Relatively small lifestyle modifications related to weight reduction, physical activity and diet have been shown to decrease the risk of type 2 diabetes. Connected with diet, low consumption of meat has been suggested as a protective factor of diabetes. The aim of the present study was to examine the association between the consumption of total meat or the specific types of meats and the risk of type 2 diabetes. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention cohort included middle-aged male smokers. Up to 12 years of follow-up, 1098 incident cases of diabetes were diagnosed from 24 845 participants through the nationwide register. Food consumption was assessed by a validated FFQ. In the age- and intervention group-adjusted model, high total meat consumption was a risk factor of type 2 diabetes (relative risk (RR) 1·50, 95 % CI 1·23, 1·82, highest v. lowest quintile). The result was similar after adjustment for environmental factors and foods related to diabetes and meat consumption. The RR of type 2 diabetes was 1·37 for processed meat (95 % CI 1·11, 1·71) in the multivariate model. The results were explained more by intakes of Na than by intakes of SFA, protein, cholesterol, haeme Fe, Mg and nitrate, and were not modified by obesity. No association was found between red meat, poultry and the risk of type 2 diabetes. In conclusion, reduction of the consumption of processed meat may help prevent the global epidemic of type 2 diabetes. It seems like Na of processed meat may explain the association.

To determine the lipid content and fatty acid (FA) composition of breast milk from fifty-two lactating women between ninth and twelfth lactation weeks in rural North China. The mothers were questioned on their dietary habits. Total milk lipids extracts were transmethylated and analysed using GLC to determine FA contents. The mean lipid content was 40·21 (sd 1·43) g/l. SFA constituted 35·92 % of the total FA. Medium-chain and long-chain SFA presented levels of 10·91 and 25·01 %, respectively. MUFA and PUFA constituted 32·59 and 19·97 % of the total FA, respectively. Oleic, linoleic and α-linolenic acid (ALA) presented contents of 31·26, 17·73 and 1·03 %, respectively. Arachidonic acid had a content of 0·30 %, while DHA content was 0·19 %. Not any form of trans FA were found in human milk samples. A maternal diet transition is proceeding in China. Further investigation on the analysis of human milk FA composition is needed to upgrade the human milk database in China.

The aim was to evaluate under protein-limiting conditions the effect of different supplemental energy sources: fermentable NSP (fNSP), digestible starch (dStarch) and digestible unsaturated fat (dUFA), on marginal efficiency of fat deposition and distribution. A further aim was to determine whether the extra fat deposition from different energy sources, and its distribution in the body, depends on feeding level. A total of fifty-eight individually housed pigs (48 (sd 4) kg) were used in a 3 × 2 factorial design study, with three energy sources (0·2 MJ digestible energy (DE)/kg0·75 per d of fNSP, dStarch and dUFA added to a control diet) at two feeding levels. Ten pigs were slaughtered at 48 (sd 4) kg body weight and treatment pigs at 106 (sd 3) kg body weight. Bodies were dissected and the chemical composition of each body fraction was determined. The effect of energy sources on fat and protein deposition was expressed relative to the control treatments within both energy intake levels based on a total of thirty-two observations in six treatments, and these marginal differences were subsequently treated as dependent variables. Results showed that preferential deposition of the supplemental energy intake in various fat depots did not depend on the energy source, and the extra fat deposition was similar at each feeding level. The marginal energetic transformation (energy retention; ER) of fNSP, dStarch and dUFA for fat retention (ERfat:DE) was 44, 52 and 49 % (P>0·05), respectively. Feeding level affected fat distribution, but source of energy did not change the relative partitioning of fat deposition. The present results do not support values of energetic efficiencies currently used in net energy-based systems.

