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American Journal of Clinical Nutrition
Journal Prestige (SJR): 3.438
Citation Impact (citeScore): 6
Number of Followers: 191  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9165 - ISSN (Online) 1938-3207
Published by Oxford University Press Homepage  [406 journals]
  • Interindividual variation of human milk metabolome
    • Authors: Koletzko B.
      Pages: 1 - 3
      Abstract: Breastfeeding is the natural form of infant feeding, and is universally recommended as the preferred feeding choice for babies, supporting normal growth, development, and short- and long-term health (1). The composition of human milk is believed to have adapted during a long evolutionary process to an optimal match to the needs of both lactating women and their infants. This is illustrated by the enormous variation of milk composition across different mammalian species which reflects considerable species differences in placental types and function, lactation patterns and duration, offspring growth characteristics, and environmental conditions. Genome analyses of different mammalian species suggests that the most variable parts of the lactome are those with nutritional or immunologic characteristics, and hence it is assumed that evolutionary selection occurred in response to different environmental and nutritional needs and infectious challenges (2). As an example, the large interspecies variation in milk protein content is closely related to differences in offspring weight-gain velocity, reflecting the importance of protein supply for growth. The comparatively low protein concentration in human milk matches the lower needs of human infants, which have relatively low weight gain rates, compared with, for example, faster-growing calves, which receive a ∼3-fold higher protein supply from cows’ milk than human milk provides, or kittens, which experience even faster weight gain supported by a milk protein content ∼9-fold higher than found in human milk (3). Moreover, human milk composition changes markedly with longer duration of lactation; for example, the protein supply falls substantially. Therefore, the protein intake per kilogram body weight of a breastfed infant at the age of 6 mo represents only ∼55% of the protein supply after birth (3). This marked reduction in milk protein supply perfectly matches the large decrease in infant protein requirements during infancy as a consequence of the rapidly slowing weight gain velocity with increasing age, which underlines the apparent power of evolutionary adaptation of lactation to the needs of the species.
      PubDate: Fri, 03 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz063
      Issue No: Vol. 110, No. 1 (2019)
  • Digging into breakfast: serving up a better understanding of the effects
           on health of the “most important meal of the day”
    • Authors: Bohan Brown M.
      Pages: 4 - 5
      Abstract: In the quest to improve health, politicians, clinicians, and patients often look for simple and effective methods to change health outcomes through various means, one of which is diet. One such simple nutrition recommendation is to eat breakfast, which has been touted, although not always proven, to affect health by improving cognitive function (1), blood glucose control (2, 3), and body weight (4, 5). Many health outcomes, such as obesity, however, are not simple but complex. When dealing with complex problems, critical thinking and evaluation of research data are necessary to advance our knowledge and solve these problems.
      PubDate: Thu, 16 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz068
      Issue No: Vol. 110, No. 1 (2019)
  • Monitoring vitamin D status and intake in the US population: essential to
           understanding the role of vitamin D in health
    • Authors: Calvo M.
      Pages: 6 - 7
      Abstract: Early in the last century, vitamin D deficiency and the crippling and often fatal bone disease of children, rickets, were all too common in North America (1). During the last half of the century, after vitamin D fortification of food and the health problems associated with vitamin D deficiency were perceived to have been eliminated, concern over vitamin D nutritional status dwindled (1). The third NHANES, NHANES III, conducted from 1988 to 1994, was the first nationally representative health survey to include monitoring of vitamin D status in the US population measured by serum concentrations of the intermediate metabolite of vitamin D, 25-hydroxyvitamin D [25(OH)D]. Since the first NHANES III survey report on vitamin D status in 2002 (2), new concern over vitamin D status of the US population has grown out of findings of a low prevalence of vitamin D deficiency but a higher prevalence of vitamin D insufficiency, notably in younger individuals. This new concern focuses more on the nonskeletal role of vitamin D in chronic disease, largely revealed by epidemiologic studies associating vitamin D status with biomarkers of disease risk, incidence of disease, or increased mortality; however, causation and reverse causation of disease due to poor vitamin D status remain controversial.
      PubDate: Fri, 10 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz069
      Issue No: Vol. 110, No. 1 (2019)
  • Animal-based and plant-based protein-rich foods and cardiovascular health:
           a complex conundrum
    • Authors: Campbell W.
      Pages: 8 - 9
      Abstract: Dietary protein is integral to human health, but controversies swirl around the cardiovascular health effects of consuming animal-based compared with plant-based protein-rich foods. This important nutrition and health issue is complicated by whether the relative effects of animal-based compared with plant-based protein-rich foods are assessed within the context of self-chosen, Western-style eating patterns typically consumed in the United States or healthier eating patterns recommended by government and health policy organizations. Other complicating factors include epidemiologic design features [e.g., observational cohort studies compared with randomized controlled trials (RCTs)] and the types of protein-rich foods and food products consumed.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz074
      Issue No: Vol. 110, No. 1 (2019)
  • Intuitive eating is associated with weight loss after bariatric surgery in
    • Authors: Nogué M; Nogué E, Molinari N, et al.
      Pages: 10 - 15
      Abstract: ABSTRACTBackgroundAlthough the data on eating behavior after bariatric surgery are substantial, data on “intuitive eating” are lacking.ObjectiveThe aim of this study was to evaluate the link between intuitive eating and weight loss after bariatric surgery.MethodsThis cross-sectional study used a self-administered questionnaire freely available on social networks and targeted women who had undergone bariatric surgery. Intuitive eating was evaluated with the Intuitive Eating Scale-2 (IES-2). The 3 questionnaire subscores (Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Unconditional Permission to Eat) were also analyzed. The relation between IES-2 scores and the relative variation in body mass index [BMI (in kg/m2)] was assessed with linear regression models. Adjusted β (βAdj) and standardized β $( {{\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}} )$ were reported.ResultsWe analyzed the responses of 401 women with a mean age of 39 ± 11 y, a mean preoperative BMI of 45.5 ± 7.9, and a mean current BMI of 30.5 ± 7. The mean relative BMI loss was 32.7 ± 12.9%, and the mean IES-2 score was 3.3 ± 0.6. The total IES-2 score was associated with the relative BMI loss, with ∼2.6% BMI loss for each 1-point increase in the IES-2 score [PAdj = 0.007; βAdj = −2.57 (95% CI: −4.44, −0.70); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$= −0.12] after adjusting for elapsed time since surgery and type of surgery. Eating for Physical Rather than Emotional Reasons was the subscore most strongly associated with BMI change after adjustment [PAdj = 0.002; βAdj = −2.08 (95% CI: −3.37, 0.79); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$ = −0.14].ConclusionsThis study highlights a significant association between intuitive eating and BMI decrease after bariatric surgery. Furthermore, eating behaviors changed with increasing time since surgery. An intuitive nutritional approach may be complementary with bariatric surgery in the postoperative phase, which should prompt complementary prospective studies to evaluate the effectiveness of therapeutic education programs centered on intuitive eating in the postoperative period.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz046
      Issue No: Vol. 110, No. 1 (2019)
  • The role of country of birth, and genetic and self-identified ancestry, in
           obesity susceptibility among African and Hispanic Americans
    • Authors: Vishnu A; Belbin G, Wojcik G, et al.
