Phosphorus Intake and Potential Dietary Influences Examined via 24-Hour Urinary Biomarker Measurements in German Children and Adolescents Over 3 Decades.

BACKGROUND: Increases in phosphorus intake have been observed over the past years in adult populations. However, biomarker-based data are lacking on whether or not phosphorus intake also increased in children. OBJECTIVE: The aim of this study was to examine 24-hour urinary phosphate excretion (PO4-Ex) and diet-related biomarkers potentially influencing phosphorus status in German children and adolescents from 1985 to 2015. DESIGN: This longitudinal noninvasive biomarker-based cohort study examined 24-hour urine samples from children and adolescents of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, collected over 3 decades. PARTICIPANTS/SETTING: Examined individuals (n = 1,057) were healthy participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, situated in Dortmund, Germany, who had been asked to collect one yearly 24-hour urine sample. Six thousand seven hundred thirty-seven samples collected from participants aged 3 to 17 years between 1985 (baseline) and 2015, were included. MAIN OUTCOME MEASURES: phosphorus intake was examined biomarker-based by analyzed PO4-Ex in 24-hour urine samples. Whether acid-base status and intakes of protein, salt, and fruits and vegetables, may have relevantly contributed to PO4-Ex levels was assessed by determining 24-hour excretions of net acid, urea-nitrogen, and sodium as well as specific standardized excretions of potassium plus oxalate. STATISTICAL ANALYSES PERFORMED: Trend analysis over 30 years and potentially influencing diet factors were examined using linear mixed-effect regression models (PROC-MIXED). Adjustments for sex, age, and body surface area were performed. RESULTS: No change was identifiable for PO4-Ex over the 3 decades; neither in 3 to 8, 9 to 13, nor in 14 to 17 year olds. However, sodium excretion increased (P = .001). PROC-MIXED analysis on intraindividual changes in PO4-Ex revealed direct relationships with net acid excretion, urea-nitrogen, and sodium excretion and an inverse relationship with a biomarker of fruit and vegetable intake. CONCLUSIONS: Despite a direct relationship between PO4-Ex and a biomarker of industrially processed food consumption; that is, sodium excretion, which showed an increasing time trend, phosphorus intake was found to remain stable over decades in children and adolescents.

Higher Renal Net Acid Excretion, but Not Higher Phosphate Excretion, during Childhood and Adolescence Associates with the Circulating Renal Tubular Injury Marker Interleukin-18 in Adulthood.

High dietary phosphorus intake (P-In) and high acid loads may adversely affect kidney function. In animal models, excessive phosphorus intake causes renal injury, which, in humans, is also inducible by chronic metabolic acidosis. We thus examined whether habitually high P-In and endogenous acid production during childhood and adolescence may be early indicators of incipient renal inflammatory processes later in adulthood. P-In and acid-base status were longitudinally and exclusively determined by biomarker-based assessment in 277 healthy children, utilizing phosphate and net acid excretion (NAE) measurements in 24 h urine samples repeatedly collected between the ages of 3 and 17 years. Standard deviation scores (by sex and age) were calculated for anthropometric data and for the urinary biomarkers available within age range 3-17 years. Multivariable linear regression was used to analyze the relations of phosphate excretion and NAE with the adulthood outcome circulating interleukin-18 (IL-18), a marker of inflammation and kidney dysfunction. After adjusting for growth- and adulthood-related covariates and pro-inflammatory biomarkers to rule out confounding by non-renal inflammatory processes, regression models revealed a significant positive relationship of long-term NAE (p = 0.01), but not of long-term phosphate excretion with adult serum IL-18. Similar significant positive regression results were obtained after replacing NAE with 24 h urinary ammonium excretion as the exposition variable. Our results suggest that even moderate elevations in renal ammonia production, as caused by habitually higher acid loading during growth, may affect the intrarenal pro-inflammatory system in the long-term, known to be boosted by acidosis-induced raised ammoniagenesis.

Effect of olive oil phenols on oxidative stress biomarkers: A systematic review and dose-response meta-analysis of randomized clinical trials.

