ω-3 Polyunsaturated Fatty Acid Status Testing in Humans: A Narrative Review of Commercially Available Options.

There is an increasing body of evidence supporting a link between low intakes of ω-3 long-chain polyunsaturated fatty acids (LCPUFA) and numerous diseases and health conditions. However, few people are achieving the levels of fish/seafood or eicosapentaenoic acid and docosahexaenoic acid intake recommended in national and international guidelines. Knowledge of a person's ω-3 LCPUFA status will benefit the interpretation of research results and could be expected to lead to an increased effort to increase intake. Dietary intake survey methods are often used as a surrogate for measuring ω-3 PUFA tissue status and its impact on health and functional outcomes. However, because individuals vary widely in their ability to digest and absorb ω-3 PUFA, analytical testing of biological samples is desirable to accurately evaluate ω-3 PUFA status. Adipose tissue is the reference biospecimen for measuring tissue fatty acids, but less-invasive methods, such as measurements in whole blood or its components (e.g., plasma, serum, red blood cell membranes) or breast milk are often used. Numerous commercial laboratories provide fatty acid testing of blood and breast milk samples by different methods and present their results in a variety of reports such as a full fatty acid profile, ω-3 and ω-6 fatty acid profiles, fatty acid ratios, as well as the Omega-3 Index, the Holman Omega-3 Test, OmegaScore, and OmegaCheck, among others. This narrative review provides information about the different ways to measure ω-3 LCPUFA status (including both dietary assessments and selected commercially available analytical tests of blood and breast milk samples) and discusses evidence linking increased ω-3 LCPUFA intake or status to improved health, focusing on cardiovascular, neurological, pregnancy, and eye health, in support of recommendations to increase ω-3 LCPUFA intake and testing.

Trends and Patterns of Chickpea Consumption among United States Adults: Analyses of National Health and Nutrition Examination Survey Data.

BACKGROUND: Chickpeas are an affordable and nutrient-dense legume, but there is limited United States data on consumption patterns and the relationship between chickpea consumption and dietary intakes. OBJECTIVES: This study examined trends and sociodemographic patterns among chickpea consumers and the relationship between chickpea consumption and dietary intake. METHODS: Adults consuming chickpeas or chickpea-containing foods on 1 or both of the 24-h dietary recalls were categorized as chickpea consumers. Data from NHANES 2003-2018 were used to evaluate trends and sociodemographic patterns in chickpea consumption (n = 35,029). The association between chickpea consumption and dietary intakes was compared to other legume consumers and nonlegume consumers from 2015-2018 (n = 8,342). RESULTS: The proportion of chickpea consumers increased from 1.9% in 2003-2006 to 4.5% in 2015-2018 (P value for trend < 0.001). This trend was consistent across age group, sex, race/ethnicity, education, and income. In 2015-2018, chickpea consumption was highest among individuals with higher incomes (2.4% among those with incomes <185% of the federal poverty guideline compared with 6.4% with incomes ≥300%), education levels (1.0% for less than high school compared with 10.2% for college graduates), physical activity levels (1.9% for no physical activity compared with 7.7% for ≥430 min of moderate-equivalent physical activity per week), and those with better self-reported health (1.7% fair/poor compared with 6.5% for excellent/very good, P-trend < 0.001 for each). Chickpea consumers had greater intakes of whole grains (1.48 oz/d for chickpea consumers compared with 0.91 for nonlegume consumers) and nuts/seeds (1.47 compared with 0.72 oz/d), less intake of red meat (0.96 compared with 1.55 oz/d), and higher Healthy Eating Index scores (62.1 compared with 51.2) compared with both nonlegume and other legume consumers (P value < 0.05 for each). CONCLUSIONS: Chickpea consumption among United States adults has doubled between 2003 and 2018, yet intake remains low. Chickpea consumers have higher socioeconomic status and better health status, and their overall diets are more consistent with a healthy dietary pattern.

An Update on Nutrition Guidance for Cardiovascular Health.

