Meeting the global protein supply requirements of a growing and ageing population.

Human dietary patterns are a major cause of environmental transformation, with agriculture occupying ~ 50% of global land space, while food production itself is responsible for ~ 30% of all greenhouse gas emissions and 70% of freshwater use. Furthermore, the global population is also growing, such that by 2050, it is estimated to exceed ~ 9 billion. While most of this expansion in population is expected to occur in developing countries, in high-income countries there are also predicted changes in demographics, with major increases in the number of older people. There is a growing consensus that older people have a greater requirement for protein. With a larger and older population, global needs for protein are set to increase. This paper summarises the conclusions from a Rank Prize funded colloquium evaluating novel strategies to meet this increasing global protein need.

In vitro determination of the protein quality of maize varieties cultivated in Malawi using the INFOGEST digestion method.

There is an urgent need to alleviate protein deficiencies in low-income countries where cereal-based diets dominate. The objective of this study was to use the INFOGEST static digestion method and a recently established analytical workflow to determine the in vitro amino acid digestibility and protein quality of seven maize varieties grown in Malawi. Protein quality was measured using the in vitro digestible indispensable amino acid score (DIAAS). Amino acid digestibility was higher for the dehulled, low fibre, provitamin A maize flour (66%), compared to whole grain maize flours (51-61%), suggesting that the presence of fibre reduced digestibility (p < 0.05). Lysine was the limiting amino acid in all varieties, with the following DIAAS values for each variety; Provitamin A maize - 24, SC 719 - 32, Mtsikinya - 37, SC 167 - 39, Quality protein maize (QPM) - 40, Bantum - 40, SC 403 - 44. In addition to the variety of maize, protein quality was dependent on the level of processing and the agronomic practice applied with higher protein quality for the SC 403 variety in which zinc enriched fertilizer was applied. Comparing protein quality data with published in vivo data showed that DIAAS data were in closer agreement than amino acid digestibility data, which was slightly lower than published values, with mean in vitro amino acid digestibilities of 56-70% compared to a mean in vivo value of 77%. Overall, the in vitro method was able to correctly predict both the direction and magnitude of response. The INFOGEST digestion method coupled with the new analytical workflow will therefore be useful in the screening of high protein cereal crops and subsequent development of cereal-based foods with high protein quality.

Identification and characterisation of a rare MTTP variant underlying hereditary non-alcoholic fatty liver disease.

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a complex trait with an estimated prevalence of 25% globally. We aimed to identify the genetic variant underlying a four-generation family with progressive NAFLD leading to cirrhosis, decompensation, and development of hepatocellular carcinoma in the absence of common risk factors such as obesity and type 2 diabetes. Methods: Exome sequencing and genome comparisons were used to identify the likely causal variant. We extensively characterised the clinical phenotype and post-prandial metabolic responses of family members with the identified novel variant in comparison with healthy non-carriers and wild-type patients with NAFLD. Variant-expressing hepatocyte-like cells (HLCs) were derived from human-induced pluripotent stem cells generated from homozygous donor skin fibroblasts and restored to wild-type using CRISPR-Cas9. The phenotype was assessed using imaging, targeted RNA analysis, and molecular expression arrays. Results: We identified a rare causal variant c.1691T>C p.I564T (rs745447480) in MTTP, encoding microsomal triglyceride transfer protein (MTP), associated with progressive NAFLD, unrelated to metabolic syndrome and without characteristic features of abetalipoproteinaemia. HLCs derived from a homozygote donor had significantly lower MTP activity and lower lipoprotein ApoB secretion than wild-type cells, while having similar levels of MTP mRNA and protein. Cytoplasmic triglyceride accumulation in HLCs triggered endoplasmic reticulum stress, secretion of pro-inflammatory mediators, and production of reactive oxygen species. Conclusions: We have identified and characterised a rare causal variant in MTTP, and homozygosity for MTTP p.I564T is associated with progressive NAFLD without any other manifestations of abetalipoproteinaemia. Our findings provide insights into mechanisms driving progressive NAFLD. Impact and Implications: A rare genetic variant in the gene MTTP has been identified as responsible for the development of severe non-alcoholic fatty liver disease in a four-generation family with no typical disease risk factors. A cell line culture created harbouring this variant gene was characterised to understand how this genetic variation leads to a defect in liver cells, which results in accumulation of fat and processes that promote disease. This is now a useful model for studying the disease pathways and to discover new ways to treat common types of fatty liver disease.

The Response of the Human Umbilical Vein Endothelial Cell Transcriptome to Variation in Magnesium Concentration.

