Objective:To derive healthy and sustainable food-based dietary guidelines (FBDG) for different target groups in the Netherlands and describe the process.Design:Optimised dietary patterns for children, adolescents, adults and the elderly were calculated using an optimisation model. Foods high in saturated and trans-fatty acids, salt and sugar, and low in dietary fibre, were excluded. The dietary patterns resembled the current food consumption as closely as possible, while simultaneously meeting recommendations for food groups, nutrients, maximum limits for foods with a high environmental impact, and within 85 % of the energy requirement. Recommended daily amounts of food groups were based on the optimised dietary patterns and expert judgement.Setting:The Netherlands.Participants:FBDG were derived for Dutch people with different ages, genders, activity levels and food preferences.Results:For most target groups the optimisation model provided dietary patterns that complied with all requirements. For some food groups, the optimised amounts varied largely between target groups. For consistent messages to consumers, the optimised dietary patterns were adjusted to uniform recommendations per target group. Recommendations were visualised in the Wheel of Five. The advice is to eat the recommended amounts of foods according to the Wheel of Five and limit consumption of other foods.Conclusions:Based on an optimisation model, scientific evidence, information on dietary patterns and expert knowledge, we derived FBDG for different target groups. The Wheel of Five is a key food-counselling model that can help Dutch consumers to make their diets healthier and more environmentally sustainable.

The findings from this prospective cohort study provided no evidence of an association between dietary acid load and risk of hypertension in older adults.

Objectives: To study the effects of two different mixtures of the main conjugated linoleic acid (CLA) isomers cis-9, trans-11 CLA and trans-10, cis-12 CLA on human immune function. Design: Double-blind, randomized, parallel, reference-controlled intervention study. Subjects and intervention: Seventy-one healthy males aged 31 -69 y received one of the following treatments: (1) mixture of 50% c9,t11 CLA and 50% t10,c12 CLA isomers (CLA 50:50); (2) mixture of 80% c9,t11 CLA and 20% t10,c12 CLA isomers (CLA 80:20); and (3) sunflower oil fatty acids (reference). The treatments were given as supplements in softgel capsules providing a total of 1.7 g (c9,t11 þ t10,c12) CLA fatty acids (50:50) or 1.6 g (c9,t11 þ t10,c12) CLA glycerides (80:20) per day in treatment groups for 12 weeks. Results: Almost twice as many subjects reached protective antibody levels to hepatitis B when consuming CLA50:50 fatty acids (15=24, 62%) compared with subjects consuming the reference substance (7=21, 33%, P ¼ 0.075). In subjects consuming CLA 80:20 glycerides this was 8=22 (36%). Other aspects of immune function, ie DTH responses, NK cell activity, lymphocyte proliferation and production of TNF-a, IL1-b, IL6, IFN-g, IL2, IL4, and PGE 2 , were not affected.

Objective: To evaluate both efficacy and safety in humans of long-term consumption of spreads containing plant sterol esters. Design: Randomized double-blind placebo-controlled parallel trial. Subjects: Hundred and eighty-five healthy volunteers (35 -64 y). Intervention: Volunteers daily consumed 20 g spread enriched with 1.6 g plant sterols as fatty acid esters or a control spread for 1 y. They continued their habitual diet and lifestyle. Outcome measures included efficacy markers such as total and LDLcholesterol, a large range of safety parameters, and reporting of adverse events. Results: Consumption of the plant sterol ester-enriched spread consistently lowered total and LDL cholesterol during the 1 y period on average by 4 and 6%, respectively (0.01 < P < 0.05). Plant sterols intake did on average not result in a lower carotenoid concentration (when expressed per LDL-cholesterol) after 52 weeks (P > 0.05). However, carotenoid concentrations changed over time. Plant sterols intake reduced lipid adjusted a-and b-carotene-concentrations by only 15 -25% after 1 y, relative to control. Lipid-adjusted fat-soluble vitamin concentrations remained unchanged. Plant sterol concentrations in serum were increased from 2.76 to 5.31 (mmol=mmol total cholesterol) for campesterol (P < 0.0001) and from 1.86 to 2.47 (mmol=mmol total cholesterol) for b-sitosterol (P < 0.0001). The increase in total plant sterol concentration in red blood cells (5.29 -9.62 mg=g) did not affect red blood cell deformability. Hormone levels in males (free and total testosterone) and females (luteinizing hormone, follicle stimulating hormone, b-estradiol and progesterone) as well as all clinical chemical and hematological parameters measured were unaffected. Adverse events reported were not different between subjects consuming control spread and subjects consuming plant sterol esters-enriched spread. Conclusion: Consumption of a plant sterol esters-enriched spread is an effective way to consistently lower blood cholesterol concentrations and is safe to use over a long period of time.