      Pages: 16 - 23
      Abstract: ABSTRACTBackgroundAfrican Americans (AAs) and Hispanic/Latinos (HLs) have higher risk of obesity than European Americans, possibly due to differences in environment and lifestyle, but also reflecting differences in genetic background.ObjectiveTo gain insight into factors contributing to BMI (in kg/m2) and obesity risk (BMI ≥ 30) among ancestry groups, we investigate the role of self-reported ancestry, proportion of genetic African ancestry, and country of birth in 6368 self-identified AA and 7569 HL participants of the New York–based BioMe Biobank.MethodsAAs and HLs are admixed populations that trace their genetic ancestry to the Americas, Africa, and Europe. The proportion of African ancestry (PAA), quantified using ADMIXTURE, was higher among self-reported AA (median: 87%; IQR: 79–92%) than among HL (26%; 15–41%) participants. Approximately 18% of AA and 59% of HL participants were non–US-born.ResultsBecause of significant differences between sexes (PPAA*sex interaction = 4.8 × 10−22), we considered women and men separately. Among women, country of birth and genetic ancestry contributed independently to BMI. US-born women had a BMI 1.99 higher than those born abroad (P = 7.7 × 10−25). Every 10% increase in PAA was associated with a BMI 0.29 higher (P = 7.1 × 10−10). After accounting for PAA and country of birth, the contribution of self-reported ancestry was small (P = 0.046). The contribution of PAA to higher BMI was significantly more pronounced among US-born (0.35/10%PAA, P = 0.003) than among non–US-born (0.26/10%PAA, P = 0.01) women (PPAA*sex interaction = 0.004). In contrast, among men, only US-born status influenced BMI. US-born men had a BMI 1.33 higher than non–US-born men, whereas PAA and self-reported ancestry were not associated with BMI. Associations with obesity risk were similar to those observed for BMI.ConclusionsBeing US-born is associated with a substantially higher BMI and risk of obesity in both men and women. Genetic ancestry, but not self-reported ancestry, is associated with obesity susceptibility, but only among US-born women in this New York–based population.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz098
      Issue No: Vol. 110, No. 1 (2019)
  • Effects of red meat, white meat, and nonmeat protein sources on
           atherogenic lipoprotein measures in the context of low compared with high
           saturated fat intake: a randomized controlled trial
    • Authors: Bergeron N; Chiu S, Williams P, et al.
      Pages: 24 - 33
      Abstract: ABSTRACTBackgroundDietary recommendations to limit red meat are based on observational studies linking intake to cardiovascular disease (CVD) risk together with the potential of its saturated fatty acid (SFA) content to raise low-density lipoprotein (LDL) cholesterol. However, the relation of white meat to CVD risk, and the effects of dietary protein source on lipoprotein particle subfractions, have not been extensively evaluated.ObjectiveWe tested whether levels of atherogenic lipids and lipoproteins differed significantly following consumption of diets with high red meat content compared with diets with similar amounts of protein derived from white meat or nonmeat sources, and whether these effects were modified by concomitant intake of high compared with low SFAs.MethodsGenerally healthy men and women, 21–65 y, body mass index 20–35 kg/m2, were randomly assigned to 1 of 2 parallel arms (high or low SFA) and within each, allocated to red meat, white meat, and nonmeat protein diets consumed for 4 wk each in random order. The primary outcomes were LDL cholesterol, apolipoprotein B (apoB), small + medium LDL particles, and total/high-density lipoprotein cholesterol.ResultsAnalysis included participants who completed all 3 dietary protein assignments (61 for high SFA; 52 for low SFA). LDL cholesterol and apoB were higher with red and white meat than with nonmeat, independent of SFA content (P < 0.0001 for all, except apoB: red meat compared with nonmeat [P = 0.0004]). This was due primarily to increases in large LDL particles, whereas small + medium LDL and total/high-density lipoprotein cholesterol were unaffected by protein source (P = 0.10 and P = 0.51, respectively). Primary outcomes did not differ significantly between red and white meat. Independent of protein source, high compared with low SFA increased LDL cholesterol (P = 0.0003), apoB (P = 0.0002), and large LDL (P = 0.0002).ConclusionsThe findings are in keeping with recommendations promoting diets with a high proportion of plant-based food but, based on lipid and lipoprotein effects, do not provide evidence for choosing white over red meat for reducing CVD risk. This trial was registered at as NCT01427855.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz035
      Issue No: Vol. 110, No. 1 (2019)
  • Salt intake and prevalence of overweight/obesity in Japan, China, the
           United Kingdom, and the United States: the INTERMAP Study
    • Authors: Zhou L; Stamler J, Chan Q, et al.
      Pages: 34 - 40
      Abstract: ABSTRACTBackgroundSeveral studies have reported that dietary salt intake may be an independent risk factor for overweight/obesity, but results from previous studies are controversial, reflecting study limitations such as use of a single spot urine or dietary recall to estimate daily salt intake rather than 24-h urine collections, and population samples from only a single country or center.ObjectiveThe aim of this study was to use data from the International Study of Macro-/Micro-nutrients and Blood Pressure (INTERMAP Study) to explore the relation between dietary salt intake estimated from 2 timed 24-h urine collections and body mass index (BMI; in kg/m2) as well as prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States.MethodsData were from a cross-sectional study of 4680 men and women aged 40–59 y in Japan (n = 1145), China (n = 839), the United Kingdom (n = 501), and the United States (n = 2195). General linear models were used to obtain the regression coefficients (β) of salt intake associated with BMI. Multivariable logistic regression models were used to determine the ORs and 95% CIs of overweight/obesity associated with a 1-g/d higher dietary salt intake.ResultsAfter adjustment for potential confounding factors including energy intake, salt intake 1 g/d higher was associated with BMI higher by 0.28 in Japan, 0.10 in China, 0.42 in the United Kingdom, and 0.52 in the United States, all P values < 0.001. Salt intake 1 g/d higher was associated with odds of overweight/obesity 21% higher in Japan, 4% higher in China, 29% higher in the United Kingdom, and 24% higher in the United States, all P values < 0.05.ConclusionsSalt intake is positively associated with BMI and the prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States. This association needs to be further confirmed in well-designed prospective studies with repeated dietary and BMI measurements.This trial was registered at as NCT00005271.
      PubDate: Tue, 21 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz067
      Issue No: Vol. 110, No. 1 (2019)
  • Effect of skipping breakfast for 6 days on energy metabolism and diurnal
           rhythm of blood glucose in young healthy Japanese males
    • Authors: Ogata H; Kayaba M, Tanaka Y, et al.
