European Journal of Nutrition (v.56, #6)

Capable and credible? Challenging nutrition science by Bart Penders; Anna Wolters; Edith F. Feskens; Fred Brouns; Machteld Huber; Els L. M. Maeckelberghe; Gerjan Navis; Theo Ockhuizen; Jogchum Plat; Jan Sikkema; Marianne Stasse-Wolthuis; Pieter van ‘t Veer; Marcel Verweij; Jan de Vries (2009-2012).
Nutrition science has enriched our understanding of how to stay healthy by producing valuable knowledge about the interaction of nutrients, food, and the human body. Nutrition science also has raised societal awareness about the links between food consumption and well-being, and provided the basis for food regulations and dietary guidelines. Its collaborative and interdisciplinary research has accomplished much, scientifically and socially. Despite this, nutrition science appears to be in crisis and is currently confronted with a public reluctance to trust nutritional insights. Though deflating trust is a general phenomenon surrounding the scientific community, its impact on nutrition science is particularly strong because of the crucial role of nutrition in everyone’s daily life. We, a Dutch collective of nutritionists, medical doctors, philosophers and sociologists of science ( http://www.nutritionintransition.nl ), have diagnosed that nutrition science is meeting inherent boundaries. This hampers conceptual and methodological progress and the translation of novel insights into societal benefit and trust. In other words, nutrition science is facing limitations to its capability and credibility, impeding its societal value. We take up the challenge to halt the threatening erosion of nutrition science’s capability and credibility, and explore a way forward. We analyse limitations to capability and credibility, then argue that nutrition science is caught in a vicious circle, and end by offering some suggestions to transcend the limitations and escape the current deadlock. We invite nutritional experts as well as scholars from adjacent disciplines to engage in the discussion.
Keywords: Nutrition science; Credibility; Capability; Inclusiveness; Evidence; Real-world experiments

Nutrition for diabetic retinopathy: plummeting the inevitable threat of diabetic vision loss by Yashodhara Sharma; Sandeep Saxena; Arvind Mishra; Anita Saxena; Shankar Madhav Natu (2013-2027).
Diabetic retinopathy (DR) is among the leading causes of preventable blindness. Hyperglycemia, hypertension, hyperlipidemia and anemia majorly predispose its pathogenesis. The current treatment modalities of DR include laser photocoagulation therapy, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents and vitreo-retinal surgery which are costly, highly invasive, unproven for prolonged use and opted in advanced stages of DR. By then retina already encounters a vast damage. Nutrients by their natural physiological, biochemical and molecular action can preserve retinal structure and functions by interfering with the various pathological steps prompting DR incidence, thereby altering the risk of developing this ocular morbidity. Nutrients can also play a central role in DR patients resistant towards the conventional medical treatments. However due to the byzantine interplay existing between nutrients and DR, the worth of nutrition in curbing this vision-threatening ocular morbidity remains silent. This review highlights how nutrients can halt DR development. A nutritional therapy, if adopted in the initial stages, can provide superior-efficacy over the current treatment modalities and can be a complementary, inexpensive, readily available, anodyne option to the clinically unmet requirement for preventing DR. Assessment of nutritional status is presently considered relevant in various clinical conditions except DR. Body Mass Index (BMI) conferred inconclusive results in DR subjects. Subjective Global Assessment (SGA) of nutritional status has recently furnished relevant association with DR status. By integrating nutritional strategies, the risk of developing DR can be reduced substantially. This review summarizes the subsisting knowledge on nutrition, potentially beneficial for preventing DR and sustaining good vision among diabetic subjects.
Keywords: Diabetic retinopathy; Nutrients; Nutritional status; Body Mass Index; Subjective Global Assessment

