28 research outputs found
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Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study
Background: Public health strategies to lower cardiovascular disease (CVD) risk involve reducing dietary saturated fatty acid (SFA) intake to ≤10% of total energy (%TE). However, the optimal type of replacement fat is unclear.
Objective: We investigated the substitution of 9.5-9.6%TE dietary SFA with either monounsaturated (MUFA) or n-6 polyunsaturated fatty acids (PUFA) on vascular function and other CVD risk factors.
Design: Using a randomized, controlled, single-blind, parallel group dietary intervention, 195 men and women aged 21-60 y with moderate CVD risk (≥50% above the population mean) from the United Kingdom followed one of three 16-wk isoenergetic diets (%TE target compositions, total fat:SFA:MUFA:n-6 PUFA): SFA-rich (36:17:11:4, n = 65), MUFA-rich (36:9:19:4, n = 64) or n-6 PUFA-rich (36:9:13:10, n = 66). The primary outcome measure was flow-mediated dilatation (%FMD); secondary outcome measures included fasting serum lipids, microvascular reactivity, arterial stiffness, ambulatory blood pressure, and markers of insulin resistance, inflammation and endothelial activation.
Results: Replacing SFA with MUFA or n-6 PUFA did not significantly impact on %FMD (primary endpoint) or other measures of vascular reactivity. Of the secondary outcome measures, substitution of SFA with MUFA attenuated the increase in night systolic blood pressure (-4.9 mm Hg, P = 0.019) and reduced E-selectin (-7.8%, P = 0.012). Replacement with MUFA or n-6 PUFA lowered fasting serum total cholesterol (TC; -8.4% and -9.2%, respectively), low-density lipoprotein cholesterol (-11.3% and -13.6%) and TC to high-density lipoprotein cholesterol ratio (-5.6% and -8.5%) (P ≤ 0.001). These changes in low-density lipoprotein cholesterol equate to an estimated 17-20% reduction in CVD mortality.
Conclusions: Substitution of 9.5-9.6%TE dietary SFA with either MUFA or n-6 PUFA did not impact significantly on %FMD or other measures of vascular function. However, the beneficial effects on serum lipid biomarkers, blood pressure and E-selectin offer a potential public health strategy for CVD risk reduction
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Replacement of dietary saturated fat with unsaturated fats increases numbers of circulating endothelial progenitor cells and decreases number of microparticles: findings from the randomized, controlled DIVAS study
Background
Endothelial progenitor cells (EPC) and microparticles (MP) are emerging novel markers of cardiovascular disease (CVD) risk, which could potentially be modified by dietary fat. We have previously shown that replacing dietary saturated fat (SFA) with monounsaturated (MUFA) or n-6 polyunsaturated fat (PUFA) improved lipid biomarkers, blood pressure and markers of endothelial activation, but their effects on circulating EPCs and MPs are unclear.
Objective
The Dietary Intervention and VAScular function (DIVAS) study investigated the replacement of 9.5-9.6% total energy (%TE) SFA with MUFA or n-6 PUFA for 16 weeks on EPC and MP numbers in UK adults with moderate CVD risk.
Design
In this randomized, controlled, single-blind, parallel group dietary intervention, men and women aged 21-60 y (n=190) with moderate CVD risk (≥50% above the population mean) consumed one of three 16-week isoenergetic diets. Target compositions for total fat, SFA, MUFA and n-6 PUFA (%TE) were: SFA-rich diet (36:17:11:4, n=64), MUFA-rich diet (36:9:19:4, n=62) and n-6 PUFA-rich diet (36:9:13:10, n=66). Circulating EPC, endothelial MP (EMP) and platelet MP (PMP) numbers were analysed by flow cytometry. Dietary intake, vascular function and other cardio-metabolic risk factors were determined at baseline.
