The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease.

BACKGROUND: C-reactive protein (CRP), a sensitive marker of inflammation, is an independent predictor of future cardiovascular disease (CVD), which is a major cause of death worldwide. In epidemiological trials, high-fibre intakes have consistently been associated with reduction in CVD risk and CRP levels. OBJECTIVE: The objective of this study was to assess the influence of dietary fibre (DF) on CRP in clinical trials. DATA SOURCES: Databases were searched from the earliest record to April 2008 and supplemented by crosschecking reference lists of relevant publications. STUDY SELECTION: Human adult intervention trials, at least 2 weeks in duration, with an increased and measurable consumption of DF were included and rated for quality. DATA SYNTHESIS: Seven clinical trials were included, and six of these reported significantly lower CRP concentrations of 25-54% with increased DF consumption with dosages ranging between 3.3-7.8 g/MJ. The seventh trial with psyllium fibre supplementation failed to lower CRP levels significantly in overweight/obese individuals. Weight loss and altered fatty acid intakes were present in most of the studies. CONCLUSIONS: In the presence of weight loss and modified saturated, monounsaturated and polyunsaturated fat intakes, significantly lower CRP concentrations (downward arrow 25-54%) are seen with increased fibre consumption (> or =3.3 g/MJ). Mechanisms are inconclusive but may involve the effect of DF on weight loss, and/or changes in the secretion, turnover or metabolism of insulin, glucose, adiponectin, interleukin-6, free fatty acids and triglycerides. Clinical studies of high- and low-fibre diets are needed to explore the potential favourable effects as observed epidemiologically, and to understand individual susceptibility to its anti-inflammatory effect and long-term cardiovascular reduction.

Association between consumption of black tea and iron status in adult Africans in the North West Province: the THUSA study.

The association between black tea consumption and iron status was investigated in a sample of African adults participating in the cross-sectional THUSA (Transition and Health during Urbanization of South Africans) study in the North West Province, South Africa. Data were analysed from 1605 apparently healthy adults aged 15-65 years by demographic and FFQ, anthropometric measurements and biochemical analyses. The main outcome measures were Hb and serum ferritin concentrations. No associations were seen between black tea consumption and concentrations of serum ferritin (men P = 0.059; women P = 0.49) or Hb (men P = 0.33; women P = 0.49). Logistic regression showed that tea consumption did not significantly increase risk for iron deficiency (men: OR 1.36; 95 % CI 0.99, 1.87; women: OR 0.98; 95 % CI 0.84, 1.13) nor for iron deficiency anaemia (men: OR 1.28; 95 % CI 0.84, 1.96; women: OR 0.93; 95 % CI 0.78, 1.11). Prevalence of iron deficiency and iron deficiency anaemia was especially high in women: 21.6 and 14.6 %, respectively. However, the likelihood of iron deficiency and iron deficiency anaemia was not significantly explained by tea consumption in sub-populations which were assumed to be at risk for iron deficiency. Regression of serum ferritin levels on tea consumption in women

Opinion of South African Pre- and Post-Menopausal Women on the Potential Menopause-Related Health Benefits of Soy and Soy products

The increased use of alternative treatment for menopausal symptoms is mainly due to women's changing opinions of conventional hormone replacement therapy (HRT). The objective of this study was to assess the opinion of preand post-menopausal South African women regarding the potential menopause-related health benefits of soy. The sample used for the study was a sub-dataset of 825 respondents; which included only pre- and post-menopausal women that had heard of soy before; selected from a representative sample of the adult South African metropolitan and rural populations. A structured questionnaire was used. Neither age nor racial groups differed practically significantly in opinion regarding any of the various statements. The study also shows that a practically significant lower proportion of women in the sub-population across both age and race groups had a positive opinion on the health benefits of soy as an alternative to HRT and reliever of menopausal symptoms than those who acknowledged its benefit for preventing cardiovascular disease and osteoporosis. Practically significantly more women who used soy than women who never used soy agreed that soy keeps bones strong. In addition; more women who were of opinion that soy has few or no health benefits disagreed that soy could be used as an alternative to HRT compared to women who held a positive opinion

Effects of a policosanol supplement on serum lipid concentrations in hypercholesterolaemic and heterozygous familial hypercholesterolaemic subjects.