PURPOSE OF REVIEW: The goal of this article is to summarize recent guidance on diet and cardiovascular health. RECENT FINDINGS: Cardiovascular diseases are the leading cause of death in the USA, and diet significantly impacts cardiovascular disease risk. The focus of contemporary dietary recommendations has shifted from single nutrient replacements to dietary patterns such as the Mediterranean, healthy USA, Dietary Approaches to Stop Hypertension, and healthy plant-based patterns. Recommended dietary patterns emphasize whole grains, fruits, vegetables, nuts, seeds, legumes/pulses, seafood, lean meats, and fish/seafood. They also limit intakes of ultra-processed foods, processed meats, and alcohol, as well as foods high in salt and added sugars, particularly sugar-sweetened beverages.

Whole grain intake, compared to refined grain, improves postprandial glycemia and insulinemia: a systematic review and meta-analysis of randomized controlled trials.

Whole grain (WG) intake has been associated with reduced risk of type 2 diabetes (T2D) and may protect against T2D by lowering postprandial glycemia and insulinemia and improving insulin sensitivity. The objective of this systematic review and meta-analysis was to evaluate the effect of WG intake, compared to refined grain (RG) intake, on postprandial glycemia and insulinemia and markers of glycemic control and insulin resistance in randomized controlled trials (RCTs) in adults. A search of PubMed and Scopus yielded 80 relevant RCTs. Compared to RG, WG intake significantly reduced postprandial glycemia (SMD: -0.30; 95% CI: -0.43, -0.18; P < 0.001), insulinemia (SMD: -0.23; 95% CI: -0.35, -0.10; P < 0.001) and glycated hemoglobin (HbA1c) (SMD: -0.21; 95% CI: -0.37, -0.06; P = 0.007). There was no effect of WG on fasting glucose, fasting insulin, or homeostatic model assessment of insulin resistance (HOMA-IR). These results suggest WG foods improve short-term glycemia and insulinemia, which may improve HbA1c, a marker of long-term glycemic control. This may partially explain the inverse association between WG intake and risk of T2D, but further investigations are needed to understand if short-term reductions in glycemia translate to longer term benefits in reducing the risk of T2D.Systematic Review Registration: PROSPERO Registration CRD42020180069.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2017838.

Beyond well-mixed: A simple probabilistic model of airborne disease transmission in indoor spaces.

We develop a simple model for assessing risk of airborne disease transmission that accounts for non-uniform mixing in indoor spaces and is compatible with existing epidemiological models. A database containing 174 high-resolution simulations of airflow in classrooms, lecture halls, and buses is generated and used to quantify the spatial distribution of expiratory droplet nuclei for a wide range of ventilation rates, exposure times, and room configurations. Imperfect mixing due to obstructions, buoyancy, and turbulent dispersion results in concentration fields with significant variance. The spatial non-uniformity is found to be accurately described by a shifted lognormal distribution. A well-mixed mass balance model is used to predict the mean, and the standard deviation is parameterized based on ventilation rate and room geometry. When employed in a dose-response function risk model, infection probability can be estimated considering spatial heterogeneity that contributes to both short- and long-range transmission.

Left ventricular mass regression, all-cause and cardiovascular mortality in chronic kidney disease: a meta-analysis.

BACKGROUND: Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. METHODS: The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. RESULTS: The meta-analysis included 42 trials with duration ≥12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 12 of other types of interventions. All-cause mortality was reported in 121/2584 (4.86%) subjects in intervention groups and 168/2606 (6.45%) subjects in control groups. The pooled RR estimate of the 27 trials ≥12 months with ≥1 event in ≥1 group was 0.72 (95% CI 0.57 to 0.90, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥6 months (34 trials), ≥9 months (29 trials), and >12 months (10 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.67, 95% CI 0.39 to 1.16. CONCLUSIONS: These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

Fibre and micronutrient intakes among fruit juice consumers and non-consumers in the UK and France: Modelling the effects of consumption of an orange pomace juice product.