Results
Relative to the SFA-rich diet, MUFA and n-6 PUFA-rich diets decreased EMP (-47.3%, -44.9%) and PMP numbers (-36.8%, -39.1%) (overall diet effects P<0.01). The MUFA-rich diet increased EPC numbers (+28.4%; P=0.023). Additional analyses using stepwise regression models identified the augmentation index (measuring arterial stiffness determined by pulse wave analysis) as an independent predictor of baseline EPC and MP numbers.
Conclusions
Replacing 9.5-9.6%TE dietary SFA with MUFA increased EPC numbers and replacement with either MUFA or n-6 PUFA decreased MP numbers, suggesting beneficial effects on endothelial repair and maintenance. Further studies are warranted to determine the mechanisms underlying the favourable effects on EPC and MP numbers following SFA replacement
Dietary responses to a multiple sclerosis diagnosis: a qualitative study
Background/objectives: Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia. Subjects/methods: Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles. Results: Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS. Conclusions: Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time
Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community
Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit
Assessing knee hyperextension in patients following stroke: A comparison of Siliconcoach movement analysis software and experienced clinical observation
Background: Observational gait analysis used by clinicians has been shown to have moderate
reliability in relation to joint angles. Siliconcoach movement analysis software uses a digital image to determine joint angles. The aim of this study was to compare Siliconcoach software against experienced clinicians in assessing knee hyperextension in patients following stroke.
Method: This was an observational comparison study with a convenient sample of 20 ambulant
participants with a unilateral stroke videoed during three walks. To determine knee hyperextension and the reliability of Siliconcoach the recordings were assessed by three raters using Siliconcoach and by three experienced clinicians.
Findings: The Kappa statistic for intra-observer agreement for knee hyperextension ranged from 0.8 to 1.0 (substantial to almost perfect) and from 0.6 to 0.9 for inter-observer agreement (moderate to almost perfect). Intra-rater and inter-rater ICC scores for Siliconcoach were all >0.75 suggesting very high reliability. Clinicians compared with Siliconcoach ranged from 0.4 to 0.7(fair to substantial).
Conclusion: Observational gait analysis appears to be an adequate measurement tool in clinical
practice particularly when undertaken by the same experienced therapist. However, Siliconcoach may be a more reliable measure and provides an objective measure of quantifying knee joint angles for both research and clinical practice
Level of disability and associated factors with musculoskeletal disorders among supermarket cashiers
ObjectivesThis study aimed to determine the severity of symptoms and the level of disability or difficulty associated with MSDs in the neck, shoulders, upper limbs, lower back, and lower limbs as well as the factors associated with MSDs.Material and MethodsThis investigation collected demographic, health (36-Item Short Form Survey [SF-36]), and occupational related-factors for supermarket cashiers through the administration of several questionnaires, including the Oswestry Disability Index (ODI), Disabilities of the Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI), Lower Extremity Functional Scale (LEFS), and Numeric Rating Scale (NRS) for pain.ResultsOne hundred ninety-three supermarket cashiers participated in this study. The mean scores for disability levels included NDI (M±SD 18.62±14.57), ODI (M±SD 20.74±13.89), DASH (M±SD 15.08±13.90), and LEFS (M±SD 63.06±14.24). Regression analyses demonstrated the existence of significant relationships between the experience of MSDs and several other factors, including the number of working days per week, the preferred working position, marital status and the need for awkward positions.ConclusionsThe results indicate MSDs that signified a mild disability level among young participants. The number of working days per week, the preferred working position, the need to assume awkward positions, and marital status were significantly associated with MSDs. The findings indicated the need for preventive to avoid or minimize the prevalence of MSDs among supermarket cashiers
The effects of substitution of dietary saturated fatty acids with either monounsaturated fatty acids or n-6 polyunsaturated fatty acids on measures of endothelial function, arterial stiffness and blood pressure: results from the DIVAS study
Substitution of dietary saturated fatty acids with monounsaturated fatty acids improves circulating levels of E-Selectin: results from the DIVAS study
Number of endothelial progenitor cells are associated with body composition, but not fat intake or blood lipids
Non peer reviewe