The aim of the study was to determine the effect of consuming meals with different fatty acid compositions on the postprandial changes over 6h in plasma triacylglycerol, NEFA, total cholesterol, glucose and insulin concentrations in middle-aged men and women. Men (n 11; 58 (5) years) and women (n 11; 56 (4) years) consumed four test meals with a similar macronutrient energy content in random order: a reference meal based on the habitual pattern of fatty acid intake in the UK, a meal with an increased (155%) linoleic acid (LA) to α-linolenic acid (αLNA) ratio (high LA:αLNA), a meal with increased (23%) MUFA content (high MUFA) and a meal with increased (583%) EPA and DHA content (high EPA+DHA). The high-LA:αLNA and high-EPA+DHA meals selectively increased the ratio of LA to αLNA (men 341%; women 310%) and the EPA+DHA (men 414%; women 438%) concentration in plasma triacylglycerol. The high-MUFA meal did not alter the change in MUFA content of the plasma. Plasma triacylglycerol, NEFA, glucose and insulin, but not total cholesterol, concentrations changed significantly after each meal. There was no significant effect of meal fatty acid composition or gender on maximum change in concentration, time to maximum concentration or area under the curve of any of the metabolites measured in the blood. These results suggest that differences in meal fatty acid composition exert little or no effect on postprandial changes in plasma lipids, glucose and insulin concentrations.

This study aimed to investigate the link between deprivation and in-hospital malnutrition and to assess any independent and interrelated effects of deprivation and malnutrition on clinical outcome in hospital. One thousand patients (mean age 71 (sd 19) years, mean BMI 25·6 (sd 5·4) kg/m2) were screened for malnutrition (using the Malnutrition Universal Screening Tool (‘MUST’)) and their clinical outcome assessed prospectively. The deprivation of patients' locality of residence prior to admission was recorded using the Index of Multiple Deprivation 2000 (IMD). Patients with medium and high malnutrition risk (42 %, n 420) were admitted from areas with significantly greater deprivation (lower ranks) than low-risk patients (IMD 3731 v. 3946; P<0·02). The prevalence of malnutrition increased by multiples of 1·14 (95 % CI 1·02, 1·28) for each increment in quartile of IMD rank. The odds of malnutrition of the most deprived quartile were greater than those of the least deprived quartile by a factor of 1·59 (95 % CI 1·11, 2·28). They were also greater for five of the six components of IMD deprivation (and by a factor of 1·73 (95 % CI 1·20, 2·49) for income and 1·69 (95 % CI 1·18, 2·42) for employment). Greater in-hospital mortality was associated with malnutrition, independently of IMD (or its individual components; odds ratio 2·04 (95 % CI 1·22, 3·44)). Length of stay was associated only with malnutrition risk (P<0·0005). This study highlights that in-hospital malnutrition and deprivation are interrelated, yet have independent, adverse associations with patient outcome. Effective strategies are required to tackle these common health inequalities in both clinical and public health settings.

The physical activity level of an individual can be determined by assigning physical activity ratios (PAR) to different activities. The PAR is the ratio of the energy expended in a particular activity and the BMR, and is thought to be independent of body weight. PAR values of selected activities in Indian male and female subjects were measured and their association with BMI was assessed. The BMR and energy cost of selected activities were measured in thirty male and thirty female subjects in the age group of 20–40 years, who were categorised into different groups of BMI. The PAR values of the underweight male subjects were significantly lower than the overweight subjects for activities such as walking at 3·2 and 4·8km/h and walking at 3·2km/h with a 5kg load. In the female subjects, the underweight subjects had significantly lower PAR values for floor swabbing, and walking at 3·2 and 4·8km/h when compared with overweight females. The mean data of the male and female subjects of the present study were slightly but significantly different to the previously reported FAO, WHO and United Nations University values and other compilations. The BMI was significantly correlated with the PAR value of the studied activities. In India, where a large proportion of the population have BMI below 18·5 and above 25kg/m2, considerations of the influence of body weight and BMI on PAR become important in accurately determining total energy expenditure.

