The association between carotenoids and subjects with overweight or obesity: a systematic review and meta-analysis.

BACKGROUND: Excess body weight, including overweight and obesity, is one of the major factors influencing human health, and plays an important role in the global burden of disease. Carotenoids serve as precursors of vitamin A-related retinoids, and are considered to have potential effects on many diseases. However, the influence of carotenoids on people with excess body weight is unclear. METHODS: This meta-analysis was conducted to assess the effects of carotenoids on overweight or obese subjects utilizing the available evidence. We searched PubMed, Medline, Cochrane Library, Web of Science and EMBASE databases up to September 2020. Random effects models were used to calculate the standard mean differences (SMDs) and odds ratios (ORs) with their 95% confidence intervals (95% CIs). RESULTS: A total of seven randomized controlled trials and eight observational studies met the inclusion criteria and contained 28 944 subjects and data on multiple carotenoid subgroups, including lycopene, astaxanthin, cryptoxanthin, α-carotene, and ß-carotene. In all included Randomized Controlled Trial (RCT), the intervention duration was 20 days at the shortest and 16 weeks at the longest, and the range of intervention doses was 1.2-60 mg d-1. Our study found that the insufficiency of serum carotenoids was a risk factor for overweight and obesity (OR = 1.73, 95% CI [1.57, 1.91], p < 0.001). Moreover, carotenoid supplementation was significantly associated with body weight reductions (SMD = -2.34 kg, 95% CI [-3.80, -0.87] kg, p < 0.001), body mass index decrease (BMI, SMD = -0.95 kg cm-2, 95% CI [-1.88, -0.01] kg cm-2, p < 0.001) and waist circumference losses (WC, SMD = -1.84 cm, 95% CI [-3.14, -0.54]cm, p < 0.001). CONCLUSION: In summary, the carotenoids show promising effects in overweight or obese subjects. Additional data from large clinical trials are needed.

Evaluation of the bioaccessibility of carotenoid esters from Lycium barbarum L. in nano-emulsions: A kinetic approach.

Lycium barbarum L., known as goji berry, is a rich source of carotenoid esters, which are mainly composed of zeaxanthin dipalmitate (ZDP), lutein palmitate (LP), ß-cryptoxanthin palmitate (ß-CP), zeaxanthin palmitate (ZP), zeaxanthin myristate palmitate (ZMP), and zeaxanthin palmitate stearate (ZPS). Oil-in-water nano-emulsions containing carotenoid esters from L. barbarum L. with olive oil (ON) and soybean oil (SN) were prepared to investigate the liberation and bioaccessibility (BA) of in vitro digestion. The particle sizes of ON and SN were approximately 160 nm stabilized with sucrose esters and monoacylglyceride as emulsifiers. ON presented an equal liberation of each carotenoid ester as SN, except that LP had a high value. Incorporation of carotenoid esters into the micelle were evaluated using a fractional conversion model, containing two phases, namely, a rapid growth rate for the first phase, and then reaching a plateau for the second phase. The kinetic rate was related to the particle size, oil type and carotenoid ester nature. BA at plateau values for ZDP and ZPS were higher than that of the four other carotenoid esters in SN. Considering the great improvement of the liberation and BA, the excipient nano-emulsion prepared in this study is a good delivery system for carotenoid esters from goji berry.

Marigold carotenoids: Much more than lutein esters.

Carotenoids constitute a large group of lipophilic pigments whose health-promoting benefits have been widely recognized. Hydroxy-containing carotenoids can be found in both free form or esterified with fatty acids in several plant matrices, but the native carotenoid profile is overall poorly explored due to the difficulty of analyzing carotenoid esters. One of the main natural sources of carotenoids is the marigold flower, which has been extensively used by the industry for the production of food colorants or supplements, both often manufactured with no saponification process. Although lutein esters are well established as the major compounds naturally found in marigold petals and their products, carotenoid esters other than the lutein ones have not been extensively examined. We carried out a comprehensive identification of carotenoids and carotenoid esters from marigold petals by LC-DAD-(APCI+)MS/MS. Whereas 18 carotenoids were identified in the saponified extract, 56 were identified when no saponification procedure was carried out: 6 free carotenoids, 20 monoesters and 30 diesters. This is the first time that esters of zeaxanthin, violaxanthin, auroxanthin, zeinoxanthin and ß-cryptoxanthin are identified in marigold. The structural information obtained through characteristic fragmentation patterns and diagnostic fragments in MS and MS/MS spectra (APCI+) sustained the differentiation between carotenoid esters with similar characteristics. Therefore, the separation of carotenoids by reversed-phase liquid chromatography using C30 columns in combination with DAD and APCI-MS/MS detection allowed high sensitivity and selectivity for carotenoid ester analysis.

