RESUMO
Recent dietary reference intake workshops focusing on nutrient requirements in chronic disease populations have called attention to the potential adverse effects of chronic medication use on micronutrient status. Although this topic is mostly ill defined in the literature, several noteworthy drug-nutrient interactions (DNIs) are of clinical and public health significance. The purpose of this narrative review is to showcase classic examples of DNIs and their impact on micronutrient status, including those related to antidiabetic, anticoagulant, antihypertensive, antirheumatic, and gastric acid-suppressing medications. Purported DNIs related to other drug families, while relevant and worthy of discussion, are not included. Unlike previous publications, this review is primarily focused on DNIs that have sufficient evidence supporting their inclusion in US Food and Drug Administration labeling materials and/or professional guidelines. While the evidence is compelling, more high-quality research is needed to establish clear and quantitative relationships between chronic medication use and micronutrient status.
Assuntos
Micronutrientes , Estado Nutricional , Humanos , Necessidades NutricionaisRESUMO
PURPOSE: We studied the health benefits of low calorie cranberry beverage consumption on glucoregulation, oxidative damage, inflammation, and lipid metabolism in overweight but otherwise healthy humans. METHODS: 78 overweight or obese men and women (30-70 years; BMI 27-35 kg/m2) with abdominal adiposity (waist: hip > 0.8 for women and > 0.9 for men; waist: height ≥ 0.5) consumed 450 mL placebo or low calorie, high polyphenol cranberry extract beverage (CEB) daily for 8 week in a randomized, double-blind, placebo-controlled, parallel design trial. Blood and urine samples were collected after overnight fast at baseline and after 8 weeks of daily beverage consumption. Blood and urine samples were also collected during 3 oral glucose tolerance test (OGTT) challenges: (1) pre-intervention without the test beverages, (2) following a single dose of placebo or CEB at baseline (week 0), and (3) following a single dose of placebo or CEB at 8 week. RESULTS: Compared to placebo, a single CEB dose at baseline lowered endothelin-1 and elevated nitric oxide and the reduced:oxidized glutathione ratio (P < 0.05). Interferon-γ was elevated (P < 0.05) after a single CEB dose at baseline; however, after 8 week of CEB intervention, fasting C-reactive protein was lower (P < 0.05). CEB consumption for 8 week also reduced serum insulin and increased HDL cholesterol compared to placebo (P < 0.05). CONCLUSIONS: An acute dose of low calorie, high polyphenol cranberry beverage improved antioxidant status, while 8 week daily consumption reduced cardiovascular disease risk factors by improving glucoregulation, downregulating inflammatory biomarkers, and increasing HDL cholesterol.
Assuntos
Bebidas , HDL-Colesterol/efeitos dos fármacos , Inflamação/prevenção & controle , Sobrepeso/metabolismo , Polifenóis/farmacologia , Vaccinium macrocarpon , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/urina , HDL-Colesterol/sangue , HDL-Colesterol/urina , Método Duplo-Cego , Feminino , Glucose/metabolismo , Teste de Tolerância a Glucose , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Sobrepeso/sangue , Sobrepeso/urina , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Polifenóis/administração & dosagemRESUMO
Oat avenanthramides (AVAs) are a group of phenolic alkaloids, consisting of an anthranilic acid and a hydroxycinnamic acid linked by a pseudo-peptide bond. Bioavailability of AVA is poor in humans, suggesting transformations for rapid excretion. Thus, we aim to identify metabolites of AVA isomers in plasma of humans after consuming AVA-enriched oats. After lipid removal, AVA and their metabolites in plasma were extracted with ethyl acetate and analysed using an Agilent UHPLC-QToF-MS. Pharmacokinetics of AVA-O showed a bimodal distribution with Cmax1 and 2 for AVA-O at 5.9 ± 5.2 and 7.9 ± 7.0 ng/mL and Tmax1 and 2 at 1.7 ± 0.7 and 3.1 ± 1.2 h, respectively. Only the methyl-AVA-O showed a single Cmax at 14 ± 9.9 ng/mL AVA-O equivalents and a Tmax of 2.4 ± 2.7 h. This analysis is the first to identify methylated metabolites of AVAs and AVA aglycones in human blood after acute AVA consumption.