This study aimed to evaluate the effect of daily consumption of vitamin D-fortified yogurt drink (doogh) in comparison with plain doogh on appetite-regulating hormones including leptin and ghrelin in type 2 diabetes (T2D) patients.In a single blind randomized clinical trial, subjects with T2D were randomly allocated to one of the two groups and received either vitamin D3-fortified doogh (FD; containing 170 mg calcium and 500 IU/250 mL, n 2 = 50) or plain doogh (PD; containing 170 mg calcium and no vitamin D/250 mL, n 1 = 50) twice a day for 12 weeks. Leptin and ghrelin were evaluated at the beginning and after 12 weeks of intervention.The intervention resulted in a significant improvement of circulating 25(OH)D, fasting glucose, Quantitative Insulin Check Index (QUICKI), hs-CRP, in FD compared with PD group. A significant rise in both serum leptin (+1.3 ± 7.2 mg/L; p = 0.013) and ghrelin (10.1 ± 26.1 ng/L; p = 0.012) was observed in FD group. A between-group difference for ghrelin changes (p = 0.029) remained significant after adjusting for changes QUICKI (p = 0.039), body mass index (p = 0.034) and hs-CRP (p = 0.022). Despite an increase in both leptin and ghrelin, leptin to ghrelin (L/G) ratio actually decreased in FD. Changes of L/G ratio showed a significant between-group difference (p = 0.036), which remained significant even after adjusting for changes of hs-CRP (p = 0.028) and fat mass (p = 0.047) but disappeared after adjusting for changes of QUICKI (p = 0.42).Daily intake of vitamin D-fortified doogh may increase circulating leptin and ghrelin but L/G ratio may actually decrease. Our results suggest that improving vitamin D may result in an improvement in insulin sensitivity which may finally regulate beneficially appetite hormones. Further studies with adequate power are needed to confirm the results.
Keywords: Vitamin D; Leptin; Ghrelin; Type 2 diabetes

Oxidized tea polyphenols prevent lipid accumulation in liver and visceral white adipose tissue in rats by Sumin Wang; Yewei Huang; Huanhuan Xu; Qiangqiang Zhu; Hao Lu; Mengmeng Zhang; Shumei Hao; Chongye Fang; Dongying Zhang; Xiaoyun Wu; Xuanjun Wang; Jun Sheng (2037-2048).
Tea polyphenols are the prominent component in tea. After the fermentation process, tea polyphenols are oxidized by polyphenol oxidase to form oxidized tea polyphenols (OTPs). OTPs contain a significant amount of hydrophobic phenyl groups that can bind with non-aqueous materials. Here, we determined whether OTPs can bind with lipids and reduce fat uptake and assessed the effect of OTPs on decreasing obesity and alleviating hyperlipidaemia and other metabolic syndromes.Rats were divided into three groups: control, high-fat diet (HFD) and OTP groups. The control and HFD groups were fed a chow diet and a high-fat diet, respectively, for 12 weeks; the OTP group was fed a high-fat diet for 6 weeks and then a high-fat diet containing 2 % OTP for 6 weeks. The serum and excrement triglyceride (TAG) and total cholesterol (CHOL) concentrations were determined, and liver tissue and white adipose tissue were collected to detect the expression levels of genes involved in lipid metabolism.Our results revealed that OTPs failed to decrease the serum concentrations of TAG and CHOL. OTPs alleviated the accumulation of lipids in the liver tissue and changed the expression levels of the regulators of lipid metabolism, i.e., peroxisome proliferation-activated receptors (ppars), compared with the rats fed a high-fat diet alone. We also observed a significantly decreased reduction of weight in the visceral white adipose, enhanced regulation of fatty acid β-oxidation by PPARα and enhanced biosynthesis of mitochondria in the visceral white adipose of the OTP rats compared with the HFD rats. Additionally, OTPs promoted the excretion of lipids.Our results suggest that OTPs alleviate the accumulation of lipids in liver and visceral white adipose tissue and promote lipid excretion in rats in vivo.
Keywords: Oxidized tea polyphenols; Liver lipid accumulation; ppars ; Lipolysis; Visceral white adipose