Vascular endothelial cells have a critical role in the maintenance of cardiovascular function. Evidence suggests that endothelial function may be compromised under conditions of magnesium deficiency, which increases vulnerability to inflammation. Whole genome transcription analysis was used to explore the acute (24 h) effects of magnesium on human umbilical vascular endothelial cells (HUVEC) cultured in low (0.1 mM) or high (5 mM) concentrations. With low magnesium 2728 transcripts were differentially expressed compared to the 1 mM control cultures and 3030 were differentially expressed with high magnesium. 615 transcripts were differentially expressed under both conditions, of which only 34 showed a concentration-dependent response. Analysis indicated that cellular organisation and biogenesis and key cellular processes such as apoptosis were impacted by both low and high conditions. High magnesium also influenced protein binding functions, intracellular signal transduction, metabolic and catalytic processes. Both conditions impacted on stress-related processes, in particular the inflammatory response. Key mediators of calcium-dependent regulation of gene expression were responsive to both high and low magnesium conditions. The HUVEC transcriptome is highly sensitive to acute changes in the concentration of magnesium in culture medium. The findings of this study support the view that whilst inflammation is an important process that is responsive to magnesium, the function of the endothelium may be impacted by other magnesium-induced changes including maintenance of cellular integrity, receptor expression and metabolic functions. The high proportion of transcripts that did not show a concentration-dependent response suggests variation in magnesium may elicit indirect changes, possibly mediated by other ions.

Limited Supply of Protein and Lysine Is Prevalent among the Poorest Households in Malawi and Exacerbated by Low Protein Quality.

We estimated dietary supplies of total and available protein and indispensable amino acids (IAAs) and predicted the risk of deficiency in Malawi using Household Consumption and Expenditure Survey data. More than half of dietary protein was derived from cereal crops, while animal products provided only 11%. The supply of IAAs followed similar patterns to that of total proteins. In general, median protein and IAA supplies were reduced by approximately 17% after accounting for digestibility, with higher losses evident among the poorest households. At population level, 20% of households were at risk of protein deficiency due to inadequate available protein supplies. Of concern was lysine supply, which was inadequate for 33% of households at the population level and for the majority of the poorest households. The adoption of quality protein maize (QPM) has the potential to reduce the risk of protein and lysine deficiency in the most vulnerable households by up to 12% and 21%, respectively.

Mapping brain activity of gut-brain signaling to appetite and satiety in healthy adults: A systematic review and functional neuroimaging meta-analysis.

Understanding how neurohormonal gut-brain signaling regulates appetite and satiety is vital for the development of therapies for obesity and altered eating behavior. However, reported brain areas associated with appetite or satiety regulators show inconsistency across functional neuroimaging studies. The aim of this study was to systematically assess the convergence of brain regions modulated by appetite and satiety regulators. Twenty-five studies were considered for qualitative synthesis, and 14 independent studies (20-experiments) found eligible for coordinate-based neuroimaging meta-analyses across 212 participants and 123 foci. We employed two different meta-analysis approaches. The results from the systematic review revealed the modulation of insula, amygdala, hippocampus, and orbitofrontal cortex (OFC) with appetite regulators, where satiety regulators were more associated with caudate nucleus, hypothalamus, thalamus, putamen, anterior cingulate cortex in addition to the insula and OFC. The two neuroimaging meta-analyses methods identified the caudate nucleus as a key area associated with satiety regulators. Our results provide quantitative brain activation maps of neurohormonal gut-brain signaling in heathy-weight adults that can be used to define alterations with eating behavior.

A Comparison of Primary Human Hepatocytes and Hepatoma Cell Lines to Model the Effects of Fatty Acids, Fructose and Glucose on Liver Cell Lipid Accumulation.