      Pages: 41 - 52
      Abstract: ABSTRACTBackgroundSkipping breakfast has become a common trend that may lead to obesity and type 2 diabetes. Previous studies, which imposed a single incidence of breakfast skipping, did not observe any decrease in 24-h energy expenditure. Furthermore, the effects of breakfast skipping on diurnal blood glucose profiles over 24 h are contradictory.ObjectiveThe aim of this study was to clarify the influence of 6 consecutive days of breakfast skipping and sedentary behavior on energy metabolism and glycemic control.MethodsTen young men participated in 2 trials (with or without breakfast) that lasted for 6 consecutive days, and the 2 trials were conducted 1 wk apart with a repeated-measures design. During the meal intervention, each subject's blood glucose was measured using the continuous glucose monitoring system. If breakfast was skipped, subjects ate large meals at lunch and dinner such that the 24-h energy intake was identical to that of the 3-meal condition. At 2200 on the fifth day, the subjects entered a room-sized respiratory chamber, where they remained for 33 h, and were instructed to carry out sedentary behavior.ResultsThe glucose levels were similar between the 2 meal conditions during the first 5 d of meal intervention, but the blood glucose at 2300 was higher in the breakfast-skipping condition than in the 3-meal condition. Breakfast skipping elevated postprandial glycemic response after lunch on the first day of meal intervention. On the sixth day, there were no significant differences in 24-h energy expenditure and substrate oxidation. When subjects remained in a metabolic chamber, the level of physical activity significantly decreased, glycemic stability slightly deteriorated, and mean blood glucose over 24 h was higher in the breakfast-skipping trial than in the 3-meal trial.ConclusionsSedentary lifestyle and repeated breakfast skipping caused abnormal glucose fluctuations, whereas 24-h energy metabolism remained unaffected. Clinical Trial Registry: This trial was registered at as UMIN000032346.
      PubDate: Thu, 16 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqy346
      Issue No: Vol. 110, No. 1 (2019)
  • Serum metabolite profiles of habitual diet: evaluation by 1H-nuclear
           magnetic resonance analysis
    • Authors: Lindqvist H; Rådjursöga M, Malmodin D, et al.
      Pages: 53 - 62
      Abstract: ABSTRACTBackgroundObjective and reliable methods to measure dietary exposure and prove associations and causation between diet and health are desirable.ObjectiveThe aim of this study was to investigate if 1H-nuclear magnetic resonance (1H-NMR) analysis of serum samples may be used as an objective method to discriminate vegan, vegetarian, and omnivore diets. Specifically, the aim was to identify a metabolite pattern that separated meat-eaters from non–meat-eaters and vegans from nonvegans.MethodsHealthy volunteers (45 men and 75 women) complying with habitual vegan (n = 43), vegetarian (n = 24 + vegetarians adding fish n = 13), or omnivore (n = 40) diets were enrolled in the study. Data were collected on clinical phenotype, body composition, lifestyle including a food-frequency questionnaire (FFQ), and a 4-d weighed food diary. Serum samples were analyzed by routine clinical test and for metabolites by 1H-NMR spectroscopy. NMR data were nonnormalized, UV-scaled, and analyzed with multivariate data analysis [principal component analysis, orthogonal projections to latent structures (OPLS) and OPLS with discriminant analysis]. In the multivariate analysis volunteers were assigned as meat-eaters (omnivores), non–meat-eaters (vegans and vegetarians), vegans, or nonvegans (lacto-ovo-vegetarians, vegetarians adding fish, and omnivores). Metabolites were identified by line-fitting of 1D 1H-NMR spectra and the use of statistical total correlation spectroscopy.ResultsAlthough many metabolites differ in concentration between men and women as well as by age, body mass index, and body composition, it was possible to correctly classify 97.5% of the meat-eaters compared with non–meat-eaters and 92.5% of the vegans compared with nonvegans. The branched-chain amino acids, creatine, lysine, 2-aminobutyrate, glutamine, glycine, trimethylamine, and 1 unidentified metabolite were among the most important metabolites in the discriminating patterns in relation to intake of both meat and other animal products.Conclusions1H-NMR serum metabolomics appears to be a possible objective tool to identify and predict habitual intake of meat and other animal products in healthy subjects. These results should be confirmed in larger cohort studies or intervention trials. This trial was registered at as NCT02039609.
      PubDate: Sat, 25 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz032
      Issue No: Vol. 110, No. 1 (2019)
  • Model of personalized postprandial glycemic response to food developed for
           an Israeli cohort predicts responses in Midwestern American individuals
    • Authors: Mendes-Soares H; Raveh-Sadka T, Azulay S, et al.
      Pages: 63 - 75
      Abstract: ABSTRACTBackgroundControlled glycemic concentrations are associated with a lower risk of conditions such as cardiovascular disease and diabetes. Models commonly used to guide interventions to control the glycemic response to food have low efficacy, with recent clinical guidelines arguing for the use of personalized approaches.ObjectiveWe tested the efficacy of a predictive model of personalized postprandial glycemic response to foods that was developed with an Israeli cohort and that takes into consideration food components and specific features, including the microbiome, when applied to individuals from the Midwestern US.DesignWe recruited 327 individuals for this study. Participants provided information regarding lifestyle, dietary habits, and health, as well as a stool sample for characterization of their gut microbiome. Participants were connected to continuous glucose monitors for 6 d, and the glycemic response to meals logged during this time was computed. The ability of a model trained using meals logged by the Israeli cohort to correctly predict glycemic responses in the Midwestern cohort was assessed and compared with that of a model trained using meals logged by both cohorts.ResultsWhen trained on the Israeli cohort meals only, model performance for predicting responses of individuals in the Midwestern cohort was better (R = 0.596) than that observed for models taking into consideration the carbohydrate (R = 0.395) or calorie content of the meals alone (R = 0.336). Performance increased (R = 0.618) when the model was trained on meals from both cohorts, likely because of the observed differences in age distribution, diet, and microbiome.ConclusionsWe show that the modeling framework described in Zeevi et al. for an Israeli cohort is applicable to a Midwestern population, and outperforms commonly used approaches for the control of blood glucose responses. The adaptation of the model to the Midwestern cohort further enhances performance and is a promising means for designing effective nutritional interventions to control glycemic responses to foods. This trial was registered at as NCT02945514.
      PubDate: Thu, 16 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz028
      Issue No: Vol. 110, No. 1 (2019)
  • Zinc supplementation improves glycemic control for diabetes prevention and
           management: a systematic review and meta-analysis of randomized controlled
    • Authors: Wang X; Wu W, Zheng W, et al.