BACKGROUND: Fruit intake, including consumption of 100% fruit juice, is generally associated with a better diet quality and overall health. However, fruit and vegetable intakes are below recommendations in many countries. METHODS: The present study examined fruit juice intake and total energy and nutrient intakes according to juice consumption or non-consumption in participants in the National Dietary and Nutrition Survey Rolling Programme 2014-2016 in the UK (n = 2723) and the Individual and National Study on Food Consumption 2006-2007 (n = 4079) in France. Total energy and nutrient intakes were also estimated for scenarios in which orange juice with pomace was either added to the daily diet or replaced 100% orange juice or beverages containing fruit juice. RESULTS: Fruit juice consumers had higher intakes of fruits and vegetables than non-consumers, were more likely to reach 5-a-day targets for fruit and vegetable consumption, and had significantly higher intakes of folate, vitamin C, potassium, magnesium, and fibre. Juice consumers also had higher total energy and sugar intakes, but lower body mass index than non-juice consumers. Modelling consumption of orange juice with pomace increased fibre and potassium intakes in orange juice consumers, and also increased fibre, most micronutrients, and 5-a-day achievements in non-juice consumers. CONCLUSIONS: These national survey results demonstrate that fruit juice consumers in the UK and France had higher intakes of fruits and vegetables than fruit juice non-consumers, and significantly higher intakes of several micronutrients and fibre. Furthermore, modelling of consumption of orange juice with pomace increased fibre and select micronutrient intakes, particularly among fruit juice non-consumers.

Keto is Trending: Implications for Body Weight and Lipid Management.

PURPOSE OF REVIEW: Very-low-carbohydrate (VLC) and ketogenic diets (KDs) have been used for weight loss and more recently in patients with insulin resistance and type 2 diabetes. The impact of VLC and KDs on lipids/lipoproteins is a concern. The purpose of this review is to discuss the impact of KDs on body weight and lipids/lipoproteins. RECENT FINDINGS: VLC/KDs contribute to greater weight loss in the short term (< 6 months) compared to higher carbohydrate diets, but there is typically no difference between the diets by 12 months. Triglyceride and high-density lipoprotein cholesterol levels generally improve, but there is a variable response in low-density lipoprotein cholesterol levels, with some individuals experiencing a dramatic increase, particularly those with latent genetic dyslipidemias. Healthcare professionals should educate patients on the risks and benefits of following VLC/KDs and encourage the consumption of carbohydrate-rich foods associated with positive health outcomes.

Dietary Influences on Atherosclerotic Cardiovascular Disease Risk.

PURPOSEOF REVIEW: Professional organizations recommend various healthy dietary patterns for atherosclerotic vascular disease (ASCVD) prevention. The purpose of this review is to discuss the evidence for the recommended healthy dietary patterns and ASCVD risk reduction, as well as briefly review specific areas of controversy. RECENT FINDINGS: The Mediterranean, Dietary Approach to Stop Hypertension, and plant-based dietary patterns have been associated with lower ASCVD risk in observational studies. The Mediterranean dietary pattern has been demonstrated to reduce ASCVD event risk in a large, randomized, controlled trial. Observational studies demonstrate dietary patterns with higher quality foods are associated with decreased ASCVD risk and mortality. Healthy dietary patterns emphasize higher intakes of plant-based foods, lean animal protein sources, and non-tropical oils, while limiting intakes of sugar-sweetened products, refined grains, and processed meats. Encouraging individuals to consume healthy dietary patterns with high-quality foods can promote ASCVD prevention and overall health.

Science dialogue mapping of knowledge and knowledge gaps related to the effects of dairy intake on human cardiovascular health and disease.

