Dietary antioxidants and the prevention of CHD evidence from clinical trials

While most epidemiological studies have demonstrated that dietary intake of vitamin E is inversely related to coronary heart complications, supplementation studies gave conflicting results. Clinical trials with antioxidants have been done in patients with or without previous history of cardiovascular disease (Table 5.2). Surrogate endpoints, such as analysis of atherosclerosis progression, or 'hard' endpoints, such as vascular death and MI, have been used to evaluate the clinical benefits of...

Dietary strategies for the control of diabetes carbohydrates and lipids

According to the American Diabetes Association, the goals of medical nutritional therapy for diabetes are to prevent and treat complications such as cardiovascular disease, hypertension, nephropathy, obesity and dislipidaemia, and include achievement and maintenance of safe and near to normal or normal blood glucose levels a normal lipoprotein profile' a change or improvement of health through food choices and physical activity' careful consideration of personal and cultural choices. A healthy...

Dietary prevention of postangioplasty restenosis

Patients treated with percutaneous transluminal coronary angioplasty (PTCA) have a high (15 to 50 per cent, depending on studies) risk of developing restenosis within the first 6 months after the procedure. At present, with the exception of stents coated with antifibrotic substances113 and probucol (the later with many unacceptable side effects), there is no drug treatment to prevent that complication. On the other hand, a dietary approach with either n-3 fatty acid or folate supplementation...

Dietary antioxidants and the prevention of CHD epidemiological evidence

A large number of epidemiological studies have evaluated potential relationships between dietary intake of antioxidants and coronary heart disease (CHD). These are summarised in Table 5.1. Among these, the Nurses' Health study,36 included over 87 000 female nurses 34 to 59 years of age, who completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. During follow-up of up to 8 years 552 cases of major coronary disease were documented. As...

Introduction classifying diabetes

Diabetes mellitus is a heterogeneous metabolic syndrome with several different causes characterized by chronic hyperglycaemia with partial or total lack of insulin secretion and a reduced sensitivity to the hormone in peripheral tissues. If monitored inadequately and associated with other lipid and protein disorders, long-term complications may develop in several organs and systems, resulting in both high morbidity and mortality rates. Many of the long-term complications can be attributed to...

Vitamin D as an antioxidant

Work by Wiseman (1993) has shown that vitamin D3 (cholecalciferol), its active metabolite 1,25-dihydroxycholecalciferol, Vitamin D2 (ergocalciferol), and 7-dehydrocholesterol (pro-Vitamin D3) are all membrane antioxidants by virtue of their abilities to inhibit iron-dependent liposomal lipid peroxidation. There are very few studies focusing on the potential role of vitamin D as an antioxidant in biological systems. One such study by Sardar et al. (1996) found that vitamin D3 may function as an...

Epidemiological studies in favour of the iron hypothesis

Serum ferritin concentration as a measure of body iron has been shown to significantly correlate to the risk of myocardial infarction or carotid artherosclerosis (Haidari et al. 2001 Kiechl et al. 1994 Kiechl et al. 1997 Klipstein-Grobusch et al. 1999b Salonen et al. 1992 Salonen et al. 1998 Tuomainen et al. 1997b, 1998). Ultimately, Lauffer (1991) showed significant correlation between iron stores, measured by liver biopsy, and cardiovascular mortality. Additionally, low prevalence of CHD has...

Sources of further information and advice

The sources mentioned below provide further relevant information. Two books provide more and up-to-date information on the process of atherosclerosis, the risk factors including nutrient iron, and some prevention advice. 1. Immune mechanisms of atherogenesis, Ming K. Heng and Madalene Heng (eds), Landes Bioscience 1st edition (June 2003), ISBN 1-58706-037-X, 2. Atlas of atherosclerosis risk factors and treatment, Peter Wilson (ed.), Current Medicine 3rd edition (June 2003), ISBN 1573401870....