Carotenoids in Adipose Tissue Biology and Obesity.

Cell, animal and human studies dealing with carotenoids and carotenoid derivatives as nutritional regulators of adipose tissue biology with implications for the etiology and management of obesity and obesity-related metabolic diseases are reviewed. Most studied carotenoids in this context are ß-carotene, cryptoxanthin, astaxanthin and fucoxanthin, together with ß-carotene-derived retinoids and some other apocarotenoids. Studies indicate an impact of these compounds on essential aspects of adipose tissue biology including the control of adipocyte differentiation (adipogenesis), adipocyte metabolism, oxidative stress and the production of adipose tissue-derived regulatory signals and inflammatory mediators. Specific carotenoids and carotenoid derivatives restrain adipogenesis and adipocyte hypertrophy while enhancing fat oxidation and energy dissipation in brown and white adipocytes, and counteract obesity in animal models. Intake, blood levels and adipocyte content of carotenoids are reduced in human obesity. Specifically designed human intervention studies in the field, though still sparse, indicate a beneficial effect of carotenoid supplementation in the accrual of abdominal adiposity. In summary, studies support a role of specific carotenoids and carotenoid derivatives in the prevention of excess adiposity, and suggest that carotenoid requirements may be dependent on body composition.

Carotenoids, vitamin A, vitamin C, vitamin E, and folate and risk of self-reported hearing loss in women.

BACKGROUND: Higher intake of certain vitamins may protect against cochlear damage from vascular compromise and oxidative stress, thereby reducing risk of acquired hearing loss, but data are limited. OBJECTIVE: We prospectively examined the relation between carotenoids, vitamin A, vitamin C, vitamin E, and folate intake and risk of self-reported hearing loss in women. DESIGN: This prospective cohort study followed 65,521 women in the Nurses' Health Study II from 1991 to 2009. Baseline and updated information obtained from validated biennial questionnaires was used in Cox proportional hazards regression models to examine independent associations between nutrient intake and self-reported hearing loss. RESULTS: After 1,084,598 person-years of follow-up, 12,789 cases of incident hearing loss were reported. After multivariable adjustment, we observed modest but statistically significant inverse associations between higher intake of ß-carotene and ß-cryptoxanthin and risk of hearing loss. In comparison with women in the lowest quintile of intake, the multivariable-adjusted RR of hearing loss among women in the highest quintile was 0.88 (95% CI: 0.81, 0.94; P-trend < 0.001) for ß-carotene and 0.90 (95% CI: 0.84, 0.96; P-trend < 0.001) for ß-cryptoxanthin. In comparison with women with folate intake 200-399 µg/d, very low folate intake (<200 µg/d) was associated with higher risk (RR: 1.19; 95% CI: 1.01, 1.41), and higher intake tended to be associated with lower risk (P-trend = 0.04). No significant associations were observed for intakes of other carotenoids or vitamin A. Higher vitamin C intake was associated with higher risk; in comparison with women with intake <75 mg/d, the RR among women with vitamin C intake ≥1000 mg/d (mainly supplemental) was 1.22 (95% CI: 1.06, 1.42; P-trend = 0.02). There was no significant trend between intake of vitamin E intake and risk. CONCLUSION: Higher intakes of ß-carotene, ß-cryptoxanthin, and folate, whether total or from diet, are associated with lower risk of hearing loss, whereas higher vitamin C intake is associated with higher risk.

