Journal Cover
American Journal of Clinical Nutrition
Journal Prestige (SJR): 3.438
Citation Impact (citeScore): 6
Number of Followers: 211  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9165 - ISSN (Online) 1938-3207
Published by Oxford University Press Homepage  [410 journals]
  • Overall lack of replication of associations between dietary intake of
           folate and vitamin B-12 and DNA methylation in peripheral blood
    • Authors: Dugué P; Chamberlain J, Bassett J, et al.
      Pages: 228 - 230
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz253
      Issue No: Vol. 111, No. 1 (2020)
  • Reply to P-A Dugué et al.
    • Authors: Mandaviya P; van Meurs J, Heil S.
      Pages: 230 - 231
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz254
      Issue No: Vol. 111, No. 1 (2020)
  • Corrigendum to “Using metabolic profiling and gene expression analyses
           to explore molecular effects of replacing saturated fat with
           polyunsaturated fat—a randomized controlled dietary intervention
           study” Am J Clin Nutr 2019;109:247–48
    • Pages: 232 - 236
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz197
      Issue No: Vol. 111, No. 1 (2020)
  • Calendar of Events
    • Pages: 237 - 237
      PubDate: Tue, 07 Jan 2020 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz325
      Issue No: Vol. 111, No. 1 (2020)
  • Knowledge and debate in the American Journal of Clinical Nutrition: new
           sections, new science, and looking forward and outward
    • Authors: Duggan C; Brennan L, Christian P, et al.
      Pages: 1 - 3
      Abstract: In Vision 2028, the ASN's 10-y vision for its role as a scientific society, it is proposed that the ASN should adopt “a new outward-facing role to more actively leverage our science in the service of humanity (and animals) through the active translation and promotion of optimal nutrition for health” (1). In contrast to endorsing an archetypical inward-focused academic society, the white paper lists several ways for the ASN to engage its members and nutrition scientists to advance science and nutrition globally.
      PubDate: Wed, 30 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz267
      Issue No: Vol. 111, No. 1 (2019)
  • Lessons from application of data science strategies in nutritional
    • Authors: Kaput J.
      Pages: 4 - 5
      Abstract: Grapefruit juice, milk, and alcohol are the common examples of foods that alter drug effectiveness but a growing list of other naturally occurring chemicals in foods have been identified that affect mechanisms of absorption, distribution, metabolism, excretion (ADME), or activity of specific prescription drugs (1). Drug–nutrient interactions (DNIs) are so critical to drug safety that the US FDA and the European Medicines Agency require evaluation of bioavailability and bioequivalence using high-caloric and high-fat test meals as a part of their approval processes. The nature of the response in the gastrointestinal tract to food intake results in dynamic local environments that may alter absorption and local metabolism of drugs (1). Hence, much research and many regulations focus on nutrients, and changing nutrient status, that alter drug effectiveness.
      PubDate: Mon, 25 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz284
      Issue No: Vol. 111, No. 1 (2019)
  • Serum magnesium and risk of coronary artery disease: are there
           implications for dietary interventions'
    • Authors: van Dam R.
      Pages: 6 - 7
      Abstract: Magnesium is a mineral that is essential for basic cellular processes and acts as a cofactor for hundreds of enzymatic reactions (1). With regard to cardiovascular function, it is involved in blood pressure regulation, glucose homeostasis, and maintaining a normal heart rhythm (1). A variety of foods are sources of magnesium including green leafy vegetables, whole grains, nuts, legumes, and dairy products. However, a substantial proportion of the US population does not meet the recommended intakes of magnesium (2). This raises the question of whether increasing magnesium intakes is a promising strategy for the prevention of coronary artery disease (CAD).
      PubDate: Sat, 16 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz289
      Issue No: Vol. 111, No. 1 (2019)
  • The significance of tryptophan metabolism and vitamin B-6 status in
           cardiovascular disease
    • Authors: Gostner J; Kurz K, Fuchs D.
      Pages: 8 - 9
      Abstract: In this issue of the Journal, Ulvik et al. (1) report on the association of tryptophan (Trp) metabolism and status of vitamin B-6 (pyridoxal 5′-phosphate, PLP) in 2 cohorts of healthy controls and cardiovascular disease (CVD) patients. The authors conclude that the combination index of 5 downstream metabolites in the Trp–kynurenine (Kyn) pathway can be applied as a surrogate marker for the evaluation of PLP status in health and disease.
      PubDate: Thu, 14 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz291
      Issue No: Vol. 111, No. 1 (2019)
  • Should formula for infants provide arachidonic acid along with DHA' A
           position paper of the European Academy of Paediatrics and the Child Health
    • Authors: Koletzko B; , Bergmann K, et al.
      Pages: 10 - 16
      Abstract: ABSTRACTRecently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from February 2020 onwards, all such products marketed in the European Union must contain 20–50 mg omega-3 DHA (22:6n–3) per 100 kcal, which is equivalent to about 0.5–1% of fatty acids (FAs) and thus higher than typically found in human milk and current infant formula products, without the need to also include ω-6 arachidonic acid (AA; 20:4n–6). This novel concept of infant formula composition has given rise to concern and controversy because there is no accountable evidence on its suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and AA, and to discuss the questions arising from the new European regulatory standards. Based on the available information, we recommend that infant and follow-on formula should provide both DHA and AA. The DHA should equal at least the mean content in human milk globally (0.3% of FAs) but preferably reach 0.5% of FAs. Although optimal AA intake amounts remain to be defined, we strongly recommend that AA should be provided along with DHA. At amounts of DHA in infant formula up to ∼0.64%, AA contents should at least equal the DHA contents. Further well-designed clinical studies should evaluate the optimal intakes of DHA and AA in infants at different ages based on relevant outcomes.
      PubDate: Sat, 26 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz252
      Issue No: Vol. 111, No. 1 (2019)
  • The pain of weight gain: self-experimentation with overfeeding
    • Authors: Bray G.
      Pages: 17 - 20
      Abstract: ABSTRACTThe Vermont overfeeding studies were published 50 y ago and began a change in the acceptance of obesity as a bona fide area of academic interest. This article chronicles the experience of the author with acute weight gain while overfeeding, in the context of current obesity research, and presents a glimpse of things to come. The pain associated with acute overeating is illustrated by the firsthand experience of the author. The rapid return to normal weight contrasts with the difficulty that almost all people with obesity experience when they attempt to lose and maintain weight loss. Contrasting the response to overfeeding of individuals who are “resistant” to obesity with those who are obesity prone provides an avenue for unraveling the difficulties people with obesity face when they try to lose weight.