Antioxidants cardiovascular disease and oxidative modifications of lowdensity lipoprotein

Both lipid-soluble and water-soluble antioxidants present in blood may be important in preventing cardiovascular disease owing to their ability to prevent the oxidation of lipid-protein complexes called lipoproteins. Lipoproteins are extremely important in cardiovascular disease since we know with certainty that high levels of LDL-C cause atherosclerosis, which is the underlying cause of most cardiovascular disease. In contrast, high levels of HDL-C are a negative risk factor for CVD....

The impact of cardiovascular disease

Owing to the enormous worldwide impact of cardiovascular disease it must be emphasized that even very modest reductions in risk factors, brought about by the appropriate design and use of functional foods, can have very important health related and economic significance. Statistics from the American Heart Association (see http www.americanheart.org statistics 03cardio.html) indicate the enormous impact of CVD. Over 61 million Americans have one or more types of CVD. CVD causes more mortality...

Conclusion and future trends reconciling the evidence

On the basis of these considerations we can conclude that there is compelling evidence that enhanced oxidative stress is detectable in patients with classic risk factors for atherosclerosis, but its impact in the context of atherosclerosis, progression is still unclear. The reason for this uncertainty is due to the lack of clear evidence indicating that markers of oxidative stress, such as blood lipid peroxides or urinary F2-isoprostane, are of some value for predicting the progression of...

Introduction oxidative stress and cardiovascular disease

This chapter will focus on the potential roles of fat-soluble nutrients and fat-soluble antioxidants in preventing cardiovascular disease (CVD). Two fat-soluble vitamins will be discussed in detail, i.e. vitamin E and vitamin D. Vitamin E (tocopherols and tocotrienols) is generally considered an antioxidant nutrient, although it may have important functions unrelated to its antioxidant functions (as discussed below). Antioxidant nutrients function by preventing damage to biological systems...

Dietary sources and intake levels of flavonoids

Only a few of the thousands of different flavonoids identified in plants are present in considerable amounts in the human diet, and the intake of these dietary flavonoids varies among countries and cultures (Table 9.1) The dihydrochalcone phloretin and its glycoside phloridzin are found in large amounts in apple, but no estimates of intake levels have been reported. The flavanones are present mainly in citrus fruits, predominated by naringin (the glycoside of naringenin), responsible for the...

Do functional foods reach the populations at risk

Several surveys have shown that a higher socioeconomic status is associated with a healthier diet, that is, a diet closer to the recommendations.10'45 Consumers with a low or middle socioeconomic status would therefore benefit most from functional foods. It has been suggested that functional foods would appeal most to healthy, well-educated and rich consumers, but this does not appear to be true in a Dutch survey among 1183 consumers aged 19-91 years, determinants of functional food use...

Vitamin E and other antioxidants in the prevention of cardiovascular disease

Loffredo, University of Rome 'La Sapienza', Italy Oxidative stress is believed to play a crucial role in the initiation and progression of atherosclerosis disease. Steinberg and colleagues1 were among the first to postulate that modified low-density lipoprotein (LDL) could account for the accumulation of lipid within macrophages, a critical early step in the formation of the atherosclerotic plaque. In the early phases, native LDL may amass in the subendothelial...

Alternative mechanisms for foam cell formation

An alternative mechanism for LDL macrophage uptake (and foam cell formation) that does not require prior formation of oxLDL is provided by mast cells. Mast cell degranulation produces neutral proteases, such as chymase, and granules. The released granules bind LDL and this LDL is also degraded and fused by the released proteases. In vivo evidence suggests that these non-oxidative modifications of LDL promote its phagocytosis by macrophages leading to foam cell formation in the human arterial...

Dietary control of conventional risk factors cholesterol blood pressure type diabetes and obesity

Cholesterol is a determinant of CHD mortality, and its blood level is at least partly regulated by diet. However, few epidemiological studies have prospec-tively included analyses of the dietary habits of the studied populations in the evaluation of their risk.119 In the Seven Countries Study, marked differences in CHD mortality, dietary habits and cholesterol distribution were observed in the different cohorts.119 Cholesterol levels were high in Northern Europe and in the USA (an average level...