Antioxidants have shown beneficial effects in several biological systems, in which they were able to prevent oxidative stress-associated damage. Vitamins C and E are key antioxidants in man. Dietary intake cannot accurately reflect plasma vitamin levels. However, the plasma levels of antioxidant vitamins could also reflect the acute assimilation of these vitamins. It has been pointed out that antioxidant vitamin blood contents reach a saturation level by intake of dietary supplements. Antioxidant vitamin plasma levels are the parameter most used to determine antioxidant status. However, the vitamin plasma levels may not reflect the nutritional status of vitamins. It has been pointed out that the vitamin E in adipose tissue can be used as a measure of vitamin E status. To determinate antioxidant vitamin contents in lymphocytes and neutrophils after exercise is a useful tool to assess the functional status of antioxidant vitamins.

Prolonged wound healing is a complication that contributes to morbidity and mortality. Overweight people regularly undergo surgery and trauma, and often develop chronic wounds, but the effects of the adipose tissue excess on cutaneous wound healing are not well understood. This study tested the hypothesis that overweight induced by a high-fat diet impairs rat cutaneous wound healing. Male Wistar rats were fed with either a high-fat or a standard (control) diet. After 15 weeks, an excisional lesion was done and the animals were killed 21 d later. Wound contraction and re-epithelialization, blood pressure, glucose and retroperitoneal fat were evaluated. After killing, lesion and adjacent normal skin were formol-fixed and paraffin-embedded. Inflammatory infiltrate, myofibroblasts, collagen fibres and cellular proliferation were analysed and blood vessels were evaluated using stereological methods. There was no difference in blood pressure and glucose, but retroperitoneal fat increased in the high-fat diet group. Animals fed with the high-fat diet presented delayed wound contraction and re-epithelialization. It was found that 21 d after wounding, overweight induced by a high-fat diet increased the inflammatory infiltrate and delayed myofibroblastic differentiation, collagen deposition, epithelial and connective tissue cell proliferation, and angiogenesis. These findings support the hypothesis that a high-fat diet exerts negative effects on rat cutaneous wound healing, due mainly to the prolongation of the inflammatory phase.

Leptin, a metabolic regulator of energy expenditure, exerts its peripheral effects primarily by altering lipid metabolism. The exocrine pancreas has a key role in the digestion of dietary lipids, but the role of leptin in regulating pancreatic lipases remains unknown. Using the exocrine pancreas in vitro AR42J cell model, we studied the direct effects of leptin on pancreatic lipase (PL) secretion and on the mRNA levels of PL and PL-related proteins 1 and 2 (PLRP1, PLRP2). Leptin directly, rapidly (within 30 min) and significantly inhibited both the secretion and intracellular activity of PL. Leptin downregulated mRNA levels of PL and PLRP1, and upregulated transcripts of PLRP2. This study provides the first evidence that leptin directly regulates exocrine lipases at the levels of synthesis, activity and secretion. This rapid regulation may be associated with a short-term control of energy balance.

Regular and moderate wine consumption is one of the explanations suggested for the lower incidence of cardiovascular events in France compared with other industrialized countries. We evaluated whether alcohol alone or combined with red wine polyphenols reduced plaque size and/or attenuated thrombotic reactivity at the site of advanced atherosclerotic lesions. Red wine extract, or purified (+)-catechin with alcohol, or alcohol alone, was added for 12 weeks to the drinking water of apoE-deficient (apoE−/−) C57B/ mice and wild-type counterparts. In the apoE−/− mice, all alcohol-containing mixtures were associated with a larger size of aortic atherosclerotic lesions. On the other hand, red wine extract and (+)-catechin significantly inhibited blood thrombotic reactivity (P<0·05) as assessed in a cylindrical perfusion chamber model of experimental thrombosis: area reductions in cross-sectional surface of the ex vivo thrombus were 64% and 63%, respectively. In the wild-type mice, red wine extract and (+)-catechin tended to reduce thrombogenicity, which was on the whole less marked than in the apoE−/− mice. These findings suggest that a moderate and regular consumption of red wine may protect against clinical cardiovascular events, mainly by attenuating the thrombogenic response rather than by reducing the development of atherosclerotic lesions. This antithrombogenic effect may include normalization of the abnormally high thrombogenic responsiveness in apoE−/− mice as well as a direct antithrombotic effect.