An investigation was carried out to determine whether there were significant changes in the intake of dietary fibre (NSP) and phytate of adult men and women in the UK from 1982 (aged 36 years) to 1999 (aged 53 years). The 1253 subjects studied were members of the Medical Research Council National Survey of Health and Development; a longitudinal study of a nationally representative cohort of births in 1946. Food intake was recorded in a 5 d diary at age 36 years in 1982, 43 years in 1989 and 53 years in 1999. The food composition database was amended with revised values for phytate. Outcome measures were mean intakes of total NSP and phytate by year, sex and food source. There were significant changes in total NSP and phytate intake over the three time points. Intakes of NSP rose significantly between 1982 and 1999 for men and women but phytate intakes rose significantly only between 1989 and 1999. Cereal foods were the most important source of both NSP and phytate. Between 1989 and 1999 there was a significant increase in the contribution from pasta, rice and other grains. The present study shows that an increase in dietary fibre that is in accordance with dietary guidelines would almost inevitably be accompanied by a rise in phytate. The increased dietary phytate is discussed in relation to its recognised inhibition of mineral absorption and its merits with regard to protection against some cancers and other diseases of an ageing population.

Migration to the UK is associated with higher incidence of stroke in African populations. A low folate status has been associated with increased risk of stroke, likely to be mediated through raised plasma homocysteine concentrations. We conducted a cross-sectional study to compare blood folate and homocysteine concentrations in eighty healthy Ghanaian migrants living in London matched by sex, age and occupation to 160 individuals from an urban population in Accra, Ghana. Folate intake was determined using three 24 h recalls. Fasting blood samples were collected for the determination of serum and erythrocyte folate and plasma homocysteine concentrations and the methylenetetrahydrofolate reductase (MTHFR) 677C → T polymorphism. Reported mean folate intake was 20 % lower in London compared with Accra (P < 0·001). However, serum folate was 44 % higher, erythrocyte folate 30 % higher and plasma homocysteine was 26 % lower in subjects from London compared with those from Accra (P < 0·001). These differences persisted after adjusting for confounders including the MTHFR 677C → T mutation, which was rare in both populations. Although there were no associations between dietary folate intake and blood folates (P>0·05), folic acid supplement use, which was more prevalent in London than Accra (25 and 10 %, respectively, P = 0·004) was associated with erythrocyte folate in both populations (P < 0·01). The main predictors of plasma homocysteine concentrations were erythrocyte folate and male sex (P < 0·001). Findings from the present study suggest that migration from Ghana to the UK results in improvement of biomarkers of folate status despite the fact that reported dietary intake of folate was apparently lower in subjects from London.

The objective of the present study was to examine anthropometric, metabolic, psychosocial and dietary factors associated with dropout in a 6-month weight loss intervention aimed at reducing body weight by 10 %. The study sample included 137 sedentary, overweight and obese postmenopausal women, participating in a weight loss intervention that consisted of either energy restriction (ER) or ER with resistance training (ER+RT). Anthropometric (BMI, percent lean body mass, percent fat mass, visceral adipose tissue and waist circumference), metabolic (total energy expenditure, RMR, insulin sensitivity and fasting plasma levels of leptin and ghrelin), psychosocial (body esteem, self-esteem, stress, dietary restraint, disinhibition, hunger, quality of life, self-efficacy, perceived benefits for controlling weight and perceived risk) and dietary (3-d food record) variables were measured. Thirty subjects out of 137 dropped out of the weight loss programme (22 %), with no significant differences in dropout rates between those in the ER and the ER+RT groups. Overall, amount of weight loss was significantly lower in dropouts than in completers ( − 1·7 (sd 3·5) v. − 5·6 (sd 4·3) kg, P < 0·05); weekly weight loss during the first 4 weeks was also significantly lower. Dropouts consumed fewer fruit servings than completers (1·7 (sd 1·1) v. 2·7 (sd 1·53), P < 0·05) and had higher insulin sensitivity levels (12·6 (sd 3·8) v. 11·1 (sd 2·8) mg glucose/min per kg fat-free mass, P < 0·05). The present results suggest that the rate of weight loss during the first weeks of an intervention plays an important role in the completion of the programme. Thus, participants with low rates of initial weight loss should be monitored intensely to undertake corrective measures to increase the likelihood of completion.