Dietary strategies for preventing the onset of diabetes

The different natures of the two types of diabetes requires diverse dietary strategies in order to prevent their onset. For type 1 diabetes, while the exact causes are still being investigated, it is acknowledged that various environmental factors increase the risk of diabetes in genetically susceptible subjects. If these factors can be identified, there could be a good chance of decreasing the incidence of the disease. It has been suggested that for type 1 diabetes an early exposure to cows'...

Differing types of claim nutritional and health claims

European experts suggest the following definition of claim A claim is any direct or indirect statement, symbol, suggestion, implication or any other form of communication (including the brand name) that a good has particular characteristics relating to its origin, properties, effect, nature, method of production, processing, composition or any other quality.5 For functional foods different types of claims are defined and classified by international bodies such as Codex Alimentarius or the...

Energyyielding nutrients

High total and saturated fat intake has been linked to the development of impaired glucose tolerance and type 2 diabetes by the findings of several long- term cohort studies (Marshall et al. 1994 Feskens et al. 1995 van Dam et al. 2002). In the Health Professionals' follow-up study, the significance disappeared after adjustment for body mass index (van Dam et al. 2002). However, obesity may well be in the causal pathway between fat intake and development of type 2 diabetes (Bray & Popkin...

Introduction diet and cardiovascular disease

Cardiovascular disease (CVD) is still a major cause of death in Western populations and is becoming an important cause of morbidity and mortality worldwide. Thanks to advanced medical knowledge and treatments, many patients survive an initial event. Because of that, prevention of secondary CVD is a growing task for nutritionists and other health professionals. Cardiovascular risk can be reduced by lifestyle changes, one of which is diet. There is now substantial evidence from epidemiological...

Woodhead Publishing Limited

Published by Woodhead Publishing Limited Abington Hall, Abington Cambridge CB1 6AH England Published in North America by CRC Press LLC 2000 Corporate Blvd, NW Boca Raton FL 33431 USA First published 2004, Woodhead Publishing Limited and CRC Press LLC 2004, Woodhead Publishing Limited The authors have asserted their moral rights. This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. Reasonable...

Energy balance

Both overall and abdominal obesity have deleterious effects on insulin sensitivity and insulin secretion and are risk predictors of impaired glucose tolerance and clinical type 2 diabetes (reviewed in Feskens 1992 Virtanen & Aro 1994 Costacou & Mayer-Davis 2003). Already a small, sustained decrease in weight improves insulin sensitivity and decreases the risk of type 2 diabetes (Tuomilehto et al. 2001 Diabetes Prevention Program Research Group 2002). The putative effects of dietary...

Functional foods defined

The term 'functional foods' is not a standard nutritional term in nutrition textbooks. Regulatory agencies and professional associations of nutrition scientists and dieticians all use different definitions. ILSI Europe, an industry-sponsored forum in which representatives from industry, academia and government address nutrition issues, proposed a definition which in abbreviated form runs A food can be regarded as 'functional' if it is satisfactorily demonstrated to affect beneficially one or...

1

RR 0.48 0.28-0.82 , P Arts et al. (2001a) 0.007 RR 0.76 0.58-1.03 Arts et al. (2001b) RR 0.79 0.63-0.99 Knekt et al. (2002) P 0.02 (quercetin) RR 0.35 0.13-0.98 Geleijnse et al. RR 0.87 0.69-1.10 , Sesso et al. (2003) P 0.49 a Data are given as average intake (mg day) and SD or range is given when available. b CHD coronary heart disease, CVD Total cardiovascular disease, M mortality. Number of cases is given in parenthesis. c Inverse association between disease and flavonid intake. d RR of the...

Mechanism of iron uptake

Iron is mainly absorbed in the duodenum and the upper jejunum of the small intestine Fig. 6.1 . Both haeme iron and soluble complexes of iron are absorbable. Iron absorption from the gut lumen across the enterocytes to the circulation occurs in two stages uptake across the apical membrane and transfer across the basolateral membrane Fig. 6.2 . The mechanisms of apical iron uptake from intestinal lumen to the enterocytes depend on the source of iron Fe II or Fe III complexes. Haeme is absorbed...

