A diet based on multiple functional concepts improves cardiometabolic risk parameters in healthy subjects

Juscelino Tovar, Anne Nilsson, Maria Johansson, Rickard Ekesbo, Ann-Margreth Aberg, Ulla Johansson, Inger Björck, Juscelino Tovar, Anne Nilsson, Maria Johansson, Rickard Ekesbo, Ann-Margreth Aberg, Ulla Johansson, Inger Björck

Abstract

Background: Different foods can modulate cardiometabolic risk factors in persons already affected by metabolic alterations. The objective of this study was to assess, in healthy overweight individuals, the impact of a diet combining multiple functional concepts on risk markers associated with cardiometabolic diseases (CMD).

Methods: Fourty-four healthy women and men (50-73 y.o, BMI 25-33, fasting glycemia ≤ 6.1 mmol/L) participated in a randomized crossover intervention comparing a multifunctional (active) diet (AD) with a control diet (CD) devoid of the "active" components. Each diet was consumed during 4 wk with a 4 wk washout period. AD included the following functional concepts: low glycemic impact meals, antioxidant-rich foods, oily fish as source of long-chain omega-3 fatty acids, viscous dietary fibers, soybean and whole barley kernel products, almonds, stanols and a probiotic strain (Lactobacillus plantarum Heal19/DSM15313).

Results: Although the aim was to improve metabolic markers without promoting body weight loss, minor weight reductions were observed with both diets (0.9-1.8 ± 0.2%; P < 0.05). CD did not modify the metabolic variables measured. AD promoted significant changes in total serum cholesterol (-26 ± 1% vs baseline; P < 0.0001), LDL-cholesterol (-34 ± 1%; P < 0.0001), triglycerides (-19 ± 3%; P = 0.0056), LDL/HDL (-27 ± 2%; P < 0.0001), apoB/apoA1 (-10 ± 2%; P < 0.0001), HbA1c (-2 ± 0.4%; P = 0.0013), hs-CRP (-29 ± 9%; P = 0.0497) and systolic blood pressure (-8 ± 1%¸ P = 0.0123). The differences remained significant after adjustment for weight change. After AD, the Framingham cardiovascular risk estimate was 30 ± 4% (P < 0.0001) lower and the Reynolds cardiovascular risk score, which considers CRP values, decreased by 35 ± 3% (P < 0.0001).

Conclusion: The improved biomarker levels recorded in healthy individuals following the multifunctional regime suggest preventive potential of this dietary approach against CMD.