      PubDate: Tue, 22 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz264
      Issue No: Vol. 111, No. 1 (2019)
  • The Intervention Nurses Start Infants Growing on Healthy Trajectories
           (INSIGHT) responsive parenting intervention for firstborns impacts feeding
           of secondborns
    • Authors: Ruggiero C; Hohman E, Birch L, et al.
      Pages: 21 - 27
      Abstract: ABSTRACTBackgroundThe Intervention Nurses Start Infant Growing on Healthy Trajectories (INSIGHT) study's responsive parenting (RP) intervention, initiated in early infancy, prevented the use of nonresponsive, controlling feeding practices and promoted use of structure-based feeding among first-time parents compared with controls.ObjectivesWe sought to examine the spillover effect of the RP intervention on maternal feeding practices with their secondborn (SB) infants enrolled in an observational-only study, SIBSIGHT, and to test the moderating effect of spacing of births.MethodsSB infants of mothers participating in the INSIGHT study were enrolled into the observation-only ancillary study, SIBSIGHT. SBs were healthy singleton infants ≥36 weeks of gestation. Infant feeding practices (i.e., food to soothe, structure vs. control-based practices) were assessed using validated questionnaires: Babies Need Soothing Questionnaire, Infant Feeding Styles Questionnaire, and the Structure and Control in Parent Feeding Questionnaire.ResultsSBs (n = 117 [RP: 57, control: 60]; 43% male) were delivered 2.5 ± 0.8 y after firstborns (FBs). At age 1 y, the Structure and Control in Parent Feeding Questionnaire revealed that the mothers in the RP group used more consistent feeding routines (4.19 [0.43] compared with 3.77 [0.62], P = 0.0006, Cohen's D: 0.69) compared with control group mothers. From the Infant Feeding Styles Questionnaire, RP group mothers also used less nonresponsive, controlling feeding practices such as pressuring their SB infant to finish (1.81 [0.52] compared with 2.24 [0.68], P = 0.001, Cohen's D: 0.68) compared with controls. In contrast to our hypotheses, no differences were detected in bottle-feeding practices such as putting to bed with a bottle/sippy cup or adding cereal to the bottle, despite observing study group differences in FBs. Spacing of births did not moderate intervention effects.ConclusionsRP guidance given to mothers of FBs may prevent the use of some nonresponsive, controlling feeding practices while establishing consistent feeding routines in subsequent siblings.
      PubDate: Fri, 29 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz277
      Issue No: Vol. 111, No. 1 (2019)
  • Intestinal sensing and handling of dietary lipids in gastric
           bypass–operated patients and matched controls
    • Authors: Martinussen C; Dirksen C, Bojsen-Møller K, et al.
      Pages: 28 - 41
      Abstract: ABSTRACTBackgroundAltered meal-related gut hormone secretion seems important for weight loss and diabetes remission after Roux-en-Y gastric bypass (RYGB). Elucidating the responsible meal components and receptors could aid discovery of new treatments of obesity and diabetes. Enteroendocrine cells respond to digestion products of dietary triacylglycerol, especially long-chain fatty acids (LCFAs) and 2-oleoyl-glycerol (2-OG), but not medium-chain fatty acids (MCFAs).ObjectiveWe examined the impact of olive oil (20 mL) and its derivates, LCFAs and 2-OG, on enteroendocrine secretions [glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), cholecystokinin (CCK), peptide YY (PYY), and neurotensin (NT)] and on glucose, lipid, and bile acid metabolism in RYGB-operated and unoperated individuals.MethodsIn an exploratory randomized crossover design, 10 RYGB-operated patients and 10 matched controls ingested 3 equimolar triacylglycerol formulations on separate days: olive oil (digested to 2-OG + LCFAs), C8-dietary oil (2-OG + MCFAs), and tricaprylin (MCFAs; negative control). Hormone responses were calculated as area under the curve (AUC).ResultsIndependent of group status, olive oil had greater effects than C8-dietary oil on AUCs of plasma GLP-1 (+32%; 95% CI: 23%, 43%; P < 0.01), CCK (+53%, P < 0.01), and NT (+71%, P < 0.01), whereas the effect on GIP differed between groups (+90% in controls, P < 0.01; +24% in RYGB, P = 0.10). Independent of group status, C8-dietary oil had greater effects than tricaprylin on AUCs of plasma CCK (+40%, P < 0.01) and NT (+32%, P < 0.01), but not GLP-1 (+5%; 95% CI: −2.9%, 13%; P = 0.22), whereas the effect on GIP again differed between groups (+78% in controls, P < 0.01; +39% in RYGB, P = 0.01). Distal (GLP-1/PYY/NT), but not proximal (CCK/GIP), enteroendocrine responses were generally greater in RYGB patients than in controls.ConclusionsThe combination of LCFAs plus 2-OG was substantially more effective than 2-OG plus MCFAs in stimulating enteroendocrine secretion in RYGB-operated and matched control individuals. Distal lipid-induced gut hormone release was greater after RYGB.This trial was registered at as NCT03223389.
      PubDate: Tue, 19 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz272
      Issue No: Vol. 111, No. 1 (2019)
  • Effects of regular-fat and low-fat dairy consumption on daytime ambulatory
           blood pressure and other cardiometabolic risk factors: a randomized
           controlled feeding trial
    • Authors: Rancourt-Bouchard M; Gigleux I, Guay V, et al.
      Pages: 42 - 51
      Abstract: ABSTRACTBackgroundThe extent to which dairy products and their fat content influence cardiovascular health remains uncertain.ObjectiveThis study aimed to assess how consumption of low-fat milk and regular-fat cheese enriched in γ-aminobutyric acid (GABA) influences daytime ambulatory blood pressure (BP) and other cardiometabolic risk factors.MethodsIn this crossover controlled feeding study, 55 healthy men and women with high-normal daytime BP were randomly assigned to sequences of three 6-wk isoenergetic diets, each comprising 1) no dairy (control diet), 2) 3 daily servings of 1% fat milk, and 3) 1 daily serving of 31% fat cheddar cheese naturally enriched in GABA. Total proteins, carbohydrates, and fats were matched across all 3 diets. The additional 2% of energy from SFAs in the cheese diet was replaced by n–6 PUFAs in the other diets.ResultsComparison of postdiet ambulatory systolic BP revealed no difference (P = 0.34), which was also the case for ambulatory diastolic BP (P = 0.45). The cheese diet increased serum LDL-cholesterol concentrations compared with the control and milk diets (+5.8%, P = 0.006 and +7.0%, P = 0.0008, respectively) and increased LDL particle size compared with the milk diet (P = 0.02). HDL-cholesterol concentrations after the milk diet were lower than after the control diet (−4.1%; P = 0.009). The milk and cheese diets increased triglycerides compared with the control diet (+9.9%, P = 0.01 and +10.5%, P = 0.007, respectively). There was no significant difference between all diets for C-reactive protein concentrations and markers of glucose/insulin homeostasis.ConclusionsThese results suggest that short-term consumption of dairy products, whether low or regular in fat, has no overall effect on daytime ambulatory BP compared with a dairy-free diet. Other cardiometabolic risk factors may be differently modified according to the fat content of the dairy product. This trial was registered at as NCT02763930.
