Lynn Cialdella-Kam

Bananas as an Energy Source during Exercise: A Metabolomics Approach

This study compared the acute effect of ingesting bananas (BAN) versus a 6% carbohydrate drink (CHO) on 75-km cycling performance and post-exercise inflammation, oxidative stress, and innate immune function using traditional and metabolomics-based profiling. Trained cyclists (N = 14) completed two 75-km cycling time trials (randomized, crossover) while ingesting BAN or CHO (0.2 g/kg carbohydrate every 15 min). Pre-, post-, and 1-h-post-exercise blood samples were analyzed for glucose, granulocyte (GR) and monocyte (MO) phagocytosis (PHAG) and oxidative burst activity, nine cytokines, F2-isoprostanes, ferric reducing ability of plasma (FRAP), and metabolic profiles using gas chromatography-mass spectrometry. Blood glucose levels and performance did not differ between BAN and CHO (2.41±0.22, 2.36±0.19 h, P = 0.258). F2-isoprostanes, FRAP, IL-10, IL-2, IL-6, IL-8, TNFα, GR-PHAG, and MO-PHAG increased with exercise, with no trial differences except for higher levels during BAN for IL-10, IL-8, and FRAP (interaction effects, P = 0.003, 0.004, and 0.012). Of 103 metabolites detected, 56 had exercise time effects, and only one (dopamine) had a pattern of change that differed between BAN and CHO. Plots from the PLS-DA model visualized a distinct separation in global metabolic scores between time points [R2Y(cum) = 0.869, Q2(cum) = 0.766]. Of the top 15 metabolites, five were related to liver glutathione production, eight to carbohydrate, lipid, and amino acid metabolism, and two were tricarboxylic acid cycle intermediates. BAN and CHO ingestion during 75-km cycling resulted in similar performance, blood glucose, inflammation, oxidative stress, and innate immune levels. Aside from higher dopamine in BAN, shifts in metabolites following BAN and CHO 75-km cycling time trials indicated a similar pattern of heightened production of glutathione and utilization of fuel substrates in several pathways.

Dose-response to 3 months of quercetin-containing supplements on metabolite and quercetin conjugate profile in adults.

Quercetin, a flavonol in fruits and vegetables, has been demonstrated to have antioxidant, anti-inflammatory and immunomodulating influences. The purpose of the present study was to determine if quercetin, vitamin C and niacin supplements (Q-500 = 500 mg/d of quercetin, 125 mg/d of vitamin C and 5 mg/d of niacin; Q-1000 = 1000 mg/d of quercetin, 250 mg/d of vitamin C and 10 mg/d of niacin) would alter small-molecule metabolite profiles and serum quercetin conjugate levels in adults. Healthy adults (fifty-eight women and forty-two men; aged 40-83 years) were assigned using a randomised double-blinded placebo-controlled trial to one of three supplement groups (Q-1000, Q-500 or placebo). Overnight fasted blood samples were collected at 0, 1 and 3 months. Quercetin conjugate concentrations were measured using ultra-performance liquid chromatography (UPLC)-MS/MS, and metabolite profiles were measured using two MS platforms (UPLC-quadrupole time-of-flight MS (TOFMS) and GC-TOFMS). Statistical procedures included partial least square discriminant analysis (PLS-DA) and linear mixed model analysis with repeated measures. After accounting for age, sex and BMI, quercetin supplementation was associated with significant shifts in 163 metabolites/quercetin conjugates (false discovery rate, P<0·05). The top five metabolite shifts were an increase in serum guaiacol, 2-oxo-4-methylthiobutanoic acid, allocystathionine and two bile acids. Inflammatory and oxidative stress metabolites were not affected. PLS-DA revealed a clear separation only between the 1000 mg/d and placebo groups (Q(2)Y = 0·763). The quercetin conjugate, isorhamnetin-3-glucuronide, had the highest concentration at 3 months followed by quercetin-3-glucuronide, quercetin-3-sulphate and quercetin diglucuronide. In human subjects, long-term quercetin supplementation exerts disparate and wide-ranging metabolic effects and changes in quercetin conjugate concentrations. Metabolic shifts were apparent at the 1000 mg/d dose; further research is required to understand the health implications of these shifts.