Efficacy of different fibres and flour mixes in South-Asian flatbreads for reducing post-prandial glucose responses in healthy adults by Hanny M. Boers; Katrina MacAulay; Peter Murray; Jack Seijen ten Hoorn; Anne-Roos Hoogenraad; Harry P. F. Peters; Maria A. M. Vente-Spreeuwenberg; David J. Mela (2049-2060).
Type 2 diabetes (T2DM) is increasing, particularly in South-East Asia. Intake of high-glycaemic foods has been positively associated with T2DM, and feasible routes to reduce the glycaemic response to carbohydrate-rich staple foods are needed. The research question was whether different fibre and legume flour mixes in flatbreads lower postprandial glucose (PPG) responses.Using a balanced incomplete block design, we tested the inclusion of guar gum (GG), konjac mannan (KM) and chickpea flour (CPF) in 10 combinations (2/4/6 g GG; 2/4 g KM; 15 g CPF, and 10 or 15 g CPF plus 2 or 4 g GG) in 100 g total of a control commercial high-fibre flatbread flour mix (“atta”) on PPG in 38 normal-weight adults. Self-reported appetite was an additional exploratory outcome. An in vitro digestion assay was adapted for flatbreads and assessed for prediction of in vivo PPG.Flatbreads with 6 g GG, 4 g KM, and 15 g CPF plus 2 or 4 g GG reduced PPG ≥30 % (p < 0.01), while no other combinations differed significantly from the control. A statistical model with four in vitro parameters (rate of digestion, %RDS, AUC, carbohydrate level) was highly predictive of PPG results (adjusted R 2 = 0.89). Test products were similar to the control for appetite-related measures.The results confirm the efficacy of specific additions to flatbread flour mixes for reducing PPG and the value of the in vitro model as a predictive tool with these ingredients and product format.This trial is registered at ClinicalTrials.gov with identifier NCT02671214.
Keywords: Atta; Viscous fibre; Glycaemic response; In vitro digestion; Appetite

Vitamin D status in young Swedish women with anorexia nervosa during intensive weight gain therapy by Anna Svedlund; Cecilia Pettersson; Bojan Tubic; Per Magnusson; Diana Swolin-Eide (2061-2067).
Anorexia nervosa (AN) is associated with reduced bone mass and an increased fracture risk. The aim was to evaluate the vitamin D status and the association with body mass index (BMI), fat mass and bone mineral density (BMD) in patients with severe AN during a prospective intervention study of intensive nutrition therapy.This study comprised 25 Swedish female AN patients (20.1 ± 2.3 years), who were treated as inpatients for 12 weeks with a high-energy diet. Serum 25-hydroxyvitamin D (25(OH)D), calcium, phosphate and parathyroid hormone (PTH) were measured. BMD and body composition were assessed by dual-energy X-ray absorptiometry at study start and after 12 weeks.Twenty-two patients completed the study. The mean weight gain was 9.9 kg and BMI (mean ± SD) increased from 15.5 ± 0.9 to 19.0 ± 0.9 kg/m2, P < 0.0001. Fat mass increased from median 12 to 27 %. The median serum 25(OH)D level was 84 nmol/L at baseline, which decreased to 76 nmol/L, P < 0.05. PTH increased from median 21.9 to 30.0 ng/L, P < 0.0001. BMC increased during the study period, P < 0.001.Serum 25(OH)D levels were adequate both at study start and completion, however, nominally decreased after the 12-week nutritional intervention. PTH increased subsequently, which coincide with the decreased 25(OH)D levels. The reduction in 25(OH)D could be due to an increased storage of vitamin D related to the increase in fat mass since vitamin D is sequestered in adipose tissue.
Keywords: Vitamin D; Anorexia nervosa; Nutrition therapy; Bone

Benefits of l-alanine or l-arginine supplementation against adiposity and glucose intolerance in monosodium glutamate-induced obesity by Thiago R. Araujo; Israelle N. Freitas; Jean F. Vettorazzi; Thiago M. Batista; Junia C. Santos-Silva; Maria L. Bonfleur; Sandra L. Balbo; Antonio C. Boschero; Everardo M. Carneiro; Rosane A. Ribeiro (2069-2080).
l-alanine (Ala) and l-arginine (Arg) have been reported to regulate pancreatic β-cell physiology and to prevent body fat accumulation in diet-induced obesity. Here, we assessed growth and adiposity parameters, glucose tolerance, insulin secretion and the expression of insulin and nutrient-regulated proteins in monosodium glutamate (MSG)-obese mice supplemented with either Ala or Arg.Male newborn C57Bl/6 mice received a daily subcutaneous injection of MSG or saline solution (CTL group), during the first 6 days of life. From 30 to 90 days of age, MSG and CTL mice received or not 2.55 % Ala (CAla or MArg groups) or 1.51 % Arg-HCl (CArg or MArg groups) in their drinking water.Adult MSG mice displayed higher adiposity associated with lower phosphorylation of the adipogenic enzyme, ACC, in adipose tissue. Glucose intolerance in MSG mice was linked to lower insulin secretion and to lower expression of IRβ in adipose tissue, as well as AS160 phosphorylation in skeletal muscle. Perigonadal fat depots were smaller in Ala and Arg mice, while retroperitoneal fat pads were decreased by Ala supplementation only. Both Ala and Arg improved fed-state glycemia as well as IRβ and pAS160 content, but only Ala led to improved glucose tolerance and insulin secretion. Adipostatic signals were increased in MAla mice, as indicated by enhanced AMPK phosphorylation and pACC content in fat depots.Ala supplementation led to more pronounced metabolic improvements compared to Arg, possibly due to suppression of lipogenesis through activation of the AMPK/ACC pathway.
Keywords: AMP-activated kinase; Insulin secretion; l-alanine supplementation; l-arginine supplementation; MSG obesity; Neuroendocrine disorder

