A perspective on vegetarian dietary patterns and risk of metabolic syndrome.

The vegetarian dietary pattern is traditionally a plant-based diet that includes fruits, vegetables, cereals, legumes, nuts, vegetable oils, soya, and possibly dairy products and/or eggs. Vegetarians and other populations who follow a plant-based dietary pattern enjoy longevity. Specifically, vegetarian dietary patterns have been associated with a lower risk for developing IHD, type 2 diabetes, hypertension, specific cancers, lower all-cause mortality and reduction in cause-specific mortality. The prevalence of the metabolic syndrome (MetS) in the USA is approximately 20 % and is currently increasing in developing countries in line with the obesity epidemic. The health care costs associated with the MetS are on a magnitude of 1.6 overall compared with healthy individuals, which makes it an important public health problem. Current evidence from several cross-sectional and case-control studies shows an association between consumption of a vegetarian dietary pattern and a reduced prevalence or risk of developing the MetS. There is a need for further research to be conducted, particularly prospective cohort studies to evaluate the effect of vegetarian dietary patterns on reducing the incidence of the MetS and, clinical trials should be designed to explore vegetarian dietary patterns for the reversal of the MetS in high-risk populations. This research could contribute to reduce the societal and economic burdens associated with the disorder.

Food selection criteria for disaster response planning in urban societies.

BACKGROUND: Nutrition professionals that have menu planning and disaster management responsibilities should consider factors that have transcended from ancient to current times, in addition to recognizing societal trends that have led to our current increased vulnerability in the event of a disaster. Hence, we proceeded to develop a set of "Disaster Response Diets" (DRDs) for use in urban societies inclusive of the aforementioned considerations. METHODS: A three-phase multidimensional approach was used to identify food groups suitable for creating a set of DRDs. Phase One consisted of calculating the percent daily nutrient intake and Drewnowski's naturally nutrient rich (NNR) score for an individual or mean composite for one serving of food from 11 specific food groups. In Phase Two, in addition to nutrient density, the 11 food groups were evaluated and scored based on the following DRD planning criteria: storage and handling properties, preparation ease and, cultural acceptance/individual tolerance. During Phase Three, three DRDs were developed based upon the data retrieved from Phases one and two. RESULTS: In Phase One, the NNR scores ranged from 2.1 for fresh fruits to 28.1 for dry cereals, a higher score indicating a higher nutrient density. During Phase Two, a maximum score of 12 was possible based on appropriateness for a disaster situation. Five plant-based food groups (dry cereals, nuts, dried fruits, grains and legumes) achieved a score ranging between 7 and 12, whereas the five fresh food groups were deemed ineligible due to sanitation and perishability concerns. During Phase Three, three DRDs (milk-inclusive, milk-free and Grab-and-Go) were developed as benchmarks for disaster response planning. CONCLUSIONS: Plant-based DRDs are universally acceptable and tolerated across cultures and religions. Therefore, we suggest nutrition professionals consider using a plant-based approach for creating DRDs for public health institutions and organizations.

The environmental cost of protein food choices.

OBJECTIVE: To investigate the resource efficiency and environmental impacts of producing one kilogram of edible protein from two plant- and three animal-protein sources. DESIGN: Primary source data were collected and applied to commodity production statistics to calculate the indices required to compare the environmental impact of producing 1 kg of edible protein from kidney beans, almonds, eggs, chicken and beef. Inputs included land and water for raising animals and growing animal feed, total fuel, and total fertilizer and pesticide for growing the plant commodities and animal feed. Animal waste generated was computed for the animal commodities. SETTING: Desk-based study at the Department of Nutrition and Department of Occupational and Environmental Health, Loma Linda University. SUBJECTS: None. RESULTS: To produce 1 kg of protein from kidney beans required approximately eighteen times less land, ten times less water, nine times less fuel, twelve times less fertilizer and ten times less pesticide in comparison to producing 1 kg of protein from beef. Compared with producing 1 kg of protein from chicken and eggs, beef generated five to six times more waste (manure) to produce 1 kg of protein. CONCLUSIONS: The substitution of beef with beans in meal patterns will significantly reduce the environmental footprint worldwide and should also be encouraged to reduce the prevalence of non-communicable chronic diseases. Societies must work together to change the perception that red meat (e.g. beef) is the mainstay of an affluent and healthy diet.

A randomized controlled trial to evaluate the effect of incorporating peanuts into an American Diabetes Association meal plan on the nutrient profile of the total diet and cardiometabolic parameters of adults with type 2 diabetes.