Assuntos
Avena/química , Cromatografia Líquida de Alta Pressão , ortoaminobenzoatos/sangue , Idoso , Alanina Transaminase/sangue , Antioxidantes/análise , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Glicemia/metabolismo , Índice de Massa Corporal , Colesterol/sangue , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Fitoquímicos/sangue , Espectrometria de Massas em Tandem , Triglicerídeos/sangueRESUMO
The lack of a biomarker for the consumption of cranberries has confounded the interpretation of several studies investigating the effect of cranberry products, especially juices, on health outcomes. The objectives of this pilot study were to develop a liquid chromatography tandem mass spectrometric method for the quantification of the proanthocyanin dimer A-2 in human urine and validate urinary proanthocyanin dimer A-2 as a biomarker of cranberry intake. Five healthy, nonsmoking, premenopausal women (20-30 years of age, body mass index: 18.5-25 kg/m(2) ) were assigned to consume a cranberry beverage containing 140 mg proanthocyanin and 35 kilocalories at 237 mL/day, according to a weekly dosing schedule for 7 weeks. Eleven 24 h and morning spot urine samples each were collected from each subject. A reliable, sensitive method for the detection of proanthocyanin dimer A-2 in urine using liquid chromatography with tandem mass spectrometry was developed with a limit of quantitation of 0.25 ng/mL and a relative standard deviation of 7.26%, precision of 5.7%, and accuracy of 91.7%. While proanthocyanin dimer A-2 was quantifiable in urine, it did not appear to be excreted in a concentration that corresponded to the dosing schedule and intake of cranberry juice.
Assuntos
Cromatografia Líquida/métodos , Extratos Vegetais/urina , Proantocianidinas/urina , Espectrometria de Massas em Tandem/métodos , Vaccinium macrocarpon/metabolismo , Adulto , Biomarcadores/química , Biomarcadores/metabolismo , Biomarcadores/urina , Dimerização , Feminino , Humanos , Masculino , Extratos Vegetais/química , Extratos Vegetais/metabolismo , Proantocianidinas/química , Proantocianidinas/metabolismo , Adulto JovemRESUMO
Polypharmacy regimens may increase the susceptibility of older adults to micronutrient inadequacy and deficiency via impairment of nutritional status. We hypothesized that a multi-vitamin-mineral supplement (MVMS) could improve nutritional status in older adults prescribed diuretics, metformin, and/or proton pump inhibitors (PPIs). We conducted a randomized, double-blind, placebo controlled, parallel clinical trial in which eligible subjects were instructed to consume either a MVMS or placebo for 16 wk. Fasting blood was collected at baseline, 8, and 16 wk and the status of selected vitamins and minerals determined. Thirty-five and 19 men and women aged 45-75 yrs in the in MVMS and placebo arms, respectively, completed the trial. The mean total number of medications among the three drug classes taken by participants did not differ between two groups. The status of vitamins B1, B12, C and folate and calcium, copper, magnesium and zinc at baseline were within normal ranges. The MVMS group had a greater change in nutrient status after 16 wk compared to the placebo group for serum folate (7.5 vs. -1.6 ng/mL, p < 0.0001), vitamin B12 (159.2 vs. -33.9 pg/mL, p = 0.007), and plasma vitamin C (0.2 vs. 0.0 mg/dL, p = 0.004). Other measured vitamins and minerals were not significantly changed during the intervention. In conclusion, the status of vitamins B12, C and folate improved with MVMS but remained within normal ranges in older adults taking diuretics, metformin, and/or PPIs.