The purpose of this research was to test the hypothesis that starch-entrapped microspheres would produce favourable fermentation profiles and microbial shifts during in vitro fermentation with the faecal microbiota from patients with inflammatory bowel disease (IBD). In vitro fermentation was carried out using a validated, dynamic, computer-controlled model of the human colon (Toegepast Natuurwetenschappelijk Onderzoek gastro-intestinal model-2) after inoculation with pooled faeces from healthy individuals, patients with inactive IBD (Crohn's disease (CD)) or patients with active IBD (ulcerative colitis (UC)). Starch-entrapped microspheres fermented more slowly and produced more butyrate than fructo-oligosaccharides (FOS) when fermented with the faecal microbiota from patients with active UC. When fermented with the microbiota from patients with inactive CD, starch-entrapped microspheres also fermented more slowly but produced similar amounts of butyrate compared with FOS. Starch-entrapped microspheres showed a greater ability to maintain a low pH during simulated-distal colon conditions compared with FOS. After fermentation with the microbiota from inactive CD patients, starch-entrapped microspheres resulted in lower concentrations of some potentially harmful gut bacteria, included in Bacteroides, Enterococcus, Fusobacterium and Veillonella, compared with FOS. These findings suggest that slow fermenting starch-entrapped microspheres may induce a favourable colonic environment in patients with IBD through high butyrate production, maintenance of low pH in the distal colon and inhibition of the growth of potentially harmful bacteria.

Dietary intake of marine n-3 PUFA has been negatively associated with the risk of CHD among subjects with known CHD, whereas an effect in healthy subjects is less documented. We assessed the hypothesis that dietary intake of marine n-3 PUFA is negatively associated with the risk of acute coronary syndrome (ACS) in healthy subjects. In the Danish Diet, Cancer and Health cohort study, 57 053 participants were enrolled. Dietary intake of total n-3 PUFA, including EPA, docosapentaenoic acid (DPA) and DHA, was assessed. During a mean follow-up period of 7·6 years, we identified all cases (n 1150) from this cohort with an incident ACS diagnosis in the Danish National Patient Registry or the Cause of Death Registry. Diagnoses were verified through medical record review. In Cox proportional hazard models, we adjusted for established risk factors for CHD. Men in the four highest quintiles of n-3 PUFA intake (>0·39 g n-3 PUFA per d) had a lower incidence of ACS compared with men in the lowest quintile. The hazard ratio was 0·83 (95 % CI 0·67, 1·03) when we compared men in the second lowest and lowest quintile of n-3 PUFA intake. Higher intake of n-3 PUFA did not strengthen this association. Associations for EPA, DPA and DHA were all negative, but less consistent. No convincing associations were found among women. In conclusion, we found borderline significant negative associations between the intake of marine n-3 PUFA and ACS among healthy men.

The aim of the present study was to verify whether extra-virgin olive oil, a dietary component naturally containing phenolic antioxidants, has the potential to protect the brain from the deleterious effects of ageing. To accomplish this goal, we used male rats fed a high-energy diet containing either maize oil, or extra-virgin olive oil with high or low phenol content (720 or 10 mg total phenols/kg oil, corresponding to a daily dose of 4 or 0·05 mg total phenols/kg body weight, respectively) from age 12 months to senescence. The measured endpoints were biochemical parameters related to oxidative stress and functional tests to evaluate motor, cognitive and emotional behaviour. Olive oil phenols did not exert major protective actions on motor and cognitive function, as we observed only a tendency to improved motor coordination on the rotarod in the old animals treated with the oil rich in phenols (40 % average increase in the time to first fall; P = 0·18). However, an interesting finding of the present study was a reduced step-through latency in the light–dark box test, found in the older animals upon treatment with the oil rich in antioxidant phenols, possibly indicating an anxiety-lowering effect. This effect was associated with decreased glutathione reductase activity and expression in the brain, a phenomenon previously associated with decreased anxiety in rodents. These results indicate a previously undetected effect of a diet containing an olive oil rich in phenols. Further studies are warranted to verify whether specific food antioxidants might also have an effect on emotional behaviour.