BACKGROUND: According to the American Diabetes Association (ADA), the nutritional goals for patients with type 2 diabetes (T2D) are to achieve an optimal nutrient intake to achieve normoglycemia and a cardioprotective lipid profile. Peanuts are nutrient dense foods that contain high levels of monounsaturated fat (MUFA) and are a natural source of arginine, fiber, phytosterols, resveritrol, niacin, folate, vitamin E and magnesium, which have the potential for improving blood lipids and glycemic control. This study sought to evaluate the effect of a peanut enriched ADA meal plan on the nutrient profile of the total diet and cardiometabolic parameters in adults with T2D. METHODS: This was a randomized, prospective 24-week parallel-group clinical trial with 60 adults with T2D [age range 34-84 years; body mass index (BMI) range 17.2-48.7 kg/m2]. Subjects consumed an ADA meal plan containing ~20% of energy from peanuts (peanut group) or a peanut-free ADA meal plan (control group). Weight, BMI, waist circumference (WC) and nutrient intake from 24-hour recalls were measured every 4 weeks and fasting blood glucose (FBG), HbA1c and blood lipids were measured every 12 weeks. A mixed-model repeated-measures analysis of covariance was performed to assess the significance of changes in the cardiometabolic parameters. RESULTS: A higher polyunsaturated fat (PUFA) to saturated fat diet ratio and higher intake of MUFA, PUFA, α-tocopherol, niacin and magnesium was observed in the peanut group as compared to the control group (P < 0.01-P = 0.04). Both groups experienced mild reductions in weight, BMI, and WC during the study (P = 0.01-P = 0.03), however there were no differences between the two groups in these measurements or in FBG, HbA1c or blood lipids. For each kilogram of weight loss in the entire cohort there were associations for reductions in WC of 0.48 cm (P < 0.01), FBG of 0.11 mmol/l (P = 0.01) and HbA1c of 0.07% (P < 0.01). CONCLUSIONS: Daily consumption of a peanut enriched (46 g/d) ADA meal plan over 24 weeks improves the nutrient profile of the total diet and is compatible with weight management and improvement in specific blood lipids. TRIAL REGISTRATION: ClinicalTrials.gov NCT00937222.

A randomized 3×3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults.

BACKGROUND: The behavioral outcome of food ingestion is a complex process that involves psychological and biological factors. Avocados are nutrient dense with properties that may favorably impact energy balance. This study sought to evaluate if incorporating approximately one half of a Hass avocado by addition or inclusion into a lunch meal will influence post-ingestive satiety, glucose and insulin response, and subsequent energy intake among overweight adults. METHODS: This was a randomized 3×3 single-blind crossover design study with 26 healthy overweight adults (mean ±SD age 40.8±11.0 years and BMI 28.1±2.4 kg/m²). Participants consumed a standardized breakfast followed by 1 of 3 lunch test meals [Control (C), avocado-free; Avocado Inclusive (AI); and, Avocado Added (AA)]. Participants rated five appetite sensations using a visual analog scale (VAS) before lunch and at specific intervals over 5 hours following the start of the test meal. Blood glucose and insulin were measured before lunch and at specific intervals over 3 hours following the start of the test meal. Mixed models were used to compare differences among the 3 test meals, and the area under the curve (AUC(0-xh)) was computed for the VAS and biological measures. RESULTS: There were significant differences in the AUC(0-5h) for the self-reported feelings of satisfaction (P=0.04) and desire to eat (P=0.05) in the mixed model analysis. Compared to the C test meal, the AA test meal increased satisfaction by 23% (P=0.05) and decreased the desire to eat by 28% (P=0.04) for the AUC(0-5h). For the AUC(0-3h), the AA test meal increased satisfaction by 26% (P=0.02) and decreased the desire to eat by 40% (P=0.01) as compared to the C test meal. Compared to the AI meal, the AUC(0-3h) for blood insulin was higher in the C and AA meals (P=0.04 and P=0.05, respectively). CONCLUSIONS: The addition of approximately one half of a Hass avocado at a lunch meal can influence post-ingestive satiety over a subsequent 3 and 5 hour period in overweight adults. A caveat to these findings is that the avocado contained an additional 112 kcal, which may have accounted for the observed increase in satisfaction and decreased desire to eat. Future trials are warranted to evaluate the effects of avocado intake on weight management in adults of varying BMIs and among insulin resistant individuals.

The risk of child and adolescent overweight is related to types of food consumed.

BACKGROUND/AIMS: To investigate the association between the risk of overweight and the consumption of food groups in children and adolescents. METHODS: We studied 1764 healthy children and adolescents (age 6-19y) attending 16 Seventh-Day Adventist schools and 13 public schools using a 106-item non-quantitative food frequency questionnaire from the late 1980 Child-Adolescent Blood Pressure Study. Logistic regression models were used to compute the risk of overweight according to consumption of grains, nuts, vegetables, fruits, meats/fish/eggs, dairy, and, low nutrient-dense foods (LNDF). RESULTS: The frequency of consumption of grains, nuts, vegetables and LNDF were inversely related to the risk of being overweight and dairy increased the risk. Specifically, the odds ratio (95% CI) for children in the highest quartile or tertile of consumption compared with the lowest quartile or tertile were as follows: grains 0.59(0.41-0.83); nuts 0.60(0.43-0.85); vegetables 0.67(0.48-0.94); LNDF 0.43(0.29-0.63); and, dairy 1.36(0.97, 1.92). CONCLUSION: The regular intake of specific plant foods may prevent overweight among children and adolescents.

