Meal fatty acids have differential effects on postprandial blood pressure and biomarkers of endothelial function but not vascular reactivity in postmenopausal women in the Randomized Controlled Dietary Intervention and VAScular function (DIVAS)-2 Study

Background: Elevated postprandial triacylglycerol concentrations, impaired vascular function and hypertension are important independent cardiovascular disease (CVD) risk factors in women. However, the effects of meal fat composition on postprandial lipemia and vascular function in postmenopausal women are unknown. Objective: This study investigated the impact of sequential meals rich in saturated (SFAs), monounsaturated (MUFAs) or n-6 polyunsaturated fatty acids (PUFAs) on postprandial flow-mediated dilatation (FMD, primary outcome measure), vascular function and associated CVD risk biomarkers (secondary outcomes) in postmenopausal women. Methods: A double-blind, randomized, cross-over, postprandial study was conducted with 32 postmenopausal women (58 ± 1 years, BMI 25.9 ± 0.7 kg/m2). After fasting overnight, participants consumed high-fat meals at breakfast (0 min; 50 g fat, containing 33-36 g SFAs, MUFAs or n-6 PUFAs) and lunch (330 min; 30 g fat, containing 19-20 g SFAs, MUFAs or n-6 PUFAs), on separate occasions. Blood samples were collected before breakfast and regularly after the meals for 480 min, with specific time points selected for measuring vascular function and blood pressure. Results: Postprandial FMD, laser Doppler imaging and digital volume pulse responses were not different after consuming the test fats. The incremental AUC (IAUC) for diastolic blood pressure was lower (-0.5-fold) after the MUFA than SFA-rich meals (P=0.009), with a similar trend for systolic blood pressure (-0.4-fold; P=0.012). This corresponded with a lower IAUC (-6.4-fold) for the plasma nitrite response after the SFA than MUFA-rich meals (P=0.010). The soluble intercellular adhesion molecule-1 (sICAM-1) time course profile, AUC and IAUC were lower after the n-6 PUFA than SFA and MUFA-rich meals (P≤0.001). Lipids, glucose and markers of insulin sensitivity did not differ between the test fats. Conclusions: Our study revealed a differential impact of meal fat composition on blood pressure, plasma nitrite and sICAM-1, but no effect on postprandial FMD or lipemia in postmenopausal women

Diet Quality Index for older adults (DQI-65) : development and use in predicting adherence to dietary recommendations and health markers in the UK National Diet and Nutrition Survey

© The Authors 2021. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1017/S0007114521005043Diet quality indexes (DQIs) are useful tools for assessing diet quality in relation to health and guiding delivery of personalised nutritional advice, however existing DQIs are limited in their applicability to older adults (aged ≥65 years). Therefore, this research aimed to develop a novel evidence-based DQI specific to older adults (DQI-65). Three DQI-65 variations were developed to assess the impacts of different component quantitation methods and inclusion of physical activity. The variations were: Nutrient and Food-based DQI-65 (NFDQI-65), NFDQI-65 with Physical Activity (NFDQI-65+PA) and Food-based DQI-65 with Physical Activity (FDQI-65+PA). To assess their individual efficacy, the NFDQI-65, NFDQI-65+PA and FDQI-65+PA were explored alongside the validated Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) using data from the cross-sectional UK National Diet and Nutrition Survey (NDNS) rolling programme. Scores for DQI-65 variations, the HEI-2015 and AHEI-2010 were calculated for adults ≥65 years from years 2-6 of the NDNS (n=871). Associations with nutrient intake, nutrient status and health markers were analysed using linear and logistic regression. Higher DQI-65s and HEI-2015 scores were associated with increased odds of meeting almost all of our previously proposed age-specific nutritional recommendations, and with health markers of importance for older adults, including lower body mass index, lower medication use and lower C-reactive protein (P<0.01). Few associations were observed for the AHEI-2010. This analysis suggests value of all three DQI-65s as measures of dietary quality in UK older adults. However, methodological limitations mean further investigations are required to assess validity and reliability of the DQI-65s.Peer reviewedFinal Accepted Versio

The eNutri app: using diet quality indices to deliver automated personalised nutrition advice

Personalising nutrition advice using digital technologies, such as web-apps, offers great potential to improve users’ adherence to healthy eating guidelines. However, commercial offerings currently lack decision engines capable of delivering personalised nutrition advice. This article outlines the core concepts, content and features of the novel eNutri app, developed by researchers at the University of Reading. Uniquely, the app identifies and recommends food-based modifications that would be most beneficial for an individual taking into account both their current diet quality and their individual preferences

Impact of the apolipoprotein E (epsilon) genotype on cardiometabolic risk markers and responsiveness to acute and chronic dietary fat manipulation