Info

Plasma concentrations of vitamins A, C, and E and carotene Coronary artery disease and vitamin E plasma levels Patients with a history of angina had a lower vitamin E cholesterol ratio than controls 3.66 vs 3.86 pmol mmol, P lt 0.01 Adjusted odds ratios for CVD between the lowest and the highest quintiles of vitamin E levels were 2.53 Coronary artery disease and vitamin E plasma levels Vitamin E cholesterol concentrations were significantly lower in coronary patients than in controls 4.35 1.03...

Dietary prevention of sudden cardiac death SCD the role of dietary fatty acids alcohol and antioxidants

SCD is usually defined as death from a cardiac cause occurring within one hour from the onset of symptoms.1 In many studies, however, investigators used quite different definitions, with a time frame of 3 or even 24 hours in the old World Health Organization definition. The magnitude of the problem is considerable since SCD is a very common, and often the first, manifestation of CHD, and it accounts for about 50 per cent of cardiovascular mortality in developed countries.1 In most cases, SCD...

Proteins

Proteins27 should account for 15-20 per cent of total caloric intake, 0.8-1 gram per kilogram of body weight. This amount should increase during pregnancy, breast feeding, infancy and childhood, illness and diseases. Proteins, unlike fats and carbohydrates, contain nitrogen. They are usually large molecules composed of amino acid, nine of which are 'essential' Table 7.7 as they cannot be synthesized and must be supplied by the diet. Foods that have all nine essential amino acids present are...

Risk factors for coronary heart disease CHD the role of oxidative stress

Endothelial Dysfunction Diabetic Foot

Endothelial dysfunction and intimal-media thickness are considered the early steps in atherosclerosis. Rassel Ross8 has modified atherosclerosis patho-genetical theories because numerous pathophysiological observations in humans and animals have led to the formulation of the response-to-injury hypothesis of atherosclerosis. Each characteristic lesion of atherosclerosis represents a different stage in a chronic inflammatory process in the artery. The lesions of atherosclerosis represent a series...

Iron homeostasis disorders primary and secondary haemochromatosis

Disorders in the iron homeostasis may lead to either iron deficiency or iron overload. Iron deficiency is a condition where the iron intake does not meet the body's demands. Its manifestations are paleness, lethargy, palpitations and shortness of breath. Iron overload, also termed haemochromatosis, on the other hand, is characterised by a progressive increase in the total amount of body iron followed by an abnormal iron deposition in multiple organs Fig. 6.3 . In advanced cases, it also causes...

The functional properties of ubiquinone CoQIO in preventing heart disease

Ubiquinone or CoQ is a lipid-soluble micronutrient present in animal cells and in many plants. Ubiquinol is the reduced form of CoQ and it functions as an antioxidant as further detailed below Frei et al., 1990 . CoQ can be synthesized in vivo and is not, therefore, a true vitamin. There are, however, circumstances in which the utilization of CoQ surpasses its rate of synthesis. For example, the use of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase HMG-CoA inhibitors for the treatment of...

CoQIO in heart disease

Compared with vitamin E, there has been only very limited research on the potential cardiovascular benefits of CoQ1O. Singh et al. 1998 have reviewed the role of CoQ1O in CVD. CoQ1O deficiency has been observed in a wide variety of cardiovascular disorders, e.g. congestive heart failure, angina pectoris, coronary artery disease, cardiomyopathy, hypertension, mitral value prolapse Singh et al., 1998 . In the apoE gene knockout mice an excellent model of human atherosclerosis supplementation with...