Daily intake of ß-cryptoxanthin prevents bone loss by preferential disturbance of osteoclastic activation in ovariectomized mice.

Although ß-cryptoxanthin, a xanthophyll carotenoid, has been shown to exert an anabolic effect on bone calcification, little attention has been paid thus far to the precise mechanism of bone remodeling. Daily oral administration of ß-cryptoxanthin significantly inhibited osteoclastic activation as well as reduction of bone volume in ovariectomized mice. In vitro studies revealed that ß-cryptoxanthin inhibited differentiation and maturation of osteoclasts by repression of the nuclear factor-κB-dependent transcriptional pathway. Our results suggest that supplementation with ß-cryptoxanthin would be beneficial for prophylaxis and for therapy of metabolic bone diseases associated with abnormal osteoclast activation.

The Influence of Iron and Zinc Supplementation on the Bioavailability of Provitamin A Carotenoids from Papaya Following Consumption of a Vitamin A-Deficient Diet.

Iron deficiency anemia, zinc and vitamin A deficiencies are serious public health problems in Cameroon, as in many developing countries. Local vegetables which are sources of provitamin A carotenoids (PACs) can be used to improve vitamin A intakes. However, traditional meals are often unable to cover zinc and iron needs. The aim of this study was to determine the bioavailability of 3 PACs (α-carotene, ß-carotene, and ß-cryptoxanthin) in young men, who were fed with a vitamin A-free diet and received iron and zinc supplementation. Twelve healthy participants were divided into three groups and were supplemented with elemental iron (20 mg of iron fumarate), 20 mg of zinc sulfate or iron+zinc (20 mg of iron in the morning and 20 mg of zinc in the evening) for 11 d. They were given a vitamin A- and PAC-free diet from the 6th to the 11th day, followed by a test meal containing 0.55 kg of freshly peeled papaya as a source of PACs. Blood samples were collected four times successively on the 11th day (the test meal day), at T0 (just after the test meal), after 2 h (T2), after 4 h (T4) and after 7 h (T7). Ultracentrifugation was used to isolate serum chylomicrons. Retinol appearance and PAC postprandial concentrations were determined. The supplementation with zinc, iron and iron+zinc influenced the chylomicron appearance of retinol and PACs differently as reflected by retention times and maximum absorption peaks. Iron led to highest retinol levels in the chylomicron. Zinc and iron+zinc supplements were best for optimal intact appearance of α-carotene, ß-carotene and ß-cryptoxanthin respectively. Supplementation with iron led to the greatest bioavailability of PACs from papaya and its conversion to retinol.

Isolation of ß-Cryptoxanthin-epoxides, Precursors of Cryptocapsin and 3'-Deoxycapsanthin, from Red Mamey (Pouteria sapota).

From an extract of red mamey (Pouteria sapota) ß-cryptoxanthin-5,6-epoxide, ß-cryptoxanthin-5',6'-epoxide, 3'-deoxycapsanthin, and cryptocapsin were isolated and characterized by UV-vis spectroscopy, electronic circular dichroism (ECD), nuclear magnetic resonance (NMR) spectroscopy, and mass spectrometry (MS). Epoxidation of ß-cryptoxanthin delivered the ß-(5'R,6'S)- and (5'S,6'R)-cryptoxanthin-5',6'-epoxides, which were identified by HPLC-ECD analysis. These carotenoids among others are quite common in the fruits of Central America, and as they are natural provitamins A, they should play an important role in the diet of the mostly vitamin A deficient population of this region.

Effect of kumquat (Fortunella crassifolia) pericarp on natural killer cell activity in vitro and in vivo.

Natural killer (NK) cells play a key role in innate immune defense against infectious disease and cancer. A reduction of NK activity is likely to be associated with increased risk of these types of disease. In this study, we investigate the activation potential of kumquat pericarp acetone fraction (KP-AF) on NK cells. It is shown to significantly increase IFN-γ production and NK cytotoxic activity in human KHYG-1 NK cells. Moreover, oral administration of KP-AF significantly improves both suppressed plasma IFN-γ levels and NK cytotoxic activity per splenocyte in restraint-stressed mice. These results indicate that raw kumquat pericarp activates NK cells in vitro and in vivo. To identify the active constituents, we also examined IFN-γ production on KHYG-1 cells by the predicted active components. Only ß-cryptoxanthin increased IFN-γ production, suggesting that NK cell activation effects of KP-AF may be caused by carotenoids such as ß-cryptoxanthin.