References

    1. WHO. The Global Burden of Disease: 2004 Update. Gèneve, Switzerland: World Health Organization; 2008.
    1. Feldeisen SE, Tucker KL. Nutritional strategies in the prevention and treatment of metabolic syndrome. Appl Physiol Nutr Metab. 2007;32:42–60.
    1. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow C, Ho M, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association's strategic impact goal through 2020 and beyond. Circulation. 2010;121:586–613. doi: 10.1161/CIRCULATIONAHA.109.192703.
    1. Jenkins DJA, Kendall CWC, Faulkner D, Vidgen E, Trautwein EA, Parker TL, Marchie A, Koumbridis G, Lapsley KG, Josse R, Leiter LA, Connelly PW. A dietary portfolio approach to cholesterol reduction: Combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism. 2002;51:1596–1604. doi: 10.1053/meta.2002.35578.
    1. Jenkins DJA, Kendall CWC, Marchie A, Faulkner DA, Josse AR, Wong JM, de Souza R, Emam A, Parker TL, Vidgen E, Trautwein EA, Lapsley KG, Josse RG, Leiter LA, Singer W, Connelly PW. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr. 2005;81:380–387.
    1. Jenkins DJ, Chiavaroli L, Wong JM, Kendall C, Lewis GF, Vidgen E, Connelly PW, Leiter LA, Josse RG, Lamarche B. Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Can Med Assoc J. 2010;182:1961–1967. doi: 10.1503/cmaj.092128.
    1. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Josse AR, Wong JM, de Souza R, Emam A, Parker TL. Direct comparison of dietary portfolio vs statin on C-reactive protein. Eur J Clin Nutr. 2005;59:851–860. doi: 10.1038/sj.ejcn.1602152.
    1. Adamsson V, Reumark A, Fredriksson IB, Hammarström E, Vessby B, Johansson G, Risérus U. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET) J Intern Med. 2011;269:150–159. doi: 10.1111/j.1365-2796.2010.02290.x.
    1. O'Keefe JH, Gheewala NM, O'Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation and cardiovascular health. J Am Coll Cardiol. 2008;51:249–255. doi: 10.1016/j.jacc.2007.10.016.
    1. Lopez-Alvarenga JC, Ebbesson SOE, Ebbesson LO, Tejero M, Vorugantia S, Comuzzie AG. Polyunsaturated fatty acids effect on serum triglycerides concentration in the presence of metabolic syndrome components. The Alaska-Siberia Project. Metabolism. 2010;59:86–92. doi: 10.1016/j.metabol.2009.07.010.
    1. Bruce KD, Hanson MA. The developmental origins, mechanisms and implications of metabolic syndrome. J Nutr. 2010;140:648–652. doi: 10.3945/jn.109.111179.
    1. Expert Panel on Detection, and Treatment of High Blood Cholesterol in Adults. Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106:3143–3421.
    1. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation - Emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48:677–685. doi: 10.1016/j.jacc.2006.03.052.
    1. Leeman M, Ostman E, Bjorck I. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic and insulinaemic responses in healthy subjects. Eur J Clin Nutr. 2005;59:1266–1271. doi: 10.1038/sj.ejcn.1602238.
    1. Nilsson M, Holst JJ, Bjorck IME. Metabolic effects of amino acid mixtures and whey protein in healthy subjects: studies using glucose-equivalent drinks. Am J Clin Nutr. 2007;85:996–1004.
    1. Valtuena S, Pellegrini N, Franzini L, Bianchi MA, Ardigò D, Del Rio D, Piatti P, Scazzina F, Zavaroni I, Brighenti F. Food selection based on total antioxidant capacity can modify antioxidant intake, systemic inflammation, and liver function without altering markers of oxidative stress. Am J Clin Nutr. 2008;87:1290–1297.
    1. Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006;83(Suppl 6):1505S–1519S.
    1. Osman N, Adawi D, Ahrne S, Jeppsson B, Molin G. Endotoxin- and D-galactosamine-induced liver injury improved by the administration of Lactobacillus, Bifidobacterium and blueberry. Dig Liver Dis. 2007;39:849–856. doi: 10.1016/j.dld.2007.06.001.
    1. Mitsou EK, Panopoulou N, Turunen K, Spiliotis V, Kyriacou A. Prebiotic potential of barley derived beta-glucan at low intake levels: A randomised, double-blinded, placebo-controlled clinical study. Food Res Int. 2010;43:1086–1092. doi: 10.1016/j.foodres.2010.01.020.
    1. Nilsson A, Ostman E, Preston T, Björck I. Effects of GI vs content of cereal fibre of the evening meal on glucose tolerance at a subsequent standardized breakfast. Eur J Clin Nutr Nutr. 2008;62:712–720. doi: 10.1038/sj.ejcn.1602784.
