Flavonoid-rich fruits and vegetables improve microvascular reactivity and inflammatory status in men at risk of cardiovascular disease – FLAVURS: a randomized controlled trial

BACKGROUND: Observed associations between increased fruit and vegetable (F&V) consumption, particularly those F&Vs that are rich in flavonoids, and vascular health improvements require confirmation in adequately powered randomized controlled trials. OBJECTIVE: This study was designed to measure the dose-response relation between high-flavonoid (HF), low-flavonoid (LF), and habitual F&V intakes and vascular function and other cardiovascular disease (CVD) risk indicators. DESIGN: A single-blind, dose-dependent, parallel randomized controlled dietary intervention study was conducted. Male and female low-F&V consumers who had a ≥1.5-fold increased risk of CVD (n = 174) were randomly assigned to receive an HF F&V, an LF F&V, or a habitual diet, with HF and LF F&V amounts sequentially increasing by 2, 4, and 6 (+2, +4, and +6) portions/d every 6 wk over habitual intakes. Microvascular reactivity (laser Doppler imaging with iontophoresis), arterial stiffness [pulse wave velocity, pulse wave analysis (PWA)], 24-h ambulatory blood pressure, and biomarkers of nitric oxide (NO), vascular function, and inflammation were determined at baseline and at 6, 12, and 18 wk. RESULTS: In men, the HF F&V diet increased endothelium-dependent microvascular reactivity (P = 0.017) with +2 portions/d (at 6 wk) and reduced C-reactive protein (P = 0.001), E-selectin (P = 0.0005), and vascular cell adhesion molecule (P = 0.0468) with +4 portions/d (at 12 wk). HF F&Vs increased plasma NO (P = 0.0243) with +4 portions/d (at 12 wk) in the group as a whole. An increase in F&Vs, regardless of flavonoid content in the groups as a whole, mitigated increases in vascular stiffness measured by PWA (P = 0.0065) and reductions in NO (P = 0.0299) in the control group. CONCLUSION: These data support recommendations to increase F&V intake to ≥6 portions daily, with additional benefit from F&Vs that are rich in flavonoids, particularly in men with an increased risk of CVD. This trial was registered at www.controlled-trials.com as ISRCTN47748735.

The consumer acceptance of novel vegetable-enriched bread products as a potential vehicle to increase vegetable consumption

Currently UK fruit and vegetable intakes are below recommendations. Bread is a staple food consumed by ~95% of adults in western countries. In addition, bread provides an ideal matrix by which functionality can be delivered to the consumer in an accepted food. Therefore, enriching bread with vegetables may be an effective strategy to increase vegetable consumption. This study evaluated consumer acceptance, purchase intent and intention of product replacement of bread enriched with red beetroot, carrot with coriander, red pepper with tomato or white beetroot (80g vegetable per serving of 200g) compared to white control bread (0g vegetable). Consumers (n=120) rated their liking of the breads overall, as well as their liking of appearance, flavour and texture using nine-point hedonic scales. Product replacement and purchase intent of the breads was rated using five-point scales. The effect of providing consumers with health information about the breads was also evaluated. There were significant differences in overall liking (P<0.0001), as well as liking of appearance (P<0.0001), flavour (P=0.0002) and texture (P=0.04), between the breads. However, the significant differences resulted from the red beetroot bread which was significantly (P<0.05) less liked compared to control bread. There were no significant differences in overall liking between any of the other vegetable-enriched breads compared with the control bread (no vegetable inclusion), apart from the red beetroot bread which was significantly less liked. The provision of health information about the breads did not increase consumer liking of the vegetable-enriched breads. In conclusion, this study demonstrated that vegetable-enriched bread appeared to be an acceptable strategy to increase vegetable intake, however, liking depended on vegetable type.