Traditionally, nuts have been considered a staple food, but because of their high energy and fat content are not considered good for body weight control or insulin sensitivity. Frequent consumption of nuts reduces the risk of coronary artery disease and type-2 diabetes and nut-enriched diets favourably alter blood lipids in normal and hypercholesterolemic individuals under controlled and free-living dietary conditions. However, whether or not frequent consumption of nuts can cause weight gain and impair insulin sensitivity is not fully understood. Review of the available data to date suggests that adding nuts to habitual diets of free-living individuals does not cause weight gain. In fact, nuts have a tendency to lower body weight and fat mass. In the context of calorie-restricted diets, adding nuts produces a more lasting and greater magnitude of weight loss among obese subjects while improving insulin sensitivity. Further studies are needed to clarify the effect of long-term (≥ year) consumption of nuts on body weight and their role in altering insulin sensitivity both in normal and type-2 diabetics. In the meantime, there is sufficient evidence to promote the inclusion of nuts as part of healthy diets.

Dietary patterns have been identified in adults, but less is known about children and adolescents. For the first time, we have investigated lifestyle patterns combining diet and physical activity in 12-year-old French preadolescents and examined their association with sociodemographic factors. Physical activity, sedentary activities and dietary habits were assessed by questionnaires given to 2724 students in 2001. Family income tax and parents' educational level, as indicators of socio-economic status, and the size of the residence commune were obtained from parents. After adjusting for socio-economic status, physical activity was positively associated with a consumption of frui/egetable/ruit juice on more than four occasions in the previous 24h (P<0·001). Sedentary activities were positively associated with the consumption of French fries or potato chips (P<0·001), with sweetened drink as the most usual drink (P<0·001) and with nibbling while watching television (P<0·001), and inversely associated with a high consumption of frui/egetable/ruit juice (P=0·04). Multiple correspondence analysis identified two independent axes and specific combinations of behaviour: one axis characterised by sedentary activity, sweetened drink as the most usual drink, the consumption of French fries or potato chips and nibbling while watching television; a second one associating physical activity and the consumption of frui/egetable/ruit juice. Both socio-economic proxies were associated with the former axis (P<0·001). The size of the residence commune was associated with the latter (P<0·1). Combinations of diet and physical activity habits were identified in adolescents, indicating that prevention programmes targeting both behaviours may have an enhanced outcome.

The role of carbohydrates in health and disease has received a high profile in recent years, in particular the glycaemic index (GI) as a physiological classification of carbohydrate foods. A common carbohydrate source in the UK is white bread, which is considered to have a high GI value and low satiety value. In the present study, the possibility of favourably altering the GI of white bread by manipulating bread structure (loaf form) was investigated. In a randomised repeated-measures design, ten subjects were tested for glycaemic and satiety responses to four loaves of varying volume, but of consistent macronutrient content. Peak plasma glucose levels and GI values were shown to be significantly reduced by lowering loaf volume (P=0·007, P<0·001 respectively). In addition, a greater satiety index (SI) was seen with decreased loaf volume (P<0·001). In conclusion, the present study demonstrates that reducing the volume of white bread, which is generally considered to be high-GI and low-SI, can favourably alter metabolic and appetite responses. Relatively small differences in the GI of regularly consumed starch foods have been shown to have beneficial effects on health.