Acute effects of energy drinks in medical students by Andrés García; César Romero; Cristhian Arroyave; Fabián Giraldo; Leidy Sánchez; Julio Sánchez (2081-2091).
To determine the acute effects of a variety of recognized energy drinks on medical students, based on the hypothesis that these beverages may affect negatively cardiovascular parameters, stress levels and working memory.Eighty young healthy medical students were included in the study. 62.5 % of the participants were male, and the age mean was 21.45 years. Each person was evaluated via measurement of systolic and diastolic blood pressure, electrocardiogram (ECG), heart rate, oxygen saturation, breath rate, temperature, STAI score (to assess anxiety state), salivary cortisol and N-back task score (to determine cognitive enhancement). These evaluations were performed before and following the intake of either carbonated water or one of three energy drinks containing caffeine in similar concentrations and an undetermined energy blend; A contained less sugar and no taurine.Thirty-minute SBP increased significantly in the A and C groups. The B group exhibited a diminution of the percentage of the 1-h SBP increase, an increase of 1-h DBP and QTc shortening. HR showed an increase in the percent change in the A and C groups. Cortisol salivary levels increased in the B group. The STAI test score decreased in the C group. The percent change in N-back scores increased in the A group.The data reinforce the need for further research on the acute and chronic effects of energy drinks to determine the actual risks and benefits. Consumers need to be more informed about the safety of these energy drinks, especially the young student population.
Keywords: Energy drink; Caffeine; Taurine; Cortisol; Blood pressure; Medical students

Evaluation of cognitive subdomains, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D in the European Male Ageing Study by Margot J. Overman; Neil Pendleton; Terence W. O’Neill; Gyorgy Bartfai; Felipe F. Casanueva; Joseph D. Finn; Gianni Forti; Giulia Rastrelli; Aleksander Giwercman; Thang S. Han; Ilpo T. Huhtaniemi; Krzysztof Kula; Michael E. J. Lean; Margus Punab; David M. Lee; Elon S. Correa; Tomas Ahern; Sabine M. P. Verschueren; Leen Antonio; Evelien Gielen; Martin K. Rutter; Dirk Vanderschueren; Frederick C. W. Wu; Jos Tournoy (2093-2103).
Although lower levels of vitamin D have been related to poor cognitive functioning and dementia in older adults, evidence from longitudinal investigations is inconsistent. The objective of this study was to determine whether 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels are associated with specified measures of cognitive decline in ageing men.The European Male Ageing Study (EMAS) followed 3369 men aged 40–79 over 4.4 years. 25(OH)D levels at baseline were measured by radioimmunoassay, and 1,25(OH)2D levels were obtained with liquid chromatography–tandem mass spectrometry. Visuoconstructional abilities, visual memory, and processing speed at baseline and follow-up were assessed using the Rey–Osterrieth Complex Figure Test (ROCF), Camden Topographical Recognition Memory (CTRM), and the Digit Symbol Substitution Test (DSST).Following attritions, a total of 2430 men with a mean (SD) age of 59.0 (10.6) were included in the analyses. At baseline, the mean 25(OH)D concentration was 64.6 (31.5) nmol/l, and mean 1,25(OH)2D level was 59.6 (16.6) pmol/l. In age-adjusted linear regression models, high 25(OH)D concentrations were associated with a smaller decline in the DSST (β = 0.007, p = 0.020). Men with low 25(OH)D levels (<50 nmol/l) showed a greater decline in the CTRM compared to men with higher (≥75 nmol/l) levels (β = −0.41, p = 0.035). However, these associations disappeared after adjusting for confounders such as depressive symptoms, BMI, and comorbidities. There was no indication of a relationship between 1,25(OH)2D and decline in cognitive subdomains.We found no evidence for an independent association between 25(OH)D or 1,25(OH)2D levels and visuoconstructional abilities, visual memory, or processing speed over on average 4.4 years in this sample of middle-aged and elderly European men.
Keywords: Vitamin D; Cognition; Ageing; Male health; Multicenter study