Antioxidant micronutrients and the risk of renal cell carcinoma in the Women's Health Initiative cohort.

BACKGROUND: Renal cell carcinoma (RCC) is the eighth leading cancer among women in incidence and commonly is diagnosed at a more advanced stage. Oxidative stress has been considered to play an important role in the pathogenesis of RCC. Various dietary micronutrients have antioxidant properties, including carotenoids and vitamins C and E; thus, diets rich in these nutrients have been evaluated in relation to RCC prevention. The objective of this study was to explore the correlation between antioxidant micronutrients and the risk of RCC. METHODS: In total, 96,196 postmenopausal women who enrolled in the Women's Health Initiative (WHI) between 1993 and 1998 and were followed through July 2013 were included in this analysis. Dietary micronutrient intake was estimated from the baseline WHI food frequency questionnaire, and data on supplement use were collected using an interview-based inventory procedure. RCC cases were ascertained from follow-up surveys and were centrally adjudicated. The risks for RCC associated with intake of α-carotene, ß-carotene, ß-cryptoxanthin, lutein plus zeaxanthin, lycopene, vitamin C, and vitamin E were analyzed using Cox proportional hazards regression adjusted for confounders. RESULTS: Two hundred forty women with RCC were identified during follow-up. Lycopene intake was inversely associated with RCC risk (P = .015); compared with the lowest quartile of lycopene intake, the highest quartile of intake was associated with a 39% lower risk of RCC (hazard ratio, 0.61; 95% confidence interval, 0.39-0.97). No other micronutrient was significantly associated with RCC risk. CONCLUSIONS: The current results suggest that further investigation into the correlation between lycopene intake and the risk of RCC is warranted.

Biofortified orange maize enhances ß-cryptoxanthin concentrations in egg yolks of laying hens better than tangerine peel fortificant.

The xanthophyll ß-cryptoxanthin provides vitamin A and has other purported health benefits. Laying hens deposit xanthophyll carotenoids into egg yolk. Hens (n = 8/group) were fed conventional-bred high ß-cryptoxanthin biofortified (orange) maize, tangerine peel-fortified white maize, lutein-fortified yellow maize, or white maize for 40 d to investigate yolk color changes using L*a*b* scales, yolk carotenoid enhancement, and hen vitamin A status. Yolks from hens fed orange maize had scores indicating a darker, orange color and mean higher ß-cryptoxanthin, zeaxanthin, and ß-carotene concentrations (8.43 ± 1.82, 23.1 ± 4.8, 0.16 ± 0.08 nmol/g, respectively) than other treatments (P < 0.0001). Yolk retinol concentrations (mean: 14.4 ± 3.42 nmol/g) were similar among groups and decreased with time (P < 0.0001). Hens fed orange maize had higher liver retinol (0.53 ± 0.20 µmol/g liver) than other groups (P < 0.0001). ß-Cryptoxanthin-biofortified eggs could be another choice for consumers, providing enhanced color through a provitamin A carotenoid and supporting eggs' status as a functional food.

Effect of ß-cryptoxanthin plus phytosterols on cardiovascular risk and bone turnover markers in post-menopausal women: a randomized crossover trial.