Exploring the effects of genotypical and phenotypical variations in bitter taste sensitivity on perception, liking and intake of brassica vegetables in the UK

Brassicaceous vegetables (BV) have chemoprotective effects and yet consumption of BV in the UK is low. Previous studies suggest perception, liking and intake of BV are influenced by bitter taste sensitivity which this study further explores. Phenotypical taste sensitivity of 136 subjects was classified using propythiouracil (PROP) and sodium chloride and fungiform papillae density (FPD) was measured from tongue images. Polymorphisms of TAS2R38 and gustin (CA6) genes were analysed. Liking and bitterness of four raw vegetables (two BV (broccoli and white cabbage) and two non-BV (spinach and courgette)), as well as habitual consumption, were evaluated. There was a significant association between TAS2R38 genotype and PROP taster status (p<0.0001) and between FPD and PROP taster status (p=0.029). Individuals with greater sensitivity for PROP predominantly had TAS2R38 PAV/PAV genotype and greater FPD. BV were perceived as more bitter than non-BV (p<0.0001) with PAV/PAV subjects perceiving significantly stronger bitter intensity. There was a significant difference in liking for the four vegetables (p=0.002), and between consumers of different TAS2R38 genotype (p=0.0024). Individuals with TAS2R38 AVI/AVI genotype liked BV more. Regarding intake, both PAV/PAV and AVI/AVI individuals consumed more total vegetables and BV than PAV/AVI. Although PROP nontasters tended to consume more vegetables and BV than the other two phenotype groups, liking and vegetable intake were not significantly affected by taste phenotype. Although there was not a significant effect of CA6 genotype on bitterness ratings, there was a significant interaction between CA6 and TAS2R38, and in addition CA6 genotype was significantly associated with BV intake. However, these effects require validation as the proportions of the population with the CA6 G/G genotype was extremely small (7%). Our results confirmed that bitter taste perception in vegetables was influenced by both genotype and phenotype of bitter taste sensitivity. Moreover, our findings demonstrated that neither genotype nor phenotype of taste sensitivity alone accurately predict vegetable liking and intake as demographic factors were found to have a substantial influence.

Urinary metabolomic profiling to identify biomarkers of a flavonoid-rich and flavonoid-poor fruits and vegetables diet: the FLAVURS trial in adults: the FLAVURS trial

The present study aims to investigate the dose dependent effects of consuming diets enriched in flavonoid-rich and flavonoid-poor fruits and vegetables on the urine metabolome of adults who had a C1.5 fold increased risk of cardiovascular diseases. A single-blind, dose-dependent, parallel randomized controlled dietary intervention was conducted where volunteers (n = 126) were randomly assigned to one of three diets: high flavonoid diet, low flavonoid diet or habitual diet as a control for 18 weeks. High resolution LC– MS untargeted metabolomics with minimal sample cleanup was performed using an Orbitrap mass spectrometer. Putative biomarkers which characterize diets with high and low flavonoid content were selected by state-of-the-art data analysis strategies and identified by HR-MS and HR-MS/MS assays. Discrimination between diets was observed by application of two linear mixedmodels: one including a diet-time interaction effect and the second containing only a time effect. Valerolactones, phenolic acids and their derivatives were among sixteen biomarkers related to the high flavonoid dietary exposure. Four biomarkers related to the low flavonoid diet belonged to the family of phenolic acids. For the first time abscisic acid glucuronide was reported as a biomarker after a dietary intake, however its origins have to be examined by future hypothesis driven experiments using a more targeted approach. This metabolomic analysis has identified a number of dose dependent urinary biomarkers (i.e. proline betaine or iberin-N-acetyl cysteine), which can be used in future observation and intervention studies to assess flavonoids and nonflavonoid phenolic intakes and compliance to fruit and vegetable intervention.

Association of dyslipidemia with intakes of fruit and vegetables and the body fat content of adults clinically selected for a lifestyle modification program

To investigate the relationship of dyslipidemia with demographic distribution and patterns of body fat and dietary intakes. From a universe of adults clinically selected for a lifestyle modification program 979 subjects (409 males and 570 females, 52.2 +/- 9.6 years) fulfilled the inclusion criteria. Overnight-fasting plasma was assayed (dry chemistry) for triglycerides (TG), total (TC) and HDL fraction of cholesterol given the non-HDL (n-HDL) fraction by the difference. Anthropometric assessment included body weight (kg), height (m), fat (bioelectrical impedance) and waist circumference (WC). Food intake was assessed by the 24-hour recall questionnaire and the food groups evaluated through recommendations from an adapted food pyramid. The chances of dyslipidemia from other variable changes were determined by logistic regression with p < 0.05. Normal values of BMI and WC were protective against all dyslipidemia markers whereas only hypercholesterolemia was influenced by diet (meat intake > 2 servings). Dietary intakes have protective effects against hypertriglyceridemia with whole grains, odds ratio (OR) 0.342 (Cl 95%, 0.154-0.760), fruits >= 3 servings (OR 0.523, 0.290-0.941) and vegetables >= 4 servings (OR 0.360, 0.176-0.735). In general total body and abdominal adiposity influenced all dystipidemia markers while dietary intake of fruits and vegetables protected against triglyceridemia.