A Mixed Flavonoid-Fish Oil Supplement Induces Immune-Enhancing and Anti-Inflammatory Transcriptomic Changes in Adult Obese and Overweight Women—A Randomized Controlled Trial

Flavonoids and fish oils have anti-inflammatory and immune-modulating influences. The purpose of this study was to determine if a mixed flavonoid-fish oil supplement (Q-Mix; 1000 mg quercetin, 400 mg isoquercetin, 120 mg epigallocatechin (EGCG) from green tea extract, 400 mg n3-PUFAs (omega-3 polyunsaturated fatty acid) (220 mg eicosapentaenoic acid (EPA) and 180 mg docosahexaenoic acid (DHA)) from fish oil, 1000 mg vitamin C, 40 mg niacinamide, and 800 µg folic acid) would reduce complications associated with obesity; that is, reduce inflammatory and oxidative stress markers and alter genomic profiles in overweight women. Overweight and obese women (n = 48; age = 40–70 years) were assigned to Q-Mix or placebo groups using randomized double-blinded placebo-controlled procedures. Overnight fasted blood samples were collected at 0 and 10 weeks and analyzed for cytokines, C-reactive protein (CRP), F2-isoprostanes, and whole-blood-derived mRNA, which was assessed using Affymetrix HuGene-1_1 ST arrays. Statistical analysis included two-way ANOVA models for blood analytes and gene expression and pathway and network enrichment methods for gene expression. Plasma levels increased with Q-Mix supplementation by 388% for quercetin, 95% for EPA, 18% for DHA, and 20% for docosapentaenoic acid (DPA). Q-Mix did not alter plasma levels for CRP (p = 0.268), F2-isoprostanes (p = 0.273), and cytokines (p > 0.05). Gene set enrichment analysis revealed upregulation of pathways in Q-Mix vs. placebo related to interferon-induced antiviral mechanism (false discovery rate, FDR < 0.001). Overrepresentation analysis further disclosed an inhibition of phagocytosis-related inflammatory pathways in Q-Mix vs. placebo. Thus, a 10-week Q-Mix supplementation elicited a significant rise in plasma quercetin, EPA, DHA, and DPA, as well as stimulated an antiviral and inflammation whole-blood transcriptomic response in overweight women.

Influence of vitamin D mushroom powder supplementation on exercise-induced muscle damage in vitamin D insufficient high school athletes

Abstract Incidence of vitamin D deficiency is increasing worldwide. The purpose of this study was to determine if supplementation with vitamin D2 from Portobello mushroom powder would enhance skeletal muscle function and attenuate exercise-induced muscle damage in low vitamin D status high school athletes. Participants were randomised to Portobello mushroom powder (600 IU/d vitamin D2) or placebo for 6 weeks. Participants then completed a 1.5-h exercise session designed to induce skeletal muscle damage. Blood samples and measures of skeletal muscle function were taken pre-supplementation, post-supplementation/pre-exercise and post-exercise. Six weeks supplementation with vitamin D2 increased serum 25(OH)D2 by 9.9-fold and decreased serum 25(OH)D3 by 28%. Changes in skeletal muscle function and circulating markers of skeletal muscle damage did not differ between groups. In conclusion, 600 IU/d vitamin D2 increased 25(OH)D2 with a concomitant decrease in 25(OD)D3, with no effect on muscular function or exercise-induced muscle damage in high school athletes.

Effects of a freeze-dried juice blend powder on exercise-induced inflammation, oxidative stress, and immune function in cyclists