Policosanol is a mixture of higher aliphatic primary alcohols that is extracted from purified sugar cane wax or a variety of other plant sources, and has been shown to have beneficial effects on serum lipid concentrations. The objective of this study was to investigate the effects of a policosanol supplement (Octa-60) on lipid profiles of hypercholesterolaemic and heterozygous familial hypercholesterolaemic subjects. Nineteen hypercholesterolaemic and familial hypercholesterolaemic subjects completed this randomised, placebo-controlled, double-blind study. The subjects received either a daily dose of 20 mg policosanol or placebo for 12 weeks. After a wash-out period of 4 weeks, the interventions were crossed over. Lipid levels were measured at baseline and at the end of each intervention period. No significant differences in total cholesterol and LDL-cholesterol from baseline to end or between policosanol and placebo were seen in the hypercholesterolaemic or familial hypercholesterolaemic groups. There were small reductions in total cholesterol and LDL-cholesterol from baseline to end in the hypercholesterolaemic group, but these changes did not differ significantly from the changes with the placebo, indicating that the observed decrease in cholesterol in the policosanol group was not due to the specific effect of policosanol treatment. The differences in response may be ascribed to the differences in composition of the higher aliphatic primary alcohols in the previously used products, compared with the local policosanol supplement. An intake of 20 mg/d policosanol for 12 weeks had no significant effect on serum lipid levels in hypercholesterolaemic and heterozygous familial hypercholesterolaemic patients when compared with placebo intake.

Substitution of high monounsaturated fatty acid avocado for mixed dietary fats during an energy-restricted diet: effects on weight loss, serum lipids, fibrinogen, and vascular function.

OBJECTIVE: First, we wanted to dispel the myth that avocados are fattening and therefore should be avoided in energy-restricted diets. Second, we examined the effects of avocados, a rich source of monounsaturated fatty acids, as part of an energy-restricted diet on weight loss, serum lipids, fibrinogen, and vascular function in overweight and obese subjects. METHODS: Sixty-one free-living volunteers (13 men and 48 women), with body mass index of 32 +/- 3.9 kg/m(2) (mean +/- standard deviation) participated in this randomized, controlled, parallel study. Subjects were paired and randomly assigned to one of two groups. The experimental group consumed 200 g/d of avocado (30.6 g of fat), which substituted for 30 g of other mixed dietary fats such as margarine or oil, and the control group excluded avocado from their energy-restricted diet for 6 wk. Seven-day isoenergetic menus were planned according to mean energy requirements of both sexes to provide total energy intakes consisting of 30% fat, 55% carbohydrates, and 15% protein. Anthropometric measurements, physical activity, blood pressure, and arterial compliance were measured with standard methods at the beginning and end of the intervention. Fasting blood samples were drawn at the beginning and end of the intervention. RESULTS: Fifty-five subjects completed the study. The compliance rate to avocado intake in the experimental group was 94.6%. The percentage of plasma oleic acid increased significantly with the consumption of avocado in the experimental group, whereas a decrease was seen in the percentage of myristic acid from baseline to the end of the intervention in both groups but was significant only in the experimental group. Anthropometric measurements (body mass, body mass index, and percentage of body fat) decreased significantly in both groups during the study (P < 0.001), and the change was similar in both groups. Serum lipid concentrations (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triacylglycerols), fibrinogen, blood pressure, and arterial compliance did not change significantly within or between groups. CONCLUSION: The consumption of 200 g/d of avocado within an energy-restricted diet does not compromise weight loss when substituted for 30 g of mixed dietary fat. Serum lipid concentrations, plasma fibrinogen, arterial compliance, and systolic and diastolic blood pressures were not affected by weight loss or avocado intake.

Extruded dry beans and serum lipoprotein and plasma haemostatic factors in hyperlipidaemic men.