In order to investigate the effects of dietary lipid sources on mechanisms involved in lipid deposition, two groups of rainbow trout were fed from first-feeding to the commercial size of 1kg (for 62 weeks) with two diets differing only by lipid source: 100% fish oil or 100% blend of vegetable oils (55% rapeseed oil, 30% palm oil, 15% linseed oil). The activities and levels of gene expression of lipogenic enzymes (fatty acid synthetase, glucose-6-phosphate dehydrogenase and malic enzyme) in liver and of lipoprotein lipase in perivisceral adipose tissue, white muscle and liver were determined. Transport of lipid was studied by determining lipid composition of plasma and lipoprotein classes. We also examined the clearance of LDL by assaying the level of LDL receptor gene expression in several tissues. Total replacement of dietary fish oil by the blend of vegetable oils did not affect growth of rainbow trout and did not modify muscle lipid content. Hepatic lipogenesis and lipid uptake in perivisceral adipose tissue, white muscle and liver were also not modified by dietary treatments. Diets containing the blend of vegetable oils induced a decrease in plasma cholesterol and LDL. In trout fed the vegetable oils diet, expression of LDL receptor gene in the liver was down-regulated.

Cancer is a disease that is characterized by the loss of genetic control over cell growth and proliferation, mainly as a result of the exposure to environmental factors. Cessation of smoking and a high consumption of fruits and vegetables are the most important means of reducing the risk of cancer in our society. Like fruits and vegetables, nuts are a source of vegetable protein, monounsaturated fatty acids, vitamin E, phenolic compounds, selenium, vegetable fibre, folic acid and phytoestrogens. There are numerous mechanisms of action by which these components can intervene in the prevention of cancer, although they have not been fully elucidated. There are very few epidemiological studies analyzing the relationship between nuts consumption and risk of cancer. One of the greatest difficulties in interpreting the results is that the consumption of nuts, seeds and legumes are often presented together. The most commonly studied location is the colon/rectum, an organ in which the effect of nuts is biologically plausible. Although the results are not conclusive, a protective effect on colon and rectum cancer is possible. Likewise, some studies show a possible protective effect on prostate cancer, but there is insufficient data on other tumour locations. New epidemiological studies are required to clarify the possible effects of nuts on cancer, particularly prospective studies that make reliable and complete estimations of their consumption and which make it possible to analyse their effects independently of the consumption of legumes and seeds.

In the present study, the production and fate of bacterial metabolites in the colon were investigated in a direct way using two substrates labelled with stable isotopes: lactose [15N, 15N]ureide as a source of labelled ammonia and egg proteins intrinsically labelled with [2H4]tyrosine as a precursor of [2H4]p-cresol. Both ammonia and phenolic compounds are believed to be carcinogenic. Stimulation of carbohydrate fermentation in order to prevent accumulation of these toxic metabolites was induced by inclusion of inulin in a test meal or by addition of inulin to the daily diet, allowing us to distinguish between changes induced by the actual presence of a fermentable carbohydrate and effects caused by a long-term dietary intervention. When a single dose of inulin was administered together with the labelled substrates, a significant increase in faecal 15N excretion, accompanied by a proportional decrease in urinary 15N excretion was observed, probably reflecting an enhanced uptake of ammonia for bacterial biosynthesis, since an increased concentration of labelled N in bacterial pellets was found. A statistically significant reduction of urinary [2H4]p-cresol excretion was also noted. Upon supplementation of inulin to the daily diet during 4 weeks, however, only a tendency towards decreased urinary excretion of both labelled and unlabelled p-cresol was noted. Further studies are warranted to confirm these results in a larger cohort.

Conjugated linoleic acids (CLA) have been shown to improve human health. They are derived from the microbial conversion of dietary linoleic acid (cis-9,cis-12-18 : 2 (LA)) in the rumen. An investigation was undertaken to determine the role of ruminal ciliate protozoa v. bacteria in the formation of CLA and its precursor in animal tissues, vaccenic acid (trans-11-18 : 1 (VA)). Mixed protozoa from the sheep rumen contained at least two to three times more unsaturated fatty acids, including CLA and VA, than bacteria. Different species had different composition, with larger fibrolytic species such as Epidinium ecaudatum caudatum containing more than ten times more CLA and VA than some small species, including Entodinium nanellum. In incubations with ruminal microbial fractions (bacterial fraction (BAC), protozoal fraction (PRO)), LA metabolism was very similar in strained ruminal fluid (SRF) and in the BAC, while the PRO had LA-metabolising activity an order of magnitude lower. Using PCR-based methods, no genes homologous to fatty acid desaturase genes were found in cDNA libraries from ruminal protozoa. The absence of an alternative route of VA/CLA formation via desaturation of stearate was confirmed by incubations of SRF, BAC or PRO with [14C]stearate. Thus, although protozoa are rich in CLA and VA, they appear to lack the ability to form these two fatty acids from LA or stearate. The most likely explanation is that protozoa preferentially incorporate CLA and VA formed by bacteria. The implication of the present findings is that the flow of unsaturated fatty acids, including CLA and VA, from the rumen could depend on the flow of protozoa rather than bacteria.