Resistant starch (RS), a non-viscous dietary fibre, may have postprandial effects on appetite regulation and metabolism, although the exact effects and mechanisms are unknown. An acute randomised, single-blind crossover study, aimed to determine the effects of consumption of 48 g RS on appetite compared to energy and available carbohydrate-matched placebo. Twenty young healthy adult males consumed either 48 g RS or the placebo divided equally between two mixed meals on two separate occasions. Effects on appetite were assessed, using an ad libitum test meal and 24-h diet diaries for energy intake, and using visual analogue scales for subjective measures. Changes to postprandial glucose, insulin and C-peptide were also assessed. There was a significantly lower energy intake following the RS supplement compared to the placebo supplement at both the ad libitum test meal (5241 (sem 313) v. 5606 (sem 345) kJ, P = 0·033) and over the 24 h (12 603 (sem 519) v. 13 949 (sem 755) kJ, P = 0·044). However, there was no associated effect on subjective appetite measures. Postprandial plasma glucose concentrations were not significantly different between supplements, but there was a significantly lower postprandial insulin response following the RS supplement (P = 0·029). The corresponding C-peptide concentrations were not significantly different, although the ratio of C-peptide to insulin was higher following the RS supplement compared to placebo (P = 0·059). These results suggest that consumption of 48 g RS, over a 24-h period, may be useful in the management of the metabolic syndrome and appetite. Further studies are required to determine the exact mechanisms.

The objective of the present study was to document the food, energy and macronutrient contribution of out-of-home prepared foods in school-going adolescents in Cotonou (Benin) and compare the food, energy and macronutrient intakes of low and high out-of-home consumers. We used a cross-sectional study with 24 h dietary recalls on two non-consecutive school days to collect food intake data. Low and high consumers were defined respectively as subjects whose percentage of daily energy intake from out-of-home foods was in the first and the third terciles of the sample distribution. The setting was twelve secondary schools in Cotonou with 656 adolescents aged 13–19 years. Out-of-home prepared foods contributed more than 40 % of the daily energy, fat, protein, carbohydrate and fibre intakes and of the daily weight of food in the adolescents. They were highly present at breakfast and as afternoon snacks in high consumers, providing respectively 94 and 82 % of the energy intake of high consumers at breakfast and as afternoon snacks. Low consumers ate more fruit and vegetables and cereal grain products than high consumers whereas high consumers consumed more sweet energy-dense foods. Both categories had a diet poor in fruit and vegetables (hardly one-fourth of the recommended 400 g) and high in fat. We concluded that out-of-home foods are important in the diet of urban school adolescents in Benin. Therefore, they should be investigated in depth and taken into account in the development of interventions to promote healthy diet and lifestyles in adolescents.

Belgium until recently lacked a systematic survey of dietary habits of its inhabitants. The present study evaluated dietary composition in Belgium with respect to energy and macronutrient intakes. Information on food intake was collected using a repeated non-consecutive 24 h recall (2–8 weeks apart) with the validated software package EPIC-SOFT, in combination with a FFQ (self-administered) covering sixty food items. The database of consumed food items was linked to food composition data. Usual macronutrient intake was estimated by the Nusser method. A representative sample of the Belgian population was randomly selected from the national register following a multi-stage procedure. Information on dietary intake was obtained from 3245 subjects aged 15 years and older. Mean energy percentage (E %) of total fat (37·9 E %) and SFA (16·0 E %) was higher than the dietary reference intakes (DRI). Mean E % of total carbohydrates (45·8 E %) was lower than the DRI, while mean E % of mono/disaccharides was 20·3. Total fat and SFA intakes were higher and total carbohydrate and sugar intakes were lower in the older age categories than in the younger age categories. The percentage of energy from SFA intake was lower and that from carbohydrates was higher than that found in an earlier Belgian study. Further efforts are necessary to improve dietary macronutrient intake, taking into account differences in age categories. In addition, it will be important to monitor its changes regularly using trend analyses.

