Background: Glucagon-like peptide 1 agonists differ in chemical structure, duration of action and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. Methods: We randomly assigned patients with type 2 diabetes and cardiovascular disease to the addition of once-weekly subcutaneous injection of albiglutide (30 mg to 50 mg) or matching placebo to standard care. We hypothesized that albiglutide would be noninferior to placebo for the primary outcome of first occurrence of cardiovascular death, myocardial infarction, or stroke. If noninferiority was confirmed by an upper limit of the 95% confidence interval for the hazard ratio of less than 1.30, closed-testing for superiority was prespecified. Findings: Overall, 9463 participants were followed for a median of 1.6 years. The primary composite outcome occurred in 338 of 4731 patients (7.1%; 4.6 events per 100 person-years) in the albiglutide group and in 428 of 4732 patients (9.0%; 5.9 events per 100 person-years) in the placebo group (hazard ratio, 0.78; 95% confidence interval [CI ], 0.68 to 0.90), indicating that albiglutide, was superior to placebo (P<0.0001 for noninferiority, P=0.0006 for superiority). The incidence of acute pancreatitis (albiglutide 10 patients and placebo 7 patients), pancreatic cancer (6 and 5), medullary thyroid carcinoma (0 and 0), and other serious adverse events did not differ significantly between the two groups. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. (Funded by GlaxoSmithKline; Harmony Outcomes ClinicalTrials.gov number, NCT02465515.) noninferiority; P = 0.06 for superiority). There seems to be variation in the results of existing trials with GLP-1 receptor agonists, which if correct, might reflect drug structure or duration of action, patients studied, duration of follow-up or other factors.

With an ageing population, dietary approaches to promote health and independence later in life are needed. In part, this can be achieved by maintaining muscle mass and strength as people age. New evidence suggests that current dietary recommendations for protein intake may be insufficient to achieve this goal and that individuals might benefit by increasing their intake and frequency of consumption of high-quality protein. However, the environmental effects of increasing animal-protein production are a concern, and alternative, more sustainable protein sources should be considered. Protein is known to be more satiating than other macronutrients, and it is unclear whether diets high in plant proteins affect the appetite of older adults as they should be recommended for individuals at risk of malnutrition. The review considers the protein needs of an ageing population (>40 years old), sustainable protein sources, appetite-related implications of diets high in plant proteins, and related areas for future research.

RationaleA significant proportion of the general population report supplementing their diet with one or more vitamins or minerals, with common reasons for doing so being to combat stress and fatigue and to improve mental functioning. Few studies have assessed the relationship between supplementation with vitamins/minerals and psychological functioning in healthy cohorts of non-elderly adults.ObjectivesThe present randomised, placebo-controlled, double–blind, parallel groups trial assessed the cognitive and mood effects of a high-dose B-complex vitamin and mineral supplement (Berocca®) in 215 males aged 30 to 55 years, who were in full-time employment.MethodsParticipants attended the laboratory prior to and on the last day of a 33-day treatment period where they completed the Profile of Mood States (POMS), Perceived Stress Scale (PSS) and General Health Questionnaire (GHQ-12). Cognitive performance and task-related modulation of mood/fatigue were assessed with the 60 min cognitive demand battery. On the final day, participants also completed the Stroop task for 40 min whilst engaged in inclined treadmill walking and subsequent executive function was assessed.ResultsVitamin/mineral supplementation led to significant improvements in ratings on the PSS, GHQ-12 and the ‘vigour’ subscale of the POMS. The vitamin/mineral group also performed better on the Serial 3s subtractions task and rated themselves as less ‘mentally tired’ both pre- and post-completion of the cognitive demand battery.ConclusionsHealthy members of the general population may benefit from augmented levels of vitamins/minerals via direct dietary supplementation. Specifically, supplementation led to improved ratings of stress, mental health and vigour and improved cognitive performance during intense mental processing.

Newcastle University ePrints -eprint.ncl.ac.uk Watson AW, Haskell-Ramsay CF, Kennedy DO, Cooney JM, Trower T, Scheepens A. Acute supplementation with blackcurrant extracts modulates cognitive functioning and inhibits monoamine oxidase-B in healthy young adults. Abstract 42Background: Berry fruit have been shown to convey a number of benefits in animal models; 43including improvements in cognitive performance, slowing of cognitive decline and 44 neuroprotection. These findings, along with epidemiological evidence and data showing 45 modulation of factors related to brain function, suggest a potential role for berry 46 polyphenols in improving cognitive performance. 47Objective: The current study assessed the effects of two blackcurrant extracts on cognitive 48 outcomes, mood, blood glucose profile and peripheral monoamine levels. Anthocyanin 49 bioavailability was also assessed. 50 Design: A randomised, double-blind, placebo-controlled, crossover study was conducted in 51 36 healthy young participants (18-35y). Following a 10 minute baseline assessment, 52 participants consumed sugar, flavour and colour matched drinks containing no polyphenols 53 (control) or 525 +/-5mg of polyphenols per 60kg body weight from either an anthocyanin 54 enriched powdered blackcurrant extract (Delcyan TM ) or cold pressed blackcurrant juice 55 (cultivar Blackadder) in counterbalanced order on separate days. A 70-minute computerised 56cognitive assessment (COMPASS) designed to be attentionally demanding and mentally 57fatiguing was then completed following a 60-minute resting absorption period. Blood 58 platelet monoamine oxidase-B (MAO-B), plasma anthocyanin levels, plasma prolactin and 59 plasma monoamines and associated metabolites were also investigated in a subsection of 60 the cohort at 2.5 hours post-consumption. 61Results: When compared to control, both blackcurrant extracts improved attention task 62performance. The juiced extract reduced reaction times during the digit vigilance task, 63whereas the powdered extract increased accuracy during a rapid visual information 64 processing task. Following the juiced Blackadder extract, platelet MAO-B was inhibited by 65 96%, dihydroxyphenylglycol (DHPG) was reduced and normetadrenalin was increased in 66 blood plasma, and a rapid decline in blood glucose levels was significantly attenuated, when 67 compared to control. 68Conclusion: This is the first illustration of a cognitive benefit of acute blackcurrant 69 supplementation in healthy young humans and the first description of a clinically significant 70 inhibition of MAO-B and MAO-A using a commonly consumed fruit. These data also illustrate 71 that compounds other than anthocyanins are important to observe in vivo MAO inhibition 72and that the degree of processing and cultivar of blackcurrant fruit used substantially alters 73 the neuroendocrinological and cognitive benefits conveyed. 74 75