Assuntos
Preparações Farmacêuticas , Vitaminas , Idoso , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , Masculino , Minerais , Estado NutricionalRESUMO
Tree nuts contain an array of phytochemicals including carotenoids, phenolic acids, phytosterols and polyphenolic compounds such as flavonoids, proanthocyanidins (PAC) and stilbenes, all of which are included in nutrient databases, as well as phytates, sphingolipids, alkylphenols and lignans, which are not. The phytochemical content of tree nuts can vary considerably by nut type, genotype, pre- and post-harvest conditions, as well as storage conditions. Genotype affects phenolic acids, flavonoids, stilbenes and phytosterols, but data are lacking for many other phytochemical classes. During the roasting process, tree nut isoflavones, flavanols and flavonols were found to be more resistant to heat than the anthocyanins, PAC and trans-resveratrol. The choice of solvents used for extracting polyphenols and phytosterols significantly affects their quantification, and studies validating these methods for tree nut phytochemicals are lacking. The phytochemicals found in tree nuts have been associated with antioxidant, anti-inflammatory, anti-proliferative, antiviral, chemopreventive and hypocholesterolaemic actions, all of which are known to affect the initiation and progression of several pathogenic processes. While tree nut phytochemicals are bioaccessible and bioavailable in humans, the number of intervention trials conducted to date is limited. The objectives of the present review are to summarise tree nut: (1) phytochemicals; (2) phytochemical content included in nutrient databases and current publications; (3) phytochemicals affected by pre- and post-harvest conditions and analytical methodology; and (4) bioactivity and health benefits in humans.
Assuntos
Antioxidantes/uso terapêutico , Magnoliopsida/química , Nozes/química , Fitoterapia , Extratos Vegetais/uso terapêutico , Agricultura/métodos , Anti-Inflamatórios/análise , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Anticolesterolemiantes/análise , Anticolesterolemiantes/farmacologia , Anticolesterolemiantes/uso terapêutico , Antineoplásicos Fitogênicos/análise , Antineoplásicos Fitogênicos/farmacologia , Antineoplásicos Fitogênicos/uso terapêutico , Antioxidantes/análise , Antioxidantes/farmacologia , Antivirais/análise , Antivirais/farmacologia , Antivirais/uso terapêutico , Humanos , Extratos Vegetais/química , Extratos Vegetais/farmacologia , ÁrvoresRESUMO
In vitro studies show Hibiscus sabdariffa L., an ingredient found in many herbal tea blends and other beverages, has antioxidant properties, and, in animal models, extracts of its calyces have demonstrated hypocholesterolemic and antihypertensive properties. Our objective in this study was to examine the antihypertensive effects of H. sabdariffa tisane (hibiscus tea) consumption in humans. A randomized, double-blind, placebo-controlled clinical trial was conducted in 65 pre- and mildly hypertensive adults, age 30-70 y, not taking blood pressure (BP)-lowering medications, with either 3 240-mL servings/d of brewed hibiscus tea or placebo beverage for 6 wk. A standardized method was used to measure BP at baseline and weekly intervals. At 6 wk, hibiscus tea lowered systolic BP (SBP) compared with placebo (-7.2 +/- 11.4 vs. -1.3 +/- 10.0 mm Hg; P = 0.030). Diastolic BP was also lower, although this change did not differ from placebo (-3.1 +/- 7.0 vs. -0.5 +/- 7.5 mm Hg; P = 0.160). The change in mean arterial pressure was of borderline significance compared with placebo (-4.5 +/- 7.7 vs. -0.8 +/- 7.4 mm Hg; P = 0.054). Participants with higher SBP at baseline showed a greater response to hibiscus treatment (r = -0.421 for SBP change; P = 0.010). No effects were observed with regard to age, gender, or dietary supplement use. These results suggest daily consumption of hibiscus tea, in an amount readily incorporated into the diet, lowers BP in pre- and mildly hypertensive adults and may prove an effective component of the dietary changes recommended for people with these conditions.
