1a. Objectives (from AD-416):
LAB NAME: Cardiovascular Nutrition 1. Determine the effect of diets differing in fat and carbohydrate type on cardiometabolic risk indicators, lipoprotein and fatty acid metabolism, response to lipid modifying therapy, and gene-nutrient interactions, using human, animal and in vitro models. 1.1 – Relative effects of palmitate (16:0), stearate (18:0) and oleate (18:1) on cardiometabolic risk factors, fatty acid kinetics and lipoprotein-mediated in vitro endothelial cell inflammatory response. 1.2 – Relative effects of simple, refined and unrefined carbohydrate on cardiometabolic risk factors, macrophage cholesterol homeostasis, subcutaneous adipose tissue macrophage infiltration/inflammatory gene expression, and intestinal microbiome. 1.3 – Synergistic effects of a ‘heart healthy’ diet and statin therapy on atherosclerosis using a porcine model. 1.4 – Common and differential effects of eicosapentaenoic acid and docosahexaenoic acid on lipid metabolism and systemic inflammation. 2. Determine the relationship between food preferences, consumption patterns and dietary acculturation, and cardiovascular health using population-based datasets. 2.1 – Impact of acculturation status on dietary patterns and health outcomes in Chinese Americans. 3. Identify novel biomarkers for food and nutrient intake related to dietary patterns and cardiovascular health. 3.1 – Effect of a comprehensive 12 month approach to family weight management on biomarkers of dietary intake and cardiometabolic risk factors in child-mothers/female guardian pairs. 3.2 – Novel nutrient biomarkers to predict risk of heart failure.
1b. Approach (from AD-416):
LAB NAME: Cardiovascular Nutrition In the next 5 years the Cardiovascular Nutrition Laboratory (CNL) will investigate the effects of diets differing in fat type and carbohydrate type on cardiometabolic risk factors, fatty acid metabolism, response to lipid modifying therapy, and gene-nutrient interactions using human, animal and in vitro models. This will be accomplished by assessing the relative effects of palmitate, stearate and oleate on cardiometabolic risk factors, fatty acid kinetics and in vitro endothelial cell inflammatory response to lipoprotein particles; relative effects of simple-carbohydrate, refined-carbohydrate and unrefined-carbohydrate on cardiometabolic risk factors, macrophage cholesterol homeostasis, and intestinal microbiome; synergistic effects of an atherogenic or ‘ heart healthy’ diet with/without statin therapy on atherosclerosis development using a porcine model; and relative effects of eicosapentaenoic and docosahexaenoic acids on systemic inflammation and lipid metabolism. The CNL will determine the relationship between food preferences, consumption patterns and dietary acculturation, and cardiovascular health using population-based datasets by assessing the impact of acculturation status on dietary patterns and health outcomes. In addition, the CNL will identify and adjudicate novel biomarkers for food and nutrient intake and merge them with established biomarkers thereof, and assess potential relationships with family-wide CVD risk and weight management, and heart failure risk.
3. Progress Report:
This report documents research conducted under 1 project in a Non-Assistance Cooperative Agreement between ARS and TUFTS UNIVERSITY. Additional details for the research are associated with project 8050-51000-086-01S, Diet and Biomarkers of Cardiovascular Health. Developing strategies to prevent excess weight gain is critical for minimizing lifetime risk of developing cardiometabolic syndrome. We determined the effect of a family-based weight management intervention on indicators (referred to as biomarkers) of diet quality and cardiometabolic risk factors in children (7-12 years) at high risk for obesity, defined as having a baseline body mass index (BMI) z-score greater than or equal to the 85th percentile. Families of these children were randomly allocated into either a control group that received standard care, or an intervention group that received weekly, then monthly, lifestyle strategies intended to improve the diet quality of the children and their parents. Biomarkers of nutrient intake and metabolism were measured using gas chromatography (GC) and high performance liquid chromatography (HPLC). At the end of one year, there were no significant differences in change in BMIz scores between the two between the control and intervention groups. However, during the one year intervention period, all children exhibited statistically significant improvements. The mean BMIz score decreased by 7%, low density lipoprotein-cholesterol decreased by 3%, liver enzymes decreased by 3%, and high density lipoprotein-cholesterol increased by 2%. Among the dietary biomarkers, plasma total trans decreased by 13%, lutein by 3%, and omega-3 fatty acids increased between 7% and 26%, depending on the individual fatty acids. After adjusting for age, sex and study intervention arm, multivariate logistic regression (odds ratios per 10% increment in biomarker [95% CI]) indicated total trans (biomarker ruminant fat and partially-hydrogenated fat intake; 1.2 [1.0-1.4]), lutein (biomarker egg and tomato-based food intake; 1.1 [1.03-1.13]) and lycopene (biomarker egg and tomato-based food intake; 1.09 [1.03-1.15]) were positively associated with change in BMIz score. The monounsaturated fatty acid 16:1n-7 (indicator of de novo lipogenesis [rate of fatty acid synthesis by the body]; 0.83 [0.72-0.96]) was negatively associated, while the polyunsaturated fatty acid 22:5n-6 (biomarker vegetable oil intake; 1.16 [1.014-1.32]) and estimated stearoyl CoA desaturase activity (rate limiting enzyme in monounsaturated fatty acid synthesis; 1.53 [1.03-2.26]) were positively associated with change in BMIz score. The results suggest that foods high in trans fat and tomato-based products (e.g., pizza) were associated with increased BMIz score, whereas changes in in vivo fatty acid metabolism were associated with decreased in BMIz score. These data can be used to design targeted interventions to minimize the risk of excessive body weight gain at a family level with the intent of improving heart health throughout the lifespan, particularly in older adults. The utility of using glycemic index (GI) values for chronic disease risk management remains controversial. While absolute GI value determinations for individual foods have been