The phenolic content of olive oil has a role in cardiovascular protection. Some clinical trial studies demonstrated that phenolic compounds of olive oil have antioxidant activity which can protect macronutrients from oxidative damages. The aim of this study was to summarize the results of clinical trials which assessed the effects of high- versus low-phenol olive oil on oxidative stress biomarkers levels. We searched Scopus, PubMed, Web of Science, Google Scholar, ProQuest, and Embase up to July 2021. Eight clinical trials which evaluated the effect of the phenolic content of olive oil on oxidized-LDL (ox-LDL), malondialdehyde (MDA), or ferric-reducing ability of plasma (FRAP) were included the meta analysis. A significant decrease was observed in ox-LDL level (WMD: -0.29 U/L; 95% CI: -0.51, -0.07) and MDA (WMD: -1.82 µmoL/L; 95% CI: -3.13, -0.50). However, after subgroup analysis for MDA, the result was not significant for not serious limitation (SMD: -0.05, 95% CI: -0.35 to 0.24), but significant for serious limitation (SMD: -3.64, 95% CI: -4.29 to -2.99). Also, no significant change was found in FRAP (WMD: 0.0 mmoL/L; 95% CI: -0.03, 0.04) level. Dose-response analysis indicated a significant linear relationship between the phenolic content of olive oil and ox-LDL. The present study showed some beneficial effects of high-phenol compared with low-phenol olive oil on ox-LDL and MDA levels. According to the meta-regression analysis along with the increasing phenolic content of olive oil, a reduction in oxidative stress biomarkers was observed.

Cost-Effectiveness Analysis of Group vs. Weblog Telecommunication (Web Tel) Nutrition Education Program on Glycemic Indices in Patients With Non-Insulin Dependent Diabetes Mellitus Type 2: A Randomized Controlled Trial.

This a randomized controlled trial study with a cost-effectiveness analysis that aimed to compare the cost-effectiveness of group nutrition education with that of Web-Tel nutrition education in the glycemic control of patients with non-insulin-dependent type 2 diabetes mellitus (T2DM). The study was conducted on 105 patients with T2DM for 3 months in Quds health centre of Bushehr province, Iran. The participants were classified based on age and disease severity (hemoglobin A1c level); then, they were randomly assigned to one of the three groups: group education, Web-Tel education, and the control group using block randomization method. The clinical (intermediate) outcome was changes in hemoglobin A1c (HbA1c). Patients' perspective was adopted, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainties. The results indicated that the expected effectiveness was 0.46, 0.63, and 0.4; the mean costs was 27,188, 5,335, and 634 purchasing power parity (PPP) dollars for group education, Web-Tel education, and the control group, respectively. The incremental cost-effectiveness ratio (ICER) of Web-Tel education vs. the control group was positive and equal to $21, 613.04 PPP; since it was less than three times of the threshold, the Web-Tel education method was considered as a more cost-effective method than the control group. On the other hand, the ICER of group education vs. control group was $447,067 PPP and above the threshold, so group education was considered as a dominated method compared with the control group. In conclusion, considering the ICER, Web-Tel education is a more cost-effective method than the other two and can be used as the first priority in educating patients with T2DM. The present study was registered in Thailand Clinical Trials Registry (TCTR20210331001).

The effect of calcium supplement intake on lipid profile: a systematic review and meta-analysis of randomized controlled clinical trials.

Despite the potential role of dietary calcium in fat excretion, the favorable effects of calcium supplements on lipid profile remains inconclusive. The current study aimed to review the effect of calcium supplement intake on lipid profile in randomized controlled clinical trials (RCTs). This systematic review and meta-analysis was conducted in PubMed, Scopus, Embase, and Central. RCTs which assessed the effects of calcium supplementation on lipid profile were included. All outcomes were recorded as continuous variables, and the effect size was measured. We classified studies according to dose of supplement, study duration, and dyslipidemia. Calcium supplement intake was associated with a significant reduction in low density lipoprotein cholesterol (LDL-C) level (WMD:-0.08; 95%CI:-0.16,-0.01)(mmol/l), especially with intakes of at least 1000 mg/day (WMD:-0.13; 95%CI:-0.23,-0.03)(mmol/l), with intakes of at least 12 weeks (WMD:-0.08; 95%CI: -0.16,-0.00)(mmol/l), and in individuals without dyslipidemia (WMD:-0.15; 95%CI:-0.26,-0.04)(mmol/l). Also, in another subgroup analysis, consumption of less than 1000 mg/day calcium supplement caused a significant increase in Total Cholesterol (TC) level (WMD: 0.24; 95%CI: 0.05,0.42) (mmol/l). In other blood lipids or study subgroups we observed no significant effect. We concluded that calcium supplements had a favorable effect on LDL-C level, especially in individuals without dyslipidemia, higher calcium intakes, and longer period of consumption.

No adverse effects of dairy products on lipid profile: A systematic review and meta-analysis of randomized controlled clinical trials.