Assuntos
Anti-Hipertensivos/uso terapêutico , Bebidas , Pressão Sanguínea/efeitos dos fármacos , Hibiscus , Hipertensão/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Adulto , Idoso , Anti-Hipertensivos/farmacologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/farmacologiaRESUMO
BACKGROUND: Compared with other common plant foods, walnuts (Juglans regia) are consistently ranked among the highest in antioxidant capacity. In vitro, walnut polyphenols inhibit plasma and LDL oxidation, while in animal models they lower biomarkers of oxidative stress and raise antioxidant capacity. A limited number of human feeding trials indicate that walnuts improve some measures of antioxidant status, but not others. METHODS: A 19 wk, randomized crossover trial was conducted in 21 generally healthy men and postmenopausal women > or = 50 y to study the dose-response effects of walnut intake on biomarkers of antioxidant activity, oxidative stress, and nutrient status. Subjects were randomized to receive either 21 or 42 g raw walnuts/d during each 6 wk intervention phase with a 6 wk washout between phases. Subjects were instructed to consume their usual diet, but refrain from eating any other tree nuts, seeds, peanuts, or ellagitannin-rich foods during the entire study, and other polyphenol-rich foods for 2 d prior to each study visit. RESULTS: Compared to baseline levels, red blood cell (RBC) linoleic acid and plasma pyridoxal phosphate (PLP) were significantly higher after 6 wk with 42 g/d walnuts (P < 0.05 for both). Overall, changes in plasma total thiols, and other antioxidant biomarkers, were not significant with either walnut dose. However, when compared to fasting levels, plasma total thiols were elevated within 1 h of walnut consumption with both doses during the baseline and end visits for each intervention phase (P < 0.05 for all). Despite the observed increase in RBC linoleic and linolenic acids associated with walnut consumption, this substrate for lipid peroxidation only minimally affected malondialdehyde (MDA) and antioxidant capacity. The proportional changes in MDA and Oxygen Radical Absorbance Capacity (ORAC) were consistent with a dose-response effect, although no significant within- or between-group differences were observed for these measures. CONCLUSIONS: Walnut consumption did not significantly change the plasma antioxidant capacity of healthy, well-nourished older adults in this pilot study. However, improvements in linoleic acid and pyridoxal phosphate were observed with chronic consumption, while total plasma thiols were enhanced acutely. Future studies investigating the antioxidant effects of walnuts in humans are warranted, but should include either a larger sample size or a controlled feeding intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00626691.
Assuntos
Antioxidantes/análise , Dieta , Juglans , Estado Nutricional , Sementes , Idoso , Colesterol/sangue , LDL-Colesterol/sangue , Estudos Cross-Over , Eritrócitos/química , Feminino , Humanos , Juglans/química , Ácido Linoleico/sangue , Ácidos Linolênicos/sangue , Peroxidação de Lipídeos , Masculino , Malondialdeído/sangue , Micronutrientes/sangue , Pessoa de Meia-Idade , Estresse Oxidativo , Projetos Piloto , Pós-Menopausa , Fosfato de Piridoxal/sangue , Espécies Reativas de Oxigênio/sangue , Espécies Reativas de Oxigênio/química , Sementes/química , Compostos de Sulfidrila/sangue , Triglicerídeos/sangueRESUMO
The pharmacokinetics of mycophenolate mofetil (MMF) in liver transplant recipients may change because of pharmacokinetic interactions with coadministered immunosuppressants or because changes in the enterohepatic anatomy may affect biotransformation of MMF to mycophenolic acid (MPA) and enterohepatic recirculation of MPA through the hydrolysis of mycophenolate acid glucuronide to MPA in the gut. In the latter case, the choice of formulation (oral versus intravenous) could have important clinical implications. We randomized liver transplant patients (n = 60) to standard (10-15 ng/mL) or reduced (5-8 ng/mL) trough levels of tacrolimus plus intravenous MMF followed by oral MMF (1 g twice daily) with corticosteroids. Pharmacokinetic sampling was performed after the last intravenous MMF dose, after the first oral MMF dose, and at selected times over 52 weeks. The efficacy and safety of the 2 regimens were also assessed. Twenty-eight and 27 patients in the tacrolimus standard-dose and reduced-dose groups, respectively, were evaluated. No significant differences between the tacrolimus standard-dose and reduced-dose groups were seen in dose-normalized MPA values of the time to the maximum plasma concentration (1.25 versus 1.28 hours), the maximum plasma concentration (15.5 +/- 7.93 versus 13.6 +/- 7.03 microg/mL), or the area under the concentration-time curve from 0 to 12 hours (AUC(0-12); 53.0 +/- 20.6 versus 43.8 +/- 15.5 microg h/mL) at week 26 or at any other time point. No relationship was observed between the tacrolimus trough or AUC(0-12) and MPA AUC(0-12). Exposure to MPA after oral and intravenous administration was similar. Safety and efficacy were similar in the two treatment groups. In conclusion, exposure to MPA is not a function of exposure to tacrolimus. The similar safety and efficacy seen with MMF plus standard or reduced doses of tacrolimus suggest that MMF could be combined with reduced doses of tacrolimus.