      PubDate: Fri, 04 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz251
      Issue No: Vol. 111, No. 1 (2019)
  • Serum magnesium and the incidence of coronary artery disease over a median
           27 years of follow-up in the Atherosclerosis Risk in Communities (ARIC)
           Study and a meta-analysis
    • Authors: Rooney M; Alonso A, Folsom A, et al.
      Pages: 52 - 60
      Abstract: ABSTRACTBackgroundLow serum magnesium (Mg) concentrations have been associated with higher coronary artery disease (CAD) risk. A previous Atherosclerosis Risk in Communities (ARIC) Study article that evaluated the Mg–CAD association, based on 319 events occurring over 4–7 y, identified a sex-interaction whereby the inverse Mg–CAD association was much stronger among women than men. More than 1700 additional ARIC CAD events have since accrued.ObjectiveWe aimed to test our hypothesis that serum Mg is inversely and independently associated with long-term CAD risk in ARIC and in a meta-analysis with other prospective studies.MethodsA total of 14,446 ARIC study participants (baseline mean ± SD age: 54 ± 6 y, 57% women, 27% African American) were followed for incident CAD through 2017. CAD events were defined by myocardial infarction or CAD mortality. Serum Mg was modeled as quintiles based on mean visit 1 (1987–1989) and visit 2 (1990–1992) concentrations. Cox regression models were used. We also conducted a random-effects meta-analysis incorporating these contemporary ARIC findings.ResultsOver a median follow-up of 27 y, 2131 incident CAD cases accrued. Overall, low serum Mg was associated with higher CAD risk after adjustment for demographics, lifestyle factors, and other CAD risk factors than was higher serum Mg (HR Q1 compared with Q5: 1.28; 95% CI: 1.11, 1.47; P-linear trend <0.001). The association was stronger among women (HR Q1 compared with Q5: 1.53; 95% CI: 1.22, 1.92) than men (HR: 1.11; 95% CI: 0.92, 1.34) (P-interaction = 0.05). In the meta-analysis including 5 studies, the pooled RR (95% CI) for CAD in the lowest compared with the highest circulating Mg category was 1.18 (1.06, 1.31) (I2 = 22%, P-heterogeneity = 0.27).ConclusionsIn this large community-based cohort and updated meta-analysis, low circulating Mg was associated with higher CAD risk than was higher Mg. Whether increasing Mg concentrations within healthy limits is a useful strategy for CAD prevention remains to be seen.
      PubDate: Thu, 17 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz256
      Issue No: Vol. 111, No. 1 (2019)
  • Dietary quality among children from 6 months to 4 years, NHANES
    • Authors: Hamner H; Moore L.
      Pages: 61 - 69
      Abstract: ABSTRACTBackgroundThe US Dietary Guidelines for Americans provide dietary recommendations for individuals aged ≥2 y and metrics exist to assess alignment. Nonfederal feeding recommendations exist for children <2 y, but limited metrics and assessment of dietary quality are available.ObjectiveWe aimed to assess dietary quality of children aged 6 mo–4 y using a modified Diet Quality Index Score (DQIS).MethodsNHANES 2011–2016 dietary data were used to estimate the dietary quality of children 6 mo–4 y old using a modified DQIS. Differences in mean modified DQIS by demographics were assessed using linear regression.ResultsMean modified DQIS ± SE was 22.4 ± 0.23 out of 45 possible points (50%) for children 6 mo–4 y of age on a given day. Modified DQIS scores on a given day decreased with age (27.7 ± 0.27 for 6- to 11-mo-olds, 23.9 ± 0.31 for 1-y-olds, 21.4 ± 0.26 for 2- to 3-y-olds, and 20.6 ± 0.49 for 4-y-olds; P < 0.0001 for trend). Children 6–11 mo old had 16% higher overall modified DQIS scores than 1-y-olds (P < 0.0001) and higher modified DQIS subcomponent scores for refined grains and protein, indicating higher age-appropriate intakes (P < 0.05). Similarly, children 6–11 mo old also had higher modified DQIS subcomponent scores, indicating no or limited intake, for 100% fruit juice, sugar-sweetened beverages, other added sugars, and salty snacks (P < 0.02).ConclusionsDietary quality declines with age and may begin as early as 1 y. The modified DQIS tool could help assess the dietary quality of young children. This may be important when identifying programmatic and policy efforts aimed at establishing and maintaining healthy dietary patterns beginning at an early age.
      PubDate: Mon, 28 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz261
      Issue No: Vol. 111, No. 1 (2019)
  • Using compositional principal component analysis to describe children's
           gut microbiota in relation to diet and body composition
    • Authors: Leong C; Haszard J, Heath A, et al.
      Pages: 70 - 78
      Abstract: ABSTRACTBackgroundGut microbiota data obtained by DNA sequencing are complex and compositional because of large numbers of detectable taxa, and because microbiota characteristics are described in relative terms. Nutrition researchers use principal component analysis (PCA) to derive dietary patterns from food data. Although compositional PCA methods are not commonly used to describe patterns from complex microbiota data, this approach would be useful for identifying gut microbiota patterns associated with diet and body composition.ObjectivesTo use compositional PCA to describe the principal components (PCs) of gut microbiota in 5-y-old children and explore associations between microbiota components, diet, and BMI z-score.MethodsA fecal sample was provided by 319 children aged 5 y. Their primary caregiver completed a validated 123-item quantitative FFQ. Body composition was determined using DXA, and a BMI z-score was calculated. Compositional PCA identified characterizing taxa and weightings for calculation of gut microbiota PC scores at the genus level, and was examined in relation to diet and body size.ResultsThree gut microbiota PCs were found. PC1 (negative loadings on uncultured Christensenellaceae and Ruminococcaceae) was related to lower BMI z-scores and longer duration of breastfeeding (per month) (β = −0.14; 95% CI: −0.26, −0.02; and β = 0.02; 95% CI: 0.003, 0.34, respectively). PC2 (positive loadings on Fusicatenibacter and Bifidobacterium; negative loadings on Bacteroides) was associated with a lower intake of nuts, seeds, and legumes (β = −0.05 per gram; 95% CI: −0.09, −0.01). When adjusted for fiber intake, PC2 was also associated with higher BMI z-scores (β = 0.12; 95% CI: 0.01, 0.24). PC3 (positive loadings on Faecalibacterium, Eubacterium, and Roseburia) was associated with higher intakes of fiber (β = 0.02 per gram; 95% CI: 0.003, 0.04) and total nonstarch polysaccharides (β = 0.02 per gram; 95% CI: 0.003, 0.04).ConclusionsOur results suggest that specific gut microbiota components determined using compositional PCA are associated with diet and BMI z-score.This trial was registered at as NCT00892983.