A freeze-dried fruit and vegetable juice powder (JUICE) was investigated as a countermeasure nutritional strategy to exercise-induced inflammation, oxidative stress, and immune perturbations in trained cyclists. Thirty-four cyclists (25 male, 9 female) were randomized to control (nonJUICE) or JUICE for 17 days. JUICE provided 230 mg·day(-1) of flavonoids, doubling the typical adult daily intake. During a 3-d period of intensified exercise (days 15-17), subjects cycled at 70%-75% V̇O2max for 2.25 h per day, followed by a 15-min time trial. Blood samples were collected presupplementation, post supplementation (pre-exercise), and immediately and 14-h post exercise on the third day of exercise. Samples were analyzed for inflammation (interleukin (IL)-6, IL-8; tumor necrosis factor alpha (TNFα); monocyte chemoattractant protein-1 (MCP-1)), oxidative stress (oxygen radical absorbance capacity (ORAC), ferric reducing ability of plasma (FRAP), reduced and oxidized glutathione, protein carbonyls), and innate immune function (granulocyte (G-PHAG) and monocyte (M-PHAG) phagocytosis and oxidative burst activity). A 2 (group) × 4 (time points) repeated measures ANOVA revealed significant time effects due to 3 days of exercise for IL-6 (396% increase), IL-8 (78% increase), TNFα (12% increase), MCP-1 (30% increase), G-PHAG (38% increase), M-PHAG (36% increase), FRAP (12.6% increase), ORAC (11% decrease at 14 h post exercise), and protein carbonyls (82% increase at 14 h post exercise) (p < 0.01). No significant interaction effects were found for any of the physiological measures. Although providing 695 gallic acid equivalents of polyphenols per day, JUICE treatment for 17 days did not change exercise-induced alterations in inflammation and oxidative stress or immune function in trained cyclists after a 3-day period of overreaching.

Quercetin and Green Tea Extract Supplementation Downregulates Genes Related to Tissue Inflammatory Responses to a 12-Week High Fat-Diet in Mice

Quercetin (Q) and green tea extract (E) are reported to counter insulin resistance and inflammation and favorably alter fat metabolism. We investigated whether a mixture of E + Q (EQ) could synergistically influence metabolic and inflammation endpoints in a high-fat diet (HFD) fed to mice. Male C57BL/6 mice (n = 40) were put on HFD (fat = 60%kcal) for 12 weeks and randomly assigned to Q (25 mg/kg of body weight (BW)/day), E (3 mg of epigallocatechin gallate/kg BW/day), EQ, or control groups for four weeks. At 16 weeks, insulin sensitivity was measured via the glucose tolerance test (GTT), followed by area-under-the-curve (AUC) estimations. Plasma cytokines and quercetin were also measured, along with whole genome transcriptome analysis and real-time polymerase chain reaction (qPCR) on adipose, liver, and skeletal muscle tissues. Univariate analyses were conducted via analysis of variance (ANOVA), and whole-genome expression profiles were examined via gene set enrichment. At 16 weeks, plasma quercetin levels were higher in Q and EQ groups vs. the control and E groups (p < 0.05). Plasma cytokines were similar among groups (p > 0.05). AUC estimations for GTT was 14% lower for Q vs. E (p = 0.0311), but non-significant from control (p = 0.0809). Genes for cholesterol metabolism and immune and inflammatory response were downregulated in Q and EQ groups vs. control in adipose tissue and soleus muscle tissue. These data support an anti-inflammatory role for Q and EQ, a result best captured when measured with tissue gene downregulation in comparison to changes in plasma cytokine levels.

A Pilot Study: Dietary Energy Density is Similar between Active Women with and without Exercise-Associated Menstrual Dysfunction.

Low energy availability (EA) (e.g., insufficient energy intake (EI) to match energy needs, including exercise energy expenditure) has been identified as a primary contributor to exercise-associated menstrual dysfunction (ExMD) in active women. For health reasons, active women may self-select diets lower in energy density (ED, kcal/g), which can inadvertently contribute to inadequate EI. Using data from two studies, we compared the ED of active women with ExMD (n = 9; 24 ± 6 years) to eumenorrheic (EU) active controls (EU: n = 18, 27 ± 6 years). ED was calculated from 6 to 7 days weighted food records using two methods: with/without beverages. ANOVA and Wilcoxon Rank-Sum were used to test group differences. ED was not different between groups, but there was a trend toward a lower median ED (10%) (p = 0.049 unadjusted; p = 0.098 adjusted) in the ExMD-group (Method 1—all beverages: ExMD = 1.01 kcal/g (range = 0.52–1.41), EU = 1.22 kcal/g (range = 0.72–1.72); Method 2—without beverages: ExMD = 1.51 kcal/g (range = 1.26–2.06), EU = 1.69 kcal/g (range = 1.42–2.54)). This lower ED represents a 9% decrease (~219 kcal/day) in EI (ExMD = 2237 ± 378 kcal/day; EU = 2456 ± 470 kcal/day; p > 0.05). EI and macro/micronutrient intakes were similar for groups. In the ExMD-group, low ED could contribute to lower EI and EA. Future research should examine the interaction of ED and exercise on appetite, EI, and EA in active women, especially those with ExMD.