Assuntos
Imunossupressores/farmacocinética , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Tacrolimo/farmacocinética , Administração Oral , Adulto , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/sangue , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/sangue , Ácido Micofenólico/farmacocinética , Tacrolimo/administração & dosagem , Tacrolimo/sangue , Resultado do TratamentoRESUMO
Evidence from observational and intervention studies has shown a high intake of tree nuts is associated with a reduced risk of cardiovascular disease (CVD), mortality from type 2 diabetes (T2DM), and all-cause mortality. However, there is limited data regarding their effects on indicators of cardiometabolic risk other than hypercholesterolemia, and little is known about the demonstrable health benefits of pecans (Carya illinoensis (Wangenh.) K.Koch). We conducted a randomized, controlled feeding trial to compare the effects of a pecan-rich diet with an isocaloric control diet similar in total fat and fiber content, but absent nuts, on biomarkers related to CVD and T2DM risk in healthy middle-aged and older adults who are overweight or obese with central adiposity. After 4 weeks on a pecan-rich diet, changes in serum insulin, insulin resistance (HOMA-IR) and beta cell function (HOMA-ß) were significantly greater than after the control diet (p < 0.05). Pecan consumption also lowered the risk of cardiometabolic disease as indicated by a composite score reflecting changes in clinically relevant markers. Thus, compared to the control diet, the pecan intervention had a concurrent and clinically significant effect on several relevant markers of cardiometabolic risk.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Carya , Alimento Funcional , Transtornos do Metabolismo de Glucose/prevenção & controle , Resistência à Insulina , Nozes , Obesidade Abdominal/dietoterapia , Adiposidade , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Boston/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Estudos Cross-Over , Fenômenos Fisiológicos da Nutrição do Idoso , Feminino , Transtornos do Metabolismo de Glucose/epidemiologia , Transtornos do Metabolismo de Glucose/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Obesidade Abdominal/metabolismo , Obesidade Abdominal/fisiopatologia , Sobrepeso/sangue , Sobrepeso/dietoterapia , Sobrepeso/metabolismo , Sobrepeso/fisiopatologia , Fatores de Risco , Método Simples-CegoRESUMO
The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug-nutrient interactions is quite limited. A comprehensive, updated review of the potential drug-nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U.S. adult population is presented. For the majority of the interactions described in this paper, more high-quality intervention trials are needed to better understand their clinical importance and potential consequences. A number of these studies have identified potential risk factors that may make certain populations more susceptible, but guidelines on how to best manage and/or prevent drug-induced nutrient inadequacies are lacking. Although widespread supplementation is not currently recommended, it is important to ensure at-risk patients reach their recommended intakes for vitamins and minerals. In conjunction with an overall healthy diet, appropriate dietary supplementation may be a practical and efficacious way to maintain or improve micronutrient status in patients at risk of deficiencies, such as those taking medications known to compromise nutritional status. The summary evidence presented in this review will help inform future research efforts and, ultimately, guide recommendations for patient care.