      PubDate: Mon, 11 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz270
      Issue No: Vol. 111, No. 1 (2019)
  • Inorganic nitrate and nitrite supplementation fails to improve skeletal
           muscle mitochondrial efficiency in mice and humans
    • Authors: Ntessalen M; Procter N, Schwarz K, et al.
      Pages: 79 - 89
      Abstract: AbstractBackgroundInorganic nitrate, abundant in leafy green vegetables and beetroot, is thought to have protective health benefits. Adherence to a Mediterranean diet reduces the incidence and severity of coronary artery disease, whereas supplementation with nitrate can improve submaximal exercise performance. Once ingested, oral commensal bacteria may reduce nitrate to nitrite, which may subsequently be reduced to nitric oxide during conditions of hypoxia and in the presence of “nitrite reductases” such as heme- and molybdenum-containing enzymes.ObjectiveWe aimed to explore the putative effects of inorganic nitrate and nitrite on mitochondrial function in skeletal muscle.MethodsMice were subjected to a nitrate/nitrite-depleted diet for 2 wk, then supplemented with sodium nitrate, sodium nitrite, or sodium chloride (1 g/L) in drinking water ad libitum for 7 d before killing. Skeletal muscle mitochondrial function and expression of uncoupling protein (UCP) 3, ADP/ATP carrier protein (AAC) 1 and AAC2, and pyruvate dehydrogenase (PDH) were assessed by respirometry and Western blotting. Studies were also undertaken in human skeletal muscle biopsies from a cohort of coronary artery bypass graft patients treated with either sodium nitrite (30-min infusion of 10 μmol/min) or vehicle [0.9% (wt:vol) saline] 24 h before surgery.ResultsNeither sodium nitrate nor sodium nitrite supplementation altered mitochondrial coupling efficiency in murine skeletal muscle, and expression of UCP3, AAC1, or AAC2, and PDH phosphorylation status did not differ between the nitrite and saline groups. Similar results were observed in human samples.ConclusionsSodium nitrite failed to improve mitochondrial metabolic efficiency, rendering this mechanism implausible for the purported exercise benefits of dietary nitrate supplementation. This trial was registered at as NCT04001283.
      PubDate: Thu, 10 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz245
      Issue No: Vol. 111, No. 1 (2019)
  • Intact and hydrolyzed casein lead to similar ileal endogenous protein and
           amino acid flows in adult humans
    • Authors: Deglaire A; Moughan P, Airinei G, et al.
      Pages: 90 - 97
      Abstract: ABSTRACTBackgroundEndogenous amino acids (AAs) contribute to terminal ileal digesta and must be corrected for in determining coefficients of true ileal digestibility. Such estimates are also needed for the factorial calculation of AA requirements.ObjectiveThe effect of the form of delivery of dietary AAs on endogenous nitrogen and AA flows at the end of the ileum was studied.MethodsIsotopically labeled 15N-casein (33–34 g), in either a hydrolyzed (HC) or intact (C) form, was included as the sole source of nitrogen in a mixed meal (320 mmol N) consumed by healthy adult humans equipped with a triple-lumen sampling tube in the small intestine. Ileal endogenous AA flows were determined by isotope dilution. An additional meal (A) containing a free AA mixture (306 mmol N) simulating the AA composition of casein was included. Serine was omitted from the AA mixture to allow direct determination of its ileal endogenous flow.ResultsEndogenous N and AA flows did not differ (P > 0.05) for diets C and HC, with mean respective N flows of 728 and 617 mg/8 h (± pooled SD: 144 mg/8 h). Endogenous serine flow was similar (P > 0.05) for diets C, HC, and A [181, 169, and 191 mg/8 h (± 56 mg/8 h)]. Recycling of the 15N marker was determined to be ∼11%, suggesting that the 15N endogenous loss values could underestimate endogenous protein and AA losses by ∼6% (the proportion of recycled 15N divided by the sum of endogenous N and recycled 15N).ConclusionsThe 3 different forms of dietary AA delivery (free AAs, HC, or C) elicited similar ileal endogenous AA flows in the adult human.This study was registered at as NCT 00873951.
      PubDate: Sat, 09 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz268
      Issue No: Vol. 111, No. 1 (2019)
  • Changing from a Western to a Mediterranean-style diet does not affect iron
           or selenium status: results of the New Dietary Strategies Addressing the
           Specific Needs of the Elderly Population for Healthy Aging in Europe
           (NU-AGE) 1-year randomized clinical trial in elderly Europeans
    • Authors: Jennings A; Tang J, Gillings R, et al.
      Pages: 98 - 109
      Abstract: ABSTRACTBackgroundMediterranean diets limit red meat consumption and increase intakes of high-phytate foods, a combination that could reduce iron status. Conversely, higher intakes of fish, a good source of selenium, could increase selenium status.ObjectivesA 1-y randomized controlled trial [New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE)] was carried out in older Europeans to investigate the effects of consuming a Mediterranean-style diet on indices of inflammation and changes in nutritional status.MethodsSelenium and iron intakes and status biomarkers were measured at baseline and after 1 y in 1294 people aged 65–79 y from 5 European countries (France, Italy, the Netherlands, Poland, and the United Kingdom) who had been randomly allocated either to a Mediterranean-style diet or to remain on their habitual, Western diet.ResultsEstimated selenium intakes increased significantly with the intervention group (P < 0.01), but were not accompanied by changes in serum selenium concentrations. Iron intakes also increased (P < 0.001), but there was no change in iron status. However, when stratified by study center, there were positive effects of the intervention on iron status for serum ferritin for participants in Italy (P = 0.04) and France (P = 0.04) and on soluble transferrin receptor (sTfR) for participants in Poland (P < 0.01). Meat intake decreased and fish intake increased to a greater degree in the intervention group, relative to the controls (P < 0.01 for both), but the overall effects of the intervention on meat and fish intakes were mainly driven by data from Poland and France. Changes in serum selenium in the intervention group were associated with greater changes in serum ferritin (P = 0.01) and body iron (P = 0.01), but not sTfR (P = 0.73); there were no study center × selenium status interactions for the iron biomarkers.ConclusionsConsuming a Mediterranean-style diet for 1 y had no overall effect on iron or selenium status, although there were positive effects on biomarkers of iron status in some countries. The NU-AGE trial was registered at as NCT01754012.