    1. Nilsson AC, Ostman EM, Holst JJ, Björck IM. Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast. J Nutr. 2008;138:732–739.
    1. Nordic Council of Ministers. Nutrition Recommendations 2004: integrating nutrition and physical activity. 4. Copenhagen: Nordic Council of Ministers; 2004.
    1. Kaliora AC, Dedoussis GVZ. Natural antioxidant compounds in risk factors for CVD. Pharmacol Res. 2007;56:99–109. doi: 10.1016/j.phrs.2007.04.018.
    1. Erlund I, Koli R, Alfthan G, Marniemi J, Puukka P, Mustonen P, Mattila P, Jula A. Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol. Am J Clin Nutr. 2008;87:323–331.
    1. Dugoua JJ, Seely D, Perri D, Cooley K, Forelli T, Mills E, Koren G. From type 2 diabetes to antioxidant activity: a systematic review of the safety and efficacy of common and cassia cinnamon bark. Can J Physiol Pharmacol. 2007;85:837–847. doi: 10.1139/Y07-080.
    1. Musa-Veloso K, Binns MA, Kocenas AC, Poon T, Elliot JA, Rice H, Oppedal-Olsen H, Lloyd H, Lemke S. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides. Nutr Rev. 2010;68:155–167. doi: 10.1111/j.1753-4887.2010.00272.x.
    1. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27:538–546. doi: 10.2337/diacare.27.2.538.
    1. Barclay A, Petocz P, McMillan-Price J, Flood V, Prvan T, Mitchell P, Brand-Miller J. Glycemic index, glycemic load and diabetes risk: a meta-analysis. Diabetes Res Clin Pract. 2008;79(Suppl 1):S30–S31.
    1. Ceriello A, Davidson J, Hanefeld M, Leiter L, Monnier L, Owens D, Tajima N, Tuomilehto J. Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nutr Metab Cardiovasc Dis. 2006;16:453–456. doi: 10.1016/j.numecd.2006.05.006.
    1. Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Padyab M, Hu FB, Willett WC. Soy inclusion in the diet improves features of the metabolic syndrome: a randomized crossover study in postmenopausal women. Am J Clin Nutr. 2007;85:735–741.
    1. Derdemezis CS, Filippatos TD, Mikhailidis DP. Effects of plant sterols and stanols beyond low-density lipoprotein cholesterol lowering. J Cardiovasc Pharmacol Ther. 2010;15:120–314. doi: 10.1177/1074248409357921.
    1. Griel AE, Kris-Etherton PM. Tree nuts and the lipid profile: a review of clinical studies. Br J Nutr. 2006;96(Suppl 2):S68–S78.
    1. Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Hu FB, Willett WC. Soy consumption, markers of inflammation, and endothelial function: a cross-over study in postmenopausal women with the metabolic syndrome. Diabetes Care. 2007;30:967–973. doi: 10.2337/dc06-2126.
    1. Azadbakht L, Esmaillzadeh A. Soy and cardio-metabolic abnormalities: an update. J Res Med Sci. 2008;13:88–96.
    1. Nagarajan S. Mechanisms of anti-atherosclerotic functions of soy-based diets. J Nutr Biochem. 2010;21:255–260. doi: 10.1016/j.jnutbio.2009.09.002.
    1. Basu A, Du M, Leyva MJ, Sanchez K, Betts NM, Wu M, Aston CE, Lyons TJ. Blueberries decrease cardiovascular risk factors in obese men and women with metabolic syndrome. J Nutr. 2010;140:1582–1587. doi: 10.3945/jn.110.124701.
    1. Lomax AR, Calder PC. Probiotics, immune function, infection and inflammation: A review of the evidence from studies conducted in humans. Curr Pharm Des. 2009;15:1428–1518. doi: 10.2174/138161209788168155.
    1. Ooi LG, Liong MT. Cholesterol-lowering effects of probiotics and prebiotics: a review of in vivo and in vitro findings. Int J Mol Sci. 2010;11:2499–2522. doi: 10.3390/ijms11062499.
    1. Friedewald WT, Levy RI, Fredriksson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. doi: 10.1007/BF00280883.
    1. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile -a statement for health-professionals. Circulation. 1991;83:356–362.
    1. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women - The Reynolds Risk Score. JAMA. 2007;297:611–619. doi: 10.1001/jama.297.6.611.
    1. Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR. C-Reactive Protein and parental history improve global cardiovascular risk prediction: The Reynolds Risk Score for men. Circulation. 2008;118:2243–2251. doi: 10.1161/CIRCULATIONAHA.108.814251.
    1. Hulthe J, Fagerberg B. Circulating oxidized LDL is associated with subclinical atherosclerosis development and inflammatory cytokines (AIR Study) Arterioscler Thromb Vasc Biol. 2002;22:1162–1167. doi: 10.1161/.
