An Assessment of Mushroom Consumption on Cardiometabolic Disease Risk Factors and Morbidities in Humans: A Systematic Review.

Mushrooms, unique edible fungi, contain several essential nutrients and bioactive compounds which may positively influence cardiometabolic health. Despite a long history of consumption, the health benefits of mushrooms are not well documented. We conducted a systematic review to assess the effects of and associations between mushroom consumption and cardiometabolic disease (CMD)-related risk factors and morbidities/mortality. We identified 22 articles (11 experimental and 11 observational) from five databases meeting our inclusion criteria. Limited evidence from experimental research suggests mushroom consumption improves serum/plasma triglycerides and hs-CRP, but not other lipids, lipoproteins, measures of glucose control (fasting glucose and HbA1c), or blood pressure. Limited evidence from observational research (seven of 11 articles with a posteriori assessments) suggests no association between mushroom consumption and fasting blood total or LDL cholesterol, glucose, or morbidity/mortality from cardiovascular disease, coronary heart disease, or type 2 diabetes mellitus. Other CMD health outcomes were deemed either inconsistent (blood pressure, HDL cholesterol, and triglycerides) or insufficient (HbA1c/hyperglycemia, hs-CRP, cerebrovascular disease, and stroke). The majority of the articles vetted were rated "poor" using the NHLBI study quality assessment tool due to study methodology and/or poor reporting issues. While new, high-quality experimental and observational research is warranted, limited experimental findings suggest greater mushroom consumption lowers blood triglycerides and hs-CRP, indices of cardiometabolic health.

Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill's criteria.

Observational research suggests higher red and processed meat intakes predict greater risks of developing or dying from cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), but this research limits causal inference. This systematic review of reviews utilizes both observational and experimental research findings to infer causality of these relations. Reviews from four databases were screened by two researchers. Reviews included unprocessed red meat (URM), processed meat (PM), or mixed URM + PM intake, and reported CVD or T2DM outcomes. Twenty-nine reviews were included, and causality was inferred using Bradford Hill's Criteria. Observational assessments of CVD outcomes and all meat types consistently reported weak associations while, T2DM outcomes and PM and Mixed URM + PM assessments consistently reported strong associations. Experimental assessments of Mixed URM + PM on CVD and T2DM risk factors were predominately not significant which lacked coherence with observational findings. For all meat types and outcomes, temporality and plausible mechanisms were established, but specificity and analogous relationships do not support causality. Evidence was insufficient for URM and T2DM. More experimental research is needed to strengthen these inferences. These results suggest that red and processed meat intakes are not likely causally related to CVD but there is potential for a causal relationship with T2DM.

Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review.

PURPOSE: To review and update the evidence of the relationship between physical activity, risk of fall-related injury, and physical function in community-dwelling older people that was presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (PAGAC Report). METHODS: Duplicate independent screenings of 1415 systematic reviews and meta-analyses published between 2006 and 2016 identified from PubMed®, Cochrane Library, and CINAHL databases yielded 111 articles used for the PAGAC Report. The PAGAC Aging Subcommittee members graded scientific evidence strength based upon a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. An updated search of 368 articles published between January 2017 and March 2018 yielded 35 additional pertinent articles. RESULTS: Strong evidence demonstrated that physical activity reduced the risk of fall-related injuries by 32% to 40%, including severe falls requiring medical care or hospitalization. Strong evidence also supported that physical activity improved physical function and reduced the risk of age-related loss of physical function in an inverse graded manner among the general aging population, and improved physical function in older people with frailty and with Parkinson's disease. Aerobic, muscle-strengthening, and/or multicomponent physical activity programs elicited the largest improvements in physical function in these same populations. Moderate evidence indicated that for older adults who sustained a hip fracture or stroke, extended exercise programs and mobility-oriented physical activity improved physical function. CONCLUSIONS: Regular physical activity effectively helps older adults improve or delay the loss of physical function and mobility while reducing the risk of fall-related injuries. These important public health benefits underscore the importance of physical activity among older adults, especially those living with declining physical function and chronic health conditions.

Reproducibility assessment of brain responses to visual food stimuli in adults with overweight and obesity.