Non-alcoholic fatty liver disease (NAFLD) begins with lipid accumulation within hepatocytes, but the relative contributions of different macronutrients is still unclear. We investigated the impact of fatty acids, glucose and fructose on lipid accumulation in primary human hepatocytes (PHH) and three different cell lines: HepG2 (human hepatoblastoma−derived cell line), Huh7 (human hepatocellular carcinoma cell line) and McA-RH7777 (McA, rat hepatocellular carcinoma cell line). Cells were treated for 48 h with fatty acids (0 or 200 µM), glucose (5 mM or 11 mM) and fructose (0 mM, 2 mM or 8 mM). Lipid accumulation was measured via Nile Red staining. All cell types accumulated lipid in response to fatty acids (p < 0.001). PHH and McA, but not HepG2 or Huh7 cells, accumulated more lipid with 11 mM glucose plus fatty acids (p = 0.004, fatty acid × glucose interaction, for both), but only PHH increased lipid accumulation in response to fructose (p < 0.001). Considerable variation was observed between PHH cells from different individuals. Lipid accumulation in PHH was increased by insulin (p = 0.003) with inter-individual variability. Similarly, insulin increased lipid accumulation in both HepG2 and McA cells, with a bigger response in McA in the presence of fatty acids (p < 0.001 for fatty acid × insulin). McA were more insulin sensitive than either HepG2 or Huh7 cells in terms of AKT phosphorylation (p < 0.001 insulin × cell type interaction). Hence, glucose and fructose can contribute to the accumulation of lipid in PHH with considerable inter-individual variation, but hepatoma cell lines are not good models of PHH.

Extraction of protein from food waste: An overview of current status and opportunities.

The chief intent of this review is to explain the different extraction techniques and efficiencies for the recovery of protein from food waste (FW) sources. Although FW is not a new concept, increasing concerns about chronic hunger, nutritional deficiency, food security, and sustainability have intensified attention on alternative and sustainable sources of protein for food and feed. Initiatives to extract and utilize protein from FW on a commercial scale have been undertaken, mainly in the developed countries, but they remain largely underutilized and generally suited for low-quality products. The current analysis reveals the extraction of protein from FW is a many-sided (complex) issue, and that identifies for a stronger and extensive integration of diverse extraction perspectives, focusing on nutritional quality, yield, and functionality of the isolated protein as a valued recycled ingredient.

Role of novel protein sources in sustainably meeting future global requirements.

Global population growth, increased life expectancy and climate change are all impacting world's food systems. In industrialised countries, many individuals are consuming significantly more protein than needed to maintain health, with the majority being obtained from animal products, including meat, dairy, fish and other aquatic animals. Current animal production systems are responsible for a large proportion of land and fresh-water use, and directly contributing to climate change through the production of greenhouse gases. Overall, approximately 60% of the global protein produced is used for animal and fish feed. Concerns about their impact on both human, and planetary health, have led to calls to dramatically curb our consumption of animal products. Underutilised plants, insects and single-cell organisms are all actively being considered as alternative protein sources. Each present challenges that need to be met before they can become economically viable and safe alternatives for food or feed. Many plant species contain anti-nutritional factors that impair the digestion and absorption of protein and micronutrients. Insects represent a potentially rich source of high-quality protein although, questions remain relating to digestibility, allergenicity and biosecurity. Algae, fungi and bacteria are also a rich source of protein and there is growing interest in the development of 'cultured meat' using stem cell technology. For the foreseeable future, it appears likely that the 'protein-economy' will remain mixed. The present paper reviews progress and future opportunities in the development of novel protein sources as food and animal feed.

Combined innovations in public policy, the private sector and culture can drive sustainability transitions in food systems.

Global food system analyses call for an urgent transition to sustainable human diets but how this might be achieved within the current global food regime is poorly explored. Here we examine the factors that have fostered major dietary shifts across eight countries in the past 70 years. Guided by transition and food-regime theories, we draw on data from diverse disciplines, reviewing post-World War 2 shifts in consumption of three food commodities: farmed tilapia, milk and chicken. We show that large-scale shifts in commodity systems and diets have taken place when public-funded technological innovation is scaled-up by the private sector under supportive state and international policy regimes, highlighting pathways between commodity systems transformation and food-system transitions. Our analysis suggests that the desired sustainability transition will require public policy leadership and private-sector technological innovation alongside consumers who culturally value and can afford healthy, sustainable diets.

Insects: A Potential Source of Protein and Other Nutrients for Feed and Food.

Sustainable production of healthy food for a growing global population, in the face of the uncertainties of climate change, represents a major challenge for the coming decade. Livestock provide food with high nutritional value but are frequently fed on human-edible crops and are associated with significant production of greenhouse gases. Recent years have seen increasing interest in the farming of insects as a sustainable source of human food, or as a replacement of ingredients such as soya or fishmeal in the feeds of terrestrial livestock or fish. This review provides an overview of insect physiology and growth regulation, considers the requirements for insect farming and mass production, and summarizes the nutritional value of the 10 most commonly studied insect species, before reviewing the literature on the use of insects as feed and food. We highlight the challenges required to develop a sustainable, safe, and affordable insect farming industry.

Are current dietary guidelines relevant to subjects on cholesterol-lowering drugs?

