Arne Torbjørn Høstmark

The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women.

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.

CHANGES IN PLASMA PHOSPHOLIPID FATTY ACIDS AND THEIR RELATIONSHIP TO DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH A VEGETARIAN DIET

In a controlled clinical trial we have recently shown that patients with rheumatoid arthritis (RA) improved after fasting for 7-10 d and that the improvement could be sustained through 3.5 months with a vegan diet and 9 months with a lactovegetarian diet. Other studies have indicated that the inflammatory process in RA can be reduced through manipulation of dietary fatty acids. A switch to a vegetarian diet significantly alters the intake of fatty acids. Therefore, we have analysed the changes in fatty acid profiles of the plasma phospholipid fraction and related these changes to disease activity. The concentrations of the fatty acids 20:3n-6 and 20:4n-6 were significantly reduced after 3.5 months with a vegan diet (P < 0.0001 and P < 0.01 respectively), but the concentration increased to baseline values with a lactovegetarian diet. The concentration of 20:5n-3 was significantly reduced after the vegan diet (P < 0.0001) and the lactovegetarian diet periods (P < 0.01). There was no significant difference in fatty acid concentrations between diet responders and diet non-responders after the vegan or lactovegetarian diet periods. Our results indicate that the changes in the fatty acid profiles cannot explain the clinical improvement.

Effect of a high intake of cheese on cholesterol and metabolic syndrome: results of a randomized trial

Background Cheese is generally rich in saturated fat, which is associated with increased risk for cardiovascular diseases. Nevertheless, recent reports suggest that cheese may be antiatherogenic. Objective The goal of this study was to assess whether intake of two types of Norwegian cheese, with widely varying fat and calcium content, might influence factors of the metabolic syndrome and serum cholesterol levels differently. Design A total of 153 participants were randomized to one of three groups: Gamalost®, a traditional fat- and salt-free Norwegian cheese (50 g/day), Gouda-type cheese with 27% fat (80 g/day), and a control group with a limited cheese intake. Blood samples, anthropometric measurements, blood pressure, and questionnaires about lifestyle and diet were obtained at inclusion and end. Results At baseline, there were no differences between the groups in relevant baseline characteristics, mean age 43, 52.3% female. After 8 weeks’ intervention, there were no changes in any of the metabolic syndrome factors between the intervention groups compared with the control group. There were no increases in total- or LDL cholesterol in the cheese groups compared with the control. Stratified analysis showed that those in the Gouda group with metabolic syndrome at baseline had significant reductions in total cholesterol at the end of the trial compared with control (−0.70 mmol/L, p=0.013), and a significantly higher reduction in mean triglycerides. In the Gamalost group, those who had high total cholesterol at baseline had a significant reduction in total cholesterol compared with control (−0.40 mmol/L, p=0.035). Conclusions In conclusion, cholesterol levels did not increase after high intake of 27% fat Gouda-type cheese over 8 weeks’ intervention, and stratified analysis showed that participants with metabolic syndrome had reduced cholesterol at the end of the trial.

Percentage oleic acid is inversely related to percentage arachidonic acid in total lipids of rat serum

BackgroundSince many health effects of oils rich in oleic acid (18:1, n-9) seem to be opposite those of arachidonic acid (20:4, n-6), i.e. concerning cardiovascular risk, we examined whether % 18:1 might be negatively associated with % 20:4.MethodsFatty acid separation by gas chromatography was performed in total serum lipids of 36 male rats. Using bivariate correlations and multiple linear regressions we studied the association between oleic acid and arachidonic acid.ResultsWe found an inverse relationship (r = -0.885, p < 0.001; n = 36) between percentages of 18:1 and 20:4 in total lipids of rat serum, persisting when controlling for the other fatty acids measured. In a multiple linear regression model with % 20:4 as the dependent variable and percentages of the other fatty acids entered simultaneously as independents, oleic acid and linoleic acid contributed most to predict % 20:4. Per cent 20:4 correlated negatively (p< 0.01) with a Delta-9 desaturase index, i.e. the (18:1)/(18:0) ratio, and %18:1 with the (20:4)/(18:2) ratio, estimating desaturases/elongase.ConclusionsPercentages of 18:1 and 20:4 seem to be inversely related and desaturase/elongase inhibition could be involved. The results might partly explain positive health effects of foods rich in oleic acid.

Short communication: Is consumption of a cheese rich in angiotensin-converting enzyme-inhibiting peptides, such as the Norwegian cheese Gamalost, associated with reduced blood pressure?