      PubDate: Thu, 26 Sep 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz243
      Issue No: Vol. 111, No. 1 (2019)
  • Drug–nutrient interactions: discovering prescription drug inhibitors of
           the thiamine transporter ThTR-2 (SLC19A3)
    • Authors: Vora B; Green E, Khuri N, et al.
      Pages: 110 - 121
      Abstract: ABSTRACTBackgroundTransporter-mediated drug–nutrient interactions have the potential to cause serious adverse events. However, unlike drug–drug interactions, these drug–nutrient interactions receive little attention during drug development. The clinical importance of drug–nutrient interactions was highlighted when a phase III clinical trial was terminated due to severe adverse events resulting from potent inhibition of thiamine transporter 2 (ThTR-2; SLC19A3).ObjectiveIn this study, we tested the hypothesis that therapeutic drugs inhibit the intestinal thiamine transporter ThTR-2, which may lead to thiamine deficiency.MethodsFor this exploration, we took a multifaceted approach, starting with a high-throughput in vitro primary screen to identify inhibitors, building in silico models to characterize inhibitors, and leveraging real-world data from electronic health records to begin to understand the clinical relevance of these inhibitors.ResultsOur high-throughput screen of 1360 compounds, including many clinically used drugs, identified 146 potential inhibitors at 200 μM. Inhibition kinetics were determined for 28 drugs with half-maximal inhibitory concentration (IC50) values ranging from 1.03 μM to >1 mM. Several oral drugs, including metformin, were predicted to have intestinal concentrations that may result in ThTR-2–mediated drug–nutrient interactions. Complementary analysis using electronic health records suggested that thiamine laboratory values are reduced in individuals receiving prescription drugs found to significantly inhibit ThTR-2, particularly in vulnerable populations (e.g., individuals with alcoholism).ConclusionsOur comprehensive analysis of prescription drugs suggests that several marketed drugs inhibit ThTR-2, which may contribute to thiamine deficiency, especially in at-risk populations.
      PubDate: Mon, 25 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz255
      Issue No: Vol. 111, No. 1 (2019)
  • The association of vitamin D status and supplementation during pregnancy
           with gestational diabetes mellitus: a Chinese prospective birth cohort
    • Authors: Yin W; Tao R, Hu H, et al.
      Pages: 122 - 130
      Abstract: ABSTRACTBackgroundPrevious studies have shown conflicting findings regarding the relation of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus (GDM). Most of these studies hypothesized that 25-hydroxyvitamin D [25(OH)D] concentrations were associated with GDM risk and glucose metabolism based on linear association models.ObjectivesWe aimed to estimate the associations of 25(OH)D concentrations and vitamin D supplementation with GDM risk and glucose metabolism and determine the threshold concentrations of 25(OH)D that could significantly affect glucose metabolism and GDM risk.MethodsIn a prospective birth cohort study, we collected information about sociodemographic characteristics, health status, and lifestyle from 4984 pregnant women. Vitamin D supplementation and 25(OH)D concentrations were assessed in the second trimester. Data from the 75-g oral-glucose-tolerance test were obtained at 24–28 weeks of gestation.ResultsA total of 922 (18.5%) women were diagnosed with GDM. Compared with women with 25(OH)D concentrations <25 nmol/L, the GDM risk was significantly lower in women with 25(OH)D concentrations ranging from 50 to 75 nmol/L (RR: 0.74; 95% CI: 0.58, 0.95) and >75 nmol/L (RR: 0.40; 95% CI: 0.22, 0.70). The curve-fitting models suggested a significant large reduction in GDM risk, fasting plasma glucose, and area under the curve of glucose with increasing 25(OH)D concentrations only for concentrations >50 nmol/L. Consistently, GDM risk was significantly reduced only in women who took 400–600 IU vitamin D/d (RR: 0.83; 95% CI: 0.70, 0.97) with a mean 25(OH)D concentration of 50 nmol/L but not in women taking vitamin D sometimes with a mean 25(OH)D concentration of 40 nmol/L.ConclusionsGDM risk was significantly reduced only in pregnant women with 25(OH)D concentrations >50 nmol/L. Pregnant women taking 400–600 IU vitamin D/d with mean 25(OH)D concentrations of 50 nmol/L had a lower risk of GDM.
      PubDate: Fri, 18 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz260
      Issue No: Vol. 111, No. 1 (2019)
  • Gastrointestinal peptides and small-bowel hypomotility are possible causes
           for fasting and postprandial symptoms in active Crohn's disease
    • Authors: Khalaf A; Hoad C, Menys A, et al.
      Pages: 131 - 140
      Abstract: ABSTRACTBackgroundCrohn's disease (CD) patients suffer postprandial aversive symptoms, which can lead to anorexia and malnutrition. Changes in the regulation of gut hormones and gut dysmotility are believed to play a role.ObjectivesThis study aimed to investigate small-bowel motility and gut peptide responses to a standard test meal in CD by using MRI.MethodsWe studied 15 CD patients with active disease (age 36 ± 3 y; BMI 26 ± 1 kg/m 2) and 20 healthy volunteers (HVs; age 31 ± 3 years; BMI 24 ± 1 kg/m 2). They underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling following a 400-g soup meal (204 kcal). Small-bowel motility, other MRI parameters, and glucagon-like peptide-1 (GLP-1), polypeptide YY (PYY), and cholecystokinin peptides were measured. Data are presented as means ± SEMs.ResultsHVs had significantly higher fasting motility indexes [106 ± 13 arbitrary units (a.u.)], compared with CD participants (70 ± 8 a.u.; P ≤ 0.05). Postprandial small-bowel water content showed a significant time by group interaction (P < 0.05), with CD participants showing higher levels from 210 min postprandially. Fasting concentrations of GLP-1 and PYY were significantly greater in CD participants, compared with HVs [GLP-1, CD 50 ± 8 µg/mL versus HV 13 ± 3 µg/mL (P ≤ 0.0001); PYY, CD 236 ± 16 pg/mL versus HV 118 ± 12 pg/mL (P ≤ 0.0001)]. The meal challenge induced a significant postprandial increase in aversive symptom scores (fullness, distention, bloating, abdominal pain, and sickness) in CD participants compared with HVs (P ≤ 0.05).ConclusionsThe decrease in fasting small-bowel motility noted in CD participants can be ascribed to the increased fasting gut peptides. A better understanding of the etiology of aversive symptoms in CD will facilitate identification of better therapeutic targets to improve nutritional status. This trial was registered at as NCT03052465.