Cardiovascular responses to sugary drinks in humans: galactose presents milder cardiac effects than glucose or fructose by Nathalie Charrière; Cathriona Loonam; Jean-Pierre Montani; Abdul G. Dulloo; Erik K. Grasser (2105-2113).
There is increasing interest into the potentially beneficial effects of galactose for obesity and type 2 diabetes management as it is a low-glycemic sugar reported to increase satiety and fat mobilization. However, fructose is also a low-glycemic sugar but with greater blood pressure elevation effects than after glucose ingestion. Therefore, we investigated here the extent to which the ingestion of galactose, compared to glucose and fructose, impacts upon haemodynamics and blood pressure.In a randomized cross-over study design, 9 overnight-fasted young men attended 3 separate morning sessions during which continuous cardiovascular monitoring was performed at rest for at least 30 min before and 120 min after ingestion of 500 mL of water containing 60 g of either glucose, fructose or galactose. These measurements included beat-to-beat systolic and diastolic blood pressure, heart rate deduced by electrocardiography, and stroke volume derived by impedance cardiography; these measurements were used to calculate cardiac output and total peripheral resistance.Ingestion of galactose, like glucose, led to significantly lesser increases in systolic, diastolic and mean blood pressure than fructose ingestion (p < 0.05). Furthermore, the increase in cardiac output and reduction in total peripheral resistance observed after ingestion of glucose were markedly lower after galactose ingestion (p < 0.01).Galactose thus presents the interesting characteristics of a low-glycemic sugar with mild cardiovascular effects. Further studies are warranted to confirm the clinical relevance of the milder cardiovascular effects of galactose than other sugars for insulin resistant obese and/or diabetic patients with cardiac insufficiency.
Keywords: Sucrose; Beat-to-beat; Randomized controlled trial; Cardiac effects; Clinical implication

Daily exposure to stress and excessive fructose intake coincides with the growing rate of obesity and related disorders, to which women are more prone than men. Glucocorticoids, the main regulators of energy balance and response to stress, have been associated with the development of metabolic disturbances. The aim of the present study was to examine the effects of fructose overconsumption and/or chronic stress on glucocorticoid signalization and lipid metabolism in female rat adipose tissue.We examined the effects of fructose-enriched diet and chronic unpredictable stress, separately and in combination, on glucocorticoid signaling in terms of 11β-hydroxysteroid dehydrogenase 1 (HSD1)-catalyzed corticosterone regeneration, glucocorticoid receptor (GR) intracellular distribution, hormone binding and transcriptional regulation of genes involved in lipolysis (hormone-sensitive lipase) and lipogenesis (lipoprotein lipase, acetyl-CoA carboxylase, fatty acid synthase and phosphoenolpyruvate carboxykinase) in the visceral adipose tissue (VAT) of adult female rats. Additionally, the nuclear level of the peroxisomal proliferator-activated receptor γ (PPARγ) was analyzed.The combination of stress and fructose-enriched diet led to an elevation in HSD1 expression and intracellular corticosterone concentration, whereas GR nuclear accumulation was enhanced after separate treatments. Furthermore, fructose was shown to induce the expression of all examined lipogenic genes and nuclear accumulation of PPARγ, thereby stimulating adipogenesis, while stress upregulated HSL, reducing the adipose tissue mass regardless of fructose consumption.Prolonged overconsumption of fructose and chronic exposure to stress promote opposite effects on lipid metabolism in the VAT of adult female rats and suggest that these effects could be mediated by glucocorticoids.
Keywords: Glucocorticoid receptor; Fructose; Chronic unpredictable stress; Lipid metabolism; Visceral adipose tissue; Female rats