Secondary haemochromatosis

Secondary haemochromatosis may be caused by several other conditions leading to iron overload. These include excess of dietary iron intake, chronic haemolysis and frequent blood transfusions. Phlebotomy is mostly impossible in these cases. The treatment most commonly used is a continuous administration of an iron-chelating agent. Chronic anaemia such as aplastic anaemia, sickle cell anaemia, and thalassaemia cause iron overload mostly because of frequent blood transfusions. Each 250 ml...

Measuring iron toxicity

In the early course of iron overload, numerous homeostatic mechanisms prevent damage from accumulating iron. These include increased ferritin production needed to sequester the labile iron, and increment in individual antioxidants and or antioxidant enzymes to protect against radical damage promoted by iron. However, these mechanisms might fail as more iron accumulates. Measurement of iron toxicity is crucial for diagnosis and management of patients with iron overload from such disorders as...

Regulation of iron uptake

The extent of iron absorption is mainly affected by the level of body iron, the degree of erythropoiesis, the amount of iron in the diet, and the composition of the diet itself. Other conditions, such as hypoxia, pregnancy and inflammation, may also alter the absorption. Furthermore, iron absorption is inappropriately increased in primary haemochromatosis. The iron stores regulator induces a moderate increase in iron absorption as the body iron stores fall, and vice versa. It is still an...

Occurrence and dietary intake of anthocyanins

The red, violet or blue anthocyanins, found in most berries and fruits, belong to the group of flavonoids. The anthocyanins consist of an aglycon, the antho-cyanidin, linked to a sugar moiety. The six most frequently found aglycons in fruits and berries are seen in Fig. 9.3. These aglycons may be glycosylated or acylated by different sugars and acids in different positions. The most common glycoside moieties found in anthocyanins are the 3-monosides, 3-biosides, 3-triosides and 3,5-diglycosides...

References

Sudden cardiac death. Circulation 1998 98 2234-51. 2 de lorgeril m, salen p, defaye p, mabo p, paillard f. Dietary prevention of sudden cardiac death. Eur Heart J 2002 23 277-85. 3 burr ml, fehily am, gilbert jf et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction Diet And Reinfarction Trial DART . Lancet 1989 2 757-61. 4 mclennan pl, abeywardena my, charnock js. Reversal of arrhythmogenic effects of long term saturated fatty...

Comt

Fig. 9.2 In vivo metabolism of dietary flavonoids. and sugar moiety Hertog et al., 1997 see Fig. 9.2 . This was supported by the findings that incubations of flavonoid glycosides with intestinal micro-flora resulted in the release of the free aglycons, and in germ-free rats the flavonoid glycosides were excreted unchanged with faeces Griffiths, 1982 . It was later demonstrated that human intestinal bacteria are in fact capable of hydrolysing flavonoid glycosides to the free aglycons and sugar...

Metabolism of flavonoids

Although an extensive number of studies have reported effects of flavonoids on enzymatic, biological and physiological processes, only very few researchers have attempted to determine the actual compound metabolite responsible for the observed effects. It has generally been assumed that the biological activities originated from the flavonoids investigated, although they may be bio-transformed into one or more structurally quite different compound in vivo. Investigations on in vitro metabolism...

Introduction classification chemical structures and occurrence of flavonoids in plant foods

Protective Chemicals Plant Flavonoids

Clinical observations, basic science and several epidemiological studies have contributed to an emerging body of evidence for a potential role of flavonoids in the prevention of cardiovascular disease CVD Hollman and Katan, 1999 . Flavonoids have been shown to inhibit the oxidation of plasma low-density lipoprotein LDL , decrease platelet function and to modulate cytokines and eicosanoids involved in inflammatory responses De Whalley et al., 1990 Murphy et al., 2003 . Several epidemiological...

Foetal nutrition and early growth

According to the so-called thrifty phenotype hypothesis, conditions such as disturbed nutrition during foetal time or early infancy could cause structural or functional changes in muscles, liver or pancreas and therefore predispose to later disorders of glucose and insulin metabolism Hales amp Baker 1992 . Low birth weight and birth thinness reflect foetal growth disturbance and have been related to an adverse profile of later glucose and insulin metabolism and to an increased risk of type 2...