Objectives Serum β-carotene (BC) concentrations are not reflective of dietary BC status as serum ... more Objectives Serum β-carotene (BC) concentrations are not reflective of dietary BC status as serum concentrations can vary as a result of intake, lifestyle factors, adiposity, and physiological factors related to digestion and absorption. Longitudinal studies have shown a positive relationship between serum carotenoids and dietary BC intake, but the role of body mass index (BMI), as a surrogate for adiposity, in predicting serum BC concentrations is not well understood. The primary objective was to determine the role of BMI in the association between reported dietary BC intakes and serum BC concentrations. Methods Relationships between serum BC and reported dietary intake of BC were estimated using data from National Health and Nutrition Examination Surveys (NHANES)/What We Eat in America (WWEIA) survey 2003–2006 for 2580 male and non-pregnant female participants aged 20–85 years in the United States (US). The distributions of reported dietary and serum BC concentrations were skewed, ...
Objectives Dietary carotenoids β-carotene (BCAR), lutein (LUT), and lycopene (LYC) are sourced fr... more Objectives Dietary carotenoids β-carotene (BCAR), lutein (LUT), and lycopene (LYC) are sourced from fruits and vegetables. The bioavailability of carotenoids is dependent on multiple post-digestion factors, especially the presence of fat in the diet. However, there is a gap in knowledge about whether specific fatty acid classes affect serum carotenoid concentrations. Our primary objective was to assess the association between carotenoid concentrations and reported intake of specific fatty acid classes, utilizing data from What We Eat in America (WWEIA)/National Health and Nutrition Examination Surveys (NHANES). Methods Data from 9182 male and female participants 20–85 years of age in the NHANES 2003–2006 nationally representative, cross-sectional survey were analyzed to determine the relationships between BCAR, LUT, and LYC concentrations and reported saturated (SFA), monounsaturated (MUFA), and polyunsaturated (PUFA) fatty acid intakes. Due to skewing, we log transformed BCAR. Mult...
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes... more Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments an...
For those individuals who are unable to consume adequate long chain omega-3 fatty acids (LCn3) fr... more For those individuals who are unable to consume adequate long chain omega-3 fatty acids (LCn3) from dietary sources, fish oil supplementation is an attractive alternative Pre-emulsified fish oil supplements, an alternative to capsular triacylglycerol, may enhance the uptake of LCn3 fatty acids it contains. A randomized, Latin-square crossover design was used to compare the effects of four fish oil supplement preparations (Emulsions S, B and N) on phospholipid fatty acid (PLFA) concentrations in ten healthy volunteers compared to oil capsules over 48 h after a single dose and chylomicron fatty acid (CMFA) was evaluated over 8 h. Blood samples were collected at 0, 2, 4, 8, 24 and 48 h and fatty acid concentrations of PLFA and CMFA were determined by gas chromatography and the integrated area under the curve over 40 h (iAUC0-48) was determined. Emulsion S and Emulsion N promoted increased uptake of EPA into PLFA over 48 h when evaluating by iAUC0-48 or individual time points of assessment. No differences were observed between supplements in the CMFA concentrations.
Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and ... more Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and Drug Administration (FDA). When used in combination the drugs may be just as effective as either drug alone, with the added advantages of the need for lower doses of each agent and perhaps fewer side effects. Although the combination has not been approved by the FDA, in 1996 the total number of prescriptions in the United States for fenfluramine and phentermine exceeded 18 million. We identified valvular heart disease in 24 women treated with fenfluramine-phentermine who had no history of cardiac disease. The women presented with cardiovascular symptoms or a heart murmur. As increasing numbers of these patients with similar clinical features were identified, there appeared to be an association between these features and fenfluramine-phentermine therapy. Twenty-four women (mean [+/-SD] age, 44+/-8 years) were evaluated 12.3+/-7.1 months after the initiation of fenfluramine-phentermine therapy. Echocardiography demonstrated unusual valvular morphology and regurgitation in all patients. Both right-sided and left-sided heart valves were involved. Eight women also had newly documented pulmonary hypertension. To date, cardiac surgical intervention has been required in five patients. The heart valves had a glistening white appearance. Histopathological findings included plaque-like encasement of the leaflets and chordal structures with intact valve architecture. The histopathological features were identical to those seen in carcinoid or ergotamine-induced valve disease. These cases arouse concern that fenfluramine-phentermine therapy may be associated with valvular heart disease. Candidates for fenfluramine-phentermine therapy should be informed about serious potential adverse effects, including pulmonary hypertension and valvular heart disease.