Previous studies have shown effects of high-protein diets, especially whey protein, on energy expenditure and satiety, yet a possible distinction between the effects of whey or α-lactalbumin has not been made. The present study assessed the effects of the addition of total whey protein (whey) or caseinomacropeptide-depleted α-lactalbumin-enriched whey protein (α-lac) to a breakfast yoghurt drink on energy expenditure and appetite suppression in human subjects. A total of eighteen females and seventeen males (aged 20·9 (sd 1·9) years; BMI 23·0 (sd 2·1) kg/m2) participated in an experiment with a randomised, three-arm, cross-over design where diet-induced energy expenditure, respiratory quotient and satiety were measured. Breakfasts were isoenergetic and subject-specific: a normal-protein (NP) breakfast consisting of whole milk (15, 47 and 38 % energy from protein, carbohydrate and fat, respectively), a high-protein (HP) breakfast with additional whey or a HP breakfast containing α-lac (41, 47 and 12 % energy from protein, carbohydrate and fat, respectively). Resting energy expenditure did not differ between the three conditions. HP breakfasts (area under the curve: whey, 217·1 (se 10·0) kJ × 4 h; α-lac, 234·3 (se 11·6) kJ × 4 h; P < 0·05) increased diet-induced thermogenesis more compared with a NP yoghurt at breakfast (179·7 (se 10·9) kJ × 4 h; P < 0·05). Hunger and desire to eat were significantly more suppressed after α-lac (hunger, − 6627 (se 823); desire to eat, − 6750 (se 805) mm visual analogue scale (VAS) × 4 h; P < 0·05) than after the whey HP breakfast (hunger, − 5448 (se 913); desire to eat, − 5070 (se 873) mm VAS × 4 h; P < 0·05). After the HP breakfasts, a positive protein balance occurred (α-lac, 0·35 (sd 0·18) MJ/4 h; whey, 0·37 (sd 0·20) MJ/4 h; P < 0·001); after the NP breakfast a positive fat balance occurred (1·03 (sd 0·29) MJ/4 h; P < 0·001). In conclusion, consumption of a breakfast yoghurt drink with added whey or α-lac increased energy expenditure, protein balance and decreased fat balance compared with a NP breakfast. The α-lac-enriched yoghurt drink suppressed hunger and the desire to eat more than the whey-enriched yoghurt drink.

The aim of the present study was to validate the Glucoday® continuous interstitial ambulatory glucose-monitoring device (AGD) against plasma glucose measured from arterialised venous (AV) and glucose from capillary whole blood (finger prick, FP) in non-diabetic subjects in response to an oral glucose tolerance test. Fifteen healthy overweight men (age 30–49 years, BMI 26–31 kg/m2) participated. Glucose levels were measured before, during and after consumption of an oral 75 g glucose load using twelve FP samples and forty-four 1 ml AV blood samples during 180 min. Interstitial glucose was measured via the AGD. Three venous samples for fasting insulin were taken to estimate insulin resistance. Profiles of AGD, AV and FP glucose were generated for each participant. Glucose values for each minute of the measurement period were interpolated using a locally weighted scatterplot smoother. Data were compared using Bland–Altman plots that showed good correspondence between all pairs of measurements. Concordance between the three methods was 0·8771 (Kendall's W, n 15, P < 0·001). Concordance was greater between AV and FP (W = 0·9696) than AGD and AV (W = 0·8770) or AGD and FP (W = 0·8764). Analysis of time to peak glucose indicated that AGD measures lagged approximately 15 min behind FP and AV measures. Percent body fat was significantly correlated with time to peak glucose levels for each measure, while BMI and estimated insulin resistance (homeostatic model assessment, HOMA) were not. In conclusion, AGD shows good correspondence with FP and AV glucose measures in response to a glucose load with a 15 min time lag. Taking this into account, AGD has potential application in nutrition and behaviour studies.