Dairy has been described as everything from a superfood to a poison; yet, arguments, assumptions, and data justifying these labels are not always clear. We used an issue-based information system, "dialogue mapping™," to summarize scientific points of a live panel discussion on the putative effects of dairy on cardiovascular diseases (CVD) from a day-long session among experts in nutrition and CVD. Dialogue mapping captures relations among ideas to explicitly, logically, and visually connect issues/questions, ideas, pro/con arguments, and agreements, even if discussed at different times. Experts discussed two propositions: for CVD risk, consumption of full-fat dairy products 1) should be minimized, in part because of their saturated fat content, or 2) need not be minimized, despite their saturated fat content. The panel discussed the dairy-CVD relation through blood lipids, diabetes, obesity, energy balance, blood pressure, dairy bioactives, biobehavioral components, and other putative causal pathways. Associations and effects reported in the literature have varied by fat content of dairy elements considered, study design, intake methods, and biomarker versus disease outcomes. Two conceptual topics emerged from the discussion: 1) individual variability: whether recommendations should be targeted only to those at high CVD risk; 2) quality of evidence: whether data on dairy-CVD relations are strong enough for reliable conclusions-positive, negative, or null. Future procedural improvements for science dialog mapping include using singular rather than competing propositions for discussion.

Varying roles of glucoregulatory function measures in postprandial cognition following milk consumption.

PURPOSE: Past work suggests milk consumption may facilitate cognition in children and college students with higher fasting glucose compared to other beverages (e.g., fruit juice). However, no studies have evaluated this phenomenon in adults, or considered other measures of glucoregulatory function. This open-label study assessed the role of glucoregulatory function in postprandial cognition after milk intake in adults. We hypothesized participants with lower fasting or post-consumption plasma glucose following a glucose excursion challenge (glucose response) would demonstrate better cognition following beverages of higher (juice) versus lower (milk) or no (water) glycemic content. METHODS: Forty-four nondiabetic, overnight-fasted adults attended three laboratory visits, ingesting 237 mL of 2% fat milk, apple juice, or water at each visit in a randomized, counterbalanced, crossover design. Participants completed cognitive testing (CNS Vital Signs) at baseline and 30, 90, and 150 min post-ingestion; primary outcomes were CNS Vital Signs composite scores. Fasting and post-consumption plasma glucose levels were assessed, with glucose response indexed as the change in plasma glucose from baseline to 30 min after juice (ΔGlucose). RESULTS: Mixed modeling revealed participants with higher fasting glucose demonstrated better complex attention after water versus juice at 30 min, but better performance after juice versus water at 150 min (p = 0.02). Participants with a larger ΔGlucose demonstrated better processing speed (p = 0.01) 30 min after milk versus water; this effect also reversed at 150 min. CONCLUSION: Different methods of measuring glucoregulatory function reveal its differing roles in postprandial cognition. Time since ingestion may also determine which beverages best optimize cognition.

Omega-3 fatty acid therapy for cardiovascular disease: justified or not?

PURPOSE OF REVIEW: To discuss the current evidence regarding the relationship between omega-3 fatty acid intake and atherosclerotic cardiovascular disease (ASCVD) risk. RECENT FINDINGS: Combined results from randomized controlled trials using low-dosage (≤1.8 g/day of ethyl esters) eicosapentaenoic acid (EPA) or EPA + docosahexaenoic acid (DHA) suggest a small benefit for reducing coronary heart disease risk. The Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) that administered 4 g/day icosapent ethyl (IPE) to individuals on statin at high or very high ASCVD risk with elevated triglycerides demonstrated a 25% relative risk reduction in the composite primary endpoint (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization and unstable angina) for IPE vs. placebo, and a lower hazard for all prespecified individual endpoints other than total mortality. Several national organizations have recommended IPE for ASCVD risk reduction in populations aligning with REDUCE-IT; the Food and Drug Administration has approved IPE for ASCVD risk reduction. However, the Outcomes Study to Assess Statin Residual Risk Reduction with Epanova (EPA + DHA carboxylic acids) in High Cardiovascular Risk Patients with Hypertriglyceridemia was recently stopped for futility. SUMMARY: At present, the best available evidence for a role of omega-3 fatty acids in ASCVD risk reduction is for 4 g/day of IPE, as an adjunct to statin therapy, for patients with ASCVD or diabetes mellitus and elevated triglycerides.

Substituting Lean Beef for Carbohydrate in a Healthy Dietary Pattern Does Not Adversely Affect the Cardiometabolic Risk Factor Profile in Men and Women at Risk for Type 2 Diabetes.