The present paper reviews the evidence as to whether patients on lipid-lowering drugs should restrict dietary SFA intake. Premature mortality from atherosclerotic CVD has fallen dramatically in many high-income countries. This appears to be due to a combination of improved treatment following a cardiovascular event and reduced risk factors, including LDL-cholesterol. Whether this reduction is due to changes in dietary habits, or the increasing availability of highly potent cholesterol-reducing drugs remains to be firmly established. While reducing dietary SFA intake has been the cornerstone of public health nutrition policy for several decades, the efficacy of such dietary changes has been challenged in recent years. While there remains a lack of consensus in the literature, there is an emerging view that dietary advice should be specifically modified to emphasise replacing SFA with PUFA in the diet rather than carbohydrate. The advice to moderate dietary SFA intake given to the general population is usually also given to those individuals at high risk of CVD who are prescribed lipid-lowering drugs. There is limited evidence to suggest that any potential benefit of such a diet on LDL-cholesterol may be offset by a concurrent decrease in HDL-cholesterol. However, as diets rich in SFA are frequently energy-dense, and rich in red and processed meat (potential risk factors for CVD in themselves), it would seem prudent to continue to advise patients on lipid-lowering drugs to maintain a low-fat diet.

The impact of reduced red and processed meat consumption on cardiovascular risk factors; an intervention trial in healthy volunteers.

Meat represents an important part of the diet for many adults, supplying essential amino acids and micronutrients. However, high red and processed meat (RPM) intake is implicated in the development of cardiovascular disease and dyslipidemia. This study aimed to reduce RPM consumption in healthy, non-obese omnivores (21-48 years), who ate RPM ≥4 times per week, and to investigate its effect on cardiovascular risk factors using a single-group longitudinal study design (comprising an initial 4-week baseline period, followed by a 12-week intervention). Participants (16M : 21F) were assessed before (BL) and after (T0) the pre-intervention period and before (T0), at week 6 (T6) and at the end of intervention (T12). In a subset (8M : 15F), haematological parameters were measured at BL, T6 and T12. Compared with BL, protein intake from RPM reduced by 67% at T6 and 47% at T12 (4-day dietary records). BMI, body fat mass, and blood pressure did not change over the intervention in the whole cohort, but mean total, LDL and HDL cholesterol were reduced in males at T12 (effect sizes -0.52, -0.41 and -0.15 mmol l-1, respectively; each P < 0.01), with no change in total : HDL ratio observed. In the study sub-set, haemoglobin concentration, plus red and white cell count fell during the intervention (estimated effect size ηp2 0.300, 0.301 and 0.354, respectively; each P < 0.001). It was possible for omnivores to approximately halve their RPM intake, and in males this dietary change appeared to reduce blood lipid concentrations. However, acute dietary changes to RPM intake may have had an unfavourable impact on haematological parameters.

Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes.

Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18-55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.

The risk of selenium deficiency in Malawi is large and varies over multiple spatial scales.

Selenium (Se) is an essential human micronutrient. Deficiency of Se decreases the activity of selenoproteins and can compromise immune and thyroid function and cognitive development, and increase risks from non-communicable diseases. The prevalence of Se deficiency is unknown in many countries, especially in sub-Saharan Africa (SSA). Here we report that the risk of Se deficiency in Malawi is large among a nationally representative population of 2,761 people. For example, 62.5% and 29.6% of women of reproductive age (WRA, n = 802) had plasma Se concentrations below the thresholds for the optimal activity of the selenoproteins glutathione peroxidase 3 (GPx3; <86.9 ng mL-1) and iodothyronine deiodinase (IDI; <64.8 ng mL-1), respectively. This is the first nationally representative evidence of widespread Se deficiency in SSA. Geostatistical modelling shows that Se deficiency risks are influenced by soil type, and also by proximity to Lake Malawi where more fish is likely to be consumed. Selenium deficiency should be quantified more widely in existing national micronutrient surveillance programmes in SSA given the marginal additional cost this would incur.

Varying magnesium concentration elicits changes in inflammatory response in human umbilical vein endothelial cells (HUVECs).