Almond consumption and cardiovascular risk factors in adults with prediabetes.

OBJECTIVE: The authors tested the hypothesis that in adults with prediabetes, an almond-enriched American Diabetes Association (ADA) diet improves measures of insulin sensitivity and other cardiovascular risk factors compared with an ADA nut-free diet. DESIGN: Randomized parallel-group trial. SETTING: Outpatient dietary counseling and blood analysis. SUBJECTS: Sixty-five adult participants with prediabetes. INTERVENTION: Sixteen weeks of dietary modification featuring an ADA diet containing 20% of energy from almonds (approximately 2 oz per day). MEASURES OF OUTCOME: Outcomes included fasting glucose, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, TC:HDL-C, and HbA1c, which were measured at weeks 0, 8, and 16. Body weight, body mass index (BMI), waist circumference, blood pressure, and nutrient intake were measured at weeks 0, 4, 8, 12, and 16. RESULTS: The almond-enriched intervention group exhibited greater reductions in insulin (-1.78 µU/ml vs. +1.47 µU/ml, p  =  0.002), homeostasis model analysis for insulin resistance (-0.48 vs. +0.30, p  =  0.007), and homeostasis model analysis for beta-cell function (-13.2 vs. +22.3, p  =  0.001) compared with the nut-free control group. Clinically significant declines in LDL-C were found in the almond-enriched intervention group (-12.4 mg/dl vs. -0.4 mg/dl) as compared with the nut-free control group. No changes were observed in BMI (-0.4 vs. -0.7 kg/m(2), p  =  0.191), systolic blood pressure (-4.4 mm Hg vs. -3.5 mm Hg, p  =  0.773), or for the other measured cardiovascular risk factors. CONCLUSIONS: An ADA diet consisting of 20% of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity and yields clinically significant improvements in LDL-C in adults with prediabetes.

Postprandial gut hormone responses to Hass avocado meals and their association with visual analog scores in overweight adults: A randomized 3 × 3 crossover trial.

OBJECTIVE: To evaluate changes in postingestive gut hormone concentrations from the consumption of Hass avocado by addition or inclusion to lunch test meals, and to examine their association with measures of appetite sensation. METHODS: A randomized 3 × 3 crossover study was conducted with 26 healthy overweight adults. Participants consumed one of three test meals: avocado-free control (C); isoenergic avocado inclusive (AI); and, energy increased avocado added (AA) one week apart. Ghrelin, peptide YY3-36 (PYY3-36), gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) concentrations were measured at specific times before and following the test meals. Appetite sensations (Hunger, Fullness, Satisfied, Desire, How Much) were self-assessed using a visual analog scale (VAS) tool at matching time points and a Composite VAS score was computed. Mixed models and repeated measures analysis were used to compare differences among the test meals for VAS measurements and gut hormones, and their associations were evaluated using regression analysis. RESULTS: A decrease in the 3-hour GLP-1 area under the curve (AUC) was observed in the AA meal compared to the C meal (P = 0.03). Negative associations were found for PYY3-36 and GIP for Hunger, Desire and How Much, and positive associations for Fullness, Satisfied and the Composite VAS score (all P < 0.001). For GLP-1, a negative association for Hunger and a positive association for Satisfied and the Composite VAS score (all P < 0.05) were noted. CONCLUSIONS: Postprandial responses to PYY3-36, GIP and GLP-1 concentrations were associated with VAS measures and the Composite VAS score following consumption of test meals in overweight adults.

Draft Genome Sequence of Exiguobacterium sp. Strain BMC-KP, an Environmental Isolate from Bryn Mawr, Pennsylvania.

Exiguobacterium sp. strain BMC-KP was isolated as part of a student environmental sampling project at Bryn Mawr College, PA. Sequencing of bacterial DNA assembled a 3.32-Mb draft genome. Analysis suggests the presence of genes for tolerance to cold and toxic metals, broad carbohydrate metabolism, and genes derived from phage.

Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient.