The UK Food Standards Agency convened a workshop on 13 May 2009 to discuss recently completed research on diet and immune function. The objective of the workshop was to review this research and to establish priorities for future research. Several of the trials presented at the workshop showed some effect of nutritional interventions (e.g. vitamin D, Zn, Se) on immune parameters. One trial found that increased fruit and vegetable intake may improve the antibody response to pneumococcal vaccination in older people. The workshop highlighted the need to further clarify the potential public health relevance of observed nutrition-related changes in immune function, e.g. susceptibility to infections and infectious morbidity.

The aim of the present study was to test the hypothesis that a prolonged refeeding duration after successful very-low-energy diet (VLED)-induced weight loss beneficially affects weight development and eating behaviour. Patients (n 269) were recruited to a 1-year obesity treatment programme with 12 weeks of an initial VLED. After the VLED, patients with ≥ 10 % weight loss were randomly allocated to 1 week (group 1) or 6 weeks (group 6) refeeding to an ordinary, energy-reduced diet, and thereafter followed and actively treated for an additional 40 weeks. Eating behaviour (revised twenty-one-item Three-Factor Eating Questionnaire) was measured at baseline, during and after refeeding, and at week 52. Weight change over time in the two treatment groups was tested by repeated-measures analysis in completers and by intention to treat (ITT). Of the patients, 169 (109 women) lost ≥ 10 % during the VLED and were randomised. At randomisation, weight loss was − 16·5 (sd 3·7) % in group 1 and − 16·7 (sd 4·3) % in group 6 (P = 0·73). Between weeks 12 and 52, completers in group 6 regained significantly less weight (3·9 (sd 9·1) %) as compared with group 1 (8·2 (sd 8·3) %; P = 0·006) (ITT, P = 0·05). Completers in group 6 also maintained a higher level of dietary restraint after refeeding was completed, but eating behaviour did not differ at week 52. Weight change after the refeeding periods were completed did not differ significantly between the groups (P = 0·06). Overall, longer refeeding duration after successful weight loss with a VLED improves weight maintenance in a 1-year perspective.

Dietary protein restriction is one major therapy in chronic kidney disease (CKD), and ketoacids have been evaluated in CKD patients during restricted-protein diets. The objective of the present study was to compare the efficacy of a low-protein diet supplemented with ketoacids (LPD+KA) and a low-protein diet alone (LPD) in halting the development of renal lesions in CKD. 5/6 Nephrectomy Sprague–Dawley rats were randomly divided into three groups, and fed with either 22 % protein (normal-protein diet; NPD), 6 % protein (LPD) or 5 % protein plus 1 % ketoacids (LPD+KA) for 24 weeks. Sham-operated rats were used as controls. Each 5/6 nephrectomy group included fifteen rats and the control group included twelve rats. Proteinuria, decreased renal function, glomerular sclerosis and tubulointerstitial fibrosis were found in the remnant kidneys of the NPD group. Protein restriction ameliorated these changes, and the effect was more obvious in the LPD+KA group after 5/6 nephrectomy. Lower body weight and serum albumin levels were found in the LPD group, indicating protein malnutrition. Lipid and protein oxidative products were significantly increased in the LPD group compared with the LPD+KA group. These findings indicate that a LPD supplemented with ketoacids is more effective than a LPD alone in protecting the function of remnant kidneys from progressive injury, which may be mediated by ketoacids ameliorating protein malnutrition and oxidative stress injury in remnant kidney tissue.