A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea.

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diet has been extensively researched, but not in the management of older adults with functional gastrointestinal symptoms. This study determines the positive and negative impacts of this dietary treatment in older adults with chronic diarrhea. A non-blinded intervention study was conducted with adults over 65 years with chronic diarrhea referred for colonoscopy where no cause was found. Participants followed a dietitian-led low FODMAP diet for six weeks and completed a structured assessment of gastrointestinal symptoms, the Hospital Anxiety and Depression scale, and a four-day food diary before and after the intervention. Twenty participants, mean age 76 years, were recruited. Adherence to the low FODMAP diet was acceptable; mean daily FODMAP intake reduced from 20.82 g to 3.75 g (p < 0.001) during the intervention and no clinically significant changes in macro- or micronutrient intakes were observed. There were clinically significant improvements in total gastrointestinal symptoms (pre diet 21.15/88 (standard deviation SD = 10.99), post diet 9.8/88 (SD = 9.58), p < 0.001) including diarrhea (pre diet 9.85 (SD = 3.84), post diet 4.05 (SD = 3.86), p < 0.001) and significant reductions in anxiety (pre diet 6.11/21 (SD = 4.31), post diet 4.26/21 (SD = 3.38), p < 0.05). In older adults the low FODMAP diet is clinically effective and does not jeopardise nutritional intake when supervised by an experienced dietitian.

SunGold Kiwifruit Supplementation of Individuals with Prediabetes Alters Gut Microbiota and Improves Vitamin C Status, Anthropometric and Clinical Markers.

Kiwifruit are a nutrient dense food and an excellent source of vitamin C. Supplementation of the diet with kiwifruit enhances plasma vitamin C status and epidemiological studies have shown an association between vitamin C status and reduced insulin resistance and improved blood glucose control. In vitro experiments suggest that eating kiwifruit might induce changes to microbiota composition and function; however, human studies to confirm these findings are lacking. The aim of this study was to investigate the effect of consuming two SunGold kiwifruit per day over 12 weeks on vitamin C status, clinical and anthropometric measures and faecal microbiota composition in people with prediabetes. This pilot intervention trial compared baseline measurements with those following the intervention. Participants completed a physical activity questionnaire and a three-day estimated food diary at baseline and on completion of the trial. Venous blood samples were collected at each study visit (baseline, 6, 12 weeks) for determination of glycaemic indices, plasma vitamin C concentrations, hormones, lipid profiles and high-sensitivity C-reactive protein. Participants provided a faecal sample at each study visit. DNA was extracted from the faecal samples and a region of the 16S ribosomal RNA gene was amplified and sequenced to determine faecal microbiota composition. When week 12 measures were compared to baseline, results showed a significant increase in plasma vitamin C (14 µmol/L, p < 0.001). There was a significant reduction in both diastolic (4 mmHg, p = 0.029) and systolic (6 mmHg, p = 0.003) blood pressure and a significant reduction in waist circumference (3.1 cm, p = 0.001) and waist-to-hip ratio (0.01, p = 0.032). Results also showed a decrease in HbA1c (1 mmol/mol, p = 0.005) and an increase in fasting glucose (0.1 mmol/L, p = 0.046), however, these changes were small and were not clinically significant. Analysis of faecal microbiota composition showed an increase in the relative abundance of as yet uncultivated and therefore uncharacterised members of the bacterial family Coriobacteriaceae. Novel bacteriological investigations of Coriobacteriaceae are required to explain their functional relationship to kiwifruit polysaccharides and polyphenols.

Inadequate Vitamin C Status in Prediabetes and Type 2 Diabetes Mellitus: Associations with Glycaemic Control, Obesity, and Smoking.