OBJECTIVE: To examine the effects of the inclusion of extruded dry beans in the diet on serum lipoprotein, plasma fibrinogen, plasma viscosity and plasminogen activator inhibitor 1 (PAI-1) levels. SUBJECTS AND STUDY DESIGN: Twenty-two free living hyperlipidaemic men participated in this randomised, controlled, cross-over study. The subjects were randomly assigned to one of two groups. After a run-in period of four weeks, during which subjects followed their normal diet with the exclusion of dry beans, group A had to include 110 g/day of extruded dry beans in the form of baked products for four weeks while group B continued with the run-in diet. A washout period of four weeks followed after which the experimental intervention was crossed-over. Anthropometric measurements, serum lipoproteins and haemostatic variables were measured with standard methods and dietary intakes were estimated with five-day dietary records at the beginning and end of each experimental period. RESULTS: Compliance was determined as 83.5% with a mean intake of 91. 9 g/day extruded dry beans. Extruded dry beans did not have significant effects on total serum cholesterol, low density lipoprotein cholesterol, triglycerides, apolipoprotein A or B, plasma fibrinogen and plasma viscosity concentrations. High density lipoprotein cholesterol concentrations decreased in both the dry bean and control periods. Lipoprotein (a) concentrations increased with intake of extruded dry beans, but this increase was probably not due to an independent effect of extruded dry beans. Plasminogen activator inhibitor 1 levels were significantly lower after the intake of extruded dry beans compared to the control period. CONCLUSIONS: The inclusion of 91.9 g extruded dry beans per day in the diet had no effects on serum lipoproteins, plasma fibrinogen and viscosity levels but decreased PAI-1 levels. SPONSORSHIP: Dry Bean Producers Organisation (South Africa) and the Potchefstroom University for Christian Higher Education, Potchefstroom, South Africa.

Possible mechanisms through which dietary pectin influences fibrin network architecture in hypercholesterolaemic subjects.

It is suspected that not only fibrinogen concentration but also the quality of fibrin networks may contribute to cardiovascular risk. Evidence is accumulating that a "prudent" diet may protect against diseases associated with raised clotting factors. The effect of diet on fibrinogen is, however, still controversial. In a previous study performed in our laboratory, it was shown that dietary pectin influences fibrin network architecture in hypercholesterolaemic men without causing any changes in fibrinogen concentration. To elucidate the possible mechanisms, it was necessary to study the possibility that pectin may itself have indirect effects on fibrin network architecture. Pectin is fermented in the gastrointestinal tract to acetate, propionate, and butyrate. In humans, only acetate reaches the circulation beyond the liver. This investigation primarily examined the possibility that pectin may, through acetate, influence fibrin network architecture in vivo. The effects of pectin and acetate supplementation in hypercholesterolaemic subjects were compared. Furthermore, this study also aimed at describing the possible in vitro effects of acetate on fibrin network architecture. Two groups of 10 male hyperlipidaemic volunteers each received a pectin (15 g/day) or acetate (6.8 g/day) supplement for 4 weeks. Acetate supplementation did not cause a significant change in plasma fibrinogen levels. As in the pectin group, significant differences were found in the characteristics of fibrin networks developed in plasma after 4 weeks of acetate supplementation. Fibrin networks were more permeable (from 213+/-76 to 307+/-81 x 10(11) cm2), had lower tensile strength (from 23+/-3 to 32+/-9% compaction), and were more lyseable (from 252+/-11 to 130+/-15 minutes). These results strongly suggest that the effect of pectin on network architecture could partially be mediated by acetate. Progressive amounts of acetate were used in vitro to investigate the possibility that acetate may be directly responsible for changes that occurred in fibrin network architecture in the plasma medium. Results indicated that acetate influenced fibrin network architecture directly. From the results, it seems highly possible that acetate may be responsible in part for the beneficial effects of pectin supplementation in vivo. It is evident that pectin or acetate supplementation can be useful during the treatment or prevention of some clinical manifestations, especially those associated with raised total cholesterol and possibly also plasma fibrinogen.

Lecithin has no effect on serum lipoprotein, plasma fibrinogen and macro molecular protein complex levels in hyperlipidaemic men in a double-blind controlled study.