BACKGROUND: Observational evidence suggests that red meat intake is associated with type 2 diabetes (T2D) and cardiovascular disease incidence, but few randomized controlled trials have assessed effects of lean, unprocessed red meat intake on insulin sensitivity and other cardiometabolic risk factors. OBJECTIVE: This study compared the USDA Healthy US-Style Eating Pattern, low in saturated fat and red meat (<40 g/d red meat; USDA-CON), with a modified version with an additional 150 g/d lean beef as an isocaloric replacement for carbohydrate (USDA-LB) on insulin sensitivity and cardiometabolic risk markers. METHODS: Participants (7 men, 26 women; 44.4 y old) with overweight/obesity [BMI (kg/m2) = 31.3] and prediabetes and/or metabolic syndrome completed this randomized, crossover, controlled-feeding trial consisting of two 28-d treatments (USDA-CON and USDA-LB) separated by a ≥14-day washout. Insulin sensitivity (primary outcome variable), lipoprotein lipids, apolipoproteins (apoA-I and apoB), and high-sensitivity C-reactive protein (hs-CRP) (secondary outcome variables), in plasma or serum, and blood pressures were assessed at baseline and the end of each diet period. RESULTS: USDA-LB and USDA-CON did not differ significantly in effects on whole-body insulin sensitivity and other indicators of carbohydrate metabolism, lipoprotein lipids, apoA-I and apoB, hs-CRP, and blood pressures. USDA-LB produced a shift toward less cholesterol carried by smaller LDL subfractions compared with USDA-CON [least-squares geometric mean ratios for LDL1+2 cholesterol of 1.20 (P = 0.016) and LDL3+4 cholesterol of 0.89 (P = 0.044)] and increased peak LDL time versus USDA-CON (1.01; P = 0.008). CONCLUSIONS: Substituting lean, unprocessed beef for carbohydrate in a Healthy US-Style Eating Pattern resulted in a shift toward larger, more buoyant LDL subfractions, but otherwise had no significant effects on the cardiometabolic risk factor profile in men and women with prediabetes and/or metabolic syndrome.This trial was registered at clinicaltrials.gov as NCT03202680.

The Effects of Carbohydrate-Restricted Dietary Patterns and Physical Activity on Body Weight and Glycemic Control.

PURPOSE OF REVIEW: Carbohydrate (CHO)-restricted dietary patterns (very-low-CHO < 25-50 g CHO/day; low CHO 50-130 g CHO/day) and physical activity are used for weight loss and type 2 diabetes (T2D) prevention and management. This review discusses evidence for effects of these lifestyle therapies on body weight and glycemic control. RECENT FINDINGS: Evidence supports the view that CHO-restricted interventions may be more effective than high-CHO, low-fat (HCLF) interventions in the short term for weight loss and glycemic control, but both produced similar levels of weight loss and glycemic control by 12 months. CHO-restricted dietary patterns resulted in a decreased use of diabetes medications. Benefits of CHO restriction were achieved at intakes that did not induce ketosis. Physical activity increases insulin sensitivity and reduces pancreatic beta-cell load, enhancing the effect of weight loss to delay or prevent T2D. A CHO-restricted dietary pattern may be a reasonable option for weight loss and T2D management for some individuals. Physical activity enhances weight management and cardiometabolic health.

Effects of Consuming Almonds on Insulin Sensitivity and Other Cardiometabolic Health Markers in Adults With Prediabetes.