Vitamin C (ascorbate) is an essential micronutrient in humans, being required for a number of important biological functions via acting as an enzymatic cofactor and reducing agent. There is some evidence to suggest that people with type 2 diabetes mellitus (T2DM) have lower plasma vitamin C concentrations compared to those with normal glucose tolerance (NGT). The aim of this study was to investigate plasma vitamin C concentrations across the glycaemic spectrum and to explore correlations with indices of metabolic health. This is a cross-sectional observational pilot study in adults across the glycaemic spectrum from NGT to T2DM. Demographic and anthropometric data along with information on physical activity were collected and participants were asked to complete a four-day weighed food diary. Venous blood samples were collected and glycaemic indices, plasma vitamin C concentrations, hormone tests, lipid profiles, and high-sensitivity C-reactive protein (hs-CRP) were analysed. A total of 89 participants completed the study, including individuals with NGT (n = 35), prediabetes (n = 25), and T2DM managed by diet alone or on a regimen of Metformin only (n = 29). Plasma vitamin C concentrations were significantly lower in individuals with T2DM compared to those with NGT (41.2 µmol/L versus 57.4 µmol/L, p < 0.05) and a higher proportion of vitamin C deficiency (i.e. <11.0 µmol/L) was observed in both the prediabetes and T2DM groups. The results showed fasting glucose (p = 0.001), BMI (p = 0.001), smoking history (p = 0.003), and dietary vitamin C intake (p = 0.032) to be significant independent predictors of plasma vitamin C concentrations. In conclusion, these results suggest that adults with a history of smoking, prediabetes or T2DM, and/or obesity, have greater vitamin C requirements. Future research is required to investigate whether eating more vitamin C rich foods and/or taking vitamin C supplements may reduce the risk of progression to, and/or complications associated with, T2DM.

Genotype vs. Phenotype and the Rise of Non-Communicable Diseases: The Importance of Lifestyle Behaviors During Childhood.

Despite continued research and growing public awareness, the incidence of non-communicable diseases (NCD) continues to accelerate. While a person may have a genetic predisposition to certain NCDs, the rapidly changing epidemiology of NCDs points to the importance of environmental, social, and behavioural determinants of health. Specifically, three lifestyle behaviours expose children to important environmental cues and stressors: physical activity, nutritional intake, and sleep behaviour. Failure to expose children to proper gene-environment interactions, through the aforementioned lifestyle behaviours, can and will predispose children to the development of NCDs. Reengineering the environments of children can induce a paradigm shift, from a predominantly biomedical health model of treating symptomology, to a more holistic model based on encouraging appropriate behavioral decisions and optimal health.

Relative validity and reproducibility of an FFQ to determine nutrient intakes of New Zealand toddlers aged 12-24 months.

OBJECTIVE: The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12-24 months. DESIGN: Cross-sectional study. SETTING: Dunedin, New Zealand. SUBJECTS: One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted). RESULTS: De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0.45 (Zn) to 0.77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34.6% (total fat, Zn) to 50.3% (Fe). Average gross misclassification was 3%. Bland-Altman statistics showed crude data had a range of 128-178% agreement with the WDR and mean FV-adjusted intakes had 112-160% agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0.65 (vitamin C) to 0.75 (Ca). CONCLUSIONS: The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants' nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers' nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

A comprehensive FFQ developed for use in New Zealand adults: reliability and validity for nutrient intakes.

OBJECTIVE: To evaluate the reliability and relative validity of a semi-quantitative FFQ for assessing the habitual intake of multiple nutrients in New Zealand (NZ) adults over the past 12 months. DESIGN: A 154-item FFQ was developed. After initial pre-testing, reliability was assessed using intra-class correlations. Relative validity was assessed by comparing nutrient intakes derived from the FFQ v. those from an 8 d diet record (8dWDR) collected over 12 months and selected blood biomarkers, using Spearman correlations. Supplementary cross-classification and Bland-Altman analyses were performed to assess validity of the FFQ v. the 8dWDR. SETTING: Dunedin, NZ. SUBJECTS: One hundred and thirty-two males and females aged 30-59 years who completed all FFQ and 8dWDR and provided a blood sample. RESULTS: Reliability coefficients ranged from 0·47 for Ca to 0·83 for alcohol, with most values falling between 0·60 and 0·80. The highest validity coefficients for energy-adjusted data were observed for alcohol (0·74), cholesterol (0·65) and ß-carotene (0·58), and the lowest for Zn (0·24) and Ca (0·28). For all energy-adjusted nutrients mean percentage correct classification was 77·9% and gross misclassification was 4·5%. Results of Bland-Altman analyses showed wide limits of agreement for all micronutrients but high agreement was observed for most macronutrients (99% for protein, 103% for total fat). When compared with biomarkers, energy-adjusted coefficients were 0·34 for ß-carotene and 0·33 for vitamin C. CONCLUSIONS: The FFQ provides highly repeatable measurements and good validity in ranking individuals' intake, suggesting that it will be a useful tool to assess nutrient intake of NZ adults in future research.