shown to differ significantly in individuals with type 1 or type 2 diabetes, there is a dearth of data on the reliability of GI value determinations and potential sources of variability among healthy adults. We determined the intra-individual (within an individual) and inter-individual (among individuals) variability in glycemic response to a single food challenge as well as biological factors that potentially mediate this response. The GI value for white bread relative to glucose was determined in 63 volunteers apparently free from chronic disease with fasting glucose concentrations less than 125mg/dL and specifically recruited to differ by sex, age (18 to 85 years) and BMI (19 to 35 kg/m2). All participants underwent 3 sets of food challenges. Each set involved glucose (500 mL glucose solution, [100 g/L], 50 gm carbohydrate) and white bread plus 500 mL water (96 gm bread; equivalent to 50 gm “available” carbohydrate). Changes in blood glucose concentrations were monitored by drawing arterialized venous blood samples at 0, 15, 30, 45, 60, 90 and 120 minute time points. GI values were calculated using the incremental area under the curve method. Body composition was measured by dual-energy X-ray absorptiometry. Percent total fat, lean muscle mass and lean plus bone mineral content was calculated for whole body, trunk and abdominal regions. The mean (± SD) GI value for white bread was 62 ± 15. The average intra-individual coefficient of variation (CV) was 45% and inter-individual CV was 25% suggesting that more variation occurred within a person than among people. No statistically significant association was observed between the GI value determination for white bread and participant’s age, sex or body composition variables, including BMI, waist circumference, waist to hip ratio, total fat, muscle mass or lean mass plus bone mineral content. On note, in mixed models, baseline HgbA1c, a measure of glycemic control, explained 15% of the inter-individual variability. The mean GI for white bread was significantly lower in individuals with HgbA1c values greater than 5.7 (57 ± 11 vs. 66 ± 15, p=0.03). Our data indicate that there is substantial variability in individual responses to GI value determinations, particularly on the basis of glycemic control, suggesting that it is unlikely to be good general approach to guide food choices in the clinical setting or at an individual level.
1. Biomarkers of dietary fat quality predict heart disease risk in women. Although the relationship between dietary fat quality and coronary heart disease risk has been evaluated extensively, typically using diet questionnaires, the results are inconsistent and data in postmenopausal women are limited. ARS funded researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, examined the association between biomarkers of dietary fat, plasma phospholipid fatty acids, and coronary heart disease risk factors in postmenopausal women who participated in the Women's Health Initiative observational study. No significant associations were observed for the predominant phospholipid fatty acids (16:0, 18:0, 18:1n-9 and 18:2n-6), plasma phospholipid saturated fatty acids and fatty acids synthesized in the body; however, phospholipid omega-6 fatty acids (20:3n-6, 22:5n-6) and estimated delta-6-desaturase activity were positively associated with coronary heart disease risk. Phospholipid omega-3 fatty acids (20:5n-3, 22:5n-3, 22:6n-3) and estimated delta-5-desaturase activity were negatively associated with coronary heart disease risk. These results support current guidelines regarding the benefits of regular fish consumption.
2. Temporal trends in fast-food restaurant energy, sodium, saturated fat, and trans fat content, United States, 1996-2013. Excess intakes of energy, sodium, saturated fat, and trans fat are associated with increased risk for cardiometabolic syndrome. ARS funded researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, examined the variability of popular food items in 3 fast-food restaurants in the U.S. by portion size and content of saturated fat, trans fat and sodium during the past 17 years. With the exception of a dramatic decline in trans fat, there was little change over the period assessed. There was considerable variability in the nutrient content of similarly labeled menu items among fast-food restaurants. In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation. The findings suggest that policy efforts to promote reductions in energy, sodium, saturated fat and trans fat intakes need to be shifted from emphasizing portion-size labels to additional factors such as total calories, frequency of eating, number of items ordered, menu choices and energy-containing beverages.
3. Healthy eating index and metabolically healthy obesity. Little is known about whether diet quality differs between metabolically-healthy-obese (MHO) and metabolically-abnormal-obese (MAO) individuals. ARS funded researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, and collaborators at the University of Massachusetts used National Health and Nutrition Examination Survey data to identify obese individuals and classify them as to either MHO (having less than 2 cardiometabolic risk factors) or MAO (having 2 or more cardiometabolic risk factors). Healthy Eating Index-2005 scores, a measure of overall diet quality, were calculated from 24-hour recall data. Compared with MAO, MHO had higher index scores, suggesting better overall diet quality, but as these individuals aged the difference in index scores between the two groups decreased. These data emphasize the importance of developing intervention strategies to improve diet quality, particularly customized for overweight and obese adults in the younger age groups, to prevent the conversion from metabolically-healthy to metabolically-abnormal obesity and improve cardiometabolic risk factors.
Bhupathiraju, S.N., Lichtenstein, A.H., Dawson-Hughes, B., Hannan, M.T., Tucker, K. 2013. Adherence to the 2006 American Heart Association Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone health in older Puerto Ricans. American Journal of Clinical Nutrition. 98:1309-1316.
Matsumoto, C., Matthan, N.R., Lichtenstein, A.H., Gaziano, M.J., Djousse, L. 2013. Red blood cell MUFAs and risk of coronary artery disease in the Physicians’ Health Study. American Journal of Clinical Nutrition. 98:749-754.
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