OBJECTIVE: To examine the effects of lecithin on serum lipoprotein, plasma fibrinogen and macro molecular protein complex (MPC) levels. SUBJECTS AND STUDY DESIGN: Twenty free living hyperlipidaemic men participated in this double-blind study which controlled for possible indirect effects. The subjects were randomly assigned to one of three treatments: frozen yoghurt or frozen yoghurt with 20 g soya bean lecithin or frozen yoghurt with 17 g sunflower oil. Sunflower oil was used to control for the increased energy and linoleic acid intake from lecithin. Yoghurt served as the 'vehicle' for the lecithin and sunflower oil and yoghurt alone was given to one group to control for possible effects due to the yoghurt 'vehicle', as well as other environmental influences. Variables were measured with standard methods twice at baseline and after 2 and 4 weeks of treatment. RESULTS: Plasma linoleic acid levels increased significantly with lecithin and sunflower oil treatments indicating that compliance to the treatments were obtained. Lecithin treatment did not have significant effects on serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B or lipoprotein (a) levels. Plasma fibrinogen and MPC levels were also not affected by lecithin therapy. Sunflower oil treatment resulted in significant increased body weight, serum TC and decreased MPC levels. CONCLUSION: Lecithin treatment had no independent effects on serum lipoprotein, plasma fibrinogen or MPC levels in hyperlipidaemic men.

Apolipoprotein E genotype modulates the effect of black tea drinking on blood lipids and blood coagulation factors: a pilot study.

Apolipoprotein E (ApoE) genotype was determined in sixty-five subjects who had taken part in a 4-week randomized crossover trial to compare the effect of six mugs of black tea per day v. placebo on blood lipids and blood coagulation factors. Four ApoE genotype variants (seven E2/E3, forty-five E3/E3, twelve E3/E4 and one E4/E4) were found. ApoE allele frequency was within the range typical for Caucasian populations (ApoE-E2 5.4%; ApoE-E3 83.8%; ApoE-E4 10.8%). Individuals bearing at least one E4 allele had substantially higher levels of serum total cholesterol, LDL cholesterol and triacylglycerols. Mean plasminogen activator inhibitor (PAI-1) activity was higher in ApoE-E4 allele-bearing individuals (E3/E4 + E4/E4, 11.89 (SE 1.27) U/ml; E3/E3, 9.19 (SE 0.80) U/ml; E2/E3, 7.21 (SE 1.04) U/ml, P values of E4-group v. E3 and E2 being respectively 0.093 and 0.030). These unexpected findings imply that elevated PAI-1 activity may be a hitherto unrecognized additional factor involved in the increased cardiovascular disease risk associated with apoE-E4 allele. The interactions between tea drinking and genotype were also examined. In the E3/E3 homozygotes, HDL-cholesterol was significantly reduced in the tea period (mean placebo 1.54 mmol/l v. mean tea 1.50 mmol/l, P = 0.027). In the E2/E3 group, triacylglycerol concentration was significantly reduced (mean placebo 1.18 mmol/l v. mean tea 1.09 mmol/l, P = 0.039). Tea also caused a significant decrease of PAI-1 activity in the subjects with E2/E3 genotype (mean placebo 7.21 U/ml v. mean tea 5.88 U/ml, P = 0.007). In the other two genotype groups, there was no significant effect of tea. The results indicate that tea drinking has a beneficial effect on some cardiovascular disease risk-associated factors, especially in E2 allele-bearing individuals. Dietary intervention may be particularly effective in population groups with certain genetic characteristics.

Plasma fibrinogen of black South Africans: the BRISK study.