Implementing Cancer Prevention into Clinical Practice

Cancer prevention has been associated with decreased rates of cancer incidence and increased survival. Cancer prevention, however, can have a greater impact if barriers to implementing cancer prevention into practice are removed and opportunities are both fostered and seized. The purpose of this article is to identify barriers and opportunities to cancer prevention in clinical practice and provide recommendations for the future. A multidisciplinary team participated in “The Future Directions Cancer Prevention and Control: Workforce Implications for Training, Practice and Policy” workshop on October 17–18, 2009 at The University of Texas MD Anderson Cancer Center in Houston, TX. During the meeting, the team discussed barriers and opportunities for the implementation of cancer prevention into clinical practice. Further data were collected from peer-reviewed journals and published government and cancer agencies reports. Several issues were identified: (1) The funding allocated to basic cancer prevention research and application is not optimal and less than that for cancer treatment; (2) participation in cancer prevention behaviors and screening practices are lower than desired, especially among the uninsured; (3) a shortage in healthcare professionals is a major challenge in meeting the future needs of cancer prevention; (4) demands on medical schools to balance increased enrollment, incorporate cancer prevention in an already crowded curriculum, and develop faculty are daunting; and (5) healthcare reforms in 2010 provide both opportunities and additional challenges for cancer prevention. Based on the current state of cancer prevention, we formed six recommendations: (1) additional funding for cancer prevention research with a focus on implementation into practice, (2) improved tracking of cancer prevention research funding and the outcomes associated with it, (3) continued monitoring of cancer prevention services participation with emphasis on closing the gap in health disparities, (4) financial and technical assistance to healthcare professional schools for incorporating cancer prevention into curricula, (5) assessment of the current state of technology in cancer prevention care, and (6) the use of effective multidisciplinary teams in cancer prevention care. Improved delivery of cancer prevention services can have a tremendous impact on cancer incidence and survival rates.

A Survey of Medical Students’ Use of Nutrition Resources and Perceived Competency in Providing Basic Nutrition Education

Purpose. The aims of this study were to assess where medical students obtain their nutrition information and their self-perceived level of competency in providing basic nutrition education to patients. Methods. A survey was distributed to all first through fourth year medical students at Case Western Reserve University (). For statistical analysis, data was expressed as percentages of total responses and binomial regression was used to answer the study hypotheses. Results. The survey response rate was 47%. Forty-two percent of respondents selected a majority of professional nutrition resources () as their most commonly used nutrition resources, 38% selected a majority of consumer resources (), and 20% selected “I do not use nutrition resources” (). The most popular nutrition resource selected was consumer websites. Seventy percent of respondents reported feeling competent in their ability to provide basic nutrition education to patients (). Conclusion. Medical students seem to feel competent in their ability to give basic nutrition education to patients, but they may be obtaining nutrition information from unreliable consumer-based resources. To help increase the provision of sound nutritional guidance, medical students should be taught to use reliable nutrition resources, as well as the value of referring patients to registered dietitians.

Vegetarian, Gluten-Free, and Energy Restricted Diets in Female Athletes

Female athletes who follow a diet that fails to meet energy and nutrient needs are at risk for musculoskeletal injuries, menstrual disturbances, and poor sports performance. Common nutritional concerns for the female athlete include low energy availability (EA) (i.e., energy intake from food remaining for metabolic processes after accounting for energy expended during exercise) and inadequate dietary intakes (i.e., not meeting sports nutrition guidelines) of carbohydrates, protein, essential fatty acids (EFAs), B-vitamins, calcium, iron, and vitamin D. Low EA and the associated nutrient deficiencies are more common in athletes who compete in weight-sensitive sports (i.e., aesthetic, gravitational, and weight category sports) because low body fat and mass confer a competitive advantage. Other athletes at risk for energy and nutrient deficits include athletes following a vegetarian or gluten-free diet (GFD). Careful dietary planning can help an athlete meet energy and nutrient needs. This review covers the nutrition issues associated with low EA and special diets (i.e., vegetarian and GFD) and describes strategies to help female athletes meet their energy and nutrient needs.