Epidemiologic studies have found whole-grain intake to be inversely associated with the risk of t... more Epidemiologic studies have found whole-grain intake to be inversely associated with the risk of type 2 diabetes and heart disease. We tested the hypothesis that whole-grain consumption improves insulin sensitivity in overweight and obese adults. This controlled experiment compared insulin sensitivity between diets (55% carbohydrate, 30% fat) including 6-10 servings/d of breakfast cereal, bread, rice, pasta, muffins, cookies, and snacks of either whole or refined grains. Total energy needs were estimated to maintain body weight. Eleven overweight or obese [body mass index (in kg/m(2)): 27-36] hyperinsulinemic adults aged 25-56 y participated in a randomized crossover design. At the end of each 6-wk diet period, the subjects consumed 355 mL (12 oz) of a liquid mixed meal, and blood samples were taken over 2 h. The next day a euglycemic hyperinsulinemic clamp test was administered. Fasting insulin was 10% lower during consumption of the whole-grain than during consumption of the refined-grain diet (mean difference: -15 +/- 5.5 pmol/L; P = 0.03). After the whole-grain diet, the area under the 2-h insulin curve tended to be lower (-8832 pmol.min/L; 95% CI: -18720, 1062) than after the refined-grain diet. The rate of glucose infusion during the final 30 min of the clamp test was higher after the whole-grain diet (0.07 x 10(-4) mmol.kg(-1).min(-1) per pmol/L; 95% CI: 0.003 x 10(-4), 0.144 x 10(-4)). Insulin sensitivity may be an important mechanism whereby whole-grain foods reduce the risk of type 2 diabetes and heart disease.
Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutr... more Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data). Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They ...
Patients and their physicians remain confused about which dietary advice to follow. Substantial e... more Patients and their physicians remain confused about which dietary advice to follow. Substantial evidence indicates that energy-appropriate, whole-food diets containing unrefined grains, an abundance of fruits and vegetables, low-fat dairy products, low-fat protein sources, and carefully chosen fats and oils can contribute significantly to chronic disease risk reduction. This article focuses on dietary composition with respect to energy-providing macronutrients, such as carbohydrate, protein, and fat; addresses dietary topics of current interest, such as glycemic index, whole grains, and plant sterols; and presents evidence-based research on adequate intake levels of macronutrients for optimal nutrition and disease risk reduction.
About 9% of average dietary energy intake in the United States comes from fructose. Such a high c... more About 9% of average dietary energy intake in the United States comes from fructose. Such a high consumption raises concern about the metabolic effects of this sugar. The objective of this study was to determine the effect of dietary fructose on plasma lipids. The study was conducted in the General Clinical Research Center at Fairview-University of Minnesota Medical Center. The participants were 24 healthy adult volunteers (12 men and 12 women; 6 of each sex were aged <40 y and 6 of each sex were aged >/=40 y). All subjects received 2 isoenergetic study diets assigned by using a randomized, balanced crossover design. One diet provided 17% of energy as fructose. The other diet was sweetened with glucose and was nearly devoid of fructose. Each diet was fed for 6 wk. Both diets were composed of common foods and contained nearly identical amounts of carbohydrate, protein, fat, fiber, cholesterol, and saturated, monounsaturated, and polyunsaturated fatty acids. All meals were prepar...