      Pages: 76 - 90
      Abstract: ABSTRACTBackgroundAlthough many studies have shown that low zinc status is associated with diabetes, the putative effects of zinc supplementation on glycemic control are inconclusive.ObjectivesThe aim of this meta-analysis of randomized controlled trials was to assess the effects of zinc supplementation in preventing and managing diabetes.MethodsPubMed, Embase, and the Cochrane Library were searched for articles that were published through February 10, 2019 and contained estimates for the outcomes of interest. The pooled results were then analyzed with the use of a random-effects model.ResultsThirty-two placebo-controlled interventions were extracted from 36 publications, involving a total of 1700 participants in 14 countries. Overall, compared with their respective control groups, the subjects in the zinc-supplementation group had a statistically significant reduction in fasting glucose [FG, weighted mean difference (WMD): −14.15 mg/dL; 95% CI: −17.36, −10.93 mg/dL], 2-h postprandial glucose (WMD: −36.85 mg/dL; 95% CI: −62.05, −11.65 mg/dL), fasting insulin (WMD: −1.82 mU/L; 95% CI: −3.10, −0.54 mU/L), homeostasis model assessment for insulin resistance (WMD: −0.73; 95% CI: −1.22, −0.24), glycated hemoglobin (WMD: −0.55%; 95% CI: −0.84, −0.27%), and high-sensitivity C-reactive protein (WMD: −1.31 mg/L; 95% CI: −2.05, −0.56 mg/L) concentrations. Moreover, subgroup analyses revealed that the effects of zinc supplementation on FG are significantly influenced by diabetic status and the formulation of the zinc supplement.ConclusionsOur analysis revealed that several key glycemic indicators are significantly reduced by zinc supplementation, particularly the FG in subjects with diabetes and in subjects who received an inorganic zinc supplement. Together, these findings support the notion that zinc supplementation may have clinical potential as an adjunct therapy for preventing or managing diabetes. This trial was registered at PROSPERO as CRD42018111838.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz041
      Issue No: Vol. 110, No. 1 (2019)
  • South African preschool children habitually consuming sheep liver and
           exposed to vitamin A supplementation and fortification have
           hypervitaminotic A liver stores: a cohort study
    • Authors: van Stuijvenberg M; Dhansay M, Nel J, et al.
      Pages: 91 - 101
      Abstract: ABSTRACTBackgroundIn some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status.ObjectiveWe evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification.MethodsAfter baseline blood samples, subjects (46.7 ± 8.4 mo; n = 94) were administered 1.0 μmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography.ResultsAt baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 μmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 μmol/g; P < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P = 0.007).ConclusionsIn children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at as NCT02915731.
      PubDate: Mon, 13 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqy382
      Issue No: Vol. 110, No. 1 (2019)
  • Iodine bioavailability from cow milk: a randomized, crossover balance
           study in healthy iodine-replete adults
    • Authors: van der Reijden O; Galetti V, Bürki S, et al.
      Pages: 102 - 110
      Abstract: ABSTRACTBackgroundMilk and dairy products are considered important dietary sources of iodine in many countries. However, to our knowledge, iodine bioavailability from milk has not been directly measured in humans.ObjectiveThe aim of this study was to compare iodine bioavailability in iodine-replete adults from: 1) cow milk containing a high concentration of native iodine; 2) milk containing a low concentration of native iodine, with the addition of potassium iodide (KI) to assess a potential matrix effect; and 3) an aqueous solution of KI as a comparator; with all 3 containing equal amounts of total iodine (263 µg/250 mL). We also speciated iodine in milk.DesignWe conducted a 3-wk, randomized, crossover balance study in adults (n = 12) consuming directly analyzed, standardized diets. During the 3 test conditions — high intrinsic iodine milk (IIM), extrinsically added iodine in milk (EIM), and aqueous iodine solution (AIS) — subjects collected 24-h urine over 3 d and consumed the test drink on the second day, with 3- or 4-d wash-out periods prior to each treatment. Iodine absorption was calculated as the ratio of urinary iodine excretion (UIE) to total iodine intake. Milk iodine speciation was performed using ion chromatography-mass spectrometry.ResultsIodine intake from the standardized diet was 195 ± 6 µg/d for males and 107 ± 6 µg/d for females; the test drinks provided an additional 263 µg. Eleven subjects completed the protocol. There was a linear relation between iodine intake and UIE (β = 0.89, SE = 0.04, P < 0.001). There were no significant differences in UIE among the 3 conditions (P = 0.24). Median (range) fractional iodine absorption across the 3 conditions was 91 (51–145), 72 (48–95), and 98 (51–143)% on days 1, 2, and 3, respectively, with day 2 significantly lower compared with days 1 and 3 (P < 0.001). In milk, 80–93% of the total iodine was inorganic iodide.ConclusionNearly all of the iodine in cow milk is iodide and although fractional iodine absorption from milk decreases with increasing dose, its bioavailability is high. The trial was registered at as NCT03590431.
      PubDate: Mon, 01 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz092
      Issue No: Vol. 110, No. 1 (2019)
  • Maternal obesity and the human milk metabolome: associations with infant
           body composition and postnatal weight gain
    • Authors: Isganaitis E; Venditti S, Matthews T, et al.
      Pages: 111 - 120
      Abstract: ABSTRACTBackgroundMaternal obesity is a risk factor for childhood obesity; this is a major public health concern given that ∼40% of pregnant women are either overweight or obese. Whether differences in milk composition in lean compared with obese women contribute to childhood obesity is unclear.ObjectivesWe aimed to analyze relationships between maternal obesity and human milk metabolites, infant body composition, and postnatal weight gain.MethodsThis was a prospective study in which mothers intending to breastfeed exclusively, and their newborn infants, were enrolled at delivery (n = 35 mother–infant pairs). We excluded mothers with diabetes, other medical conditions, or pregnancy complications. Participants were grouped by maternal prepregnancy BMI <25 (lean) or ≥25 kg/m2 (overweight/obese). We analyzed infant body composition by dual-energy X-ray absorptiometry and used untargeted liquid chromatography–gas chromatography–mass spectrometry to measure the milk content of 275 metabolites at 1 and 6 mo postpartum.ResultsAt 1 mo postpartum, 10 metabolites differed between overweight/obese and lean groups with nominal P < 0.05, but none was altered with a false discovery rate <0.25. Many differentially abundant metabolites belonged to the same chemical class; e.g., 4/10 metabolites were nucleotide derivatives, and 3/10 were human milk oligosaccharides. Milk adenine correlated positively with both continuously distributed maternal BMI and with infant adiposity and fat accrual. Analysis of milk composition at 6 mo postpartum revealed 20 differentially abundant metabolites (P < 0.05) in overweight/obese compared with lean women, including 6 metabolites with a false discovery rate of <0.25. At both 1 and 6 mo, human milk abundance of 1,5-anhydroglucitol, which has not previously been described in milk, was positively associated with maternal BMI.ConclusionsMaternal obesity is associated with changes in the human milk metabolome. While only a subset of metabolites correlated with both maternal and infant weight, these point to potential milk-dependent mechanisms for mother–child transmission of obesity. This trial was registered at as NCT02535637.
      PubDate: Wed, 10 Apr 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqy334
      Issue No: Vol. 110, No. 1 (2019)
  • Randomized controlled trial investigating the effects of a breastfeeding
           relaxation intervention on maternal psychological state, breast milk
           outcomes, and infant behavior and growth
    • Authors: Mohd Shukri N; Wells J, Eaton S, et al.