There has been increased attention on the importance of identifying and distinguishing the differences between stress-induced hyperglycemia (SH), newly diagnosed hyperglycemia (NDH), and hyperglycemia in persons with established diabetes mellitus (DM). Inpatient blood glucose control is now being recognized as not only a cost issue for hospitals but also a concern for patient safety and care. The reasons for the increased incidence of hyperglycemia in hospitalized patients include preexisting DM, undiagnosed DM or prediabetes, SH, and medication-induced hyperglycemia with resulting transient blood glucose variability. It is clear that identifying and documenting hyperglycemia in hospitalized patients with and without a previous diagnosis of DM and initiating prompt insulin treatment are important. Agreement on the optimum treatment goals for hyperglycemia remains quite controversial, and the benefits of intensive glucose management may be lost at the cost of hypoglycemia in intensive care unit patients. Nutrition support in the form of enteral nutrition (EN) increases the risk of hyperglycemia in both critical and non-critically ill hospitalized patients. Reasons for beginning a tube feeding are the same whether a person has NDH or DM. What differs is how to incorporate EN into the established insulin management protocols. The risk for hyperglycemia with the addition of EN is even higher in those without a previous diagnosis of DM. This review discusses the incidence of hyperglycemia, the pathogenesis of hyperglycemia, factors contributing to hyperglycemia in the hospitalized patient, glycemic management goals, current glycemic management recommendations, and considerations for EN formula selection, administration, and treatment.

Vegetarian diets and childhood obesity prevention.

The increased prevalence of childhood overweight and obesity is not unique to industrialized societies; dramatic increases are occurring in urbanized areas of developing countries. In light of the consensus that obesity is a significant public health concern and that many weight-loss interventions have been unsuccessful in the long term, an exploration of food patterns that are beneficial in the primary prevention of obesity is warranted. The focus of this article is to review the relation between vegetarian diets and obesity, particularly as they relate to childhood obesity. Epidemiologic studies indicate that vegetarian diets are associated with a lower body mass index (BMI) and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI (in kg/m(2)). Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. Plant-based diets are low in energy density and high in complex carbohydrate, fiber, and water, which may increase satiety and resting energy expenditure. Plant-based dietary patterns should be encouraged for optimal health and environmental benefits. Food policies are warranted to support social marketing messages and to reduce the cultural and economic forces that make it difficult to promote plant-based dietary patterns.

Nuts, blood lipids and cardiovascular disease.

The aim of this paper is to evaluate nut-related epidemiological and human feeding study findings and to discuss the important nutritional attributes of nuts and their link to cardiovascular health. Frequent nut consumption has been found to be protective against coronary heart disease in five large epidemiological studies across two continents. A qualitative summary of the data from four of these studies found an 8.3% reduction in risk of death from coronary heart disease for each weekly serving of nuts. Over 40 dietary intervention studies have been conducted evaluating the effect of nut containing diets on blood lipids. These studies have demonstrated that intake of different kinds of nuts lower total and LDL cholesterol and the LDL: HDL ratio in healthy subjects or patients with moderate hypercholesterolaemia, even in the context of healthy diets. Nuts have a unique fatty acid profile and feature a high unsaturated to saturated fatty acid ratio, an important contributing factor to the beneficial health effects of nut consumption. Additional cardioprotective nutrients found in nuts include vegetable protein, fiber, alpha-tocopherol, folic acid, magnesium, copper, phytosterols and other phytochemicals.

Childhood obesity and adult morbidities.

The prevalence and severity of obesity have increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure.

Decreasing the linoleic acid to alpha-linolenic acid diet ratio increases eicosapentaenoic acid in erythrocytes in adults.

The n-6/n-3 fatty acid (FA) ratio has increased in the Western-style diet to approximately 10-15:1 during the last century, which may have contributed to the rise in cardiovascular disease (CVD). Prior studies have evaluated the effects on CVD risk factors of manipulating the levels of n-6 and n-3 FA using food and supplements or investigated the metabolic fate of linoleic acid (LNA) and alpha-linolenic acid (ALA) by varying the n-6/n-3 ratios. However, no previous studies have investigated the potential interaction between diet ratios and supplementation with eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3). We used a factorial design approach with adults (n = 24) in a controlled feeding trial to compare the accretion of EPA and DHA into red blood cell membranes (RBC) by adding a direct source (algal oil supplement) of EPA and DHA in a diet with a 10:1 versus 2:1 ratio of n-6/n-3 FA. Subjects were randomized into 8-week crossover diet sequences and each subject consumed three of four diets [10:1, 10:1 plus supplement (10:1 + S), 2:1 and 2:1 + S]. LNA and ALA intakes were 9.4 and 7.7%, and 1.0 and 3.0% during the low and high ALA diets, respectively. Compared to the Western-style 10:1 diet, the 2:1 diet increased EPA by 60% (P < 0.0001) in RBC membranes without the direct EPA source and a 34% increase (P = 0.027) was observed with the 10:1 + S diet; however, DHA levels increased in both diet ratios only with a direct DHA source. Shifting towards a 2:1 diet is a valid alternative to taking EPA-containing supplements.