RESUMO
The American cranberry (Vaccinium macrocarpon) is one of the three commercially important fruits native to North America. Cranberries are a particularly rich source of phenolic phytochemicals, including phenolic acids (benzoic, hydroxycinnamic, and ellagic acids) and flavonoids (anthocyanins, flavonols, and flavan-3-ols). A growing body of evidence suggests that polyphenols, including those found in cranberries, may contribute to reducing the risk of cardiovascular disease (CVD) by increasing the resistance of LDL to oxidation, inhibiting platelet aggregation, reducing blood pressure, and via other anti-thrombotic and anti-inflammatory mechanisms. Research regarding the bioactivity of cranberries and their constituents on risk factors for CVD is reviewed.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Fitoterapia/métodos , Vaccinium macrocarpon , Animais , Antioxidantes/efeitos adversos , Antioxidantes/uso terapêutico , LDL-Colesterol/efeitos dos fármacos , Flavonoides , Humanos , Proantocianidinas/efeitos adversos , Proantocianidinas/uso terapêutico , Ratos , Fatores de Risco , Vaccinium macrocarpon/efeitos adversosRESUMO
AIMS: To compare the pharmacokinetics of mycophenolic acid (MPA) and its metabolite (MPAG) when mycophenolate mofetil (MMF) is administered in combination with sirolimus or ciclosporin (CsA) in renal allograft recipients. Safety and efficacy (biopsy-proven acute rejection (BPAR)) were also assessed. METHODS: Patients (n = 45) were randomized 2 : 1 to receive treatment with sirolimus (n = 30; dosed to maintain trough concentrations of 10-25 ng ml(-1) until week 8, and then 8-15 ng ml(-1) thereafter) or CsA (n = 15; administered as per centre practice) both in combination with daclizumab, oral MMF and corticosteroids. Pharmacokinetic assessments were performed at day 7, week 4, and months 3 and 6 post-transplant. The primary endpoint was the AUC(0,12 h) for MPA and MPAG. The pharmacokinetics of sirolimus were also assessed. RESULTS: MPA exposure was 39-50% lower (month 6 mean AUC(0,12 h) (95%CI): 40.4 (33.8, 47.0) vs. 68.5 (54.9, 82.0) microg ml(-1) h) and MPAG exposure was 25-52% higher (722 (607, 838) vs. 485 (402, 569) microg ml(-1) h at month 6) in the presence of CsA compared with sirolimus across visits. BPAR was 40.0% with sirolimus and 13.3% with CsA. The incidence of hypertension, tremors and hirsutism was higher with CsA than with sirolimus, while the incidence of diarrhoea, hyperlipidaemia and impaired wound closure was higher with sirolimus. No deaths, malignancies or graft losses were reported. CONCLUSIONS: Co-administration of sirolimus with MMF led to greater MPA exposure, but lower MPAG exposure, than co-administration with CsA. As rejection rates were higher in the absence of CsA, further study of calcineurin inhibitor-free regimens is required before general recommendations can be made.
Assuntos
Ciclosporina/farmacocinética , Rejeição de Enxerto/metabolismo , Rejeição de Enxerto/prevenção & controle , Transplante de Rim , Ácido Micofenólico/análogos & derivados , Sirolimo/farmacocinética , Adulto , Idoso , Ciclosporina/administração & dosagem , Ciclosporina/efeitos adversos , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/tratamento farmacológico , Humanos , Leucopenia/induzido quimicamente , Leucopenia/metabolismo , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/efeitos adversos , Ácido Micofenólico/farmacocinética , Estudos Prospectivos , Sirolimo/administração & dosagem , Sirolimo/efeitos adversosRESUMO
Education level, more than any other socioeconomic factor, can predict disease risk, health behavior patterns, and diet quality. It has been suggested that one reason higher education promotes more healthful diets is that better-educated people may get better nutrition information. We present data from a survey examining specific sources of nutrition information among an older adult population (age >50 years, n=176), and compare the difference in sources associated with extent of education. Reliance on doctors, television, and neighbors was significantly higher among those with less education (P<0.05). Our results also show that less-educated older adults rely more upon different specific sources for their nutrition information than those who have attained a higher level of education. Strategies to improve and/or ensure the quality of the specific nutrition information sources this vulnerable group relies on may be needed.
