The metabolic fate of dietary anthocyanins (ACN) has not been fully clarified in humans. In all previous studies, the proportion of total ACN absorbed and excreted in urine was <1% intake. This study aimed to elucidate the human metabolism of cyanidin-glucosides (CyG) contained in blood orange juice (BOJ). One liter of BOJ, containing 71 mg CyG, was consumed by 6 healthy, fasting volunteers. Blood, urine, and fecal samples were collected at baseline and at different times up to 24 h after juice consumption. The content of native CyG, glucuronidated/methylated derivatives, and various phenolic acids was determined by HPLC/MS/MS. The serum maximal concentration of cyanidin-3-glucoside (Cy-3-glc) was 1.9 +/- 0.6 nmol/L and that of protocatechuic acid (PCA) was 492 +/- 62 nmol/L at 0.5 h and 2 h after juice consumption, respectively. The calculated total amounts in plasma corresponded for Cy-3-glc to 0.02% and for PCA to 44% of CyG ingested. CyG and glucuronidated/methylated metabolites, but not PCA, were detected in urine. ACN recovered in 24-h urine collections represented approximately 1.2% of the ingested dose. Both CyG (1.90 +/- 0.04 nmol/g) and PCA (277 +/- 0.2 nmol/g) were recovered in 24-h fecal samples. Data explained the metabolic fate of 74% of BOJ ACN. PCA was for the first time, to our knowledge, identified in humans as a CyG metabolite, accounting for almost 73% of ingested CyG. A high concentration of PCA may explain the short-term increased plasma antioxidant activity observed after intake of cyanidin-rich food and it can also contribute to the numerous health benefits attributed to dietary ACN consumption.

Many studies have reported that higher adherence to Mediterranean diet may decrease cardiovascular disease (CVD) incidence and mortality. We performed a meta-analysis to explore the association in prospective studies and randomized control trials (RCTs) between Mediterranean diet adherence and CVD incidence and mortality. The PubMed database was searched up to June 2014. A total of 17 studies were extracted and 11 qualified for the quantitative analysis. Individuals in the highest quantile of adherence to the diet had lower incidence [relative risk (RR): 0.76, 95% confidence intervals (CI): 0.68, 0.83] and mortality (RR: 0.76, 95% CI: 0.68, 0.83) from CVD compared to those least adherent. A significant reduction of risk was found also for coronary heart disease (CHD) (RR: 0.72, 95% CI: 0.60, 0.86), myocardial infarction (MI) (RR: 0.67; 95% CI: 0.54, 0.83), and stroke (RR: 0.76; 95% CI: 0.60, 0.96) incidence. Pooled analyses of individual components of the diet revealed that the protective effects of the diet appear to be most attributable to olive oil, fruits, vegetables, and legumes. An average reduced risk of 40% for the aforementioned outcomes has been retrieved when pooling results of RCTs. A Mediterranean dietary pattern is associated with lower risks of CVD incidence and mortality, including CHD and MI. The relative effects of specific food groups should be further investigated.

Background: Epidemiology associates whole-grain (WG) consumption with several health benefits. Mounting evidence suggests that WG wheat polyphenols play a role in mechanisms underlying health benefits. Objective: The objective was to assess circulating concentration, excretion, and the physiologic role of WG wheat polyphenols in subjects with suboptimal dietary and lifestyle behaviors. Design: A placebo-controlled, parallel-group randomized trial with 80 healthy overweight/obese subjects with low intake of fruit and vegetables and sedentary lifestyle was performed. Participants replaced precise portions of refined wheat (RW) with a fixed amount of selected WG wheat or RW products for 8 wk. At baseline and every 4 wk, blood, urine, feces, and anthropometric and body composition measures were collected. Profiles of phenolic acids in biological samples, plasma markers of metabolic disease and inflammation, and fecal microbiota composition were assessed. Results: WG consumption for 4-8 wk determined a 4-fold increase in serum dihydroferulic acid (DHFA) and a 2-fold increase in fecal ferulic acid (FA) compared with RW consumption (no changes). Similarly, urinary FA at 8 wk doubled the baseline concentration only in WG subjects. Concomitant reduction in plasma tumor necrosis factor-a (TNF-a) after 8 wk and increased interleukin (IL)-10 only after 4 wk with WG compared with RW (P = 0.04) were observed. No significant change in plasma metabolic disease markers over the study period was observed, but a trend toward lower plasma plasminogen activator inhibitor 1 with higher excretion of FA and DHFA in the WG group was found. Fecal FA was associated with baseline low Bifidobacteriales and Bacteroidetes abundances, whereas after WG consumption, it correlated with increased Bacteroidetes and Firmicutes but reduced Clostridium. TNF-a reduction correlated with increased Bacteroides and Lactobacillus. No effect of dietary interventions on anthropometric measurements and body composition was found. Conclusions: WG wheat consumption significantly increased excreted FA and circulating DHFA. Bacterial communities influenced fecal FA and were modified by WG wheat consumption. This trial was registered at clinicaltrials.gov as NCT01293175.Am J Clin Nutr 2015;101:251-61.