BACKGROUND AND AIMS: The current study aimed to review the effects of dairy foods on lipid profile in randomized controlled clinical trials (RCTs). METHODS: We searched PubMed, Scopus, Embase, and Central. RCTs that assess the effects of dairy foods on lipid profile were included. RESULTS: The overall effects of dairy foods on lipid profile were non-significant. Dairy foods were associated with a non-significant reduction in triacylglycerol level, and a non-significant increase in total cholesterol, low density lipoprotein cholesterol, and high-density lipoprotein cholesterol level. CONCLUSION: We conclude that dairy foods doesn't have any unfavorable effects on lipids.

Effects of Conjugated Linoleic Acid Intake in the Form of Dietary Supplement or Enriched Food on C-Reactive Protein and Lipoprotein (a) Levels in Humans: A Literature Review and Meta-Analysis.

BACKGROUND: C-reactive protein (CRP) and lipoprotein (a) (Lp[a]) play essential roles in cardiovascular disease incidence. This study aimed to review the association between the intake of conjugated linoleic acid (CLA) in the form of dietary supplement or enriched food with different treatment durations and the levels of Lp(a) and CRP in human studies. METHODS: All the articles published in Cochrane Library, ProQuest, Scopus, and Google Scholar from November 2014 to October 2015 were searched and the clinical trials on the effects of CLA on Lp(a) and CRP levels were assessed. Of the 2249 articles initially retrieved, 21 eligible randomized clinical trials were enrolled in this systematic review. The publication dates of the eligible articles ranged from 2005 to 2013. The mean difference and the standard deviation of changes in CRP and Lp(a) levels in intervention and control groups were used as effect-size measures for meta-analysis. The obtained data from the eligible randomized controlled trials were meta-analyzed using Stata, version 13. RESULTS: The intake of CLA as a dietary supplement led to a significant increase in CRP levels (standardized mean difference [SMD]=0.41, 95% CI: 0.28 to 0.54; P=0.001). Subgroup analysis based on the duration of CLA consumption showed that CLA consumption more than 24 weeks resulted in a significant increase in the levels of CRP (SMD=0.52, 95% CI: 0.36 to 0.68; P=0.001) and Lp(a) (SMD=0.24, 95% CI: 0.01 to 0.47; P=0.04). CONCLUSION: The current systematic review and meta-analysis showed that the long-term consumption of CLA increases the levels of CRP and Lp(a).

Role of Fatty Acids Intake in Generalized Vitiligo.

BACKGROUND: Previous studies indicated the effect of fat on autoimmune diseases. The present study was aimed to investigate the association between fat intake and vitiligo. METHODS: This case-control study was conducted in the Skin and Leishmania Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Intakes of fatty acids were examined for their relation to risk of vitiligo among 100 cases and 110 controls. We included patients who suffered from generalized or localized vitiligo for <5 years that was approved by a dermatologist via the Vitiligo European Task Force criteria and the vitiligo area scoring index. Fat intake was assessed through individual interviews by a standardized food frequency questionnaire. RESULTS: Vitiligo group consumed more saturated fatty acid (SFA) and less eicosapentaenoic acid and docosahexaenoic acid than control group, while other fatty acids were not significantly different among two groups (P > 0.05). Crude analysis showed that total fat (odds ratio [OR] = 3.33, 95% confidence interval [CI]: 1.46-7.58) and SFA (OR = 2.22, 95% CI: 1.04-4.90) intakes were associated with an increased risk of vitiligo (for highest quartile vs. lowest quartile). Results demonstrated a decrease in the risk of vitiligo for those within the highest quartile of monounsaturated fatty acids intake (OR = 0.41, 95% CI: 0.18-0.92). However, this relationship disappeared after adjustment for confounders as energy, age, sex, and body mass index, except for total fat (OR = 2.84, 95% CI: 1.63-5.44). Crude and adjusted analyses for polyunsaturated fatty acids and cholesterol intake were not statistically significant. CONCLUSIONS: Total-fat content of the diet had more impressive role than the specific subclasses of fats on the incidence risk of vitiligo. High-fat diet escalated the vitiligo risk. Regarding the role of fats on skin autoimmune diseases especially vitiligo, future studies are crucial.

Effect of Conjugated Linoleic Acid as a Supplement or Enrichment in Foods on Blood Glucose and Waist Circumference in Humans: A Metaanalysis.