      PubDate: Thu, 26 Sep 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz240
      Issue No: Vol. 111, No. 1 (2019)
  • Cost-effectiveness of teduglutide in adult patients with short bowel
           syndrome: Markov modeling using traditional cost-effectiveness criteria
    • Authors: Raghu V; Binion D, Smith K.
      Pages: 141 - 148
      Abstract: ABSTRACTBackgroundAdults with short bowel syndrome have a high mortality and significant morbidity due to unsuccessful attempts at rehabilitation that necessitate chronic use of parenteral nutrition (PN). Teduglutide is a novel therapy that promotes intestinal adaptation to improve rehabilitation but with a price >$400,000/y.ObjectiveThe current study evaluated the cost-effectiveness of using teduglutide in US adult patients with short bowel syndrome.MethodsA Markov model evaluated the costs (in US dollars) and effectiveness (in quality-adjusted life years, or QALYs) of treatment compared with no teduglutide use, with a presumed starting age of 40 y. Parameters were obtained from published data or estimation. The primary effect modeled was the increased likelihood of reduced PN days per week when using teduglutide, leading to greater quality of life and lower PN costs. Sensitivity analyses were performed on all model parameters.ResultsIn the base scenario, teduglutide cost $949,910/QALY gained. In 1-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of $100,000/QALY gained. Specifically, teduglutide cost would need to be reduced by >65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a $100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations.ConclusionsTeduglutide does not meet a traditional cost-effectiveness threshold as treatment for PN reduction in adult patients with short bowel syndrome compared with standard intestinal rehabilitation. Subpopulations that demonstrate maximum benefit could be cost-saving, and complete nonuse could lead to financial loss. Teduglutide becomes economically reasonable only if its cost is substantially reduced.
      PubDate: Wed, 30 Oct 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz269
      Issue No: Vol. 111, No. 1 (2019)
  • Comparison of the impact of bovine milk β-casein variants on digestive
           comfort in females self-reporting dairy intolerance: a randomized
           controlled trial
    • Authors: Milan A; Shrestha A, Karlström H, et al.
      Pages: 149 - 160
      Abstract: ABSTRACTBackgroundLactose malabsorption (LM) is a major cause of digestive discomfort from dairy products. Recently, a role for bovine β-casein A1 has been proposed.ObjectivesWe examined whether there are distinct symptoms of digestive discomfort due to either lactose or differing bovine β-casein types.MethodsWomen (n = 40; age: 25.2 ± 0.5 y) with self-reported varying dairy tolerance underwent a 50-g lactose challenge. Based on postchallenge LM and digestive discomfort, participants were classified as either lactose intolerant (LI; n = 10, self-reported intolerant, diagnosed lactose intolerant), nonlactose dairy intolerant (NLDI; n = 20, self-reported intolerant, diagnosed lactose tolerant), or dairy tolerant (DT; n = 10, self-reported tolerant, diagnosed lactose tolerant). In a double-blinded randomized sequence, participants consumed 750 mL conventional milk (CON; containing A1 and A2 β-casein and lactose), a2 Milk (A2M; exclusively containing A2 β-casein with lactose), or lactose-free conventional milk (LF-CON; containing A1 and A2 β-casein without lactose). Subjective digestive symptoms and breath hydrogen (measuring LM) were recorded regularly over 3 h, and further ad hoc digestive symptoms over 12 h.ResultsLI subjects experienced prolonged digestive discomfort with CON milk. A2M reduced (P < 0.05) some symptoms (nausea: A2M 8 ± 3 mm compared with CON 15 ± 3mm; fecal urgency: A2M 4 ± 1 compared with CON 10 ± 3 mm), and attenuated the rise in breath hydrogen over 3 h, relative to CON milk (A2M 59 ± 23 compared with CON 98 ± 25 ppm at 150 min; P < 0.01). In contrast, NLDI subjects experienced rapid-onset, transient symptoms (abdominal distension, bloating, and flatulence) without increased breath hydrogen, irrespective of milk type.ConclusionsIn LI individuals, LM and digestive comfort with lactose-containing milks was improved with milk containing exclusively A2 β-casein. Furthermore, self-reported dairy intolerance without LM (NLDI) is characterized by early-onset digestive discomfort following milk ingestion, irrespective of lactose content or β-casein type. This trial was registered at as ACTRN12616001694404.
      PubDate: Wed, 27 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz279
      Issue No: Vol. 111, No. 1 (2019)
  • Differences in methodology impact estimates of survival and dependence on
           home parenteral support of patients with nonmalignant short bowel syndrome
    • Authors: Fuglsang K; Brandt C, Scheike T, et al.
      Pages: 161 - 169
      Abstract: ABSTRACTBackgroundIn patients with intestinal failure (IF), who are receiving home parenteral support (HPS), variations between centers in estimates of survival and HPS dependency often reflect differences in population characteristics. However, variations in methodology and adherence to model assumptions may further contribute.ObjectivesWe investigated how differences in methodology affect estimates of outcomes in IF patients.MethodsWe applied different model assumptions and statistical methods to real-life outcome data from a well-characterized cohort of nonmalignant short bowel syndrome (SBS) patients. This retrospective study was based on extracts from the Copenhagen IF database and from the Danish death registry.ResultsEstimates of mortality varied substantially, depending on the study design and statistical method. The 5-y mortality rate obtained with the Kaplan-Meier (KM) method was estimated to be 10.1% higher if patients were only followed during HPS treatment, compared with follow-up regardless of HPS treatment. The 5-y cumulative incidence of weaning off HPS was overestimated by 4.4% when inappropriately using the KM method, instead of the cumulative incidence function. The 5-y survival rates in nonmalignant SBS-IF patients who initiated HPS were 89.1% for those aged younger than 40 y, 74.8% for patients aged 40–60 y, and 52.1% for those older than 60 y. A Cox regression analysis identified age and diagnoses other than inflammatory bowel disease as significant risk factors for mortality. For HPS dependency, bowel anatomy was significantly associated with the ability to wean off, and no patients without a colon and less than 100 cm remnant of the small bowel remained continuously weaned off and alive for one year.ConclusionsThe large variations in outcomes illustrated in this study emphasize the importance of the appropriate selection of statistical methods. A comparison between studies is problematic, due to differences in the methods employed.
      PubDate: Fri, 27 Sep 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz242
      Issue No: Vol. 111, No. 1 (2019)
  • Randomized placebo-controlled study of the memory effects of pomegranate
           juice in middle-aged and older adults
    • Authors: Siddarth P; Li Z, Miller K, et al.