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Background and Purpose-A systematic review of the prospective studies addressing the relationship of overweight and obesity to major stroke subtypes is lacking. We evaluated the occurrence of a graded association between overweight, obesity, and incidence of ischemic and hemorrhagic stroke by a meta-analysis of cohort studies. Methods-A search of online databases and relevant reviews was performed. Inclusion criteria were original article in English, prospective study design, follow-up Ն4 years, indication of number of subjects exposed, and number of events across body mass index categories. Crude unadjusted relative risk (RR) and 95% CI were calculated for each study for overweight or obese compared with normal-weight categories. Log-transformed values and SE were used to calculate the pooled RR with random effects models; publication bias was checked. Additional analyses were performed using the multivariate estimates of risk reported in the individual studies. Results-Twenty-five studies were included, with 2 274 961 participants and 30 757 events. RR for ischemic stroke was 1.22 (95% CI, 1.05-1.41) for overweight and 1.64 (95% CI, 1.36 -1.99) for obesity, whereas RR for hemorrhagic stroke was 1.01 (95% CI, 0.88 -1.17) and 1.24 (95% CI, 0.99 -1.54), respectively. Subgroup and meta-regression analyses ruled out gender, population average age, body mass index and blood pressure, year of recruitment, year of study publication, and length of follow-up as significant sources of heterogeneity. The additional analyses relying on the published multivariate estimates of risk provided qualitatively similar results. Conclusions-Overweight and obesity are associated with progressively increasing risk of ischemic stroke, at least in part, independently from age, lifestyle, and other cardiovascular risk factors. (Stroke. 2010;41:e418-e426.)Key Words: body mass index Ⅲ cerebrovascular disease Ⅲ excess body weight Ⅲ meta-analysis Ⅲ stroke S troke is a major cause of death in developed countries. Its prevalence and disability burden are expected to increase in the future because of population aging. 1 Besides age, risk factors include hypertension, smoking, diabetes mellitus, left ventricular hypertrophy, and atrial fibrillation. 2 Obesity is a precursor of hypertension, diabetes, and their complications, which play an important indirect role in the epidemiology of stroke; moreover, it is associated with the action of powerful cytokines impacting on the sympathetic nervous system activity, the renin-angiotensin axis, the endothelial function, and the microcirculation. 3 Randomized, controlled trials of the effects of treating obesity on the risk of stroke are lacking. Recently, a large collaborative study provided prospective results about the relationship between obesity and mortality from stroke on a total population of nearly 900 000 individuals, mainly from Western countries, but it did not provide incidence rates, which are actually a more informative index of the burden imposed by stroke on the community. 4 Another r...

Apple is among the most consumed fruits worldwide. It is available on the market for the whole year being a major source of dietary polyphenols. Several studies suggested that apple polyphenols could play a role in prevention of degenarative diseases. The action of these compounds has been partially ascribed to their antioxidative ability, and fruit antioxidants profile is influenced by apple variety and by the postharvest storage. In this work, the polyphenols composition of the flesh of four apple varieties cultivated in southern Italy were investigated by HPLC, and a flow injection MS/MS procedure to quantify cholorogenic acid and catechins was set up. Phenolic composition and the radical scavenging activity were monitored during a postharvest storage of four months. The quantification by flow injection procedure gives results comparable to those obtained by HPLC, and the increase of the antioxidant activity during storage correlated with an increase of the concentration of catechin and phloridzin. This trend is particularly evident for the variety "Annurca" which is a typical product cultivated in the area around Naples. The genetic characteristics of the Annurca variety together with the anticipated harvest time and the peculiar postharvest conditions are likely responsible for this increase of the antioxidant activity.

Background & aims: Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cutoffs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes. Methods: A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool. Results: Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cutoff point values from 4.05 to 5.05 have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients. Conclusions: Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia.

Objective-To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. Methods-Doppler echocardiographic indices ofleft ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index <20. Results-13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0-001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity EIA ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity EIA ratio was inversely related to left atrial dimension (r = -0 43, p < 0.0001) and cardiac output (r = -0-64, p < 0.0001)