Epidemiological and clinical studies have shown that angiotensin-converting enzyme (ACE)-inhibiting peptides derived from dairy products may decrease blood pressure. These peptides have been identified in many cheeses, and Gamalost, a traditional Norwegian cheese, is particularly rich in these peptides. The aim of this cross-sectional study was to examine whether frequency of Gamalost intake was associated with blood pressure in a Norwegian population sample. Blood pressure and other clinical measurements, including the factors of metabolic syndrome, were obtained from 168 participants (56% female, mean age = 51 yr) who completed a questionnaire about dietary habits and other health-related factors. Mean Gamalost intake was 2 servings per week. The prevalence of hypertension was 23.8% in the population, with mean systolic and diastolic blood pressures of 128 and 78 mmHg, respectively. Intake of Gamalost was inversely associated with systolic blood pressure. Each increase in frequency unit of Gamalost intake corresponded to a reduction in systolic blood pressure of 0.72 mmHg, after controlling for sex, age, education, waist circumference, physical activity, smoking status, and dairy food intake. Results from this study indicate that consumption of Gamalost (or other foods rich in ACE-inhibiting peptides) may reduce blood pressure.

The oslo health study: a dietary index estimating frequent intake of soft drinks and rare intake of fruit and vegetables is negatively associated with bone mineral density.

Background. Since nutritional factors may affect bone mineral density (BMD), we have investigated whether BMD is associated with an index estimating the intake of soft drinks, fruits, and vegetables. Methods. BMD was measured in distal forearm in a subsample of the population-based Oslo Health Study. 2126 subjects had both valid BMD measurements and answered all the questions required for calculating a Dietary Index = the sum of intake estimates of colas and non-cola beverages divided by the sum of intake estimates of fruits and vegetables. We did linear regression analyses to study whether the Dietary Index and the single food items included in the index were associated with BMD. Results. There was a consistent negative association between the Dietary Index and forearm BMD. Among the single index components, colas and non-cola soft drinks were negatively associated with BMD. The negative association between the Dietary Index and BMD prevailed after adjusting for gender, age, and body mass index, length of education, smoking, alcohol intake, and physical activity. Conclusion. An index reflecting frequent intake of soft drinks and rare intake of fruit and vegetables was inversely related to distal forearm bone mineral density.

Does cheese intake blunt the association between soft drink intake and risk of the metabolic syndrome? Results from the cross-sectional Oslo Health Study

Objectives A high soft drink intake may promote, whereas intake of cheese may reduce risk of the metabolic syndrome (MetS), but will cheese intake blunt the soft drink versus MetS association? Design Cross-sectional study. Setting The Oslo Health Study. Participants Among the 18 770 participants of the Oslo Health Study there were 5344 men and 6150 women having data on cheese and soft drink intake and on risk factors for MetS, except for fasting glucose. The MetSRisk index=the weighted sum of triglycerides (TG), systolic blood pressure, diastolic blood pressure, waist circumference and body mass index (BMI) divided by high-density lipoprotein (HDL) were used as a combined risk estimate to examine the cheese/soft drink versus MetS interaction, and the SumRisk index was used to assess whether increasing intake of soft drinks/cheese would include an increasing number of MetS factors being above the cut-off values. We analysed the data using non-parametric correlation and analysis of covariance (ANCOVA). Results In all three groups of soft drink intake (seldom/rarely, 1–6 glasses/week, ≥1 glass/day), there was a negative cheese versus MetSRisk correlation (p≤0.003), but in the highest intake group the influence of cheese seemed to level off, suggesting interaction. However, there was no interaction between cheese and soft drinks within the fully adjusted models. Conversely, at all four levels of cheese intake, MetSRisk increased with an increasing intake of soft drinks (p≤0.001 at all cheese levels). Similar associations were found with the SumRisk index. When controlling for a large number of covariates (eg, sex, age group, smoking, education, physical activity, intake of fruits/berries and vegetables), the above associations prevailed. Conclusions Cheese intake blunted the association between soft drink intake and MetS, an influence possibly related to fatty acid desaturation, or to undetected covariates.

The inverse association between relative abundances of oleic acid and arachidonic acid is related to alpha -linolenic acid