Case study: nutritional strategies of a cyclist with celiac disease during an ultraendurance race.

Food intolerance is becoming increasingly prevalent, and increasing numbers of athletes have celiac disease. This poses challenges as dietary recommendations for exercise are largely based on gluten-containing carbohydrate-rich foods. The K4 cycle race covers 384 km around the Coromandel Peninsula, New Zealand. Lack of sleep, darkness, and temperature variations pose a number of nutritional challenges. Limited food choices present those with celiac disease with even greater challenges. This case study describes the intakes of one such athlete during training and competing in the K4. Nutritional intakes were obtained during training using weighed-food records and during the race via dietary recall and the weighing of foods pre- and post-race. As simple substitution of gluten-containing foods for gluten-free foods leads to increased energy intake, alternatives need to be considered. During the race, insufficient energy was consumed to meet the nutritional guidelines for endurance performance. This was probably due to the nature of the course, racing conditions, the consistency of gluten-free food, and, toward the end of the race, sensory-specific satiety.

Energy intakes of ultraendurance cyclists during competition, an observational study.

Endurance events>10 hr are becoming increasingly popular but provide numerous physiological challenges, several of which can be attenuated with optimal nutritional intakes. Previous studies in ultraendurance races have reported large energy deficits during events. The authors therefore aimed to assess nutritional intakes in relation to performance among ultraendurance cyclists. This observational study included 18 cyclists in a 384-km cycle race. At race registration each cyclist's support crew was provided with a food diary for their cyclist. On completion of the race, cyclists were asked to recall their race food and drink intakes. All food and fluids were analyzed using a computer software package. Mean (SD) time to complete the race was 16 hr 21 min (2 hr 2 min). Mean (SD) energy intake was 18.7 (8.6) MJ, compared with an estimated energy requirement for the race of 25.5 (7.4) MJ. There was a significant negative relationship between energy intake and time taken to complete the race (p=.023, r²=-.283). Mean (SD) carbohydrate, fat, and protein intakes were 52 (27), 15.84 (56.43), and 2.94 (7.25) g/hr, respectively. Only carbohydrate (p=.015, r²=-.563) and fat intake (p=.037, r²=-.494) were associated with time taken to complete the race. This study demonstrates the difficulties in meeting the high energy demands of ultraendurance cycling. The relationship between energy intake and performance suggests that reducing the energy deficit may be advantageous. Given the high carbohydrate intakes of these athletes, increasing energy intake from fat should be investigated as a means of decreasing energy deficits.

The effect of increasing consumption of pulses and wholegrains in obese people: a randomized controlled trial.

BACKGROUND: Wholegrain intake is inversely related to weight gain over time, but little information is available on the role of pulses in weight control. OBJECTIVE: To compare weight loss, metabolic outcomes, and nutrient intakes in obese people assigned to a diet rich in pulses and wholegrains or a control diet. METHODS: Randomized controlled study of 18 months with 113 volunteers (body mass index [BMI] ≥ 28 kg/m(2)). Diets were based on guidelines published by the National Heart Foundation of New Zealand. The intervention group was advised to consume 2 serves of pulses and 4 serves of wholegrain foods per day as substitutions for more refined carbohydrates. RESULTS: Fiber intakes were higher, intakes of several vitamins and minerals were better maintained, and dietary glycemic index was lower in the intervention compared with the control group. Mean (standard error [SE]) weight loss at 6 months was 6.0 (0.7) kg and 6.3 (0.6) kg in the control and intervention groups, respectively, and was not different between groups (p > 0.05). Blood pressure, triglycerides, and glycemic load were lowered in both groups compared with baseline. Waist circumference was decreased at 18 months in the intervention compared with the control group (-2.8 cm; 95% confidence interval [CI]: -0.4, -5.1). CONCLUSIONS: Incorporation of pulses and wholegrain foods into a weight loss program resulted in a greater reduction in waist circumference compared with the group consuming a control diet, although no difference in weight loss was noted between groups. Retention of several nutrients was better with the pulse and wholegrain diet.

Effect of supplementation with B vitamins and antioxidants on levels of asymmetric dimethylarginine (ADMA) and C-reactive protein (CRP): a double-blind, randomised, factorial design, placebo-controlled trial.