Assuntos
Dieta/normas , Escolaridade , Comportamentos Relacionados com a Saúde , Meios de Comunicação de Massa/normas , Ciências da Nutrição , Idoso , Idoso de 80 Anos ou mais , Boston , Dieta/psicologia , Ingestão de Alimentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ciências da Nutrição/educação , Fatores SocioeconômicosRESUMO
While dietary fiber plays an important role in the health benefits associated with whole grain consumption, other ingredients concentrated in the outer bran layer, including alkylresorcinols, lignans, phenolic acids, phytosterols, and tocols, may also contribute to these outcomes. To determine the acute bioavailability and pharmacokinetics of the major phytochemicals found in barley and oats, we conducted a randomized, three-way crossover trial in 13 healthy subjects, aged 40-70 years with a body mass index (BMI) of 27-35.9 kg/m². After a two-day run-in period following a diet low in phytochemicals, subjects were randomized to receive muffins made with either 48 g whole oat flour, whole barley flour, or refined wheat flour plus cellulose (control), with a one-week washout period between each intervention. At the same time, an oral glucose tolerance test was administered. In addition to plasma phytochemical concentrations, glucose and insulin responses, biomarkers of antioxidant activity, lipid peroxidation, inflammation, and vascular remodeling were determined over a 24-h period. There was no significant effect on acute bioavailability or pharmacokinetics of major phytochemicals. Administered concurrently with a glucose bolus, the source of whole grains did not attenuate the post-prandial response of markers of glucoregulation and insulin sensitivity, inflammation, nor vascular remodeling compared to the refined grain control. No significant differences were observed in the bioavailability or postprandial effects between whole-oat and whole-barley compared to a refined wheat control when administered with a glucose challenge. These null results may be due, in part, to the inclusion criteria for the subjects, dose of the whole grains, and concurrent acute administration of the whole grains with the glucose bolus.
Assuntos
Avena/química , Farinha , Hordeum/química , Compostos Fitoquímicos/farmacocinética , Período Pós-Prandial/efeitos dos fármacos , Adulto , Idoso , Análise de Variância , Área Sob a Curva , Disponibilidade Biológica , Glicemia/análise , Estudos Cross-Over , Método Duplo-Cego , Feminino , Glucose/administração & dosagem , Teste de Tolerância a Glucose , Voluntários Saudáveis , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Edulcorantes/administração & dosagem , Triticum/químicaRESUMO
Cranberries (Vaccinium macrocarpon) are a rich source of phenolic phytochemicals, which likely contribute to their putative health benefits. A single-dose pharmacokinetic trial was conducted in 10 healthy adults ⩾50y to evaluate the acute (24-h) absorption and excretion of flavonoids, phenolic acids and proanthocyanidins (PACs) from a low-calorie cranberry juice cocktail (54% juice). Inter-individual variability was observed in the Cmax and Tmax of many of these compounds in both plasma and urine. The sum total concentration of phenolics detected in plasma reached a peak of 34.2µg/ml between 8 and 10h, while in urine this peak was 269.8µg/mg creatinine, and appeared 2-4h earlier. The presence of PAC-A2 dimers in human urine has not previously been reported. After cranberry juice consumption, plasma total antioxidant capacity assessed using ORAC and TAP assays correlated with individual metabolites. Our results show phenolic compounds in cranberry juice are bioavailable and exert antioxidant actions in healthy older adults.
Assuntos
Flavonoides/farmacocinética , Hidroxibenzoatos/farmacocinética , Vaccinium macrocarpon/química , Idoso , Antioxidantes/metabolismo , Disponibilidade Biológica , Feminino , Sucos de Frutas e Vegetais , Humanos , Lipoproteínas LDL/metabolismo , Masculino , Pessoa de Meia-IdadeRESUMO
Improving the effectiveness of written information to promote compliance with therapeutic regimens is essential, particularly among older adults. Guiding their development and evaluating their effectiveness with an accepted communication theory or model may help. A preliminary test of written materials developed within the context of the Extended Parallel Process Model (EPPM) to motivate compliant behaviors among older adults at risk for cardiovascular disease is described. Participants who were not previously following the recommendations felt more confident in their ability to do so after reading a high-threat/high-efficacy message. Advanced age, lower education level, an existing chronic illness, and a higher initial homocysteine level were factors associated with lower levels of perceived threat and/or fear and may have attenuated the effectiveness of the message. This study's results contribute to our understanding of the usefulness of theory-guided written materials in motivating compliant health behaviors. Recommendations for using this model are provided.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/métodos , Homocisteína/efeitos adversos , Materiais de Ensino , Doenças Cardiovasculares/sangue , Feminino , Homocisteína/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Cardiovascular disease remains the leading cause of morbidity and mortality in the United States and other developed countries, and is fast growing in developing countries, particularly as life expectancy in all parts of the world increases. Current recommendations for the prevention of cardiovascular disease issued jointly from the American Academy of Cardiology and American Heart Association emphasize that lifestyle modification should be incorporated into any treatment plan, including those on statin drugs. However, there is a dearth of data on the interaction between diet and statins with respect to additive, complementary or antagonistic effects. This review collates the available data on the interaction of statins and dietary patterns, cognition, genetics and individual nutrients, including vitamin D, niacin, omega-3 fatty acids, fiber, phytochemicals (polyphenols and stanols) and alcohol. Of note, although the available data is summarized, the scope is limited, conflicting and disparate. In some cases it is likely there is unrecognized synergism. Virtually no data are available describing the interactions of statins with dietary components or dietary pattern in subgroups of the population, particularly those who may benefit most were positive effects identified. Hence, it is virtually impossible to draw any firm conclusions at this time. Nevertheless, this area is important because were the effects of statins and diet additive or synergistic harnessing the effect could potentially lead to the use of a lower intensity statin or dose.