OBJECTIVE: The brain's reward system influences ingestive behavior and subsequently obesity risk. Functional magnetic resonance imaging (fMRI) is a common method for investigating brain reward function. This study sought to assess the reproducibility of fasting-state brain responses to visual food stimuli using BOLD fMRI. METHODS: A priori brain regions of interest included bilateral insula, amygdala, orbitofrontal cortex, caudate, and putamen. Fasting-state fMRI and appetite assessments were completed by 28 women (n = 16) and men (n = 12) with overweight or obesity on 2 days. Reproducibility was assessed by comparing mean fasting-state brain responses and measuring test-retest reliability of these responses on the two testing days. RESULTS: Mean fasting-state brain responses on day 2 were reduced compared with day 1 in the left insula and right amygdala, but mean day 1 and day 2 responses were not different in the other regions of interest. With the exception of the left orbitofrontal cortex response (fair reliability), test-retest reliabilities of brain responses were poor or unreliable. CONCLUSIONS: fMRI-measured responses to visual food cues in adults with overweight or obesity show relatively good mean-level reproducibility but considerable within-subject variability. Poor test-retest reliability reduces the likelihood of observing true correlations and increases the necessary sample sizes for studies.

Effects of Dietary Protein Source and Quantity during Weight Loss on Appetite, Energy Expenditure, and Cardio-Metabolic Responses.

Higher protein meals increase satiety and the thermic effect of feeding (TEF) in acute settings, but it is unclear whether these effects remain after a person becomes acclimated to energy restriction or a given protein intake. This study assessed the effects of predominant protein source (omnivorous, beef/pork vs. lacto-ovo vegetarian, soy/legume) and quantity (10%, 20%, or 30% of energy from protein) on appetite, energy expenditure, and cardio-metabolic indices during energy restriction (ER) in overweight and obese adults. Subjects were randomly assigned to one protein source and then consumed diets with different quantities of protein (4 weeks each) in a randomized crossover manner. Perceived appetite ratings (free-living and in-lab), TEF, and fasting cardio-metabolic indices were assessed at the end of each 4-week period. Protein source and quantity did not affect TEF, hunger, or desire to eat, other than a modestly higher daily composite fullness rating with 30% vs. 10% protein diet (p = 0.03). While the 20% and 30% protein diets reduced cholesterol, triacylglycerol, and APO-B vs. 10% protein (p < 0.05), protein source did not affect cardio-metabolic indices. In conclusion, diets varying in protein quantity with either beef/pork or soy/legume as the predominant source have minimal effects on appetite control, energy expenditure and cardio-metabolic risk factors during ER-induced weight loss.

Assessment of protein requirement in octogenarian women with use of the indicator amino acid oxidation technique.

BACKGROUND: Data on the protein requirements of elderly adults are limited, because it is impractical to conduct repeated nitrogen balance protocols in these vulnerable humans. OBJECTIVE: This study was designed to determine the dietary protein requirement of elderly women by using the recently developed minimally invasive indicator amino acid oxidation (IAAO) technique. DESIGN: Six white women aged 80-87 y [mean ± SEM: 82 ± 1 y and body mass index (in kg/m²) 26 ± 2] completed a 3-d protocol 7 times. Each woman consumed an adaptation diet for 2 d and on day 3 consumed a complete test diet with a crystalline amino acid mixture containing 1 of 7 protein intakes (0.1, 0.3, 0.6, 0.9, 1.2, 1.5, or 1.8 g · kg⁻¹ · d⁻¹) tested randomly. A group-based protein requirement was assessed by using a nonlinear mixed model of protein intake and L-[1-¹³C]phenylalanine oxidation. The breakpoint, at which there was no further decline in the rate of appearance of ¹³C in the breath, was used as an index of the mean protein requirement. RESULTS: The mean protein requirement (95% CI) was 0.85 (0.60, 1.09) g · kg⁻¹ · d⁻¹. This requirement is 29% higher than the current Estimated Average Requirement (EAR) for adults of 0.66 g · kg⁻¹ · d⁻¹ based on the nitrogen balance technique, although the 95% CI includes the current EAR. The corresponding adequate protein allowance of 1.15 (0.77, 1.54) g · kg⁻¹ · d⁻¹ is 44% higher, although the 95% CI includes the Recommended Dietary Allowance (RDA) of 0.80 g · kg⁻¹ · d⁻¹. CONCLUSIONS: Notwithstanding uncertainty about the validity of the use of the IAAO technique to assess protein requirements, the results of this study with octogenarian women suggest that the current EAR and RDA for elderly women may be underestimated. The limitations of this short-term, noninvasive method underscore the need for new research that uses alternative experimental designs and measuring physiologic, morphologic, and health-related outcomes.