BACKGROUND AND AIM: Post-menopausal women are at higher risk of cardiovascular disease and bone demineralization. Phytosterols (PS) may be used for hypercholesterolemia in some groups and ß-cryptoxanthin (ß-Cx) displays a unique anabolic effect on bone. Our aim was to assess the changes in cardiovascular and bone turnover markers from the oral intake of ß-Cx and PS in post-menopausal women. METHODS AND RESULTS: A randomized, double-blind, crossover study with ß-Cx (0.75 mg/day) and PS (1.5 g/day), single and combined, was performed in 38 postmenopausal women. Diet was supplemented with 1 × 250 mL milk-based fruit drink/day for 4 weeks with a wash-out period of 4-weeks in between. Serum ß-Cx and PS were determined by UPLC and CG-FID respectively. Outcome variables included markers of bone turnover and cardiovascular risk. Biological effect was assessed by paired t test and generalized estimating equations analysis that included the previous treatment, the order of intervention and the interactions. The intake of beverages containing ß-Cx and PS brought about a significant increase in serum levels of ß-Cx, ß-sitosterol and campesterol. Intervention caused changes in almost all the markers while the order, previous treatment and the interaction did not reach statistical significance. Only the intake of the beverage containing ß-Cx plus PS brought about significant decreases in total cholesterol, c-HDL, c-LDL and bone turnover markers. CONCLUSIONS: ß-Cx improves the cholesterol-lowering effect of PS when supplied simultaneously and this combination may also be beneficial in reducing risk of osteoporosis. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov number NCT01074723.

Serum carotenoid levels and risk of lung cancer death in US adults.

Lung cancer is one of the most common cancers worldwide and is the leading cause of cancer-induced death in the USA. Although much attention has been focused on the anti-carcinogenic effect of consuming carotenoid-containing food or supplements, the results have been inconsistent. We investigated whether serum carotenoid levels were associated with the mortality risk of lung cancer in US adults using data from a nationally representative sample. The data were obtained from the Third Nutrition and Health Examination Survey (NHANES III) database and the NHANES III Linked Mortality File. A total of 10,382 participants aged over 20,years with available serum carotenoid levels and no other missing information on questionnaires and biomarkers at baseline (NHANES III) were included in the present study. Of the 10,382 participants, 161 subjects died due to lung cancer. We found that high serum levels of alpha-carotene and beta-cryptoxanthin at baseline were significantly associated with a lower risk of lung cancer death. When we stratified the risk by current smoking status, the risk of death of current smokers was significantly decreased to 46% (95% confidence interval, 31-94%) for alpha-carotene and 61% (95% confidence interval, 19-80%) for beta-cryptoxanthin. By contrast, no association was observed among never/former smokers at baseline. High serum levels of alpha-carotene and beta-cryptoxanthin are associated with a lower risk of lung cancer death in US adults.

Validation of an FFQ to assess short-term antioxidant intake against 30 d food records and plasma biomarkers.

OBJECTIVE: To validate a brief FFQ developed for capturing short-term antioxidant intake in a sample of US college students. DESIGN: A seventy-four-item antioxidant FFQ was developed based on major antioxidant sources in the American diet. The FFQ was validated against 30 d food records (FR) and plasma antioxidant concentrations. The reliability of the FFQ was evaluated by two FFQ administered at a 1-month interval. Settings University of Connecticut, CT, USA. SUBJECTS: Sixty healthy college students. RESULTS: Estimates of dietary antioxidants from the FFQ were moderately to highly correlated with those estimated from the 30 d FR (r = 0·29-0·80; P < 0·05) except for γ-tocopherol and ß-cryptoxanthin. Total antioxidant capacity from diet only or from diet and supplements estimated by the 30 d FR and FFQ were highly correlated (r = 0·67 and 0·71, respectively; P < 0·0001). The FFQ categorized 91 % of participants into the same or adjacent tertiles of antioxidant intake as the 30 d FR. Most dietary carotenoids estimated from the FFQ were correlated with plasma levels (P < 0·05). Correlation coefficients for test-retest reliability ranged from 0·39 to 0·86. More than 94 % of the participants were classified in the same or adjacent tertiles between the two administrations of the FFQ. CONCLUSIONS: The brief FFQ demonstrated reasonable validity for capturing a comprehensive antioxidant intake profile. This FFQ is applicable in epidemiological or clinical studies to capture short-term antioxidant intake or to simply document the variations of antioxidant intake in intervention trials. Cross-validation studies are warranted in other target populations.

Maize genotype and food matrix affect the provitamin A carotenoid bioefficacy from staple and carrot-fortified feeds in Mongolian gerbils (Meriones unguiculatus).

