seeking medical advice before commencing a physical activity programme
- The importance of working with qualified exercise prescribers when embarking on a new activity programme
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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X
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:
Authors highlight that although the relationship between physical activity (PA), sedentary behaviour (SB) and markers of obesity and body composition (BC) have been studied extensively, the balance between PA at different levels of intensity e.g. light physical activity (LPA) intensity and medium to vigorous activity (MVPA) intensity as well as SB in older, obese/overweight adults remains unclear.
Aim and Objectives:
This longitudinal, observational prospective study aimed to explore the relationships between PA and SB in an older population with Metabolic Syndrome (MetS) over a period of 12 weeks (n=1564).
The objectives were specifically to:
1. Evaluate the relationship of concurrent changes in self=reported PA and SB with body composition changes at 12 months using dual-energy X-ray absorptiometry (DEXA).
2. Evaluate the impact of replacing SB with PA at different intensities (LA and MVPA) on BC changes.
Accelerometer-derived inactive time (IT) data was used as a proxy for SB.
Study Design:
The study was nested in the PREDIMED-Plus trial, registered at ISRCTN (89898870). 1564 participants were recruited for the sub-sample (men aged 55-75 n=813; women aged 60-75 n=751) with a BMI >27 and < 40kg/m2 and 3 components of MetS. Data was collected at baseline, 6 and 12 months.
Intervention:
Multicomponent weight loss based on energy restricted Mediterranean Diet (erMedDiet), increasing 30 mins of total PA with behavioural support.
Control:
MedDiet without energy restriction or additional support.
Results:
- At 12 months, participants (intervention and control groups) reduced their waist circumference, BMI, body fat, visceral adipose tissue (VAT) and total energy intake compared to baseline. They increased percentage of muscle mass and muscle-to-fat mass ratio.
- At 6 and 12 months, participants accrued more total PA, LPA and MVPA and less total SB compared to baseline.
After adjustment for potential confounders:
- Increasing 30 min of PA was significantly associated with a decrease in body fat (β − 0.07%, 95% CIs − 0.10; − 0.04%) and VAT (− 13.9 g; − 21.5; − 6.23) and increased muscle mass (0.07%; 0.04; 0.10) and muscle-to-fat mass ratio (0.41; 0.15; 0.67).
- Increasing 30 min of MVPA was linked to significantly reduced body fat (− 0.08%, − 0.11; − 0.04%) and VAT (− 15.6 g; − 24.1; − 7.25) and with increased muscle mass (0.07%; 0.04; 0.10) and muscle-to-fat mass ratio (0.44; 0.15; 0.72).
- Overall, 30 more minutes of total SB was associated with significantly greater body fat and lower muscle mass.
- No significant associations were observed for LPA.
Conclusions:
Increasing PA and substituting SB with PA, in particular MVPA is correlated with improvements in body composition in overweight or obese older adults with MetS.
Clinical practice applications:
- To inform older clients (>55yrs) on the benefits of PA on a range of health conditions e.g. cardiovascular disease and symptoms e.g. metabolic symptoms
- To provide guidance on the benefits of replacing SB with PA, with examples of optimal amount of time and intensity, obviously working within professional boundaries and referring on to relevant experts when necessary
- To encourage practitioners to include recommendations of physical activity as part of a comprehensive approach to physical well-being
Considerations for future research:
- Analyse how increases in physical activity may benefit other chronic health conditions in older adults
- Evaluate how exchanging sedentary behaviour with physical activity may benefit mental health symptoms such as mood and anxiety in adults.
- Explore different facilitators and barriers to increasing physical activity to reduce sedentary behaviour in adults.
Abstract
BACKGROUND The optimal distribution between physical activity (PA) levels and sedentary behaviour (SB) for the greatest benefits for body composition among older adults with overweight/obesity and chronic health conditions remains unclear. We aimed to determine the prospective association between changes in PA and in SB with concurrent changes in body composition and to examine whether reallocating inactive time into different physical activity levels was associated with 12-month change to body composition in older adults. METHODS Longitudinal assessment nested in the PREDIMED-Plus trial. A subsample (n = 1564) of men and women (age 55-75 years) with overweight/obesity and metabolic syndrome from both arms of the PREDIMED-Plus trial was included in the present analysis. Participants were followed up at 6 and 12 months. Physical activity and SB were assessed using validated questionnaires. Out of 1564 participants, 388 wore an accelerometer to objectively measure inactive time and PA over a 7-day period. At each time point, participants' body composition was measured using dual-energy X-ray absorptiometry (DXA). Standard covariate-adjusted and isotemporal substitution modelling were applied to linear mixed-effects models. RESULTS Increasing 30 min of total PA and moderate-to-vigorous physical activity (MVPA) was associated with significant reductions in body fat (β - 0.07% and - 0.08%) and visceral adipose tissue (VAT) (- 13.9 g, and - 15.6 g) at 12 months (all p values < 0.001). Reallocating 30 min of inactive time to MVPA was associated with reductions in body fat and VAT and with an increase in muscle mass and muscle-to-fat mass ratio (all p values < 0.001). CONCLUSIONS At 12 months, increasing total PA and MVPA and reducing total SB and TV-viewing SB were associated with improved body composition in participants with overweight or obesity, and metabolic syndrome. This was also observed when substituting 30 min of inactive time with total PA, LPA and MVPA, with the greatest benefits observed with MVPA. TRIAL REGISTRATION International Standard Randomized Controlled Trial (ISRCTN), 89898870 . Retrospectively registered on 24 July 2014.