Can wheat germ have a beneficial effect on human health? A study protocol for a randomised crossover controlled trial to evaluate its health effects

André Moreira-Rosário, Helder Pinheiro, Conceição Calhau, Luís Filipe Azevedo, André Moreira-Rosário, Helder Pinheiro, Conceição Calhau, Luís Filipe Azevedo

Abstract

Introduction: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide and diet is an important contributor to CVD risk. Thus, several food derivatives are being investigated for their beneficial impact on reducing cardiometabolic risk factors, either in risk groups or in healthy population as a preventive measure. Wheat germ is a food by-product with high nutritional value, especially as a concentrated source of dietary fibre and essential fatty acids, but its incorporation into the diet has been rare up to now. Previous studies do not clarify the hypothesised potential causal relationship between the consumption of wheat germ and benefits for human health.

Methods and analysis: We are conducting a randomised, double-blinded, crossover, placebo-controlled clinical trial designed to assess the physiological effects of daily consumption of wheat germ-enriched bread (containing 6 g of wheat germ) compared with non-enriched bread, over a 4-week period with a 15-week follow-up, in a healthy human population. A total of 55 participants (healthy volunteers, aged 18-60) have been recruited from the Porto metropolitan area in northern Portugal. Our aim is to evaluate the health effects of wheat germ on blood cholesterol and triglycerides, postprandial glycaemic response, gastrointestinal function and discomfort, and changes in intestinal microbiota and insulin resistance as secondary outcomes. The study follows the best practices for evaluating health claims in food according to the European Food Safety Authority (EFSA) scientific opinion, namely random allocation, double blinding, reporting methods to measure and maximise compliance, and validated outcomes with beneficial physiological effects as recommended by EFSA.

Ethics and dissemination: The study has been approved by the Health Ethics Committee of São João Hospital Centre (156-15) and the Ethics Committee of Faculty of Medicine of the University of Porto (PCEDCSS-FMUP07/2015). Results will be disseminated through peer-reviewed publications and presentations at international scientific meetings.

Trial registration number: NCT02405507; pre-results.

Keywords: cardiovascular risk; gastrointestinal discomfort; health claims; randomized controlled trial; wheat germ.

Conflict of interest statement

Conflicts of Interest: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Trial flow chart. WG+ is wheat bread with wheat germ supplementation. WG− is wheat bread without wheat germ.