Biofortification to increase provitamin A carotenoids is an agronomic approach to alleviate vitamin A deficiency. Two studies compared biofortified foods using in vitro and in vivo methods. Study 1 screened maize genotypes (n = 44) using in vitro analysis, which demonstrated decreasing micellarization with increasing provitamin A. Thereafter, seven 50% biofortified maize feeds that hypothesized a one-to-one equivalency between ß-cryptoxanthin and ß-carotene were fed to Mongolian gerbils. Total liver retinol differed among the maize groups (P = 0.0043). Study 2 assessed provitamin A bioefficacy from 0.5% high-carotene carrots added to 60% staple-food feeds, followed by in vitro screening. Liver retinol was highest in the potato and banana groups, maize group retinol did not differ from baseline, and all treatments differed from control (P < 0.0001). In conclusion, ß-cryptoxanthin and ß-carotene have similar bioefficacy; meal matrix effects influence provitamin A absorption from carrot; and in vitro micellarization does not predict bioefficacy.

The effects of daily consumption of ß-cryptoxanthin-rich tangerines and ß-carotene-rich sweet potatoes on vitamin A and carotenoid concentrations in plasma and breast milk of Bangladeshi women with low vitamin A status in a randomized controlled trial.

BACKGROUND: The potential of ß-cryptoxanthin (CX)-rich foods to form vitamin A (VA) in humans in not well understood. OBJECTIVE: We measured the effects of consuming CX- and ß-carotene (BC)-rich foods on plasma and breast milk VA and carotenoids in lactating women with low VA status. DESIGN: Participants were randomly assigned to 4 groups (n = 34, 34, 34, and 33, respectively) receiving orange-fleshed sweet potatoes (OFSPs) (12 mg BC/d), tangerines (5.3 mg CX/d), white-fleshed sweet potatoes (WFSPs) with a VA supplement (0.5 mg/d), or WFSPs 2 times/d, 6 d/wk for 3 wk. All except the VA group received placebo capsules identical in appearance to VA supplements. Changes in plasma and breast milk VA, BC, and CX were measured. RESULTS: Plasma retinol increased in the VA group. Plasma BC in the OFSP group and CX in the tangerine group increased 250% and 830%, respectively; apparent relative absorption in the CX group, considering the amounts consumed, was 4 times that in the BC group. Mean (±SEM) changes in milk VA in the OFSP (0.028 ± 0.074 µmol/L) and tangerine (0.067 ± 0.091 µmol/L) groups did not differ from those in the control (-0.077 ± 0.068 µmol/L) or VA (0.277 ± 0.094 µmol/L) group. Milk CX increased in the tangerine group. CONCLUSIONS: VA capsules increased plasma and milk VA concentrations. The greater change in CX concentrations in the tangerine group than in BC concentrations in the OFSP group suggests that CX in tangerines was better absorbed, but both foods failed to increase milk VA concentrations. This trial was registered at clinicaltrials.gov as NCT01420406.

Enzymatic formation of ß-citraurin from ß-cryptoxanthin and Zeaxanthin by carotenoid cleavage dioxygenase4 in the flavedo of citrus fruit.

In this study, the pathway of ß-citraurin biosynthesis, carotenoid contents and the expression of genes related to carotenoid metabolism were investigated in two varieties of Satsuma mandarin (Citrus unshiu), Yamashitabeni-wase, which accumulates ß-citraurin predominantly, and Miyagawa-wase, which does not accumulate ß-citraurin. The results suggested that CitCCD4 (for Carotenoid Cleavage Dioxygenase4) was a key gene contributing to the biosynthesis of ß-citraurin. In the flavedo of Yamashitabeni-wase, the expression of CitCCD4 increased rapidly from September, which was consistent with the accumulation of ß-citraurin. In the flavedo of Miyagawa-wase, the expression of CitCCD4 remained at an extremely low level during the ripening process, which was consistent with the absence of ß-citraurin. Functional analysis showed that the CitCCD4 enzyme exhibited substrate specificity. It cleaved ß-cryptoxanthin and zeaxanthin at the 7,8 or 7',8' position. But other carotenoids tested in this study (lycopene, α-carotene, ß-carotene, all-trans-violaxanthin, and 9-cis-violaxanthin) were not cleaved by the CitCCD4 enzyme. The cleavage of ß-cryptoxanthin and zeaxanthin by CitCCD4 led to the formation of ß-citraurin. Additionally, with ethylene and red light-emitting diode light treatments, the gene expression of CitCCD4 was up-regulated in the flavedo of Yamashitabeni-wase. These increases in the expression of CitCCD4 were consistent with the accumulation of ß-citraurin in the two treatments. These results might provide new strategies to improve the carotenoid contents and compositions of citrus fruits.