Metabolizable energy and oil intake in brown commercial layers

With the objective to establish the best metabolizable energy (ME) intake for layers, and the best dietary vegetable oil addition level to optimize egg production, an experiment was carried out with 432 30-week-old Hisex Brown layers. Birds were distributed into nine treatments with six replicates of eight birds each according to a 3 × 3 factorial arrangement, consisting of three daily metabolizable energy intake (280, 300 or 320 kcal/bird/day) and three oil levels (0.00; 0.75 and 1.50 g/bird/day). Daily feed intake was limited to 115, 110 and 105 g/bird in order to obtain the desired energy and oil intake in each treatment. The following parameters were evaluated: initial weight, final weight, body weight change, egg production, egg mass, feed conversion ratio per dozen eggs and per egg mass and energy conversion. There was no influence of the treatments on egg production (%) or egg mass (g/bird/day). Final weight and body weight change were significantly affected by increasing energy intake. Feed conversion ratio per egg mass, feed conversion ratio per dozen eggs and energy conversion significantly worsened as a function of the increase in daily energy intake. An energy intake of 280 kcal/bird/day with no addition of dietary oil does not affect layer performance.

Metabolizable energy and oil intake in brown commercial layers

With the objective to establish the best metabolizable energy (ME) intake for layers, and the best dietary vegetable oil addition level to optimize egg production, an experiment was carried out with 432 30-week-old Hisex Brown layers. Birds were distributed into nine treatments with six replicates of eight birds each according to a 3 x 3 factorial arrangement, consisting of three daily metabolizable energy intake (280, 300 or 320 kcal/bird/day) and three oil levels (0.00; 0.75 and 1.50 g/bird/day). Daily feed intake was limited to 115, 110 and 105 g/bird in order to obtain the desired energy and oil intake in each treatment. The following parameters were evaluated: initial weight, final weight, body weight change, egg production, egg mass, feed conversion ratio per dozen eggs and per egg mass and energy conversion. There was no influence of the treatments on egg production (%) or egg mass (g/bird/day). Final weight and body weight change were significantly affected by increasing energy intake. Feed conversion ratio per egg mass, feed conversion ratio per dozen eggs and energy conversion significantly worsened as a function of the increase in daily energy intake. An energy intake of 280 kcal/bird/day with no addition of dietary oil does not affect layer performance.

Do Tobacco and Alcohol Modify Protective Effects of Diet on Oral Carcinogenesis?

Recent systematic reviews concluded that the frequent consumption of fruits and vegetables is inversely associated with the risk of oral cancer. We assessed this association, specifically comparing results obtained to nonsmokers and smokers, as well to nondrinkers and drinkers. We conducted a case-control study involving 296 patients with oral squamous cell carcinoma (cases) attended in 3 major hospitals of Sao Paulo, Brazil, paired with 296 controls, recruited from outpatient units of the same hospitals. Multivariate models assessed the effect of fruits and salads according to smoking and drinking. The intake of fruit was associated with the prevention of the disease in the specific assessment among light [odds ratio (OR) = 0.46; 95% confidence interval (CI) = 0.27-0.78) and heavy (OR = 0.30; 95% CI = 0.14-0.65) smokers. The same was observed for vegetables consumption. For nonsmokers, no fruit (OR = 50; 95% CI = 0.22-1.12) or vegetable (for tomato, OR = 0.53; 95% CI = 0.31-0.93) was associated with reduced risk of oral and oropharyngeal cancer. Similar results were found in the stratified analysis according to drinking status with OR = 0.51 (95% CI = 0.30-0.87) and 0.18 for fruits (95% CI = 0.07-0.45), respectively, for light and heavy drinkers. This observation suggests that the protective effect of fruit and salad intake may modulate the deleterious effects from tobacco and alcohol.