Lactic acid-fermented foods have been shown to increase Fe absorption in human subjects, possibly by lowering pH, activation of phytases, and formation of soluble complexes of Fe and organic acids. We tested the effect of an oat gruel fermented with Lactobacillus plantarum 299v on non-haem Fe absorption from a low-Fe bioavailability meal compared with a pasteurised, fermented oat gruel and non-fermented oat gruels. In a cross-over trial twenty-four healthy women with a mean age of 25 (sd 4) years were served (A) fermented gruel, (B) pasteurised fermented gruel, (C) pH-adjusted non-fermented gruel, and (D) non-fermented gruel with added organic acids. The meals were extrinsically labelled with 55Fe or 59Fe and consumed on 4 consecutive days, for example, in the order ABBA or BAAB followed by CDDC or DCCD in a second period. Fe absorption was determined from isotope activities in blood samples. The fermented gruel with live L. plantarum 299v increased Fe absorption significantly (p<0·0001) compared with the pasteurised and non-fermented gruels. The lactic acid concentration in the fermented gruel was 19% higher than in the pasteurised gruel, but the Fe absorption was increased by 50%. In the gruel with organic acids, the lactic acid concentration was 52% lower than in the pasteurised gruel, with no difference in Fe absorption. The fermented gruel increased non-haem Fe absorption from a phytate-rich meal in young women, indicating a specific effect of live L. plantarum 299v and not only an effect of the organic acids.

We have examined the current scientific evidence on the relationship between nutrition and the most frequent tumours in the Spanish population: lung, colorectal, prostate, breast and stomach. Consumption of fruit is negatively associated with cancer of the lung and stomach, possibly with colorectal cancer, but probably not with prostate cancer and breast cancer. Consumption of vegetables probably reduces the risk of colorectal and stomach cancer, but probably is not associated with cancer of the lung, prostate and breast. Consumption of red and processed meat is positively associated with colorectal cancer and probably with stomach cancer. Animal fat is possibly associated with colorectal cancer and probably with prostate and breast cancer. High alcohol intake increases the risk of colorectal and breast cancer, while dairy products and calcium seem to decrease the risk of colorectal cancer. Obesity is a recognised risk factor of colorectal cancer and breast cancer in postmenopausal women, while foods with a high glycaemic index and glycaemic load possibly increase the risk of colorectal and prostate cancer. The relevance of nutrition on the cancer process is evident. Nevertheless important issues remain to be solved and further studies are needed. This accumulative knowledge should be used by public health authorities to develop recommendations and activities to reduce overweight and obesity and to promote healthy dietary habits.

Since the 1970s it has been postulated that dietary fibre is a protective factor against colorectal cancer. Several epidemiological studies have been performed following different designs (correlation studies, case–control, cohort) and overall they have supported the hypothesis of a benefit of dietary fibre. However, a few intervention trials have not demonstrated the preventive role of dietary fibre on the occurrence of adenomatous colorectal polyps. Nevertheless, there are multiple animal experimental studies that support the role of fibre in the prevention of colorectal cancer. In the present review, the most important contributions to this controversial question are revised. Finally, it is recommended to continue encouraging an increase in the daily consumption of fibre, since it probably plays an important role in the prevention of colorectal cancer, together with other beneficial effects.