Apolipoprotein (APO) E (ε) genotype is considered to play an important role in lipid responses to dietary fat manipulation but the impact on novel cardiometabolic risk markers is unclear. To address this knowledge gap, we investigated the relationship between the APOE genotype and cardiometabolic risk markers in response to acute and chronic dietary fat intakes. Associations with fasting (baseline) outcome measures (n = 218) were determined using data from the chronic DIVAS (n = 191/195 adults at moderate cardiovascular disease risk) and acute DIVAS-2 (n = 27/32 postmenopausal women) studies examining the effects of diets/meals varying in saturated, polyunsaturated and monounsaturated (MUFA) fatty acid composition. Participants were retrospectively genotyped for APOE (rs429358, rs7412). For baseline cardiometabolic outcomes, E4 carriers had higher fasting total and low-density lipoprotein-cholesterol (LDL-C), total cholesterol: high-density lipoprotein-cholesterol (HDL-C) and LDL-C: HDL-C ratios, but lower C-reactive protein (CRP) than E3/E3 and E2 carriers (p ≤ 0.003). Digital volume pulse stiffness index was higher in E2 carriers than the E3/E3 group (p = 0.011). Following chronic dietary fat intake, the significant diet × genotype interaction was found for fasting triacylglycerol (p = 0.010), with indication of a differential responsiveness to MUFA intake between the E3/E3 and E4 carriers (p = 0.006). Test fat × genotype interactions were observed for the incremental area under the curve for the postprandial apolipoprotein B (apoB; p = 0.022) and digital volume pulse reflection index (DVP-RI; p = 0.030) responses after the MUFA-rich meals, with a reduction in E4 carriers and increase in the E3/E3 group for the apoB response, but an increase in E4 carriers and decrease in the E3/E3 group for the DVP-RI response. In conclusion, baseline associations between the APOE genotype and fasting lipids and CRP confirm previous findings, although a novel interaction with digital volume pulse arterial stiffness was observed in the fasted state and differential postprandial apoB and DVP-RI responses after the MUFA-rich meals. The reported differential impact of the APOE genotype on cardiometabolic markers in the acute and chronic state requires confirmation

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

High prevalence of undernutrition and low dietary diversity in institutionalised elderly living in Sri Lanka

This research received no specific grant from any funding agency in the public, commercial and not-for-profit sectors. The authors wish to thank the participants, administrators and caregivers of the homes for elders for their enthusiastic cooperation and also the Nutrition Research Team of the Department of Applied Nutrition, Wayamba University of Sri Lanka, for their valuable assistance during the course of the study. The authors also wish to thank Mr. S. Rahanan for coordination and the assistance given in data collection especially in Tamil speaking participants. K.M.R designed and managed the study, interpreted the data and drafted the manuscript. M.P.P.M contributed to the data collection, data analysis and coordination of the study. M.W, K.G.J and J.A.L assisted in data interpretation and critical revision of the manuscript. The authors declare that there is no conflict of interest of any kind involved in this study or this publication. Ethical clearance for this study was obtained from the Ethical Review Committee of the Sri Lanka Medical Association (ERC/13-037)

A review of nutritional requirements for adults aged ≥65 years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) Recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) A literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2gkg-1day-1), calcium (1000mgday-1), folate (400μgday-1), vitamin B-12 (2.4μgday-1) and fluid (1.6Lday-1 women, 2.0Lday-1 men) for those ≥65y. UK recommendations for carbohydrates, free sugars, dietary fibre, dietary fat and fatty acids, sodium and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy ageing

Impact of meal fatty acid composition on postprandial lipaemia, vascular function and blood pressure in postmenopausal women

Cardiovascular diseases (CVD) are the leading cause of death in women globally, with aging associated with progressive endothelial dysfunction and increased CVD risk. Natural menopause is characterised by raised non-fasting triacylglycerol (TAG) concentrations and impairment of vascular function compared with premenopausal women. However, the mechanisms underlying the increased CVD risk after women have transitioned through the menopause are unclear. Dietary fat is an important modifiable risk factor relating to both postprandial lipaemia and vascular reactivity. Meals rich in saturated (SFA) and monounsaturated fatty acids (MUFA) are often associated with greater postprandial TAG responses compared with those containing n-6 polyunsaturated fatty acids (PUFA), but studies comparing their effects on vascular function during the postprandial phase are limited, particularly in postmenopausal women. This review aimed to evaluate the acute effects of test meals rich in SFA, MUFA and n-6 PUFA on postprandial lipaemia, vascular reactivity and other CVD risk factors in postmenopausal women. The systematic literature search identified 778 publications. The impact of fat-rich meals on postprandial lipaemia was reported in seven relevant studies, of which meal fat composition was compared in one study described by three papers. An additional study determined the impact of a high fat meal on vascular reactivity. Although moderately consistent evidence suggests detrimental effects of high fat meals on postprandial lipaemia in postmenopausal (than premenopausal) women, there is insufficient evidence to establish the impact of meals of differing fat composition. Furthermore, there is no robust evidence to conclude the effect of meal fatty acids on vascular function or blood pressure. In conclusion, there is an urgent requirement for suitably powered robust randomised controlled trials to investigate the impact of meal fat composition on postprandial novel and established CVD risk markers in postmenopausal women, an understudied population at increased cardiometabolic risk

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 quality in vegetarian and omnivorous female students in Germany: a retrospective study

Vegetarian diets have gained in popularity, especially among highly educated women, and are considered beneficial to health. Comparative studies assessing the diet of vegetarians against omnivores are rather limited and often provide ambivalent results. Therefore, this study examined the nutrient intake and nutritional quality of vegetarian and omnivorous diets in a group of 61 female students in Germany. Habitual dietary intake was evaluated using a validated graphical online food frequency questionnaire (FFQ). Differences in nutrient intakes were analyzed by Mann–Whitney-U-Tests. Odds Ratios (OR) were calculated for vegetarians exceeding dietary reference values (DRV) compared to omnivores. The overall nutritional quality was assessed using the Healthy-Eating-Index-2015 (HEI-2015). In omnivores, intakes of total energy from saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), long-chain omega-3 polyunsaturated fatty acids (LC-n3-PUFA), cholesterol, sucrose, lactose, retinol, and cobalamin were significantly higher than in vegetarians. Significantly lower intakes were observed for fiber, magnesium, and beta-carotene. Significant OR were detected for total fat (OR = 0.29), SFA (OR = 0.04), beta-carotene (OR = 4.55), and cobalamin (OR = 0.32). HEI-2015 scores were higher for vegetarians than for omnivores (79 points versus 74 points) and significant differences were recorded for the HEI-2015 components dairy, seafood plant proteins, fatty acids, added sugars, and saturated fatty acids