Effect of foxtail millet protein hydrolysates on lowering blood pressure in spontaneously hypertensive rats by Jing Chen; Wei Duan; Xin Ren; Chao Wang; Zhongli Pan; Xianmin Diao; Qun Shen (2129-2138).
The objective of this study was to determine the effect of foxtail millet protein hydrolysates on lowering blood pressure in spontaneously hypertensive rats (SHRs).The protein of foxtail millet after extruding or fermenting and the raw foxtail millet was extracted and hydrolyzed by digestive protease to generate angiotensin-converting enzyme (ACE) inhibitory peptides. The potential antihypertensive effect of protein hydrolysates from foxtail millet in SHRs was investigated.After 4 weeks of treatment with 200 mg peptides/kg of body weight of protein hydrolysates, blood pressure was lowered significantly, and the raw and extruded samples were more effective than the fermented samples. The serum ACE activity and angiotensin II levels in the treatment groups were significantly lower than that of the control. The percent heart weight decreased in the treatment groups.Thus, ingestion of foxtail millet protein hydrolysates especially for the raw and extruded hydrolysates may ameliorate hypertension and alleviate related cardiovascular diseases.
Keywords: Angiotensin-converting enzyme; Angiotensin II; Antioxidant; Foxtail millet protein hydrolysates; Hypertension; Spontaneously hypertensive rats

It is believed that breakfast is an important meal due to its effect on appetite control and cognitive performance, yet little evidence exists to support this hypothesis.Using a crossover design, 33 healthy undergraduates (aged 22 ± 2 years with a BMI of 23.5 ± 1.7 kg/m2) were randomized one of four breakfast treatments: no breakfast, a low-protein breakfast containing no animal protein, a high-carbohydrate/low-protein breakfast containing animal protein or a low-carbohydrate/high-protein breakfast. After an overnight fast, participants reported to the laboratory and baseline appetite questionnaires and cognitive tests were completed. A baseline blood sample was also collected. These measures were repeated at regular intervals throughout the test session. An ad libitum lunch meal was provided 240 min after breakfast, and the amount eaten recorded. Diet diaries and hourly appetite questionnaires were completed for the rest of the day.The no-breakfast treatment had a marked effect on appetite before lunch (p < .05). Moreover, participants consumed more energy at lunch following the no-breakfast treatment (p < .05). There was no difference in appetite before lunch or food intake at lunch following any treatment when breakfast was eaten. However, food intake over the entire test day was lowest for the no-breakfast treatment (p < .05). Plasma glucose and insulin were lower following the high-protein/low-carbohydrate treatment compared to the low-protein/high-carbohydrate—no animal protein treatment (p < .05). Participants were less happy when they missed breakfast (p < .05), but there were no other statistically significant effects of breakfast on mood or cognitive performance.These results suggest that changing the macronutrient content of breakfast influences the glycemic response, but has no effect on the appetitive or cognitive performance measures used in this present study.
Keywords: Protein; Satiety; Cognitive performance; Breakfast

Protein intake during pregnancy and offspring body composition at 6 years: the Generation R Study by Myrte J. Tielemans; Eric A. P. Steegers; Trudy Voortman; Vincent W. V. Jaddoe; Fernando Rivadeneira; Oscar H. Franco; Jessica C. Kiefte-de Jong (2151-2160).
Intra-uterine exposure to protein may affect body composition and may increase the prevalence of childhood adiposity. Therefore, we examined whether protein intake during pregnancy is associated with offspring body composition at the age of 6 years and whether associations differ for animal protein and vegetable protein.We included 2694 Dutch mother–child pairs participating in a prospective population-based cohort in Rotterdam, the Netherlands. Energy-adjusted protein was measured in pregnancy using a food-frequency questionnaire and analyzed in quartiles. At a mean age of 6.1 ± 0.4 years, we measured children’s body mass index, and fat-free mass index and fat mass index using dual-energy X-ray absorptiometry. Outcomes were standardized for age and sex. BMI was used to classify children’s overweight status.After adjustment for sociodemographic and lifestyle factors, a higher maternal protein intake was associated with a higher children’s fat-free mass index [difference 0.14 standard deviation (95 % CI 0.03, 0.25) for highest vs. lowest quartile of protein intake], but not with children’s fat mass index or body mass index. Comparable associations were found for animal protein and vegetable protein. Maternal protein intake was not associated with children’s overweight.This study suggests that higher protein intake during pregnancy is associated with a higher fat-free mass in children at the age of 6 years, but not with their fat mass. Our results do not suggest specific recommendations regarding maternal protein intake during pregnancy to prevent overweight in the offspring.
Keywords: Protein intake; Pregnancy; Body composition; Obesity; Offspring; Fetal programming