References

    1. McGee DL, Reed DM, Yano K et al. . Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Epidemiol 1984;119:667–76.
    1. Michas G, Micha R, Zampelas A. Dietary fats and cardiovascular disease: putting together the pieces of a complicated puzzle. Atherosclerosis 2014;234:320–8. 10.1016/j.atherosclerosis.2014.03.013
    1. Schwingshackl L, Hoffmann G. Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression. BMJ Open 2014;4:e004487 10.1136/bmjopen-2013-004487
    1. Willett W, Manson J, Liu S. Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 2002;76:274S–80S.
    1. Hauner H, Bechthold A, Boeing H et al. . Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab 2012;60(Suppl 1):1–58. 10.1159/000335326
    1. Esposito K, Maiorino MI, Bellastella G et al. . A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 2015;5:e008222 10.1136/bmjopen-2015-008222
    1. de Jong N, Hoendervangers CT, Bleeker JK et al. . The opinion of Dutch dietitians about functional foods. J Hum Nutr Diet 2004;17:55–62. 10.1046/j.1365-277X.2003.00498.x
    1. Vella MN, Stratton LM, Sheeshka J et al. . Functional food awareness and perceptions in relation to information sources in older adults. Nutr J 2014;13:44 10.1186/1475-2891-13-44
    1. Zong G, Gao A, Hu FB et al. . Whole grain intake and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Circulation 2016;133:2370–80. 10.1161/CIRCULATIONAHA.115.021101
    1. Aune D, Keum N, Giovannucci E et al. . Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ 2016;353:i2716 10.1136/bmj.i2716
    1. Whitehead A, Beck EJ, Tosh S et al. . Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2014;100:1413–21. 10.3945/ajcn.114.086108
    1. European Food Safety Authority. Scientific Opinion on the substantiation of health claims related to beta glucans and maintenance of normal blood cholesterol concentrations (ID 754, 755, 757, 801, 1465, 2934) and maintenance or achievement of a normal body weight (ID 820, 823) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2009; 7(9):1254. (accessed 13 Jan 2016).
    1. European Food Safety Authority. Scientific Opinion on the substantiation of health claims related to walnuts and maintenance of normal blood LDL-cholesterol concentrations (ID 1156, 1158) and improvement of endothelium-dependent vasodilation (ID 1155, 1157) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2011;9(4):2074. (accessed 13 Jan 2016).
    1. Brandolini A, Hidalgo A. Wheat germ: not only a by-product. Int J Food Sci Nutr 2012;63(Suppl 1):71–4. 10.3109/09637486.2011.633898
    1. Ge Y, Sun A, Ni Y et al. . Some nutritional and functional properties of defatted wheat germ protein. J Agric Food Chem 2000;48:6215–18. 10.1021/jf000478m
    1. Zhou C, Ma H, Yu X et al. . Pretreatment of defatted wheat germ proteins (by-products of flour mill industry) using ultrasonic horn and bath reactors: effect on structure and preparation of ACE-inhibitory peptides. Ultrason Sonochem 2013;20:1390–400. 10.1016/j.ultsonch.2013.04.005
    1. Lairon D, Lacombe C, Borel P et al. . Beneficial effect of wheat germ on circulating lipoproteins and tissue lipids in rats fed a high fat, cholesterol-containing diet. J Nutr 1987;117:838–45.
    1. Cara L, Borel P, Armand M et al. . Effects of increasing levels of raw or defatted wheat germ on liver, feces and plasma lipids and lipoproteins in the rat. Nutrition Res 1991;11:907–16. 10.1016/S0271-5317(05)80618-9
    1. Cara L, Borel P, Armand M et al. . Plasma lipid lowering effects of wheat germ in hypercholesterolemic subjects. Plant Foods Hum Nutr 1991;41:135–50. 10.1007/BF02194082
    1. Cara L, Armand M, Borel P et al. . Long-term wheat germ intake beneficially affects plasma lipids and lipoproteins in hypercholesterolemic human subjects. J Nutr 1992;122:317–26.
    1. Matteuzzi D, Swennen E, Rossi M et al. . Prebiotic effects of a wheat germ preparation in human healthy subjects. Food Microbiology 2004;21:119–24. 10.1016/S0740-0020(03)00009-1
    1. van Bakel MM, Kaaks R, Feskens EJ et al. . Dietary glycaemic index and glycaemic load in the European prospective investigation into cancer and nutrition. Eur J Clin Nutr 2009;63(Suppl 4):S188–205. 10.1038/ejcn.2009.81
    1. Burton PM, Monro JA, Alvarez L et al. . Glycemic impact and health: new horizons in white bread formulations. Crit Rev Food Sci Nutr 2011;51:965–82. 10.1080/10408398.2010.491584
    1. Brand-Miller J, Hayne S, Petocz P et al. . Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003;26:2261–7. 10.2337/diacare.26.8.2261
    1. Stein EA, Raal FJ. Targeting LDL: is lower better and is it safe? Best Pract Res Clin Endocrinol Metab 2014;28:309–24. 10.1016/j.beem.2013.10.010
    1. European Food Safety Authority. Guidance on the scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health. EFSA Journal 2011;9(12):2474. (accessed 13 Jan 2016).
    1. Ahmadi-Abhari S, Luben RN, Wareham NJ et al. . Seventeen year risk of all-cause and cause-specific mortality associated with C-reactive protein, fibrinogen and leukocyte count in men and women: the EPIC-Norfolk study. Eur J Epidemiol 2013;28:541–50. 10.1007/s10654-013-9819-6
    1. European Food Safety Authority. Scientific Opinion on the substantiation of health claims related to astaxanthin and maintenance of joints, tendons, and connective tissue (ID 1918, 1978, 3142), protection of DNA, proteins and lipids from oxidative damage (ID 1449, 3141), maintenance of visual acuity (ID 1448), maintenance of blood cholesterol concentrations and maintenance of low plasma concentrations of C-reactive protein (ID 1450) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2009; 7(9):1253. (accessed 13 Jan 2016).
    1. Fardet A. New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr Res Rev 2010;23:65–134. 10.1017/S0954422410000041