      Pages: 121 - 130
      Abstract: ABSTRACTBackgroundBiological signaling and communication between mothers and infants during breastfeeding may shape infant behavior and feeding. This signaling is complex and little explored in humans, although it is potentially relevant for initiatives to improve breastfeeding rates.ObjectivesThe aim of this study was to investigate physiological and psychological aspects of mother–infant signaling during breastfeeding experimentally, testing the effects of a relaxation intervention on maternal psychological state, breast milk intake, milk cortisol levels, and infant behavior and growth.MethodsPrimiparous breastfeeding mothers and full-term infants were randomly assigned to receive relaxation therapy [intervention relaxation group; n = 33 (RG)] or to the control group [n = 31 (CG); no relaxation therapy] at 2 wk postpartum. Both groups received standard breastfeeding support. Home visits were conducted at 2 (HV1), 6 (HV2), 12 (HV3) and 14 (HV4) wk to measure maternal stress and anxiety, breast milk intake and milk cortisol, and infant behavior and growth.ResultsRG mothers had lower stress scores postintervention than the CG (HV3 ∆ = −3.13; 95% CI: −5.9, −0.3) and lower hindmilk cortisol at HV1 (∆ = −44.5%; 95% CI: −76.1%, −12.9%) but not at HV2. RG infants had longer sleep duration (∆ = 82 min/d; 95% CI: 16, 149 min/d) at HV2 and higher gains in weight and body mass index standardized deviation score than the CG infants (∆ = 0.76; 95% CI: 0.3, 1.22; and ∆ = 0.59; 95% CI: 0.09, 1.1, respectively). RG infants had a mean milk intake at HV3 that was 227 g/d higher than that of the CG infants (P = 0.031) after controlling for gender and milk intake at HV1.ConclusionsThe trial shows the effectiveness of a simple relaxation intervention for improving maternal and infant outcomes and identifies some potential signaling mechanisms for investigation in future and larger studies, especially in settings where mothers are more stressed, such as those with preterm or low birth weight infants. This trial was registered at as NCT01971216.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz033
      Issue No: Vol. 110, No. 1 (2019)
  • Enteric dysfunction and other factors associated with attained size at
           5 years: MAL-ED birth cohort study findings
    • Authors: Richard S; McCormick B, Murray-Kolb L, et al.
      Pages: 131 - 138
      Abstract: ABSTRACTBackgroundPoor growth in early childhood has been associated with increased risk of mortality and morbidity, as well as long-term deficits in cognitive development and economic productivity.ObjectivesData from the MAL-ED cohort study were used to identify factors in the first 2 y of life that are associated with height-for-age, weight-for-age, and body mass index z-scores (HAZ, WAZ, BMIZ) at 5 y of age.MethodsA total of 1017 children were followed from near birth until 5 y of age at sites in Bangladesh, Brazil, India, Nepal, Peru, South Africa, and Tanzania. Data were collected on their growth, environmental enteric dysfunction (EED), micronutrient status, enteric pathogen burden, illness prevalence, dietary intake, and various other socio-economic and environmental factors.ResultsEED biomarkers were related to size at 5 y. Mean lactulose:mannitol z-scores during the first 2 y of life were negatively associated with all of the growth measures (HAZ: −0.11 [95% CI: −0.19, −0.03]; WAZ: −0.16 [95% CI: −0.26, −0.06]; BMIZ: −0.11 [95% CI: −0.23, 0.0]). Myeloperoxidase was negatively associated with weight (WAZ: −0.52 [95% CI: −0.78, −0.26] and BMIZ: −0.56 [95% CI: −0.86, −0.26]); whereas α-1-antitrypsin had a negative association with HAZ (−0.28 [95% CI: −0.52, −0.04]). Transferrin receptor was positively related to HAZ (0.18 [95% CI: 0.06, 0.30]) and WAZ (0.21 [95% CI: 0.07, 0.35]). Hemoglobin was positively related to HAZ (0.06 [95% CI: 0.00, 0.12]), and ferritin was negatively related to HAZ (−0.08 [95% CI: −0.12, −0.04]). Bacterial density in stool was negatively associated with HAZ (−0.04 [95% CI: −0.08, 0.00]), but illness symptoms did not have any effect on size at 5 y.ConclusionsEED markers, bacterial density, and iron markers are associated with growth at 5 y of age. Interventions to reduce bacterial burden and EED may improve long-term growth in low-income settings.
      PubDate: Sat, 25 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz004
      Issue No: Vol. 110, No. 1 (2019)
  • Gut microbiome–targeted therapies in nonalcoholic fatty liver disease: a
           systematic review, meta-analysis, and meta-regression
    • Authors: Sharpton S; Maraj B, Harding-Theobald E, et al.
      Pages: 139 - 149
      Abstract: ABSTRACTBackgroundPreclinical evidence suggests that modulation of the gut microbiome could represent a new therapeutic target in nonalcoholic fatty liver disease (NAFLD).ObjectivesThe aim of this study was to evaluate the most current evidence for liver-specific and metabolic effects of microbiome-targeted therapies (MTTs) in persons with NAFLD.MethodsWe searched multiple electronic databases for randomized controlled trials (RCTs) published from January 1, 2005 to December 1, 2018 that enrolled persons with NAFLD who received MTT rather than placebo or usual care. MTT was defined as antibiotics, probiotics, synbiotics, or fecal microbiota transplantation (FMT). Clinical outcomes were pooled with the use of random-effects models and heterogeneity was assessed with the I2 statistic. A random-effects meta-regression was performed to determine sources of heterogeneity in prevalence estimates between studies.ResultsTwenty-one RCTs (1252 participants) were included; 9 evaluated probiotics and 12 evaluated synbiotics, with treatment duration ranging from 8 to 28 wk. No RCTs examined the efficacy of antibiotics or FMT. Probiotics/synbiotics were associated with a significant reduction in alanine aminotransferase activity [ALT, weighted mean difference (WMD): −11.23 IU/L; 95% CI: −15.02, −7.44 IU/L] and liver stiffness measurement (LSM) by elastography (reflecting inflammation and fibrosis) (WMD: −0.70 kPa; 95% CI: −1.00, −0.40 kPa), although analyses showed heterogeneity (I2 = 90.6% and I2 = 93.4%, respectively). Probiotics/synbiotics were also associated with increased odds of improvement in hepatic steatosis, as graded by ultrasound (OR: 2.40; 95% CI: 1.50, 3.84; I2 = 22.4%). No RCTs examined sequential liver biopsy findings. Probiotics (WMD: −1.84; 95% CI: −3.30, −0.38; I2 = 23.6%), but not synbiotics (WMD: −0.85; 95% CI: −2.17, 0.47; I2 = 96.6%), were associated with a significant reduction in body mass index.ConclusionsThe use of probiotics/synbiotics was associated with improvement in liver-specific markers of hepatic inflammation, LSM, and steatosis in persons with NAFLD. Although promising, given the heterogeneity in pooled analyses, additional well-designed RCTs are needed to define the efficacy of probiotics/synbiotics for treatment of NAFLD. This study was registered with PROSPERO as CRD42018091455.