Relationships between hydration biomarkers and total fluid intake in pregnant and lactating women by Amy L. McKenzie; Erica T. Perrier; Isabelle Guelinckx; Stavros A. Kavouras; Giselle Aerni; Elaine C. Lee; Jeff S. Volek; Carl M. Maresh; Lawrence E. Armstrong (2161-2170).
Previous research established significant relationships between total fluid intake (TFI) and urinary biomarkers of the hydration process in free-living males and females; however, the nature of this relationship is not known for pregnant (PREG) and lactating (LACT) women.To determine the relationship between urinary and hematological hydration biomarkers with TFI in PREG and LACT.Eighteen PREG/LACT (age: 31 ± 3 years, pre-pregnancy BMI: 24.26 ± 5.85 kg m−2) collected 24-h urine samples, recorded TFI, and provided a blood sample at 5 time points (15 ± 2, 26 ± 1, 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation); 18 pair-matched non-pregnant (NP), non-lactating (NL) women (age: 29 ± 4 years, BMI: 24.1 ± 3.7 kg m−2) provided samples at similar time intervals. Twenty-four-hour urine volume (U VOL), osmolality (U OSM), specific gravity (U SG), and color (U COL) were measured. Hematocrit, serum osmolality (S OSM), and serum total protein (S TP) were measured in blood.Significant relationships were present between TFI and urinary biomarkers in all women (P < 0.004); these relationships were not different between PREG and NP, and LACT and NL, except U VOL in PREG (P = 0.0017). No significant relationships between TFI and hematological biomarkers existed (P > 0.05).Urinary biomarkers of hydration, but not hematological biomarkers, have a strong relationship with TFI in PREG, LACT, NP, and NL women. These data suggest that urinary biomarkers of hydration reflect TFI during pregnancy and breast-feeding.
Keywords: Hydration status; Urine biomarkers; Blood biomarkers; Fluid intake adequacy; Gestation; Breast-feeding

Circulating linoleic acid and alpha-linolenic acid and glucose metabolism: the Hoorn Study by Mieke Cabout; Marjan Alssema; Giel Nijpels; Coen D. A. Stehouwer; Peter L. Zock; Ingeborg A. Brouwer; Amany K. Elshorbagy; Helga Refsum; Jacqueline M. Dekker (2171-2180).
Data on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabetes mellitus (T2DM) risk are scarce and inconsistent. The aim of this study was to investigate the association of serum LA and ALA with fasting and 2 h post-load plasma glucose and glycated hemoglobin (HbA1c).This study included 667 participants from third examination (2000) of the population-based Hoorn study in which individuals with glucose intolerance were overrepresented. Fatty acid profiles in serum total lipids were measured at baseline, in 2000. Diabetes risk markers were measured at baseline and follow-up in 2008. Linear regression models were used in cross-sectional and prospective analyses.In cross-sectional analyses (n = 667), serum LA was inversely associated with plasma glucose, both in fasting conditions (B = −0.024 [−0.045, −0.002]) and 2 h after glucose tolerance test (B = −0.099 [−0.158, −0.039]), but not with HbA1c (B = 0.000 [−0.014, 0.013]), after adjustment for relevant factors. In prospective analyses (n = 257), serum LA was not associated with fasting (B = 0.003 [−0.019, 0.025]) or post-load glucose (B = −0.026 [−0.100, 0.049]). Furthermore, no significant associations were found between serum ALA and glucose metabolism in cross-sectional or prospective analyses.In this study, serum LA was inversely associated with fasting and post-load glucose in cross-sectional, but not in prospective analyses. Further studies are needed to elucidate the exact role of serum LA and ALA levels and dietary polyunsaturated fatty acids in glucose metabolism.
Keywords: Serum fatty acids; Linoleic acid; Alpha-linolenic acid; Type 2 diabetes; Glucose; Hemoglobin A1c