Objective: This study was designed to assess the effects of replacing high-carbohydrate (CHO) foods with raw almonds on insulin sensitivity and cardiometabolic health markers in overweight or obese adults with prediabetes.Method: This randomized crossover study consisted of two 6-week dietary intervention periods, separated by a ≥ 4-week washout. Subjects incorporated 1.5 oz of raw almonds twice daily or isocaloric CHO-based foods into their diets, with instructions to maintain body weight. Dietary intakes as well as insulin sensitivity, CHO metabolism indices, lipoprotein lipids and particles, and inflammatory markers were assessed.Results: Thirty-three subjects (17 male, 16 female), mean age 48.3 ± 2.2 years and body mass index 30.5 ± 0.7 kg/m2, provided evaluable data. Compared to CHO, almonds resulted in significantly (p < 0.01) higher intakes of protein, fat (unsaturated fatty acids), fiber, and magnesium and significantly (p < 0.001) lower intakes of CHO and sugars. No differences were observed between diet conditions for changes from baseline in the insulin sensitivity index from a short intravenous glucose tolerance test or other indices of glucose homeostasis. No significant differences were observed in biomarkers of cardiovascular risk except that the CHO intervention led to a shift toward a higher concentration of cholesterol in small, dense low-density lipoprotein subfraction 3+4 (LDL3 + 4) particles (p = 0.024 vs almonds).Conclusions: Intake of 3.0 oz/d raw almonds, vs energy-matched CHO foods, improved the dietary nutrient profile, but did not significantly affect insulin sensitivity and most markers of cardiometabolic health in overweight and obese men and women with prediabetes.

Strategies to improve bioavailability of omega-3 fatty acids from ethyl ester concentrates.

PURPOSE OF REVIEW: To describe recent strategies that have been developed to enhance absorption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from dietary supplements. RECENT FINDINGS: The long-chain omega-3 fatty acids EPA and DHA have important physiologic functions, and numerous potential health benefits have been suggested by results from observational studies and randomized, controlled trials. EPA and DHA intakes in the average American diet are substantially below recommended levels. Dietary supplements are available for consumers wishing to increase their intakes, but many of these are in ethyl ester formulations from which EPA and DHA are poorly absorbed when consumed without a meal containing dietary fat. Technologies have been developed to enhance EPA and DHA absorption through in-situ emulsification, which facilitates bioavailability, even in the absence of a fat-containing meal. Findings from randomized controlled trials of absorption enhancers incorporated into omega-3 fatty acid supplements demonstrate that they can markedly improve the bioavailability of EPA and DHA. SUMMARY: The development of absorption enhancement technology to increase bioavailability of long-chain omega-3 fatty acids has important implications for studies on the health effects of dietary supplement and pharmaceutical products containing EPA and/or DHA.

Corn Oil Lowers Plasma Cholesterol Compared with Coconut Oil in Adults with Above-Desirable Levels of Cholesterol in a Randomized Crossover Trial.

Background: Few trials have examined the effects of coconut oil consumption in comparison with polyunsaturated fatty acid-rich oils such as corn oil. Objective: This trial assessed the effects of consuming foods made with corn oil compared with coconut oil on lipids, glucose homeostasis, and inflammation. Methods: This was a preliminary randomized crossover study of men (n = 12) and women (n = 13) with a mean age of 45.2 y, mean body mass index (in kg/m2) of 27.7, fasting LDL cholesterol ≥115 mg/dL and <190 mg/dL, and triglycerides (TGs) ≤375 mg/dL. Subjects consumed muffins and rolls providing 4 tablespoons (∼54 g) per day of corn oil or coconut oil as part of their habitual diets for 4 wk, with a 3-wk washout between conditions. Fasting plasma lipids and high-sensitivity C-reactive protein (hs-CRP) and glucose metabolism were assessed via an intravenous glucose tolerance test at baseline and 15 and 29 d of treatment. Responses were compared between treatments by ANCOVA. Results: Median baseline concentrations of LDL cholesterol, non-HDL cholesterol, total cholesterol (total-C), HDL cholesterol, total-C:HDL cholesterol, and TGs were 123, 144, 188, 46.0, 4.21, and 92.5 mg/dL, respectively. Changes from baseline for corn oil and coconut oil conditions, respectively, were: LDL cholesterol (primary outcome; -2.7% compared with +4.6%), non-HDL cholesterol (-3.0% compared with +5.8%), total-C (-0.5% compared with +7.1%), HDL cholesterol (+5.4% compared with +6.5%), total-C:HDL cholesterol (-4.3% compared with -3.3%), and TGs (-2.1% compared with +6.0%). Non-HDL cholesterol responses were significantly different between corn and coconut oil conditions (P = 0.034); differences between conditions in total-C and LDL cholesterol approached significance (both P = 0.06). Responses for hs-CRP and carbohydrate homeostasis parameters did not differ significantly between diet conditions. Conclusions: When incorporated into the habitual diet, consumption of foods providing ∼54 g of corn oil/d produced a more favorable plasma lipid profile than did coconut oil in adults with elevated cholesterol. This trial was registered at clinicaltrials.gov as NCT03202654.