Assuntos
Interações Alimento-Droga , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacocinética , Doenças Cardiovasculares/prevenção & controle , Cognição/efeitos dos fármacos , Dieta , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estados UnidosRESUMO
In our efforts to understand how various dietary factors can influence the risk and progression of chronic disease, much recent research has focused on phytochemicals. Phytochemicals are defined as nonessential nutrients found in plant-based food, many of which have been established as bioactive and thus may affect human health. The largest group of phytochemicals is the polyphenols, comprised principally of the flavonoids, which are characterized chemically by two benzene rings joined by a linear carbon chain. Evidence from observational studies indicates that regular consumption of foods containing flavonoids may reduce the risk several chronic conditions, including neurodegenerative diseases, atherosclerosis, and certain forms of cancer. These results have generated considerable interest in flavonoids, although much basic information about their nutrient characteristics in humans remains limited, e.g., their bioavailability and metabolism, interactions with other dietary factors, mechanisms of action, and intakes associated with specific health outcomes. Although flavonoids are commonly defined as dietary antioxidants and their putative health benefits commonly attributed to this mechanism, it now appears their principal actions are mediated in vivo via other biochemical and molecular pathways.
Assuntos
Doença Crônica/prevenção & controle , Dieta , Flavonoides/uso terapêutico , Plantas Comestíveis/química , Flavonoides/efeitos adversos , Flavonoides/química , Flavonoides/farmacologia , Humanos , Extratos Vegetais/efeitos adversos , Extratos Vegetais/química , Extratos Vegetais/farmacologiaRESUMO
OBJECTIVE: We assessed whether a wheat bran extract containing arabino-xylan-oligosaccharide (AXOS) elicited a prebiotic effect and influenced other physiologic parameters when consumed in ready-to-eat cereal at two dose levels. METHODS: This double-blind, randomized, controlled, crossover trial evaluated the effects of consuming AXOS at 0 (control), 2.2, or 4.8 g/d as part of ready-to-eat cereal for 3 wk in 55 healthy men and women. Fecal microbial levels, postprandial serum ferulic acid concentrations, and other physiologic parameters were assessed at the beginning and end of each condition. RESULTS: The median bifidobacteria content of stool samples (log10/grams of dry weight [DW]) was found to be higher in the subjects consuming the 4.8-g/d dose (10.03) than in those consuming 2.2 g/d (9.93) and control (9.84, P < 0.001). No significant changes in the populations of other fecal microbes were observed, indicating a selective increase in fecal bifidobacteria. Postprandial ferulic acid was measured at 120 min at the start and end of each 3-wk treatment period in subjects at least 50 y old (n = 37) and increased in a dose-dependent manner (end-of-treatment values 0.007, 0.050, and 0.069 µg/mL for the control, AXOS 2.2 g/d, and AXOS 4.8 g/d conditions, respectively, P for trend < 0.001). CONCLUSION: These results indicate that AXOS has prebiotic properties, selectively increasing fecal bifidobacteria, and increases postprandial ferulic acid concentrations in a dose-dependent manner in healthy men and women.