BACKGROUND: Controversy persists regarding the effect of mixtures of conjugated linoleic acids (c9, t11- and t10, c12-CLA) in fasting blood glucose (FBG) and waist circumference (WC) in humans. OBJECTIVE: The aim of this meta-analysis is to explore the effect of CLA on FBG and WC. METHOD: PubMed, Google Scholar, Cochrane Library, Science Direct, Pro-Quest and Ovid were searched up to January 2015. Studies that examined the effect of CLA supplementation or foods enriched with CLA on FBG and WC in healthy adults were included. Studies in animals or unhealthy individuals and studies other than clinical trials were excluded. Of the 3,095 articles initially retrieved, 32 eligible randomized clinical trials were included in this systematic review. The mean difference and standard deviation of changes in FBG and WC in the intervention and control groups were used as effect size measures for the meta-analysis. RESULTS: Subgroup analysis showed that CLA supplement consumption did not significantly influence FBG (standardized mean differences [SMD] = 0.075 mg/dL; 95% confidence interval (CI) = -0.099 to 0.249; p = 0.399) or WC (SMD = -0.149 cm; 95% CI = -0.522 to 0.225; p = 0.435). Foods enriched in CLA also showed no significant effect on FBG (SMD = 0.126 mg/dL; 95% CI = -0.100 to 0.352; p = 0.274) or WC (SMD = -0.233 cm; 95% CI = -0.625 to 0.159; p = 0.244). CONCLUSION: We conclude that c9, t11- and t10, c12-CLA administered as a supplement or used to enrich foods does not affect FBG or WC in humans.

Association of conjugated linoleic acid consumption and liver enzymes in human studies: A systematic review and meta-analysis of randomized controlled clinical trials.

OBJECTIVE: The aim of this study was to systematically review the association of conjugated linoleic acid (CLA) consumption in two forms of foods enriched or supplemented with CLA on serum liver enzymes in human studies. METHODS: We searched PubMed, Google Scholar, Cochrane Library, ScienceDirect, ProQuest, and Ovid up to January 2015. Studies that examined the effect of CLA supplementation or foods enriched with CLA on liver enzymes concentrations among healthy adults were included. The mean difference and SD of changes in serum liver enzymes between the intervention and control groups were used as effect size for the meta-analysis. RESULTS: The analysis demonstrated that CLA supplementation led to slight and nonsignificant decreases in alkaline phosphatase (ALP) levels (mean difference [MD] -0.216; 95% confidence interval [CI], -0.60 to 0.17; P = 0.28). CLA intake can nonsignificantly increase alanine transaminase (ALT) levels (MD = 0.107 U/L; 95% CI, -0.29 to 0.244; P = 0.124) and can significantly increase aspartate aminotransferase (AST) levels (MD = 0.171 U/L; 95% CI, 0.034-0.307; P = 0.01). Subgroup analysis based on CLA source showed that CLA supplementation or foods enriched with CLA did not significantly alter ALT levels. Subgroup analysis showed that CLA supplementation led to significant increases in AST levels (MD = 0.224 U/L; 95% CI, 0.071-0.376; P = 0.004). However, foods enriched with CLA did not have any significant effects on AST levels. CONCLUSION: CLA supplementation was associated with a significantly increased circulating AST without any significant effect on ALP and ALT levels. Prospective studies are necessary to assess the clinical outcomes of the association between CLA and liver enzyme concentrations.

Effect of honey vinegar syrup on blood sugar and lipid profile in healthy subjects.

BACKGROUND: The impact of honey or vinegar on several metabolic abnormalities has been studied separately, a mixture of these two ingredients known as honey vinegar syrup (HVS) has not been investigated previously so far. The aim of this study was to assess the impact of HVS consumption (Iranian's traditional syrup) on glycemic parameters and lipid profiles in healthy individuals. METHODS: We conducted a 4-week, randomized, controlled, parallel study consisting of two groups of nonobese healthy volunteers. All subjects were asked to stay on their normal diet. Intervention group (n = 36) received a cup of HVS daily in the evening snack for 4-week (250 cc syrup contains 21.66 g honey vinegar). Assessments of fasting blood sugar (FBS), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were conducted at the baseline and after 4-week of study. RESULTS: We observed no significant effect of HVS on FBS, HOMA-IR, LDL-C and TG. A significant effect of HVS was found on increasing fasting insulin and HOMA-IR and reduction in TC level only in intervention group (Δ =3.39 P = 0.01, Δ =1.65 P = 0.03, Δ = -9.43 P = 0.005, respectively). Changes of FBS, TG and LDL-C were 1.83 mg/dl, -1.53 mg/dl and - 3.99 mg/dl respectively in the intervention group. These changes were not significant. An unfavorable and significant reduction in HDL-C level was also observed between two groups (Δ = -4.82 P < 0.001 in the intervention group). CONCLUSIONS: Honey vinegar syrup increased fasting insulin level and decreased TC level in the intervention group. HVS had an unfavorable effect on HDL-C level. Further prospective investigations are warranted to confirm these findings.