Effects of a health advocacy program to promote physical activity and nutrition behaviors among adolescents: An evaluation of the Young Leaders for Healthy Change program

Background. This study was designed to evaluate the effects of the Young Leaders for Healthy Change program, an internet-delivered program in the school setting that emphasized health advocacy skills-development, on nutrition and physical activity behaviors among older adolescents (13–18 years). The program consisted of online curricular modules, training modules, social media, peer and parental support, and a community service project. Module content was developed based on Social Cognitive Theory and known determinants of behavior for older adolescents. ^ Methods. Of the 283 students who participated in the fall 2011 YL program, 38 students participated in at least ten of the 12 weeks and were eligible for this study. This study used a single group-only pretest/posttest evaluation design. Participants were 68% female, 58% white/Caucasian, 74% 10th or 11th graders, and 89% mostly A and/or B students. The primary behavioral outcomes for this analysis were participation in 60-minutes of physical activity per day, 20-minutes of vigorous- or moderate- intensity physical activity (MVPA) participation per day, television and computer time, fruit and vegetable (FV) intake, sugar-sweetened beverage intake, and consumption of breakfast, home-cooked meals, and fast food. Other outcomes included knowledge, beliefs, and attitudes related to healthy eating, physical activity, and advocacy skills. ^ Findings. Among the 38 participants, no significant changes in any variables were observed. However, among those who did not previously meet behavioral goals there was an 89% increase in students who participated in more than 20 minutes of MVPA per day and a 58% increase in students who ate home-cooked meals 5–7 days per week. The majority of participants met program goals related to knowledge, beliefs, and attitudes prior to the start of the program. Participants reported either maintaining or improving to the goal at posttest for all items except FV intake knowledge, taste and affordability of healthy foods, interest in teaching others about being healthy, and ease of finding ways to advocate in the community. ^ Conclusions. The results of this evaluation indicated that promoting healthy behaviors requires different strategies than maintaining healthy behaviors among high school students. In the school setting, programs need to target the promotion and maintenance of health behaviors to engage all students who participate in the program as part of a class or club activity. Tailoring the program using screening and modifying strategies to meet the needs of all students may increase the potential reach of the program. The Transtheoretical Model may provide information on how to develop a tailored program. Additional research on how to utilize the constructs of TTM effectively among high school students needs to be conducted. Further evaluation studies should employ a more expansive evaluation to assess the long-term effectiveness of health advocacy programming.^

Woodland Cottage, or, Henry and Emma Acton's conversations to their children, on the animal and vegetable world. /

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Dietary patterns and metabolic syndrome - a review of epidemiologic evidence

Metabolic syndrome is associated with increased risk of coronary heart disease and type 2 diabetes, and appears to be widely prevalent in both developed and developing countries. While lifestyle modification is recommended for management of the syndrome, the dietary pattern most beneficial for patients is yet to be ascertained. Original research papers from the Medline database were examined for dietary patterns that may be associated with the syndrome. Three large-scale epidemiological studies were found fitting our criteria. Dietary patterns high in fruit and vegetable content were generally found to be associated with lower prevalence of metabolic syndrome. Diet patterns with high meat intake were frequently associated with components of metabolic syndrome, particularly impaired glucose tolerance. High dairy intake was generally associated with reduced risk for components of metabolic syndrome with some inconsistency in the literature regarding risk of obesity. Minimally processed cereals appeared to be associated with decreased risk of metabolic syndrome, while highly processed cereals with high glycaemic index are associated with higher risk. Fried foods were noticeably absent from any dietary pattern associated with decreased prevalence of metabolic syndrome. The conclusion of this review is that no individual dietary component could be considered wholly responsible for the association of diet with metabolic syndrome. Rather it is the overall quality of the diet that appears to offer protection against lifestyle disease such as metabolic syndrome. Further research is required into conditions, such as overweight and obesity, which may influence the effect of diet on the development of metabolic syndrome.

Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane food study

Understanding the particularly low intake of fruits and vegetables among socioeconomically disadvantaged groups is an important issue for public health. This study investigated whether access to retail outlets is similar across areas of varying socioeconomic disadvantage in an Australian urban setting, in terms of distance, the numbers of local shops, and their opening hours. This ecological cross-sectional study used 50 randomly sampled census collection districts and their nearby shopping environment (i.e. within 2.5 km), and generally found minimal or no socioeconomic differences in shopping infrastructure. Important methodological and social/economic issues may explain this contrast with overseas findings.

Advances in (poly)phenol research: novel sources, bioavailability, bioaccumulation and bioactivity

In the last decades, increasing scientific evidence has correlated the regular consumption of (poly)phenol-rich foods to a potential reduction of chronic disease incidence and mortality. However, epidemiological evidence on the role of (poly)phenol intake against the risk of some chronic diseases is promising, but not conclusive. In this framework a proper approach to (poly)phenol research is requested, using a step by step strategy. The plant kingdom produces an overwhelming array of structurally diverse secondary metabolites, among which flavonoids and related phenolic and (poly)phenolic compounds constitute one of the most numerous and widely distributed group of natural products. To date, more than 8000 structures have been classified as members of the phytochemical class of (poly)phenol, and among them over 4000 flavonoids have been identified. For this reason, a detailed food (poly)phenolic characterization is essential to identify the compounds that will likely enter the human body upon consumption, to predict the metabolites that will be generated and to unravel the potential effects of phenolic rich food sources on human health. In the first part of this work the attention was focused on the phenolic characterization of fruit and vegetable supplements, considering the increasing attention recently addressed to the so called "nutraceuticals", and on the main coffee industry by-product, namely coffee silverskin. The interest oriented toward (poly)phenols is then extended to their metabolism within the human body, paramount in the framework of their putative health promoting effects. Like all nutrients and non-nutrients, once introduced through the diet, (poly)phenols are subjected to an intense metabolism, able to convert the native compounds into similar conjugated, as well as smaller and deeply modified molecules, which in turn could be further conjugated. Although great strides have been made in the last decades, some steps of the (poly)phenol metabolism remain unclear and are interesting points of research. In the second part of this work the research was focused on a specific bran fraction, namely aleurone, added in feed pellets and in bread to investigate the absorption, metabolism and bioavailability of its phenolic compounds in animal and humans, with a preliminary in vitro step to determine their potential bioaccesibility. This part outlines the best approaches to assess the bioavailability of specific phenolics in several experimental models. The physiological mechanisms explaining the epidemiological and observational data on phenolics and health, are still far from being unraveled or understood in full. Many published results on phenolic actions at cell levels are biased by the fact that aglycones or native compounds have been used, not considering the previously mentioned chemical and biological transformations. In the last part of this thesis work, a new approach in (poly)phenol bioactivity investigation is proposed, consisting of a medium-long term treatment of animals with a (poly)phenol source, in this specific case resveratrol, the detection of its metabolites to determine their possible specific tissue accumulation, and the evaluation of specific parameters and/or mechanism of action at target tissue level. To conclude, this PhD work has contributed to advancing the field, as novel sources of (poly)phenols have been described, the bioavailability of (poly)phenols contained in a novel specific bran fraction used as ingredient has been evaluated in animal and in humans, and, finally, the tissue accumulation of specific (poly)phenol metabolites and the evaluation of specific parameters and/or mechanism of action has been carried out. For these reasons, this PhD work should be considered an example of adequate approach to the investigation of (poly)phenols and of their bioactivity, unavoidable in the process of unequivocally defining their effects on human health.

Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study

BACKGROUND:Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. METHODS: This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. RESULTS: Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. CONCLUSIONS: Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.

A multilevel study of area socio-economic status and food purchasing behaviour

Objective: This study examined the association between area socioeconomic status (SES) and food purchasing behaviour.----- Setting: Melbourne city, Australia, 2003.----- Participants: Residents of 2,564 households located in 50 small areas.----- Design: Data were collected by mail survey (64.2% response rate). Area SES was indicated by the proportion of households in each area earning less than Aus$400 per week, and individual-level socioeconomic position was measured using education, occupation, and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socioeconomic factors.----- Results: Residents of low SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt, and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.----- Conclusions In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility, and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.