      PubDate: Fri, 24 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz042
      Issue No: Vol. 110, No. 1 (2019)
  • Vitamin D status in the United States, 2011–2014
    • Authors: Herrick K; Storandt R, Afful J, et al.
      Pages: 150 - 157
      Abstract: ABSTRACTBackgroundVitamin D is important for bone health; in 2014 it was the fifth most commonly ordered laboratory test among Medicare Part B payments.ObjectivesThe aim of this study was to describe vitamin D status in the US population in 2011–2014 and trends from 2003 to 2014.MethodsWe used serum 25-hydroxyvitamin D data from NHANES 2011–2014 (n = 16,180), and estimated the prevalence at risk of deficiency (<30 nmol/L) or prevalence at risk of inadequacy (30–49 nmol/L) by age, sex, race and Hispanic origin, and dietary intake of vitamin D. We also present trends between 2003 and 2014.ResultsIn 2011–2014, the percentage aged ≥1 y at risk of vitamin D deficiency or inadequacy was 5.0% (95% CI: 4.1%, 6.2%) and 18.3% (95% CI: 16.2%, 20.6%). The prevalence of at risk of deficiency was lowest among children aged 1–5 y (0.5%; 95% CI: 0.3%, 1.1%), peaked among adults aged 20–39 y (7.6%; 95% CI: 6.0%, 9.6%), and fell to 2.9% (95% CI: 2.0%, 4.0%) among adults aged ≥60 y; the prevalence of at risk of inadequacy was similar. The prevalence of at risk of deficiency was higher among non-Hispanic black (17.5%; 95% CI: 15.2%, 20.0%) than among non-Hispanic Asian (7.6%; 95% CI: 5.9%, 9.9%), non-Hispanic white (2.1%; 95% CI: 1.5%, 2.7%), and Hispanic (5.9%; 95% CI: 4.4%, 7.8%) persons; the prevalence of at risk of inadequacy was similar. Persons with higher vitamin D dietary intake or who used supplements had lower prevalences of at risk of deficiency or inadequacy. From 2003 to 2014 there was no change in the risk of vitamin D deficiency; the risk of inadequacy declined from 21.0% (95% CI: 17.9%, 24.5%) to 17.7% (95% CI: 16.0%, 19.7%).ConclusionThe prevalence of at risk of vitamin D deficiency in the United States remained stable from 2003 to 2014; at risk of inadequacy declined. Differences in vitamin D status by race and Hispanic origin warrant additional investigation.
      PubDate: Fri, 10 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz037
      Issue No: Vol. 110, No. 1 (2019)
  • Age-specific reference ranges are needed to interpret serum methylmalonic
           acid concentrations in the US population
    • Authors: Mineva E; Sternberg M, Zhang M, et al.
      Pages: 158 - 168
      Abstract: ABSTRACTBackgroundSerum vitamin B-12 is measured to evaluate vitamin B-12 status. Serum methylmalonic acid (MMA) is a specific functional indicator of vitamin B-12 status; however, concentrations increase with impaired renal function.ObjectiveThe aim of this study was to describe the distribution of serum vitamin B-12 and MMA in US adults, and estimate age-specific reference intervals for serum MMA in a healthy subpopulation with replete vitamin B-12 status and normal renal function.MethodsWe examined cross-sectional data for serum vitamin B-12 and MMA in adults participating in the NHANES from 2011 to 2014. Vitamin B-12 was measured by electrochemiluminescence assay and MMA by isotope-dilution liquid chromatography–tandem mass spectrometry.ResultsIn both bivariate and multivariate analyses, age, race/Hispanic origin, and vitamin B-12 supplement use were generally significantly associated with serum vitamin B-12 and MMA concentrations. Serum MMA concentrations increased with age, particularly in persons aged ≥70 y. Non-Hispanic white persons had lower vitamin B-12 and higher MMA concentrations than non-Hispanic black persons. Shorter fasting times and impaired renal function were significantly associated with higher serum MMA concentrations, but not with serum vitamin B-12 concentrations after controlling for covariates. The central 95% reference intervals for serum vitamin B-12 and MMA concentrations were widest for persons aged ≥70 y compared with younger age groups. Compared with the overall population, the central 95% reference intervals for serum MMA concentrations were considerably narrower for a vitamin B-12–replete subpopulation with normal renal function, but still age-dependent. Serum vitamin B-12 showed little, whereas serum MMA showed notable, increases with impaired renal function.ConclusionsThe higher serum MMA concentrations throughout the entire distribution in older persons (especially persons aged ≥70 y) who are vitamin B-12–replete and have normal renal function indicate the need for age-specific MMA reference intervals to better interpret vitamin B-12 status in epidemiologic research.
      PubDate: Sat, 25 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz045
      Issue No: Vol. 110, No. 1 (2019)
  • Egg consumption, cholesterol intake, and risk of incident stroke in men:
           the Kuopio Ischaemic Heart Disease Risk Factor Study
    • Authors: Abdollahi A; Virtanen H, Voutilainen S, et al.
      Pages: 169 - 176
      Abstract: ABSTRACTBackgroundEpidemiologic studies suggest inverse associations between consumption of egg, a major source of dietary cholesterol, and stroke. However, the evidence of the relation remains limited, especially among carriers of apolipoprotein E4 (apoE4), which influences cholesterol metabolism.ObjectiveThe aim of this study was to investigate associations of egg and cholesterol intakes with risk of stroke and with the major stroke risk factor, blood pressure, in middle-aged and older men from eastern Finland and whether apoE phenotype could modify these associations.MethodsA total of 1950 men aged 42–60 y in 1984–1989 were included at the baseline examinations of the prospective population-based Kuopio Ischaemic Heart Disease Risk Factor Study. Data on apoE phenotype were available for 1015 men. Dietary intakes were assessed with 4-d food records at baseline and incident stroke events were assessed by record linkage to hospital discharge registries. Cox proportional hazards regression analyses were used to estimate associations with stroke risk. Associations with baseline blood pressure were evaluated with ANCOVA.ResultsDuring the mean ± SD follow-up of 21.2 ± 7.2 y, there were 217 incidences of any stroke: 166 of ischemic stroke and 55 of hemorrhagic stroke. Comparing the highest egg intake quartile with the lowest, the multivariable-adjusted HRs were 0.81 for total stroke (95% CI: 0.54, 1.23; P-trend = 0.32), 0.84 for ischemic stroke (95% CI: 0.53, 1.34; P-trend = 0.44), and 0.75 for hemorrhagic stroke (95% CI: 0.32, 1.77; P-trend = 0.40). The respective HRs for the highest cholesterol intake quartile compared with the lowest were 0.86 (95% CI: 0.57, 1.32; P-trend = 0.42), 0.74 (95% CI: 0.46, 1.20; P-trend = 0.32), and 1.10 (95% CI: 0.45, 2.66; P-trend = 0.75). Diastolic blood pressure was 1.6 mm Hg (P-trend = 0.04) lower in the highest egg intake quartile compared with the lowest, but there were no associations with systolic blood pressure or with cholesterol intake. ApoE phenotype (32% had apoE4 phenotype) did not modify the associations.ConclusionNeither egg nor cholesterol intakes were associated with stroke risk in this cohort, regardless of apoE phenotype.This trial was registered at as NCT03221127.
