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Flavan-3-ols and cardiometabolic health: a guideline recommendation by the Academy of Nutrition and Dietetics
Guideline recommendation for a plant bioactive such as flavan-3-ols is a departure from previous recommendations as it is not based on deficiencies but rather improvement in health outcomes. Nevertheless, there is a rapidly growing body of clinical data reflecting benefits of flavan-3-ol intake that outweigh potential harms. Thus, the objective of the Expert Panel was to develop an intake recommendation for flavan-3-ols and cardiometabolic outcomes to inform multiple stakeholders including clinicians, policymakers, public health entities, and consumers.
Guideline development followed the process set forth by the Academy of Nutrition and Dietetics which includes use of Evidence to Decision Framework. Studies informing this guideline (157 randomized controlled trials and 15 cohort studies) were previously reviewed in a recently published systematic review and meta-analysis. Quality and strength-of-evidence along with risk-of-bias in reporting was reviewed. In drafting the guideline, data assessments and opinions by authoritative scientific bodies providing guidance on the safety of flavan-3-ols were considered.
Moderate evidence supporting cardiometabolic protection resulting from flavan-3-ol intake in the range of 400-600 mg/d was supported in the literature. Further, increasing consumption of dietary flavan-3-ols may help improve blood pressure, cholesterol levels, and blood sugar. Strength of evidence was strongest for some biomarkers (i.e., systolic blood pressure, total cholesterol, HDL-cholesterol, and insulin/glucose dynamics). It should be noted that this is a food-based guideline and not a recommendation for flavan-3-ol supplements. This guideline was based on beneficial effects observed across a range of disease biomarkers and endpoints. While a comprehensive assessment of available data has been reviewed, evidence gaps identified herein can inform scientists whereby guiding future randomized clinical trials
Sensory comparison of low-protein recipes with glycomacropeptide-containing BetterMilk and liquid non-dairy coffee creamer among adults with phenylketonuria
Phenylketonuria (PKU) results from deficiency of phenylalanine hydroxylase enzyme which is responsible for converting the essential amino acid phenylalanine to the non-essential amino acid tyrosine. PKU is treated with a low-protein diet and medical food/ formula providing supplemental protein without excess phenylalanine. Naturally phenylalanine-free, Glycomacropeptide (GMP) used in PKU medical foods/ formulas contains four essential amino acids and is fortified with methionine, leucine, histidine, tryptophan, and tyrosine to provide a near complete protein. Although sensory research has been conducted on GMP-based foods, sensory evaluation of commonly utilized low-protein recipes substituted with GMP-based formulas is undocumented. Such research is critical to development of appealing means for formula consumption. Study objectives were to compare sensory attributes (taste, aroma, texture, and overall acceptability) and preferences for low-protein cream of tomato soup, lemon pudding, and vanilla ice cream containing either a GMP-based formula or unflavored liquid non-dairy coffee creamer as the primary liquid ingredient and to solicit medical formula/food procurement information among adults with PKU. Data were subjected to paired t-tests with the Bonferroni correction (p< 0.0125) and analysis of variance. Thirty-one adults (80% female, 93% white) completed the study. Significantly higher scores (p<0.01) were reported for aroma, taste, and overall acceptability of the control soup and for all four sensory attributes of the control pudding. Control ice cream was ranked significantly higher (p<0.01) in taste and overall acceptability. No significant differences existed among scores of the four sensory attributes within each control or experimental recipe. Control samples were preferred over experimental samples for all recipes. Experimental samples for each recipe were on average scored in the "like" range. Only 23% of the sample reported they frequently consume medical foods, while equal numbers of participants reported they were/were not interested in using a medical food in preparation of low-protein recipes. These data may partially explain why control samples were preferred. Additionally, lower sensory scores for taste and aroma of the experimental soup, pudding, and ice cream may be attributed to the probiotics and docosahexaenoic acid within the GMP-based formula as both of these functional ingredients are capable of imparting strong flavors and aromas to foods. Additional research is needed to investigate the use of GMP-based formulas without added functional ingredients and isolated GMP, not GMP-based formulas, in low-protein recipes in order to expand dietary offerings for individuals with PKU. (Published By University of Alabama Libraries