Dietary fiber intake modifies the association between secondhand smoke exposure and coronary heart disease mortality among Chinese non-smokers in Singapore.

OBJECTIVE: Secondhand smoke (SHS) exposure increases the risk for coronary heart disease (CHD) by an estimated 25% to 30% via oxidative stress and inflammatory mechanisms that may be ameliorated by dietary components. The aim of this study was to evaluate the hypothesized modifying role of nutrients with known antioxidant and/or anti-inflammatory properties on the relationship between SHS exposure and CHD mortality. METHODS: Detailed SHS exposure and dietary information was collected among 29,579 non-smokers in the Singapore Chinese Health Study, a prospective population-based cohort. The evaluation of whether or not dietary factors (ß-cryptoxanthin, lutein, ω-3 polyunsaturated fatty acids, fiber, isothiocyanates, and soy isoflavones) modified the relationship between SHS exposure and CHD mortality was conducted within multivariable Cox proportional hazards models by creating an interaction term between the potential dietary effect modifier (lowest quartile of intake versus the second through fourth quartiles of intake) and the SHS exposure (none versus living with at least one smoker[s]). RESULTS: Evidence for a main-effects association between SHS exposure and risk for CHD mortality was not observed. In stratified analyses by levels of selected dietary nutrient intake, fiber modified the effects of SHS exposure on risk for CHD mortality (P for interaction = 0.02). The adjusted hazards ratio for SHS exposure (living with at least one smoker[s] versus living with no smokers) and CHD mortality was 1.62 (95% confidence interval, 1.00-2.63) for those with low-fiber intake. In contrast, among those with high-fiber intake, there was no association with SHS exposure. CONCLUSION: We provide evidence that a diet high in fiber may ameliorate the harmful effects of SHS exposure on risk for CHD mortality.

Nutritional impacts of a fruit and vegetable subsidy programme for disadvantaged Australian Aboriginal children.

Healthy food subsidy programmes have not been widely implemented in high-income countries apart from the USA and the UK. There is, however, interest being expressed in the potential of healthy food subsidies to complement nutrition promotion initiatives and reduce the social disparities in healthy eating. Herein, we describe the impact of a fruit and vegetable (F&V) subsidy programme on the nutritional status of a cohort of disadvantaged Aboriginal children living in rural Australia. A before-and-after study was used to assess the nutritional impact in 174 children whose families received weekly boxes of subsidised F&V organised through three Aboriginal medical services. The nutritional impact was assessed by comparing 24 h dietary recalls and plasma carotenoid and vitamin C levels at baseline and after 12 months. A general linear model was used to assess the changes in biomarker levels and dietary intake, controlled for age, sex, community and baseline levels. Baseline assessment in 149 children showed low F&V consumption. Significant increases (P< 0.05) in ß-cryptoxanthin (28.9 nmol/l, 18%), vitamin C (10.1 µmol/l, 21%) and lutein-zeaxanthin (39.3 nmol/l, 11%) levels were observed at the 12-month follow-up in 115 children, although the self-reported F&V intake was unchanged. The improvements in the levels of biomarkers of F&V intake demonstrated in the present study are consistent with increased F&V intake. Such dietary improvements, if sustained, could reduce non-communicable disease rates. A controlled study of healthy food subsidies, together with an economic analysis, would facilitate a thorough assessment of the costs and benefits of subsidising healthy foods for disadvantaged Aboriginal Australians.