      PubDate: Thu, 16 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz066
      Issue No: Vol. 110, No. 1 (2019)
  • When poorly conducted systematic reviews and meta-analyses can mislead: a
           critical appraisal and update of systematic reviews and meta-analyses
           examining the effects of probiotics in the treatment of functional
           constipation in children
    • Authors: Harris R; Neale E, Ferreira I.
      Pages: 177 - 195
      Abstract: ABSTRACTBackgroundRecent systematic reviews and meta-analyses on the efficacy of probiotics in the treatment of functional constipation in children have yielded conflicting results.ObjectivesThe aim of this study was to critically review and update the evidence in this field by mapping all the steps involved against those reported in previous reviews, in an attempt to understand the nature of their conflicting results.MethodsFour literature databases, trial registries, and citations were searched through December 1, 2018. We included randomized controlled trials (RCTs) that assessed the effects of probiotics compared with placebo or treatment as usual on defecation frequency [bowel movements (BMs)/wk] or treatment success rates in children with functional constipation. Independent reviewers extracted the data and assessed risk of bias in each RCT. Data were pooled with (inverse variance) random-effects models.ResultsWe identified 17 RCTs, of which 14 and 11 provided sufficient data to enable meta-analysis of the effects of probiotics compared with control on defecation frequency (n = 965) or treatment success (n = 835), respectively. When compared to (any) control intervention, probiotics did not significantly increase defecation frequency [weighted mean difference (WMD): 0.28 BMs/wk; 95% CI: −0.12, 0.69; P = 0.165] but were more efficacious in achieving treatment success (RR: 1.24; 95% CI: 1.03, 1.50; P = 0.024). These effects did not differ by type of control (i.e., active or inactive) intervention. However, in analyses confined to the RCTs that were free of high risk of bias (only 5), probiotics did not confer any beneficial effects on defecation frequency (WMD: −0.55 BMs/wk; 95% CI: −1.37, 0.26; P = 0.185) and achievement of treatment success (RR: 1.01; 95% CI: 0.90, 1.13; P = 0.873), compared with control interventions.ConclusionsThe current evidence thus does not support the use of probiotics as a single or coadjuvant therapy for treatment of functional constipation in children and refutes recently published reviews reporting favorable effects of probiotics. Conflicting findings of previous reviews resulted from methodologic errors, highlighting the susceptibility of evidence synthesis to oversights in study selection, quality assessments, and data extraction and collation. This review was registered at PROSPERO as CRD42019119109.
      PubDate: Sat, 25 May 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz071
      Issue No: Vol. 110, No. 1 (2019)
  • Assessing the effects of vegetable consumption on the psychological health
           of healthy adults: a systematic review of prospective research
    • Authors: Tuck N; Farrow C, Thomas J.
      Pages: 196 - 211
      Abstract: ABSTRACTBackgroundTo alleviate the immense health and economic burden of mental illness, modifiable targets to promote psychological health are required. Emerging evidence suggests that both fruit and vegetable (F&V) consumption may play an important role. However, the precise contribution of vegetable consumption, which may represent a more potent target than the consumption of fruit, has received little attention.ObjectivesThis review aimed to synthesize and evaluate research investigating the effects of vegetable consumption on mental health and psychological well-being in nonclinical, healthy adult populations. We aimed to provide insight into the causal relation between vegetable consumption and these outcomes.MethodsOnly studies with prospective or experimental data were included. The survey of the literature was last implemented on 1 February, 2019.ResultsTen eligible studies were identified, with a total sample size of n = 33,645, that measured vegetable intake separately from fruit, or combined this with fruit intake. Where studies explored the independent effects of fruit and vegetable consumption on psychological health (n = 3), 2 reported a preferential effect of vegetables (compared with fruit) on psychological well-being, whereas 1 reported a superior effect of fruit intake on odds reduction of symptoms of depression. More broadly, there was evidence that consuming the recommended amount of F&V (and exceeding this) was associated with increased psychological well-being. However, the effects of F&V consumption on mental health symptoms were inconsistent.ConclusionsIncreased F&V consumption has a positive effect on psychological well-being and there appears to be a preferential effect of vegetables (compared with fruit) from the limited data examined. The effect of F&V intake on mental health is less clear and, at present, there are no clear data to support a preferential effect of vegetable intake on mental health outcomes. Hence, additional research is warranted to investigate the influence of vegetables, compared with fruit, on psychological health in order to inform nutrition-based interventions. This review was registered at as CRD42017072880.
      PubDate: Sat, 01 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz080
      Issue No: Vol. 110, No. 1 (2019)
  • Plasma copper and the risk of first stroke in hypertensive patients: a
           nested case-control study
    • Authors: Zhang J; Cao J, Zhang H, et al.
      Pages: 212 - 220
      Abstract: ABSTRACTBackgroundPrevious studies indicated that trace elements may play an important role in cardiovascular diseases. However, data concerning the association between blood copper and the risk of stroke are limited.ObjectiveThe aim of this study was to evaluate the association between plasma copper and the risk of first stroke, and examine any possible effect modifiers in hypertensive patients.MethodsWe conducted a nested case-control study, using data from the China Stroke Primary Prevention Trial. Hypertension is defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg, or taking antihypertensive medication. A total of 618 first stroke cases and 618 controls matched for age, sex, treatment group, and study site were included in this study. The crude and adjusted risks of first stroke were estimated by ORs and 95% CIs using conditional logistic regression, without or with adjusting for pertinent covariates, respectively.ResultsThere were significant positive associations of plasma copper with risk of first stroke (per SD increment—OR: 1.20; 95% CI: 1.03, 1.39) and first ischemic stroke (OR: 1.26; 95% CI: 1.07, 1.50). When plasma copper was categorized in quartiles, significantly higher risks of first stroke (OR: 1.72; 95% CI: 1.12, 2.65) and first ischemic stroke (OR: 1.91; 95% CI: 1.18, 3.11) were found in participants in quartile 4 (≥ 117.0 μg/dL) than in those in quartile 1 (< 91.2 μg/dL). Furthermore, the plasma copper–first stroke association was significantly stronger in participants with higher BMI (< 25.0 compared with ≥ 25.0 kg/m2, P-interaction = 0.024). However, there was no significant association between plasma copper and first hemorrhagic stroke.ConclusionsIn Chinese hypertensive patients, there was a significant positive association between baseline plasma copper and the risk of first stroke, especially among those with higher BMI.This trial was registered at as NCT00794885.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz099
      Issue No: Vol. 110, No. 1 (2019)
  • A prospective study of artificially sweetened beverage intake and
           cardiometabolic health among women at high risk
    • Authors: Hinkle S; Rawal S, Bjerregaard A, et al.