    1. Scazzina F, Siebenhandl-Ehn S, Pellegrini N. The effect of dietary fibre on reducing the glycaemic index of bread. Br J Nutr 2013;109:1163–74. 10.1017/S0007114513000032
    1. Anand SS, Hawkes C, de Souza RJ et al. . Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system: a report from the workshop convened by the World Heart Federation. J Am Coll Cardiol 2015;66:1590–614. 10.1016/j.jacc.2015.07.050
    1. Reaven G. Insulin resistance and coronary heart disease in nondiabetic individuals. Arterioscler Thromb Vasc Biol 2012;32:1754–9. 10.1161/ATVBAHA.111.241885
    1. Laakso M, Kuusisto J. Insulin resistance and hyperglycaemia in cardiovascular disease development. Nat Rev Endocrinol 2014;10:293–302. 10.1038/nrendo.2014.29
    1. Fedor D, Kelley DS. Prevention of insulin resistance by n-3 polyunsaturated fatty acids. Curr Opin Clin Nutr Metab Care 2009;12:138–46. 10.1097/MCO.0b013e3283218299
    1. Meyer D, Stasse-Wolthuis M. The bifidogenic effect of inulin and oligofructose and its consequences for gut health. Eur J Clin Nutr 2009;63:1277–89. 10.1038/ejcn.2009.64
    1. Shen W, Gaskins HR, McIntosh MK. Influence of dietary fat on intestinal microbes, inflammation, barrier function and metabolic outcomes. J Nutr Biochem 2014;25:270–80. 10.1016/j.jnutbio.2013.09.009
    1. European Food Safety Authority. Scientific Opinion on the substantiation of health claims related to decreasing potentially pathogenic gastro-intestinal microorganisms (ID 785) pursuant to Article 13(1) of Regulation (EC) No 1924/20061. EFSA Journal 2011;9(6):2256. (accessed 15 Sep 2015).
    1. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 2011;25:3–18. 10.1016/j.bpg.2010.12.010
    1. European Food Safety Authority. General scientific guidance for stakeholders on health claim applications. EFSA Journal 2016;14(1):4367. (accessed 13 Jan 2016).
    1. European Food Safety Authority. Scientific opinion on the substantiation of health claims related to various food(s)/food constituents(s) and increasing numbers of gastro-intestinal microorganisms (ID 760, 761, 779, 780, 779, 1905), and decreasing potentially pathogenic gastro-intestinal microorganisms (ID 760, 761, 779, 780, 779, 1905) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2010;8(10):1809. (accessed 13 Jan 2016).
    1. European Food Safety Authority. Scientific opinion on the substantiation of health claims related to fructo-oligosaccharides (FOS) and decreasing potentially pathogenic gastro-intestinal microorganisms (ID 781) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2011;9(6):2222. . (accessed 13 Jan 2016).
    1. Frank L, Kleinman L, Farup C et al. . Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol 1999;34:870–7. 10.1080/003655299750025327
    1. Slappendel R, Simpson K, Dubois D et al. . Validation of the PAC-SYM questionnaire for opioid-induced constipation in patients with chronic low back pain. Eur J Pain 2006;10:209–17. 10.1016/j.ejpain.2005.03.008
    1. Mapi Research Trust. . (accessed 25 Feb 2015).
    1. Wolever TMS. The glycaemic index: a physiological classification of dietary carbohydrate. Oxfordshire: CABI, 2006.
    1. Marquis P, De La Loge C, Dubois D et al. . Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 2005;40:540–51. 10.1080/00365520510012208
    1. Dubois D, Gilet H, Viala-Danten M et al. . Psychometric performance and clinical meaningfulness of the Patient Assessment of Constipation-Quality of Life questionnaire in prucalopride (RESOLOR) trials for chronic constipation. Neurogastroenterol Motil 2010;22:e54–63. 10.1111/j.1365-2982.2009.01408.x
    1. Ostrowska L, Witczak K, Adamska E. Effect of nutrition and atherogenic index on the occurrence and intensity of insulin resistance. Pol Arch Med Wewn 2013;123:289–96.
    1. Pais-Ribeiro J, Marques T. A avaliação do stresse: a propósito de um estudo de adaptação da escala de percepção de stresse. Psicol Saúde Doenças 2009;10:237–48.
    1. Kuriyan R, Kumar DR, R R et al. . An evaluation of the hypolipidemic effect of an extract of Hibiscus Sabdariffa leaves in hyperlipidemic Indians: a double blind, placebo controlled trial. BMC Complement Altern Med 2010;10:27 10.1186/1472-6882-10-27
    1. Lee SH, Park S, Kang SM et al. . Effect of atorvastatin monotherapy and low-dose atorvastatin/ezetimibe combination on fasting and postprandial triglycerides in combined hyperlipidemia. J Cardiovasc Pharmacol Ther 2012;17:65–71. 10.1177/1074248411399762
    1. Skulas-Ray AC, Flock MR, Richter CK et al. . Red blood cell docosapentaenoic acid (DPA n-3) is inversely associated with triglycerides and C-reactive protein (CRP) in healthy adults and dose-dependently increases following n-3 fatty acid supplementation. Nutrients 2015;7:6390–404. 10.3390/nu7085291
    1. Tapola N, Karvonen H, Niskanen L et al. . Glycemic responses of oat bran products in type 2 diabetic patients. Nutr Metab Cardiovasc Dis 2005;15:255–61. 10.1016/j.numecd.2004.09.003
    1. Sonia S, Witjaksono F, Ridwan R. Effect of cooling of cooked white rice on resistant starch content and glycemic response. Asia Pac J Clin Nutr 2015;24:620–5.
    1. Tack J, Stanghellini V, Dubois D et al. . Effect of prucalopride on symptoms of chronic constipation. Neurogastroenterol Motil 2014;26:21–7. 10.1111/nmo.12217
    1. Pocock SJ. Clinical trials: a practical approach. Chichester, UK: John Wiley & Sons Ltd, 1983.
    1. Cust AE, Skilton MR, van Bakel MM et al. . Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2009;63(Suppl 4):S37–60. 10.1038/ejcn.2009.74
    1. Whitton C, Nicholson SK, Roberts C et al. . National Diet and Nutrition Survey: UK food consumption and nutrient intakes from the first year of the rolling programme and comparisons with previous surveys. Br J Nutr 2011;106:1899–914. 10.1017/S0007114511002340

Source: PubMed

3
Předplatit