The disease risk indicator plasma total homocysteine (tHcy) is influenced by genetic and environmental factors, including folate and vitamin B12 status. Little is known about the determinants of tHcy in rural West Africa. We explored the hypothesis that tHcy in rural Gambian adults might vary between the sexes and physiological groups, an/r with folate and vitamin B12 status. Comparisons were made with a British national survey. Non-pregnant Gambian women (n 158) had tHcy concentrations (geometric mean 9·0μmo/) similar to those of non-pregnant UK women (n 449; 9·4μmo/), whereas pregnant Gambian women (n 12) had significantly lower values (6·2μmo/). Gambian men (n 22) had significantly higher values (14·7μmo/) than British men (n 354; 10·8μmo/). Gambian lactating women and British men and women exhibited significant inverse relationships between loge(tHcy) and folate status; however, only the British subjects exhibited significant inverse relationships between loge(tHcy) and vitamin B12 status. In the British sample, and in Gambian lactating women, folate and vitamin B12 status variations together accounted for 20–25% of the variation in loge(tHcy). Within the UK, black-skinned adults had folate and tHcy levels similar to those of their white-skinned counterparts, but significantly higher vitamin B12 values. We conclude that, whereas folate and vitamin B12 status are similar between British and rural Gambian populations, tHcy is higher in Gambian men and lower in pregnant Gambian women, and that serum vitamin B12 values appear to be higher in black-skinned than white-skinned British subjects. Possible reasons are discussed.

The rate of alcohol absorption is dependent on gastric emptying (GE). As the slowing of GE by fat is dependent on lipolysis, orlistat may increase the rise in blood alcohol when alcohol is consumed with, or after, fat. The aim of the study was to evaluate the effects of orlistat on GE and blood alcohol after an alcohol-containing drink following a fat ‘preload’, in healthy subjects. Ten healthy males consumed 120 ml cream with or without 120 mg orlistat, 30 min before an alcohol-containing drink labelled with 20 MBq [99 mTc]sulfur colloid on 2 d. GE, plasma alcohol and blood glucose were measured. GE was slightly faster with orlistat (P<0·05) compared with control. Plasma alcohol at 15 min was slightly higher with orlistat (0·034 (sem 0·006) g/100 ml) v. control (0·029 (sem 0·005) g/100 ml) (P<0·05), but there was no effect on the area under the curve 0–240 min. The increase in blood glucose was greater with orlistat, for example, at 15 min (1·07 (sem 0·2) mmol/l) v. control (0·75 (sem 0·2) mmol/l) (P=0·05). The rise in blood glucose and plasma alcohol were related (for example, at 15 min r 0·49; P=0·03). In conclusion, lipase inhibition accelerates GE of an alcohol-containing drink following a fat ‘preload’ with a minor increase in the initial rise in plasma alcohol.

An in vitro digestion/Caco-2 cell model was applied to explore the impact of lactic acid (LA) fermentation by Lactobacillus pentosus FSC1 and Leuconostoc mesenteroides FSC2 on the Fe bioavailability of carrot juice. The redox state of Fe in fermented carrot juice was also assessed as a crucial factor for absorption. LA fermentation was shown to improve mineral solubility to different extents at simulated physiological conditions: Mn (2-fold); Fe (1·5–1·7-fold); Zn (1·2-fold); Cu (1-fold). Soluble Fe2+ was increased about 16-fold by LA fermentation, and about one third of the Fe2+ remained soluble after in vitro digestion (about 4–5-fold higher than in fresh juice). Data on cell-line studies showed a 4-fold increase in the efficiency of Fe uptake, but not in transepithelial transfer by Caco2 cells, as a result of fermentation. The increases in Fe2+ level and the efficiency of cellular Fe uptake were strain-dependent. To sum up the effect on both Fe solubility and cellular uptake efficiency, the amount of cellularly absorbed Fe from Ln. mesenteroides FSC2-fermented juice was about 20 % higher than that from L. pentosus FSC1-fermented juice (22·7 v. 19·2 μg/l juice per mg protein). To conclude, LA fermentation enhanced Fe absorption by Caco-2 cells from carrot juice because of increases in not only Fe solubility after digestion, but also the efficiency of cellular Fe uptake. The fermentation-improved efficiency of Fe uptake was possibly due to the increased level of soluble Fe2+ rather than a being a strain-specific event.