    1. King DE, Egan BM, Woolson RF, Mainous A III, Al-Solaiman Y, Jesri A. Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Arch Intern Med. 2007;167:502–506. doi: 10.1001/archinte.167.5.502.
    1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–1645. doi: 10.1161/CIRCULATIONAHA.109.192644.
    1. Esposito K, Ciotola M, Giugliano D. Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. 2007;51:1268–1274.
    1. Welin L, Adlerberth A, Caidahl K, Eriksson H, Hansson PO, Johansson S, Rosengren A, Svärdsudd K, Welin C, Wilhelmsen L. Prevalence of cardiovascular risk factors and the metabolic syndrome in middle-aged men and women in Gothenburg, Sweden. BMC Public Health. 2008;8:403. doi: 10.1186/1471-2458-8-403.
    1. Sierra-Johnson J, Somers VK, Kuniyoshi FHS, Garza CA, Isley WL, Gami AS, Lopez-Jimenez F. Comparison of apolipoprotein-B/apolipoprotein-A1 in subjects with versus without the metabolic syndrome. Am J Cardiol. 2006;98:1369–1373. doi: 10.1016/j.amjcard.2006.06.029.
    1. de Rougemont A, Normand S, Nazare JA, Skilton MR, Sothier M, Vinoy S, Laville M. Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects. Br J Nutr. 2007;98:1288–1298.
    1. Jenkins DJ, Wolever TM, Buckley G, Lam KY, Giudici S, Kalmusky J, Jenkins AL, Patten RL, Bird J. et al.Low-glycemic-index starchy foods in the diabetic diet. Am J Clin Nutr. 1988;48:248–254.
    1. Verzelloni E, Pellacani C, Tagliazucchi D, Tagliaferri S, Calani L, Costa LG, Brighenti F, Borges G, Crozier A, Conte A, Del Rio D. Antiglycative and neuroprotective activity of colon-derived polyphenol catabolites. Mol Nutr Food Res. 2011;55(Suppl 1):S35–S43.
    1. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415–1428. doi: 10.1016/S0140-6736(05)66378-7.
    1. Ridker PM, Hennekens CH, Buring JE, Rifai N. C reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–843. doi: 10.1056/NEJM200003233421202.
    1. de Mello VDF, Schwab U, Kolemainen M, Koenig W, Siloaho M, Poutanen K, Mykkänen H, Uusitupa M. A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomized controlled trial: The Sysdimet study. Diabetologia. 2011;54:2755–2767. doi: 10.1007/s00125-011-2285-3.
    1. Morris MC, Sacks F, Rosner B. Does fish-oil lower blood pressure? A metanalysis of controlled trials. Circulation. 1993;88:523–533.
    1. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. Benazepril plus Amlodipine or Hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417–2428. doi: 10.1056/NEJMoa0806182.
    1. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, Fiol M, Gómez-Gracia E, López-Sabater MC, Vinyoles E, Arós F, Conde M, Lahoz C, Lapetra J, Sáez G, Ros E. the PREDIMED Study investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006;145:1–11.
    1. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344:3–10. doi: 10.1056/NEJM200101043440101.
    1. Tighe P, Duthie G, Vaughan N, Brittenden J, Simpson WG, Duthie S, Mutch W, Wahle K, Horgan G, Thies F. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr. 2010;92:733–740. doi: 10.3945/ajcn.2010.29417.
    1. Barnard ND, Scialli AR, Bertron P, Hurlock D, Edmonds K, Talev L. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol. 2000;85:969–972. doi: 10.1016/S0002-9149(99)00911-X.
    1. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care. 2005;28:2823–2831. doi: 10.2337/diacare.28.12.2823.
    1. Dagogo-Jack S, Egbuonu N, Edeoga C. Principles and practice of nonpharmacological interventions to reduce cardiometabolic risk. Med Princ Pract. 2010;19:167–175. doi: 10.1159/000285280.
    1. Mehner A, Lindblad U, Råstam L, Boström KB. Cholesterol in women at high cardiovascular risk is less successfully treated than in corresponding men. The Skaraborg Hypertension and Diabetes Project. Eur J Clin Pharmacol. 2008;64:815–820. doi: 10.1007/s00228-008-0482-x.
    1. Santos RD, Waters DD, Tarasenko L, Messig M, Jukema JW, Ferrières J, Verdejo J, Chiang CW. L-TAP 2 Investigators. Low- and high-density lipoprotein cholesterol goal attainment in dyslipidemic women: The Lipid Treatment Assessment Project (L-TAP) 2. Am Heart J. 2009;158:860–866. doi: 10.1016/j.ahj.2009.08.009.

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