The aims of this study were to determine whether low concentrations of magnesium in vitro exacerbated the human umbilical vein endothelial cell (HUVEC) response to inflammatory challenge, and whether expression of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) through the toll-like receptor 4 (TLR4) played a role in this process. HUVECs were incubated with different concentrations of Mg (low- 0.1mM, control- 1mM, high- 5mM) for 72 h before being stimulated with bacterial lipopolysaccharide (LPS) for 4 h. The response of cells to LPS was greater in cells cultured in low Mg, relative to control cells and suppressed in high Mg. Expression of NF-κB was increased in low-Mg and decreased with high Mg. Low Mg increased the expression of TLR4 mRNA, but only in the presence of LPS. Antibody blockade of TLR4 but not TLR2 blunted the response of cells to LPS in low Mg, such that they were similar to unblocked 1mM Mg cells. Associations of Mg with cardiovascular disease may therefore relate to inflammatory responses mediated through the TLR4/NF-κB pathway.

Magnesium deficiency heightens lipopolysaccharide-induced inflammation and enhances monocyte adhesion in human umbilical vein endothelial cells.

Given a possible anti-inflammatory role of magnesium in endothelial cells, the aim of this study was to investigate the effects of magnesium on human umbilical vein endothelial cell (HUVEC) viability, gene expression, and the pro-inflammatory response caused by a bacterial endotoxin (LPS). HUVECs were cultured at three different concentrations of magnesium sulphate (0.1 mM; control-1 mM; 5 mM) for 72 hours. Exposing the cells to LPS reduced cell viability in culture with low magnesium, but high magnesium protected the HUVECs from LPS-induced cell death. LPS-treated HUVECs cultured in low magnesium showed up-regulation of mRNA expression for pro-inflammatory factors and the expression of cytokine proteins, including IL-2, IL-3, IL-8, IL-15 and MCP-1. This was associated with greater adhesion of monocytes to the cells. In contrast, high magnesium decreased the expression of inflammatory factors and cytokines. The study found that LPS activation of the expression of many pro-inflammatory factors is exacerbated in the presence of low magnesium concentration whilst a high magnesium concentration partly inhibited the inflammatory response to LPS.

Component analysis of nutritionally rich chloroplasts: recovery from conventional and unconventional green plant species.

A study of the literature indicates that chloroplasts synthesise a range of molecules, many of which have nutritional value for humans, but the nutritional credentials of chloroplasts recovered from plant cells are not established. Chloroplast-rich-fractions (CRFs) were prepared from green plant species and the macro- and micro-nutrient composition compared with the whole leaf materials (WLMs). The results indicated that, on a dry weight basis, CRF material from a range of green biomass was enriched in lipids and proteins, and in a range of micronutrients compared with the WLM. Vitamins E, pro-vitamin A, and lutein were all greater in CRF preparations. Of the minerals, iron was most notably concentrated in CRF. Spinach CRFs possessed the highest α-tocopherol [62 mg 100 g-1, dry weight (DW)], ß-carotene (336 mg 100 g-1 DW) and lutein (341 mg 100 g-1 DW) contents, whilst grass CRFs had the highest concentration of alpha-linolenic acid (ALA) (69.5 mg g-1). The higher concentrations of α-tocopherol, ß-carotene, lutein, ALA and trace minerals (Fe and Mn) in CRFs suggested their potential use as concentrated ingredients in food formulations deficient in these nutrients.

Fetal and neonatal exposure to trans-fatty acids impacts on susceptibility to atherosclerosis in apo E*3 Leiden mice.

Nutrition during pregnancy can impact on the susceptibility of the offspring to CVD. Postnatal consumption of trans-fatty acids (TFA), associated with partially hydrogenated vegetable oil (PHVO), increases the risk of atherosclerosis, whereas evidence for those TFA associated with ruminant-derived dairy products and meat remain equivocal. In this study, we investigate the impact of maternal consumption of dietary PHVO (P) and ruminant milk fat (R) on the development of atherosclerosis in their offspring, using the transgenic apoE*3 Leiden mouse. Dams were fed either chow (C) or one of three high-fat diets: a diet reflecting the SFA content of a 'Western' diet (W) or one enriched with either P or R. Diets were fed during either pregnancy alone or pregnancy and lactation. Weaned offspring were then transferred to an atherogenic diet for 12 weeks. Atherosclerosis was assessed as lipid staining in cross-sections of the aorta. There was a significant effect of maternal diet during pregnancy on development of atherosclerosis (P=0·013) in the offspring with those born of mothers fed R or P during pregnancy displaying smaller lesions that those fed C or W. This was not associated with changes in total or lipoprotein cholesterol. Continuing to feed P during lactation increased atherosclerosis compared with that seen in offspring of dams fed P only during pregnancy (P<0·001). No such effect was seen in those from mothers fed R (P=0·596) or W (P=901). We conclude that dietary TFA have differing effects on cardiovascular risk at different stages of the lifecycle.