Objectives Serum β-carotene (BC) concentrations are not reflective of dietary BC status as serum ... more Objectives Serum β-carotene (BC) concentrations are not reflective of dietary BC status as serum concentrations can vary as a result of intake, lifestyle factors, adiposity, and physiological factors related to digestion and absorption. Longitudinal studies have shown a positive relationship between serum carotenoids and dietary BC intake, but the role of body mass index (BMI), as a surrogate for adiposity, in predicting serum BC concentrations is not well understood. The primary objective was to determine the role of BMI in the association between reported dietary BC intakes and serum BC concentrations. Methods Relationships between serum BC and reported dietary intake of BC were estimated using data from National Health and Nutrition Examination Surveys (NHANES)/What We Eat in America (WWEIA) survey 2003–2006 for 2580 male and non-pregnant female participants aged 20–85 years in the United States (US). The distributions of reported dietary and serum BC concentrations were skewed, ...
Objectives Dietary carotenoids β-carotene (BCAR), lutein (LUT), and lycopene (LYC) are sourced fr... more Objectives Dietary carotenoids β-carotene (BCAR), lutein (LUT), and lycopene (LYC) are sourced from fruits and vegetables. The bioavailability of carotenoids is dependent on multiple post-digestion factors, especially the presence of fat in the diet. However, there is a gap in knowledge about whether specific fatty acid classes affect serum carotenoid concentrations. Our primary objective was to assess the association between carotenoid concentrations and reported intake of specific fatty acid classes, utilizing data from What We Eat in America (WWEIA)/National Health and Nutrition Examination Surveys (NHANES). Methods Data from 9182 male and female participants 20–85 years of age in the NHANES 2003–2006 nationally representative, cross-sectional survey were analyzed to determine the relationships between BCAR, LUT, and LYC concentrations and reported saturated (SFA), monounsaturated (MUFA), and polyunsaturated (PUFA) fatty acid intakes. Due to skewing, we log transformed BCAR. Mult...
Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes... more Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments an...
For those individuals who are unable to consume adequate long chain omega-3 fatty acids (LCn3) fr... more For those individuals who are unable to consume adequate long chain omega-3 fatty acids (LCn3) from dietary sources, fish oil supplementation is an attractive alternative Pre-emulsified fish oil supplements, an alternative to capsular triacylglycerol, may enhance the uptake of LCn3 fatty acids it contains. A randomized, Latin-square crossover design was used to compare the effects of four fish oil supplement preparations (Emulsions S, B and N) on phospholipid fatty acid (PLFA) concentrations in ten healthy volunteers compared to oil capsules over 48 h after a single dose and chylomicron fatty acid (CMFA) was evaluated over 8 h. Blood samples were collected at 0, 2, 4, 8, 24 and 48 h and fatty acid concentrations of PLFA and CMFA were determined by gas chromatography and the integrated area under the curve over 40 h (iAUC0-48) was determined. Emulsion S and Emulsion N promoted increased uptake of EPA into PLFA over 48 h when evaluating by iAUC0-48 or individual time points of assessment. No differences were observed between supplements in the CMFA concentrations.
Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and ... more Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and Drug Administration (FDA). When used in combination the drugs may be just as effective as either drug alone, with the added advantages of the need for lower doses of each agent and perhaps fewer side effects. Although the combination has not been approved by the FDA, in 1996 the total number of prescriptions in the United States for fenfluramine and phentermine exceeded 18 million. We identified valvular heart disease in 24 women treated with fenfluramine-phentermine who had no history of cardiac disease. The women presented with cardiovascular symptoms or a heart murmur. As increasing numbers of these patients with similar clinical features were identified, there appeared to be an association between these features and fenfluramine-phentermine therapy. Twenty-four women (mean [+/-SD] age, 44+/-8 years) were evaluated 12.3+/-7.1 months after the initiation of fenfluramine-phentermine therapy. Echocardiography demonstrated unusual valvular morphology and regurgitation in all patients. Both right-sided and left-sided heart valves were involved. Eight women also had newly documented pulmonary hypertension. To date, cardiac surgical intervention has been required in five patients. The heart valves had a glistening white appearance. Histopathological findings included plaque-like encasement of the leaflets and chordal structures with intact valve architecture. The histopathological features were identical to those seen in carcinoid or ergotamine-induced valve disease. These cases arouse concern that fenfluramine-phentermine therapy may be associated with valvular heart disease. Candidates for fenfluramine-phentermine therapy should be informed about serious potential adverse effects, including pulmonary hypertension and valvular heart disease.