Chronic pistachio intake modulates circulating microRNAs related to glucose metabolism and insulin resistance in prediabetic subjects by Pablo Hernández-Alonso; Simona Giardina; Jordi Salas-Salvadó; Pierre Arcelin; Mònica Bulló (2181-2191).
To assess the effects of a pistachio-enriched diet on the profile of circulating microRNAs (miRNAs) related to glucose metabolism and insulin resistance (IR).Randomized crossover clinical trial in 49 subjects with prediabetes was performed. Subjects consumed a pistachio-supplemented diet (PD, 50 % carbohydrates, 33 % fat, including 57 g/day of pistachios) and an isocaloric control diet (CD, 55 % carbohydrates and 30 % fat) for 4 months each, separated by a 2-week washout period. The plasma profile of a set of seven predefined miRNAs related to glucose and insulin metabolism was analyzed by quantitative RT-PCR.After the PD period, subjects have shown significant lower circulating levels of miR-192 and miR-375 compared to CD period, whereas miR-21 nonsignificantly increased after PD compared with CD (47 vs. 2 %, P = 0.092). Interestingly, changes in circulating miR-192 and miR-375 were positively correlated with plasma glucose, insulin and HOMA-IR.Chronic pistachio consumption positively modulates the expression of some miRNA previously implicated on insulin sensitivity.
Keywords: Prediabetes; Pistachio; microRNA; Glucose

Addition of arabinoxylan and mixed linkage glucans in porcine diets affects the large intestinal bacterial populations by John B. Gorham; Seungha Kang; Barbara A. Williams; Lucas J. Grant; Christopher S. McSweeney; Michael J. Gidley; Deirdre Mikkelsen (2193-2206).
To investigate the effects of two cereal soluble dietary fibres (SDF), wheat arabinoxylan (AX) and oat-mixed linkage glucans (MLG), on fermentative end-products and bacterial community profiles of the porcine caecum (Cae) and distal colon (DC). We hypothesised that feeding pigs these SDF would stimulate Cae and DC carbohydrate fermentation, resulting in a modification of the resident bacterial communities.Five groups of six pigs were each fed one diet based on wheat starch (WS) only, or treatment diets in which some WS was replaced by 10 % AX, or 10 % MLG, a combination of 5 % AX:5 % MLG (AXMLG), or completely replaced with ground whole wheat. Post-euthanasia, Cae and DC digesta were collected for analysis of fermentative end-products, and bacterial community profiles were determined by 16S rRNA gene amplicon 454 pyrosequencing.Across all the SDF-containing diets, predominantly in the proximal region of the large intestine, Prevotella, Lactobacillus, Mitsuokella and Streptococcus were most significantly influenced (P < 0.05), while notable changes were observed for the Ruminococcaceae and Lachnospiraceae families in the Cae and DC. The addition of MLG or AXMLG had the greatest effect of influencing bacterial profiles, reducing sequence proportions assigned to the genus Clostridium, considered detrimental to gut health, with associated increases in short-chain fatty acid and reduced ammonia concentrations.This study demonstrated how the cereal SDF AX and MLG altered the large intestinal bacterial community composition, particularly proximally, further giving insights into how diets rich in specific complex carbohydrates shift the bacterial population, by increasing abundance and promoting greater diversity of those bacteria considered beneficial to gut health.
Keywords: 16S rRNA gene; Arabinoxylan; Mixed linkage glucans; Pig model; Pyrosequencing; Soluble dietary fibre

Maternal vitamin D status during pregnancy in Europe: the two sides of the story by Spyridon N. Karras; Carol L. Wagner; Elena Angeloudi; Kalliopi Kotsa (2207-2208).

Reply to Letter to the Editor to Maternal vitamin D status during pregnancy in Europe: the two sides of the story by Hauta-alus HH; Holmlund-Suila EM; Andersson S; Mäkitie OM; Viljakainen HT (2209-2210).

Reply to Letter to the Editor to J-shaped relationship between habitual coffee consumption and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA study by Georgia-Maria Kouli; Demosthenes B. Panagiotakos; Ekavi N. Georgousopoulou; Duane D. Mellor; Christina Chrysohoou; Adela Zana; Constantine Tsigos; Dimitrios Tousoulis; Christodoulos Stefanadis; Christos Pitsavos (2213-2214).