Consumption of foods containing 110 mg/d of soy isoflavone aglycone equivalents for 1 y did not prevent postmenopausal bone loss and did not affect bone turnover in apparently healthy early postmenopausal white women. This trial was registered at clinicaltrials.gov as NCT00301353.

SummaryBackground and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. This study examined the association of metabolic acid load with acidosis and with cardiovascular risk factors in RTRs and aimed to identify dietary factors associated with acidosis.Design, participants, setting, & measurements 707 RTRs were included. Metabolic acid load was assessed by measuring 24-hour urinary net acid excretion (NAE; i.e., titratable acid + ammonium 2 bicarbonate). Acidosis was defined as serum [HCO 3 2 ] , 24 mmol/L. BP and insulin resistance, reflected by hemoglobin A1c, were among cardiovascular risk factors. Diet was assessed with food-frequency questionnaires. Linear regression analysis was applied to investigate association between NAE and acidosis and between dietary factors and acidosis.Results Mean age 6 SD was 53613 years; 57% of patients were male. Acidosis was present in 31% of RTRs. NAE was associated with acidosis (serum HCO 3 2 : b=20.61; serum pH: b=20.010; both P,0.001). Patients with high intake of animal protein (i.e., from meat, cheese, and fish) and low intake of fruits and vegetables had significantly lower serum HCO 3 2 and serum pH. No associations were observed between NAE and cardiovascular risk factors, such as hypertension and insulin resistance.Conclusions In addition to conventional factors contributing to acidosis, diet might influence acid-base homeostasis in RTRs. Higher intake of fruits and vegetables and lower animal protein intake is associated with less acidosis in RTRs.

BackgroundElevated blood pressure (BP), which is a major risk factor for cardiovascular disease, is highly prevalent worldwide. Recently, interest has grown in the role of dietary protein in human BP. We performed a systematic review of all published scientific literature on dietary protein, including protein from various sources, in relation to human BP.Methodology/Principal FindingsWe performed a MEDLINE search and a manual search to identify English language studies on the association between protein and blood pressure, published before June 2010. A total of 46 papers met the inclusion criteria. Most observational studies showed no association or an inverse association between total dietary protein and BP or incident hypertension. Results of biomarker studies and randomized controlled trials indicated a beneficial effect of protein on BP. This beneficial effect may be mainly driven by plant protein, according to results in observational studies. Data on protein from specific sources (e.g. from fish, dairy, grain, soy, and nut) were scarce. There was some evidence that BP in people with elevated BP and/or older age could be more sensitive to dietary protein.Conclusions/SignificanceIn conclusion, evidence suggests a small beneficial effect of protein on BP, especially for plant protein. A blood pressure lowering effect of protein may have important public health implications. However, this warrants further investigation in randomized controlled trials. Furthermore, more data are needed on protein from specific sources in relation to BP, and on the protein-BP relation in population subgroups.

The hypothesis was tested that dietary lactose v. glucose stimulates Mg absorption in rats because lactose lowers pH of the ileal lumen, which improves Mg solubility which in turn enhances Mg availability for transport across the ileal epithelium. For comparison, the effects of lactulose were studied because it shares with lactose the characteristic of being poorly digestible. Replacement of glucose by lactose (100 g/Kg) significantly stimulated apparent absorption of Mg. Apart from Mg absorption, lactulose also significantly enhanced absorption of Ca and phosphate. Lactose v. glucose lowered the pH of the ileal lumen from 7.5 to 7.2, whereas lactulose significantly reduced it to 7.0. In in vitro incubations a decrease in pH within the range of fluctuation in vivo was found to cause an improved solubility of Mg, and to a lesser extent also of Ca and phosphate. The smaller fall of ileal pH induced by feeding lactose instead of lactulose may explain why lactose improved Mg absorption only. For all individual rats combined there were negative relationships between ileal pH and apparent absorption of minerals, the relationship being strongest for Mg. Neither lactose nor lactulose was found to raise ileal solubility of minerals, which could relate to the possibility that the time of sampling was not appropriate. It is suggested that lactose-induced stimulation of Mg absorption in rats is caused by a lowering of ileal pH.