BackgroundMany health effects of oils rich in oleic acid (OA, 18:1 n9) seem to be opposite those of arachidonic acid (AA, 20:4 n6), i.e. concerning cardiovascular risk. In recent studies in humans and in the rat we observed that percentages of OA and AA were inversely related, raising the question of whether the inverse association is a general one, and how it might be explained. In the present work we examine whether percentages of OA and AA are inversely associated in breast muscle lipids of chickens, and whether alpha-linolenic acid (ALA) may be related to the OA/AA ratio.MethodsThe study group consisted of 163 chickens. Breast muscle was collected, and the concentration of fatty acids in muscle lipids was determined using gas chromatography. We studied association between fatty acids using bivariate correlations (Pearson) and linear regression. Synthesis of OA from stearic acid (Stear) was estimated using the OA/Stear ratio, and formation of AA from linoleic acid (LA) was estimated by the AA/LA ratio.ResultsWe found a strong inverse relationship (r = -0.942, p < 0.001; n = 163) between % OA and % AA in breast muscle lipids of the chickens. There was an inverse association (r = -0.887, p < 0.001) between the OA/Stearic acid ratio, estimating Delta9 desaturase, and the AA/LA ratio, estimating desaturases/elongase activities. Furthermore, there was a strong negative association between % AA and the OA/Stearic acid ratio (r = -0.925, p < 0.001), and % OA correlated negatively (r = -0.914, p < 0.001) with the AA/LA ratio. ALA was positively associated (r = 0.956, p < 0.001) with the OA/AA ratio, and this association prevailed when controlling for the other fatty acids. ALA was positively associated (r = 0.857, p < 0.001) with the OA/Stear ratio, but was negatively related (r = -0.827, p < 0.001) to the AA/LA ratio.ConclusionsThe relative abundances of OA and AA that are inversely related in muscle lipids of chickens may be explained by a feedback regulation between the synthesis of OA and AA, and related to ALA, which seems to stimulate formation of OA, and inhibit synthesis of AA, but further studies are required to clarify whether this hypothesis is valid.

Effect of a cheese rich in angiotensin-converting enzyme-inhibiting peptides (Gamalost(®)) and a Gouda-type cheese on blood pressure: results of a randomised trial.

Background High blood pressure (BP) is the leading risk factor for global disease burden, contributing to 7% of global disability adjusted life years. Angiotensin converting enzyme (ACE)-inhibiting bioactive peptides have the potential to reduce BP in humans. These peptides have been identified in many dairy products and have been associated with significant reductions in BP. Objective The objective of this trial was to examine whether a cheese rich in ACE-inhibiting peptides (Gamalost®), or a standard Gouda-type cheese could lower BP. Design A total of 153 healthy participants were randomised to one of three parallel arms: Gamalost® (n=53, 50 g/day for 8 weeks), Gouda-type cheese (n=50, 80 g/day for 8 weeks), and control (n=50). BP and anthropometric measurements were taken at the baseline and at the end, with an additional BP measurement midway. Based on BP at baseline, participants were categorised as having optimal BP (<120/<80 mmHg), normal-high BP (120–139/80–89 mmHg), or being hypertensive (>140/>90 mmHg). Questionnaires about lifestyle, health, and dietary habits were completed at baseline, midway and end. Results In total, 148 participants (mean age 43, 52% female) completed the intervention. There were no differences among the three groups in relevant baseline characteristics. BP was reduced in the entire study population, but the cheese groups did not differ from control. However, in a subgroup of participants with slightly elevated BP, BP at 4 weeks of intervention seemed to be borderline significantly more reduced in the Gamalost® group compared with the control group (Dunnett test: diastolic BP −3.5 mmHg, 95% confidence interval (CI) −7.3, 0.4, systolic BP: −4.3 mmHg, 95% CI −9.8, 1.1). Conclusion An intention-to-treat analysis of the data showed no cheese effect upon BP compared to control, but Gamalost® seemed to have a small, non-significant lowering effect on diastolic BP after 4 weeks in people with a normal-high BP.

Relationship between fecal content of fatty acids and cyclooxygenase mRNA expression and fatty acid composition in duodenal biopsies, serum lipoproteins, and dietary fat in colectomized familial adenomatous polyposis patients.

A few familial adenomatous polyposis studies have focused upon faecal sterols and bile acids but none has analysed the fecal content of fatty acids. We report here findings of an observational study on 29 colectomized familial adenomatous polyposis patients that describe the fecal content of fatty acids, and relate this to the proportions of fatty acids and levels of cyclooxygenase mRNA expression in duodenal biopsies, levels of serum lipoproteins, and diet. In the ileostomy group separately (n = 12), the fecal content of arachidonic acid was correlated negatively to the proportions of eicosapentaenoic acid and docosahexaenoic acid in duodenal biopsies. Total serum-cholesterol was negatively correlated to the fecal content of saturates and monounsaturates. The fecal palmitoleic acid/palmitic acid ratio was positively correlated to the levels of cyclooxygease-2 expression in duodenal biopsies.In the ileal-pouch-anal anastomosis group separately (n = 17), significant correlations were found between the fecal contents of oleic acid, linoleic acid, and alpha-linolenic acid, and the proportions of myristic acid, oleic acid and eicosaenoic acid in duodenal biopsies. Dietary monounsaturates were positively correlated to different fecal fatty acids. Future studies should focus on molecular mechanisms relevant to fatty acid metabolism, inflammation, and angiogenesis, in addition to nutrition.