Effects of food form on food intake and postprandial appetite sensations, glucose and endocrine responses, and energy expenditure in resistance trained v. sedentary older adults.

Limited research has suggested that the food form of nutritional supplements (FFNS) and resistance training (RT) influence ingestive behaviour and energy balance in older adults. The effects of the FFNS and RT on acute appetitive, endocrine and metabolic responses are not adequately documented. The present study assessed the effects of the FFNS and RT on postprandial appetite sensations (hunger and fullness), endocrine responses (plasma insulin, cholecystokinin, ghrelin and glucagon-like peptide-1 (GLP-1)), metabolism (glucose, energy expenditure and RER) and food intake (satiation) in older adults. On separate days, eighteen sedentary (Sed) and sixteen RT healthy adults (age 62-84 years) consumed 12·5 % of their energy need as an isoenergetic- and macronutrient-matched solid or beverage. Postprandial responses were assessed over 4 h. No RT × FFNS interactions were observed for any parameter. Fasting cholecystokinin was higher in the RT v. Sed group (P < 0·05). RT did not influence fullness, but fullness was higher following the solid v. beverage intake (P < 0·01). Neither RT nor FFNS influenced hunger. Glucose and insulin were higher after the solid v. beverage intake (P < 0·01). Ghrelin, GLP-1 and energy expenditure were not different between the RT and FFNS groups. Postprandial cholecystokinin was higher in the RT v. Sed group (P < 0·01) and for solid v. beverage (P < 0·05). RER was lower for solid v. beverage (P < 0·001). Neither RT nor FFNS independently or interactively influenced food intake 2 h after post-nutritional supplements. In conclusion, RT had little influence on ingestive behaviour. The appetitive and endocrine responses suggested the solid-promoted satiety; however, the FFNS did not alter subsequent food intake.

Water turnover assessment in overweight adolescents.

Adequate intake (AI) standards for water in adolescents range between 2.4-3.3 l/day for males and 2.1-2.3 l/day for females, independent of obesity status. Water intakes and excretions of this population are not well documented. The purposes of this study were to assess water turnover, inputs, and outputs in overweight adolescents, compare these parameters between males and females, and evaluate the reproducibility of water turnover. Eighteen girls (BMI 31.7 ± 4 kg/m(2); mean ± s.d.) and nine boys (BMI 26.3 ± 3 kg/m(2)) aged 12-15 years completed two 3-week metabolic balance trials. Rate of water turnover (rH(2)O) was measured by tracking the decline of deuterated water from the body over 14 days. Water inputs (diet*, ad libitum(#), metabolic(#)) and outputs (urine*, feces*, insensible(#)) were assessed (*measured, #estimated). rH(2)O was lower (P = 0.002) in girls vs. boys (3,742 ± 536 vs. 4,537 ± 623 g/day). Per kg body weight, rH(2)O was 28% lower in girls vs. boys (46 ± 7 vs. 64 ± 9 g·kg(-1)·day(-1)). Water input from food and beverages provided and metabolic production were 44 and 28% lower, respectively, in girls vs. boys. Urine and insensible water losses were 21 and 17% lower in girls vs. boys. BMI was positively associated with water turnover in both sexes (girls P = 0.037; boys P = 0.014). The intraclass correlation of rH(2)O between trials was 0.981 (P < 0.001). In conclusion, these overweight adolescents consumed water well in excess of sex-specific AI standards. The lower rH(2)O in girls compared to boys is consistent with adult females and males.

Consumption of the slow-digesting waxy maize starch leads to blunted plasma glucose and insulin response but does not influence energy expenditure or appetite in humans.