      Pages: 170 - 177
      Abstract: ABSTRACTBackgroundAntioxidant nutrients such as the polyphenols in pomegranate juice may prevent neuronal damage from the free radicals produced during normal metabolism. Previous research in animals and a short-term clinical trial in middle-aged and older adults support the potential memory benefits of pomegranate juice; however, the long-term effects of pomegranate juice consumption on cognition have not been studied.ObjectiveIn this study, we investigated the long-term effect of pomegranate juice on memory in nondemented middle-aged and older adults.MethodsWe performed a 12-month, randomized, double-blind, placebo-controlled trial of pomegranate juice in middle-aged and older adults. Two hundred and sixty-one subjects (aged 50–75 y) were randomly assigned to consume pomegranate juice [8 oz (236.5 mL) per day] or a placebo drink (8 oz, matched constituents of pomegranate juice except for pomegranate polyphenols). Memory measures [Brief Visuospatial Memory Test-Revised (BVMT-R) and Buschke Selective Reminding Test (SRT)] were assessed at 6 and 12 mo and analyzed using a mixed-effects general linear model.ResultsTwenty-eight subjects in the pomegranate juice group and 33 subjects in the placebo group dropped out before completing the study. Baseline variables in the 98 pomegranate juice and 102 placebo group subjects who completed the study did not differ significantly. Group by time interaction was statistically significant for BVMT-R Learning (F[2, 257]= 5.90, P = 0.003; between-group effect size [ES] = 0.45): the change within the pomegranate group was not significant (ES = 0.15), whereas the placebo group showed a significant decline (ES = −0.35). Changes in the other BVMT-R scores as well as the SRT measures were not significantly different between groups.ConclusionsDaily consumption of pomegranate juice may stabilize the ability to learn visual information over a 12-mo period. This trial was registered at as NCT02093130.
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz241
      Issue No: Vol. 111, No. 1 (2019)
  • Tryptophan catabolites as metabolic markers of vitamin B-6 status
           evaluated in cohorts of healthy adults and cardiovascular patients
    • Authors: Ulvik A; Midttun Ø, McCann A, et al.
      Pages: 178 - 186
      Abstract: ABSTRACTBackgroundVitamin B-6 status is routinely measured as pyridoxal 5′-phosphate (PLP) in plasma. Low concentrations of PLP are associated with rheumatic, cardiovascular, and neoplastic diseases. We have previously shown that vitamin B-6 status affects the kynurenine (Kyn) pathway of tryptophan (Trp) catabolism.ObjectiveThis study aimed to comprehensively evaluate the use of Kyns as potential markers of functional vitamin B-6 status across 2 large cohorts.MethodsWe measured circulating concentrations of the first 6 metabolites in the Trp catabolic pathway by LC–MS-MS in the community-based Hordaland Health Study (HUSK; n = 7017) and cardiovascular patient–based Western Norway Coronary Angiography Cohort (WECAC; n = 4161). Cross-sectional and longitudinal associations of plasma PLP with Kyns were estimated using linear and nonlinear regression–based methods.Results3′-Hydroxykynurenine (HK), a substrate, and all 4 products formed directly by the PLP-dependent enzymes kynurenine transaminase and kynureninase contributed to the explanation of circulating PLP in multivariable-adjusted regression models. The construct HK:(kynurenic acid + xanthurenic acid + 3′-hydroxyanthranilic acid + anthranilic acid), termed HK ratio (HKr), was related to plasma PLP with standardized regression coefficients (95% CIs) of −0.47 (−0.49, −0.45) and −0.46 (−0.49, −0.43) in HUSK and WECAC, respectively. Across strata of cohort and sex, HKr was 1.3- to 2.7-fold more sensitive, but also 1.7- to 2.9-fold more specific to changes in PLP than a previously proposed marker, HK:xanthurenic acid. Notably, the association was strongest at PLP concentrations < ∼20 nmol/L, a recognized threshold for vitamin B-6 deficiency. Finally, PLP and HKr demonstrated highly sex-specific and corroborating associations with age.ConclusionsThe results demonstrate that by combining 5 metabolites in the Kyn pathway into a simple index, HKr, a sensitive and specific indicator of intracellular vitamin B-6 status is obtained. The data also underscore the merit of evaluating alterations in Kyn metabolism when investigating vitamin B-6 and health.
      PubDate: Thu, 26 Sep 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz228
      Issue No: Vol. 111, No. 1 (2019)
  • Dietary sugars and cardiometabolic risk factors: a network meta-analysis
           on isocaloric substitution interventions
    • Authors: Schwingshackl L; Neuenschwander M, Hoffmann G, et al.
      Pages: 187 - 196
      Abstract: ABSTRACTBackgroundThere is controversy on the relevance of dietary sugar intake for cardiometabolic health.ObjectiveThe aim of this network meta-analysis (NMA) was to assess how isocaloric substitutions of dietary sugar with other carbohydrates affect cardiometabolic risk factors, comparing different intervention studies.MethodsWe included randomized controlled trials (RCTs) investigating the isocaloric effect of substituting dietary sugars (fructose, glucose, sucrose) with other sugars or starch on cardiometabolic risk markers, including LDL cholesterol, triacylglycerol (TG), fasting glucose (FG), glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), uric acid, C-reactive protein (CRP), alanine transaminase (ALT), aspartate transaminase (AST), and liver fat content. To identify the most beneficial intervention for each outcome, random-effects NMA was conducted by calculating pooled mean differences (MDs) with 95% CIs, and by ranking the surface under the cumulative ranking curves (SUCRAs). The certainty of evidence was evaluated using the Confidence In Network Meta-Analysis tool.ResultsThirty-eight RCTs, including 1383 participants, were identified. A reduction in LDL-cholesterol concentrations was shown for the exchange of sucrose with starch (MD: −0.23 mmol/L; 95% CI: −0.38, −0.07 mmol/L) or fructose with starch (MD: −0.22 mmol/L; 95% CI: −0.39, −0.05 mmol/L; SUCRAstarch: 98%). FG concentrations were also lower for the exchange of sucrose with starch (MD: −0.14 mmol/L; 95% CI: −0.29, 0.01 mmol/L; SUCRAstarch: 91%). Replacing fructose with an equivalent energy amount of glucose reduced HOMA-IR (MD: −0.36; 95% CI: −0.71, −0.02; SUCRAglucose: 74%) and uric acid (MD: −23.77 µmol/L; 95% CI: −44.21, −3.32 µmol/L; SUCRAglucose: 93%). The certainty of evidence was rated very low to moderate. No significant effects were observed for TG, HbA1c, CRP, ALT, and AST.ConclusionsOur findings indicate that substitution of sucrose and fructose with starch yielded lower LDL cholesterol. Insulin resistance and uric acid concentrations were beneficially affected by replacement of fructose with glucose. Our findings are limited by the very low to moderate certainty of evidence. This review was registered at as CRD42018080297.