PURPOSE: Cardiovascular risk factors such as elevated levels of asymmetric dimethylarginine (ADMA)/C-reactive protein (CRP) and homocysteine are potentially related to essential micronutrients such as certain B vitamins and antioxidant vitamins. The aim of the present study was to investigate whether supplementation with moderate doses of B vitamins and/or antioxidants could alter either ADMA and/or CRP concentrations in middle-aged, apparently healthy men with mildly elevated homocysteine levels. METHODS: A randomised, double-blind, factorial design, intervention study was carried out on 132 men with mildly elevated homocysteine levels, allocated to four groups (a) B vitamins alone--1 mg folic acid, 7.2 mg pyridoxine, 0.02 mg cyanocobalamin daily, (b) antioxidants alone--150 mg ascorbic acid, 67 mg vitamin E, 9 mg ß-carotene daily, (c) B vitamins with antioxidant vitamins, or (d) placebo. A total of 101 men completed the study to 8 weeks. RESULTS: When the percentage of baseline ADMA and CRP was examined at 8 weeks, no statistically significant differences were observed between the four groups (p = 0.21 and p = 0.90, respectively). Similar non-significant results were observed when analysis was stratified based on baseline CRP levels (<1.0 mg/L, p = 0.10; ≥1.0 mg/L, p = 0.64) and smoking status (all p ≥ 0.05). CONCLUSIONS: Supplementation with moderate doses of B vitamins and/or antioxidants did not alter either ADMA or CRP concentrations in these middle-aged, apparently healthy men with mildly elevated homocysteine levels.

Thiol and cardiovascular risk factor status in a male northern Irish population.

OBJECTIVES: Raised plasma homocysteine is a risk factor for cardiovascular disease (CVD). Cysteine has also been associated with CVD risk. In this study, we investigated the association between known CVD risk factors, dietary factors, and total plasma cysteine, cysteinyl-glycine, and homocysteine. METHODS: The study group was 765 male workers aged between 30-49 years. The dietary habits of the subjects were recorded using a food frequency questionnaire. Body mass index (BMI), smoking status, and blood pressure were assessed, and fasting blood samples were taken for analysis of serum concentrations of vitamins, lipids, total plasma cysteine, cysteinyl-glycine, and homocysteine, and genotyping for the methylenetetrahydrofolate reductase (MTHFR) polymorphism. RESULTS: In multivariable analyses, cysteine was significantly positively associated with age and negatively associated with serum vitamin B12 and serum vitamin B6, while cysteinyl-glycine was significantly positively associated with BMI. Homocysteine (tHcy) was significantly negatively associated with serum folate, serum vitamin B12, and fruit and vegetable intake, and also depended on the MTHFR 677C>T genotype. CONCLUSIONS: Our data show a significant relationship between age, serum levels of B-vitamins and cysteine, and BMI and cysteinyl-glycine. In agreement with other studies, we also confirm an association between tHcy, serum folate and vitamin B12, MTHFR genotype, and fruit and vegetable intake. Further investigation into the role of these thiols and their determinants in CVD is required.

Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period.

The long-term physiological effects of refined carbohydrates on appetite and mood remain unclear. Reported effects when subjects are not blind may be due to expectations and have rarely been studied for more than 24 h. The present study compared the effects of supplementary soft drinks added to the diet over 4 weeks on dietary intake, mood and BMI in normal-weight women (n 133). Subjects were categorised as 'watchers' or 'non-watchers' of what they ate then received sucrose or artificially sweetened drinks (4 x 250 ml per d). Expectancies were varied by labelling drinks 'sugar' or 'diet' in a counter-balanced design. Sucrose supplements provided 1800 kJ per d and sweetener supplements provided 67 kJ per d. Food intake was measured with a 7 d diary and mood with ten single Likert scales. By 4 weeks, sucrose supplements significantly reduced total carbohydrate intake (F(1,129) = 53.81; P<0.001), fat (F(2,250) = 33.33; P<0.001) and protein intake (F(2,250) = 28.04; P<0-001) compared with sweetener supplements. Mean daily energy intake increased by just under 1000 kJ compared with baseline (t (67 df) = 3.82; P< 0.001) and was associated with a non-significant trend for those receiving sucrose to gain weight. There were no effects on appetite or mood. Neither dietary restraint status as measured by the Dutch Eating Behaviour Questionnaire nor the expectancy procedure had effects. Expectancies influenced mood only during baseline week. It is concluded that sucrose satiates, rather than stimulates, appetite or negative mood in normal-weight subjects.