Assessing Cardiovascular Disease Risk and Responses to Preventive Therapies in Clinical Practice.

PURPOSE OF REVIEW: The aims of this review are to provide perspective on evaluation of relative and absolute cardiovascular disease (CVD) risk reductions for assessing the efficacy of preventive therapies and to summarize methods for evaluation of CVD risk in clinical practice. RECENT FINDINGS: Major CVD risk factors can be used to stratify patients into risk categories. Results from recent trials reinforce the view that benefits of preventive therapies will be greatest in those with the highest absolute risk and in those with the most severe disturbance in the risk factor targeted. In evaluating clinical utility, it is necessary to assess the impact of an intervention on both relative and absolute risk. Quantitative risk scoring using major CVD risk factors is effective for identifying those at low, moderate, and high CVD risk. When there is uncertainty about the appropriate treatment strategy, additional testing may be used to refine risk assessment. This may include measurement of inflammatory markers, subclinical indicators of atherosclerosis (e.g., coronary artery calcium and ankle brachial index), urinary albumin/creatinine ratio, and the level of lipoprotein (a). The benefit of a preventive therapy will generally be the greatest in those with the highest absolute risk and in those with the most severe disturbance in the risk factor targeted. Quantitative risk scoring with major CVD risk factors can be supplemented with additional testing for refinement of risk assessment in patients for whom decisions about pharmacotherapy, or the intensity of therapy, for risk factor modification are uncertain.

The Effect of Cranberry Juice Consumption on the Recurrence of Urinary Tract Infection: Relationship to Baseline Risk Factors.

OBJECTIVE: The objective of this study was to assess relationships between clinical predictors of urinary tract infection (UTI) and effects of cranberry juice consumption on recurrence in a post hoc analysis of a 24-week, randomized, double-blind, placebo-controlled, multicenter clinical trial in women with a recent history of UTI. METHODS: Participants consumed a cranberry (n = 185) or placebo (n = 188) beverage (240 mL) daily. Odds ratios (OR) from 20 candidate predictor variables were evaluated in univariate analyses to assess clinical UTI incidence relationships in the placebo group. A multivariate logistic regression model was developed. The effects of cranberry juice consumption were evaluated in subsets categorized by the likelihood of a UTI event based on the prediction model. RESULTS: In the placebo group, the final multivariate regression model identified four variables associated with the odds for having ≥ 1 UTI: intercourse frequency ≥ 1 time during the prior 4 weeks (OR: 2.36; 95% confidence interval [CI]: 0.98, 5.71; p = 0.057), use of vasectomy or hormonal methods for contraception (OR: 2.58; 95% CI: 1.20, 5.58; p = 0.016), most recent UTI < 90 days prior to screening (OR: 2.28; 95% CI; 1.12, 4.67; p = 0.024), and living in France compared with the United States (OR: 0.17; 95% CI: 0.04, 0.79; p = 0.024). Three propensity categories were investigated (24-week probability < 10%, 10%-21%, and > 21%). Incidence rate ratios for the cranberry vs placebo groups were 0.76 (95% CI: 0.22, 2.60; p = 0.663) for those with < 10% probability, 0.73 (95% CI: 0.35, 1.53; p = 0.064) for those with 10% to 21% probability, and 0.58 (95% CI: 0.35, 0.97; p = 0.039) for those with > 21% probability. CONCLUSIONS: Results suggest that clinical predictors identify women with low and high risk of clinical UTI recurrence, which may be useful for design of clinical studies evaluating preventive therapies.