      PubDate: Sat, 09 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz273
      Issue No: Vol. 111, No. 1 (2019)
  • Tea consumption and risk of stroke in Chinese adults: a prospective cohort
           study of 0.5 million men and women
    • Authors: Tian T; Lv J, Jin G, et al.
      Pages: 197 - 206
      Abstract: ABSTRACTBackgroundMany cohort studies have explored the relation between tea consumption and stroke risk; however, the conclusions have been inconsistent. In addition, evidence is lacking in China, where the patterns of tea consumption and main types of tea consumed differ substantially from those in high-income countries.ObjectiveWe aimed to systematically assess the association of tea consumption with the risk of stroke based on a Chinese large-scale cohort study.MethodsA total of 487,377 participants from the China Kadoorie Biobank were included in the present study. Detailed information about tea consumption (including frequency, duration, amount, and tea type) was self-reported at baseline. After ∼4.3 million person-years of follow-up, 38,727 incident cases of stroke were recorded, mainly through linkage with mortality and morbidity registries and based on the national health insurance system.ResultsOverall, 128,280 adults (26.3%) reported drinking tea almost daily (41.4% men, 15.9% women), predominantly green tea (86.7%). Tea consumption had an inverse and dose–response relation with the risk of stroke (Ptrend < 0.001). Compared with nonconsumers, those who consumed tea occasionally, weekly, and daily had adjusted HRs and 95% CIs of 0.96 (0.94, 0.99), 0.94 (0.90, 0.98), and 0.92 (0.89, 0.95) respectively, with little difference by stroke type. Among those who consumed tea daily, the HRs for stroke decreased with the increasing duration and amount of tea consumed (all P < 0.001). These inverse associations were significant for green tea but not for other types of tea. Among men, but not women, the inverse relations could be detected, and similar inverse associations could be found for male noncurrent alcohol-consumers and noncurrent smokers as well.ConclusionsAmong Chinese adults, higher consumption of tea, especially green tea, was associated with a lower risk of ischemic and hemorrhagic stroke.
      PubDate: Mon, 11 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz274
      Issue No: Vol. 111, No. 1 (2019)
  • Lipid-based nutrient supplements and all-cause mortality in children
           6–24 months of age: a meta-analysis of randomized controlled trials
    • Authors: Stewart C; Wessells K, Arnold C, et al.
      Pages: 207 - 218
      Abstract: ABSTRACTBackgroundUndernutrition is associated with an elevated risk of mortality among children in low- and middle-income countries. Small-quantity lipid-based nutrient supplements (LNS) have been evaluated as a method to prevent undernutrition and improve infant development, but the effects on mortality are unknown.ObjectiveOur objective was to evaluate the effect of LNS on all-cause mortality among children 6–24 mo old.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials of LNS designed to prevent undernutrition, with or without other interventions. Literature was searched in May 2019 and trials were included if they enrolled children between 6 and 24 mo old and the period of supplementation lasted ≥6 mo. We extracted data from participant flow diagrams and contacted study investigators to request data. We conducted a meta-analysis to produce summary RR estimates.ResultsWe identified 18 trials conducted in 11 countries that enrolled 41,280 children and reported 586 deaths. The risk of mortality was lower in the LNS arms than in the non-LNS comparison arms (RR: 0.73; 95% CI: 0.59, 0.89; 13 trials). Estimates were similar when trials with maternal LNS intervention arms were added or when alternative formulations of LNS were excluded. The results appeared stronger in trials in which LNS were compared with passive control arms. Excluding these contrasts and only comparing multicomponent arms with LNS groups and comparison groups that contained all the same components without LNS attenuated the effect estimate (RR: 0.82; 95% CI: 0.61, 1.10).ConclusionsLNS provided for the prevention of undernutrition may reduce the risk of mortality, but more trials with appropriate comparison groups allowing isolation of the effect of LNS alone are needed.This study was registered at as CRD42019128718.
      PubDate: Thu, 07 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz262
      Issue No: Vol. 111, No. 1 (2019)
  • Comparative effects of different types of tree nut consumption on blood
           lipids: a network meta-analysis of clinical trials
    • Authors: Liu K; Hui S, Wang B, et al.
      Pages: 219 - 227
      Abstract: ABSTRACTBackgroundRecent evidence has confirmed that nuts are one of the best food groups at reducing LDL cholesterol and total cholesterol (TC). However, the comparative effects of different types of nuts on blood lipids are unclear.ObjectivesThis network meta-analysis of randomized clinical trials aimed to assess the comparative effects of walnuts, pistachios, hazelnuts, cashews, and almonds on typical lipid profiles.MethodsWe conducted literature searches to identify studies comparing ≥2 of the following diets—walnut-enriched, pistachio-enriched, hazelnut-enriched, cashew-enriched, almond-enriched, and control diets—for the management of triglycerides (TGs), LDL cholesterol, TC, and HDL cholesterol. Random-effects network meta-analyses, ranking analyses based on the surface under the cumulative ranking (SUCRA) curves, and sensitivity analyses according to the potential sources of heterogeneity across the included studies were performed for each outcome.ResultsThirty-four trials enrolling 1677 participants were included in this study. The pistachio-enriched diet was ranked best for TG (SUCRA: 85%), LDL cholesterol (SUCRA: 87%), and TC (SUCRA: 96%) reductions. For TG and TC reductions, the walnut-enriched diet was ranked as the second-best diet. Regarding LDL cholesterol reduction, the almond-enriched diet was ranked second best. The pistachio-enriched and walnut-enriched diets were more effective at lowering TG, LDL cholesterol, and TC compared with the control diet. Regarding TG and TC reductions, the pistachio-enriched diet was also more effective than the hazelnut-enriched diet. For TG reduction, the walnut-enriched diet was better than the hazelnut-enriched diet. However, these findings are limited by the low quality of evidence ratings. In addition, the quality of this network meta-analysis was limited by the small number and generally poor reporting of available studies.ConclusionsThe pistachio-enriched and walnut-enriched diet could be better alternatives for lowering TGs, LDL cholesterol, and TC compared with other nut-enriched diets included in this study. The findings warrant further evaluation by more high-quality studies.This network meta-analysis was registered at as CRD42019131128.
      PubDate: Wed, 27 Nov 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz280
      Issue No: Vol. 111, No. 1 (2019)
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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