      Pages: 221 - 232
      Abstract: ABSTRACTBackgroundArtificially sweetened beverages (ASBs) are commonly consumed and recommended for individuals at high risk for cardiometabolic diseases; however, the health effects of ASBs remain contradictory. Given that cross-sectional analyses are subject to reverse causation, prospective studies with long-term follow-up are needed to evaluate associations between ASBs and cardiometabolic health, especially among high-risk individuals.ObjectiveThe aim of this study was to examine associations of ASB intake and cardiometabolic health among high-risk women with prior gestational diabetes mellitus (GDM).MethodsWe included 607 women with GDM from the Danish National Birth Cohort (DNBC; 1996–2002) who completed a clinical exam 9–16 y after the DNBC pregnancy for the Diabetes & Women's Health (DWH) Study (2012–2014). We assessed ASB intake using FFQs completed during the DNBC pregnancy and at the DWH Study clinical exam. We examined cardiometabolic outcomes at the DWH clinical exam. We estimated percentage differences in continuous cardiometabolic markers and RRs for clinical endpoints in association with ASB intake both during pregnancy and at follow-up adjusted for prepregnancy BMI, diet, and lifestyle factors. Sensitivity analyses to account for reverse causation were performed.ResultsIn pregnancy and at follow-up, 30.4% and 36.4% of women regularly (≥2 servings/wk) consumed ASB, respectively. Consumption of ASBs, both during pregnancy and at follow-up, was associated with higher glycated hemoglobin (HbA1c), insulin, HOMA-IR, triglycerides, liver fat, and adiposity and with lower HDL at follow-up. After adjustment for covariates, particularly prepregnancy BMI, the majority of associations between ASB intake in pregnancy and outcomes at follow-up became null with the exception of HbA1c. ASB intake at follow-up (≥1 serving/d compared with <1 serving/mo) was associated with higher HbA1c (6.5%; 95% CI: 1.9, 11.3; P-trend = 0.007); however, associations were not upheld in sensitivity analyses for reverse causation.ConclusionsAmong Danish women with a history of GDM, ASB intake was not significantly associated with cardiometabolic profiles.
      PubDate: Fri, 07 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz094
      Issue No: Vol. 110, No. 1 (2019)
  • Food neophobia associates with poorer dietary quality, metabolic risk
           factors, and increased disease outcome risk in population-based cohorts in
           a metabolomics study
    • Authors: Sarin H; Taba N, Fischer K, et al.
      Pages: 233 - 245
      Abstract: ABSTRACTBackgroundFood neophobia is considered a behavioral trait closely linked to adverse eating patterns and reduced dietary quality, which have been associated with increased risk of obesity and noncommunicable diseases.ObjectivesIn a cross-sectional and prospective study, we examined how food neophobia is associated with dietary quality, health-related biomarkers, and disease outcome incidence in Finnish and Estonian adult populations.MethodsThe study was conducted based on subsamples of the Finnish DIetary, Lifestyle, and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) cohort (n = 2982; age range: 25–74 y) and the Estonian Biobank cohort (n = 1109; age range: 18–83 y). The level of food neophobia was assessed using the Food Neophobia Scale, dietary quality was evaluated using the Baltic Sea Diet Score (BSDS), and biomarker profiles were determined using an NMR metabolomics platform. Disease outcome information was gathered from national health registries. Follow-up data on the NMR-based metabolomic profiles and disease outcomes were available in both populations.ResultsFood neophobia associated significantly (adjusted P < 0.05) with health-related biomarkers [e.g., ω-3 (n–3) fatty acids, citrate, α1-acid glycoprotein, HDL, and MUFA] in the Finnish DILGOM cohort. The significant negative association between the severity of food neophobia and ω-3 fatty acids was replicated in all cross-sectional analyses in the Finnish DILGOM and Estonian Biobank cohorts. Furthermore, food neophobia was associated with reduced dietary quality (BSDS: β: −0.03 ± 0.006; P = 8.04 × 10−5), increased fasting serum insulin (β: 0.004 ± 0.0013; P = 5.83 × 10−3), and increased risk of type 2 diabetes during the ∼8-y follow-up (HR: 1.018 ± 0.007; P = 0.01) in the DILGOM cohort.ConclusionsIn the Finnish and Estonian adult populations, food neophobia was associated with adverse alteration of health-related biomarkers and risk factors that have been associated with an increased risk of noncommunicable diseases. We also found that food neophobia associations with ω-3 fatty acids and associated metabolites are mediated through dietary quality independent of body weight.
      PubDate: Tue, 04 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz100
      Issue No: Vol. 110, No. 1 (2019)
  • Effect of 2000 IU compared with 800 IU vitamin D on cognitive performance
           among adults age 60 years and older: a randomized controlled trial
    • Authors: Schietzel S; Fischer K, Brugger P, et al.
      Pages: 246 - 253
      Abstract: ABSTRACTBackgroundFindings on the effects of vitamin D on cognitive performance have been inconsistent and no clinical trials with detailed cognitive testing in healthy older adults have been reported.ObjectivesWe tested whether 2000 IU is superior to 800 IU vitamin D3/d for cognitive performance among relatively healthy older adults.DesignWe analyzed data on cognitive performance as the secondary outcome of a 2-y double-blind randomized controlled trial that originally investigated the effect of vitamin D3 on knee function and pain in seniors with osteoarthritis. Participants were randomly assigned to either 2000 or 800 IU vitamin D3/d. Capsules had identical appearances and taste. A total of 273 community-dwelling older adults aged ≥60 y were enrolled 6–8 wk after unilateral joint replacement. Inclusion required a baseline Mini Mental State Examination (MMSE) score of 24. We implemented a detailed 2-h cognitive test battery. The primary cognitive endpoint was the score achieved in the MMSE. Secondary endpoints included a composite score of 7 executive function tests, auditory verbal and visual design learning tests, and reaction times.ResultsAt baseline, mean age was 70.3 y, 31.4% were vitamin D–deficient [25(OH)D <20 ng/mL], and mean ± SD MMSE score was 28.0 ± 1.5. Although the mean ± SD 25(OH)D concentrations achieved differed significantly between treatment groups at 24-mo follow-up (2000 IU = 45.1 ± 10.2 ng/mL; 800 IU = 37.5 ± 8.8 ng/mL; P < 0.0001), none of the primary or secondary endpoints of cognitive performance differed between treatment group. Results by treatment were similar for predefined subgroups of baseline 25(OH)D status (deficient compared with replete) and age (60–69 y compared with ≥70 y).ConclusionsOur study does not support a superior cognitive benefit of 2000 IU compared with 800 IU vitamin D/d among relatively healthy older adults over a 24-mo treatment period. This trial was registered at as NCT00599807.
      PubDate: Sat, 01 Jun 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz081
      Issue No: Vol. 110, No. 1 (2019)
  • Calendar of Events
    • Pages: 254 - 254
      PubDate: Mon, 01 Jul 2019 00:00:00 GMT
      DOI: 10.1093/ajcn/nqz140
      Issue No: Vol. 110, No. 1 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
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