OBJECTIVE: To describe the distribution of plasma fibrinogen and relationships with other risk factors for coronary heart disease (CHD) and stroke in the black population of the Cape Peninsula. DESIGN: A cross-sectional survey of a stratified proportional sample of randomly selected black men and women. SETTING: Households in Gugulethu, Langa, Nyanga, New Crossroads, KTC, Old Crossroads and Khayelitsha in the Cape Peninsula, South Africa. SUBJECTS: One subject per household (352 men and 447 women), aged 15-64 years, voluntarily participated. Visitors, pregnant, lactating, ill, mentally retarded and intoxicated subjects were excluded. RESULTS: Mean fibrinogen (thrombin time coagulation method) of men and women were higher than published data for Europeans but slightly lower than values of black Americans. Women aged 45-54 years had the highest level (3.13+/-0.89 g l(-1)) and men aged 15-24 years had the lowest (2.13+/-0.88 g l(-1)). Fifteen per cent of the men and 12% of the women had a level greater than 1 standard deviation of the mean for their age group. Univariate and multivariate analyses revealed significant (P<0.05) positive correlations of fibrinogen with smoking habit, age, body mass index (BMI), total and low-density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and white blood cell count, and significant negative correlations with high-density lipoprotein (HDL) cholesterol, gamma glutamyl transferase (GGT), serum iron and ferritin. The correlations with BMI, serum lipoproteins, iron, ferritin, and GGT suggest that nutritional status and therefore diet influences plasma fibrinogen. CONCLUSION: Relatively high fibrinogen levels, tending to cluster with other, including diet-related, risk factors for CHD and stroke, were observed in black South Africans. It is suggested that fibrinogen may contribute to the high stroke incidence of this population group.

Soluble-fibre concentrate lowers plasminogen activator inhibitor-1 in baboons (Papio ursinus).

The effects of a soluble NSP (fibre) concentrate (SFC) on plasma fibrinogen and plasminogen activator inhibitor-1 (PAI-1), serum and liver lipids and lipoproteins and glucose tolerance were compared with those of bezafibrate (BF), a lipid-lowering drug, in obese baboons (Papio ursinus). The basal diet was a high-fat (37% of total energy), low-NSP (12.4 g/d) Westernized diet, supplemented for 8 weeks with either 20 SFCg/baboon per d or 6.7 mg BF/kg body weight per baboon per d. SFC supplementation significantly lowered PAI-1, total serum cholesterol, HDL-cholesterol and circulating free fatty acid levels. BF significantly lowered total serum cholesterol, but unexpectedly raised serum triacylglycerol levels. Although not statistically significant, the mean liver triacylglycerol concentration of baboons fed on BP was lower than that of baboons fed on SFC supplements. These results suggest that: (1) the mechanism of action of the two cholesterol-lowering treatments differ, with BF having a liver triacylglycerol-lowering effect and (2) the SFC ahd additional beneficial effect on fibrinolysis by lowering PAI-1 levels.

Effect of black tea drinking on blood lipids, blood pressure and aspects of bowel habit.

Thirty-one men (47 (SD 14) years) and thirty-four women (35 (SD 13) years) took part in a 4-week randomized cross-over trial to compare the effect of six mugs of black tea daily v. placebo (water, caffeine, milk and sugar) on blood lipids, bowel habit and blood pressure, measured during a run-in period and at the end of weeks 2, 3 and 4 of the test periods. Compliance was established by adding a known amount of p-aminobenzoic acid (PABA) to selected tea bags, and then measuring its excretion in urine. Mean serum cholesterol values during run-in, placebo and on tea drinking were 5.67 (SD 1.05), 5.76 (SD 1.11) and 5.69 (SD 1.09) mmol/l (P = 0.16). There were also no significant changes in diet, LDL-cholesterol, HDL-cholesterol, triacylglycerols, and blood pressure in the tea intervention period compared with placebo. Compared with placebo, stool consistency was softened with tea (P = 0.04), and no other differences were found in bowel habit. Results were unchanged when fifteen 'non-compliers', whose PABA excretion indicated that fewer than six tea bags had been used, were excluded from the analysis, and when differences between run-in and tea periods were considered separately for those who were given tea first or second.

Dietary pectin influences fibrin network structure in hypercholesterolaemic subjects.