Limited research in humans suggests that slowly digestible starch may blunt the postprandial increase and subsequent decline of plasma glucose and insulin concentrations, leading to prolonged energy availability and satiety, compared to more rapidly digestible starch. This study examined the postprandial metabolic and appetitive responses of waxy maize starch (WM), a slow-digestible starch. It was hypothesized that the waxy maize treatment would result in a blunted and more sustained glucose and insulin response, as well as energy expenditure and appetitive responses. Twelve subjects (6 men and 6 women) (age, 23 +/- 1 years; body mass index, 22.2 +/- 0.7 kg/m(2); insulin sensitivity [homeostatic model assessment], 16% +/- 2%; physical activity, 556 +/- 120 min/wk) consumed, on separate days, 50 g of available carbohydrate as WM, a maltodextrin-sucrose mixture (MS), or white bread (control). Postprandial plasma glucose and insulin, energy expenditure, and appetite (hunger, fullness, desire to eat) were measured over 4 hours. Compared to control, the 4-hour glucose response was not different for MS and WM, and the 4-hour insulin response was higher for MS (P < .005) and lower for WM (P < .05). Compared to MS, WM led to lower 4-hour glucose and insulin responses (P < .001). These differences were driven by blunted glucose and insulin responses during the first hour for WM. Postprandial energy expenditure and appetite were not different among treatments. These results support that WM provides sustained glucose availability in young, insulin-sensitive adults.

Comparison of self-reported, measured, metabolizable energy intake with total energy expenditure in overweight teens.

BACKGROUND: The accuracy of dietary energy assessment tools is critical to understanding the role of diet in the increasing rate of obesity. OBJECTIVES: The purposes of our study in overweight adolescent boys and girls were 1) to assess the energy reporting bias of diet records against the referent of total energy expenditure (TEE) and 2) to compare the methods of determining energy needs by using measured metabolizable energy intake (MEI) and TEE. DESIGN: Twenty girls [12-15 y, body mass index (in kg/m2) = 33.0 +/- 5] and 14 boys (12-14 y, body mass index = 27.4 +/- 4) participated in 2- to 3-wk metabolic balance studies. TEE was measured by using doubly labeled water (TEE(DLW)), and MEI was measured by bomb calorimetry of composite daily diet, urine, and fecal collections. Food records were collected before each study. RESULTS: Food records underreported TEE(DLW) by 35 +/- 20%. Underreporting of energy intake was correlated with all macronutrient intake concentrations (g or kcal) (P < 0.0001). A multiple regression model showed that 86.4% of the variance in underreporting error was explained by dietary fat (g), BMI, and sex. The intrasubject CV was 3.9% for TEE(DLW) and 9.9% for MEI. MEI for weight stability (MEI(wtstb)) averaged 99 +/- 11% of TEE. CONCLUSIONS: The increased underreporting of dietary intake with increasing body weight in teens may explain in part previous reports noting that there has been an increased incidence of obesity, although energy intakes have not appeared to increase. MEI(wtstb) and TEE(DLW) gave similar estimates of energy needs. This trial was registered at clinicaltrials.gov as NCT 00592137.

The Yale Physical Activity Survey for older adults: predictions in the energy expenditure due to physical activity.

OBJECTIVE: To evaluate the accuracy of the Yale Physical Activity Survey (YPAS) for older adults. DESIGN: Fourteen-week strictly controlled diet study. SUBJECTS/SETTING: Eleven men and 17 women, age range 55 to 78 years, spent 10 weeks in an outpatient setting and 4 weeks in an inpatient setting at the General Clinical Research Center, Noll Physiological Research Center, The Pennsylvania State University, University Park. INTERVENTION: Subjects were provided dietary energy to maintain body weight within +/-0.5 kg of baseline weight. The daily menus contained 0.8 g protein per kilogram body weight and nonprotein energy as 60% carbohydrate and 40% fat. MAIN OUTCOME MEASURES: Metabolizable energy intake (MEI) was measured at week 14 from the gross energy contents of food, urine, and feces, with corrections for any body composition changes during the last 6 weeks of weight maintenance. Resting energy expenditure (REE) was determined using indirect calorimetry. The thermic effect of feeding (TEF) was estimated to be 10% of the MEI. The energy expenditure due to physical activity (EEPA) was derived by the formula: EEPA=MEI-REE-TEF. This value was compared with the EEPA estimated from the YPAS. Statistical analyses performed Two-factor analysis of variance with repeated measures and paired t tests. RESULTS: At week 14, after a minimum of 6 weeks of sustained weight stability, the derived EEPA was not different from that estimated using the YPAS for the men and the men and women combined, while the YPAS estimate was more than the measured mean value for the women (P<.05). There was wide variability in the accuracy of the EEPA prediction for individual subjects (range=-637 to 794 kcal). APPLICATIONS/CONCLUSIONS: The YPAS may be used, with caution, to estimate the EEPA for groups of older individuals, and may provide inaccurate estimates of the EEPA in older individuals.