Epidemiologic studies have found whole-grain intake to be inversely associated with the risk of t... more Epidemiologic studies have found whole-grain intake to be inversely associated with the risk of type 2 diabetes and heart disease. We tested the hypothesis that whole-grain consumption improves insulin sensitivity in overweight and obese adults. This controlled experiment compared insulin sensitivity between diets (55% carbohydrate, 30% fat) including 6-10 servings/d of breakfast cereal, bread, rice, pasta, muffins, cookies, and snacks of either whole or refined grains. Total energy needs were estimated to maintain body weight. Eleven overweight or obese [body mass index (in kg/m(2)): 27-36] hyperinsulinemic adults aged 25-56 y participated in a randomized crossover design. At the end of each 6-wk diet period, the subjects consumed 355 mL (12 oz) of a liquid mixed meal, and blood samples were taken over 2 h. The next day a euglycemic hyperinsulinemic clamp test was administered. Fasting insulin was 10% lower during consumption of the whole-grain than during consumption of the refined-grain diet (mean difference: -15 +/- 5.5 pmol/L; P = 0.03). After the whole-grain diet, the area under the 2-h insulin curve tended to be lower (-8832 pmol.min/L; 95% CI: -18720, 1062) than after the refined-grain diet. The rate of glucose infusion during the final 30 min of the clamp test was higher after the whole-grain diet (0.07 x 10(-4) mmol.kg(-1).min(-1) per pmol/L; 95% CI: 0.003 x 10(-4), 0.144 x 10(-4)). Insulin sensitivity may be an important mechanism whereby whole-grain foods reduce the risk of type 2 diabetes and heart disease.
Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutr... more Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data). Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They ...
Patients and their physicians remain confused about which dietary advice to follow. Substantial e... more Patients and their physicians remain confused about which dietary advice to follow. Substantial evidence indicates that energy-appropriate, whole-food diets containing unrefined grains, an abundance of fruits and vegetables, low-fat dairy products, low-fat protein sources, and carefully chosen fats and oils can contribute significantly to chronic disease risk reduction. This article focuses on dietary composition with respect to energy-providing macronutrients, such as carbohydrate, protein, and fat; addresses dietary topics of current interest, such as glycemic index, whole grains, and plant sterols; and presents evidence-based research on adequate intake levels of macronutrients for optimal nutrition and disease risk reduction.
About 9% of average dietary energy intake in the United States comes from fructose. Such a high c... more About 9% of average dietary energy intake in the United States comes from fructose. Such a high consumption raises concern about the metabolic effects of this sugar. The objective of this study was to determine the effect of dietary fructose on plasma lipids. The study was conducted in the General Clinical Research Center at Fairview-University of Minnesota Medical Center. The participants were 24 healthy adult volunteers (12 men and 12 women; 6 of each sex were aged <40 y and 6 of each sex were aged >/=40 y). All subjects received 2 isoenergetic study diets assigned by using a randomized, balanced crossover design. One diet provided 17% of energy as fructose. The other diet was sweetened with glucose and was nearly devoid of fructose. Each diet was fed for 6 wk. Both diets were composed of common foods and contained nearly identical amounts of carbohydrate, protein, fat, fiber, cholesterol, and saturated, monounsaturated, and polyunsaturated fatty acids. All meals were prepar...
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