Fibrinogen is an important risk factor for atherosclerosis, stroke and cardiovascular heart disease (CHD). This risk is increased when associated with a high serum cholesterol. Furthermore, it is also believed that not only fibrinogen concentration, but also the quality of fibrin networks may be an important risk factor for the development of CHD. CHD and stroke as a result of atherosclerosis, plus the related problems of hyperinsulinaemia, hyperlipidaemia and hypertension are strongly related to diet. The "western" diet, defined by low fibre and high fat, sucrose and animal protein intakes, appears to be a major factor leading to death. It has been established that the water-soluble dietary fibre, pectin, significantly decrease the concentration of serum cholesterol levels. Evidence is also accumulating that a diet rich in fibre may protect against diseases associated with raised clotting factors. This investigation studied the possible effects of pectin on fibrinogen levels and fibrin network architecture. Two groups of 10 male hyperlipidaemic volunteers each, received a pectin supplement (15 g/day) or placebo (15 g/day) for 4 weeks. Lipid and fibrin network structure variables were measured at baseline and the end of supplementation. Pectin supplementation caused significant decreases in total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A & B and lipoprotein (a). Significant changes in the characteristics of fibrin networks developed in the plasma of the pectin supplemented group indicated that networks were more permeable and had lower tensile strength. These network structures are believed to be less atherogenic. It is suspected that pectin modified network characteristics by a combination of its effects on metabolism and altered fibrin conversion. This confirms the therapeutic possibilities of dietary intervention. Furthermore, this study also showed that changes in plasma fibrinogen need not be present to induce alterations in fibrin network architecture.

Diet and haemostatic processes.

Diet plays an important role in the primary and secondary prevention of cardiovascular disease. The growing perception that abnormal haemostatic processes of coagulation, platelet aggregation and fibrinolysis contribute to cardiovascular disease aetiology motivated this review on the relationships of diet, specific foods and nutrients with haemostatic function. Functional endpoints that reflect the function and status of some of these processes and which can be measured in dietary trials are identified. The effects of energy intake and expenditure, alcohol, total fat and specific fatty acids, non-starch polysaccharides (dietary fibre), antioxidant nutrients and some foods on a variety of haemostatic markers are reviewed. The results indicate that the prudent low-fat, high-fibre diet and maintenance of ideal body weight recommended to protect against and treat hyperlipidaemia and coronary heart disease will also benefit haemostatic profiles. It is concluded that more research on specific effects is needed for improved recommendations on a population level for prevention of cardiovascular disease.

Differences in plasminogen activator inhibitor 1 activity between blacks and whites may be diet related.

Two matched groups of healthy non-smoking male volunteers between 18 and 23 years old and with a body mass index of 19-24 kg/m2 were selected from urban whites (n = 15) and from rural Vendas (blacks; n = 17). Fasting venous blood samples were collected between 07.00 and 10.00 h, and a validated food frequency questionnaire was administered. The results showed highly significant differences in dietary patterns. Significant differences were observed with regard to serum cholesterol (p < 0.02), percentage high-density lipoprotein cholesterol (p < 0.02), calculated insulin sensitivity index (p < 0.04), and plasma fibrinogen levels (p < 0.03). Tissue plasminogen activator antigen did not differ significantly. The plasminogen activator inhibitor 1 activity was significantly lower (p < 0.0001) in the Vendas than in the whites. It is concluded that diet may be an important determinant of plasminogen activator inhibitor 1 activity.

Both fish oil and olive oil lowered plasma fibrinogen in women with high baseline fibrinogen levels.

This double-blind, cross-over study with olive oil as placebo, examined the effect of a daily dosage of 6 g fish oil on cardiovascular risk markers of 20 healthy young volunteers (10 men, 10 women). Serum lipids and lipoproteins, and plasma coagulation and fibrinolytic enzymes, including fibrinogen concentrations and plasminogen activator inhibitor-1 (PAI-1) activity were measured at baseline and after 6-week supplementation of either fish or olive oil. The results showed that fish oil had an independent lowering effect on triglycerides and coagulation factors Vc and VIIc. Both fish and olive oil significantly raised PAI-1 levels and lowered plasma factor Xc and fibrinogen levels in the women, who had higher initial levels than the men. Mean fibrinogen levels of the women were lowered from 3.23 +/- 0.98 to 2.64 +/- 0.55 g/l and from 3.19 +/- 0.72 to 2.66 +/- 0.49 g/l by fish and olive oil respectively. This study raises the question whether a particular fatty acid or group of fatty acids, or another constituent of the oil such as vitamin E may be responsible for the fibrinogen lowering effect.