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Lawrence J Appel - One of the best experts on this subject based on the ideXlab platform.
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effects of dietary macronutrients on serum urate results from the omniheart trial
The American Journal of Clinical Nutrition, 2021Co-Authors: Matthew J Belanger, Frank M Sacks, Lawrence J Appel, Edgar R Miller, Christina C Wee, Kenneth J Mukamal, Robert H Shmerling, Hyon K Choi, Stephen P JuraschekAbstract:Background Dietary recommendations to prevent gout emphasize a low-purine diet. Recent evidence suggests that the Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate while also improving blood pressure and lipids. Objective To compare the effects of DASH-style diets emphasizing different macronutrient proportions on serum urate reduction. Methods We conducted a secondary analysis of the Optimal Macronutrient Intake Trial to Prevent Heart Disease feeding study, a 3-period, crossover design, randomized trial of adults with prehypertension or hypertension. Participants were provided with 3 DASH-style diets in random order, each for 6 wk. Each DASH-style diet emphasized different macronutrient proportions: a carbohydrate-rich (CARB) diet, a protein-rich (PROT) diet, and an Unsaturated Fat-rich (UNSAT) diet. In the PROT diet, approximately half of the protein came from plant sources. We compared the effects of these diets on serum urate at weeks 4 and 6 of each feeding period. Results Of the 163 individuals included in the final analysis, the mean serum urate at baseline was 5.1 mg/dL. Only the PROT diet reduced serum urate from baseline at the end of the 6-wk feeding period (-0.16 mg/dL; 95% CI: -0.28, -0.04; P = 0.007). Neither the CARB diet (-0.03 mg/dL; 95% CI: -0.14, 0.09; P = 0.66) nor the UNSAT diet (-0.01 mg/dL; 95% CI: -0.12, 0.09; P = 0.78) reduced serum urate from baseline. The PROT diet lowered serum urate by 0.12 mg/dL (95% CI: -0.20, -0.03; P = 0.006) compared with CARB and by 0.12 mg/dL (95% CI: -0.20, -0.05; P = 0.002) compared with UNSAT. Conclusions A DASH-style diet emphasizing plant-based protein lowered serum urate compared with those emphasizing carbohydrates or Unsaturated Fat. Future trials should test the ability of a DASH-style diet emphasizing plant-based protein to lower serum urate and prevent gout flares in patients with gout. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets enriched with carbohydrate protein or Unsaturated Fat on circulating short chain Fatty acids results from the omniheart randomized trial
The American Journal of Clinical Nutrition, 2020Co-Authors: Noel T Mueller, Stephen P Juraschek, Edgar R Miller, Mingyu Zhang, Lawrence J AppelAbstract:BACKGROUND: Short chain Fatty acids (SCFAs; e.g., acetate, propionate, and butyrate) are produced by microbial fermentation of fiber in the colon. Evidence is lacking on how high-fiber diets that differ in macronutrient composition affect circulating SCFAs. OBJECTIVES: We aimed to compare the effects of 3 high-fiber isocaloric diets differing in %kcal of carbohydrate, protein, or Unsaturated Fat on circulating SCFAs. Based on previous literature, we hypothesized that serum acetate, the main SCFA in circulation, increases on all high-fiber diets, but differently by macronutrient composition of the diet. METHODS: OmniHeart is a randomized crossover trial of 164 men and women (≥30 y old); 163 participants with SCFA data were included in this analysis. We provided participants 3 isocaloric high-fiber (∼30 g/2100 kcal) diets, each for 6 wk, in random order: a carbohydrate-rich (Carb) diet, a protein-rich (Prot) diet (protein predominantly from plant sources), and an Unsaturated Fat-rich (Unsat) diet. We used LC-MS to quantify SCFA concentrations in fasting serum, collected at baseline and the end of each diet period. We fitted linear regression models with generalized estimating equations to examine change in ln-transformed SCFAs from baseline to the end of each diet; differences between diets; and associations of changes in SCFAs with cardiometabolic parameters. RESULTS: From baseline, serum acetate concentrations were increased by the Prot (β: 0.24; 95% CI: 0.12, 0.35), Unsat (β: 0.21; 95% CI: 0.10, 0.33), and Carb (β: 0.12; 95% CI: 0.01, 0.24) diets; between diets, only Prot compared with Carb was significant (P = 0.02). Propionate was decreased by the Carb (β: -0.10; 95% CI: -0.16, -0.03) and Unsat (β: -0.10; 95% CI: -0.16, -0.04) diets, not the Prot diet; between diet comparisons of Carb vs. Prot (P = 0.006) and Unsat vs. Prot (P = 0.002) were significant. The Prot diet increased butyrate (β: 0.05; 95% CI: 0.00, 0.09) compared with baseline, but not compared with the other diets. Increases in acetate were associated with decreases in insulin and glucose; increases in propionate with increases in leptin, LDL cholesterol, and blood pressure; and increases in butyrate with increases in insulin and glucose, and decreases in HDL cholesterol and ghrelin (Ps < 0.05). CONCLUSIONS: Macronutrient composition of high-fiber diets affects circulating SCFAs, which are associated with measures of appetite and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets and macronutrient substitution on bloating findings from the omniheart trial
Clinical and translational gastroenterology, 2020Co-Authors: Mingyu Zhang, Stephen P Juraschek, Lawrence J Appel, Edgar R Miller, Pankaj J Pasricha, Noel T MuellerAbstract:OBJECTIVES: To examine the effects of high-fiber, isocaloric, macronutrient substitutions on bloating. METHODS: The OmniHeart study is a randomized 3-period crossover feeding trial conducted from April 2003 to June 2005. Participants were provided 3 isocaloric versions of high-fiber (∼30 g per 2,100 kcal) diet, each different in carbohydrate, protein, and Unsaturated Fat composition. Each feeding period lasted for 6 weeks with a 2- to 4-week washout period between diets. Participants reported the presence and severity of bloating at baseline (participants were eating their own diet) and at the end of each feeding period. RESULTS: One hundred sixty-four participants were included in the analysis (mean age: 53.1 years; 45% women; 55% black). The prevalence of bloating at baseline and at the end of the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich diet period was 18%, 24%, 33%, and 30%, respectively. Compared with baseline, the relative risk of bloating for the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich high-fiber diet was 1.34 (95% confidence interval [CI]: 0.93, 1.92), 1.78 (95% CI: 1.32, 2.40), and 1.63 (95% CI: 1.17, 2.26), respectively. The protein-rich diet increased the risk of bloating more than the carbohydrate-rich diet (relative risk = 1.40; 95% CI: 1.03, 1.88). Bloating did not significantly vary between protein-rich vs Unsaturated Fat-rich or Unsaturated Fat-rich vs carbohydrate-rich diets. Black participants compared with non-black participants had a higher risk of bloating after all 3 versions of the high-fiber OmniHeart diet (P-value for interaction = 0.012). DISCUSSION: Substitution of protein with carbohydrate may be an effective strategy to decrease bloating among individuals experiencing gastrointestinal bloating from a high-fiber diet.
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the effects of carbohydrate Unsaturated Fat and protein intake on measures of insulin sensitivity results from the omniheart trial
Diabetes Care, 2013Co-Authors: Meghana D Gadgil, Frank M Sacks, Lawrence J Appel, Cheryl A M Anderson, Edgar R Miller, Edwina H YeungAbstract:OBJECTIVE Impaired insulin sensitivity increases the risk of cardiovascular disease. Although calorie restriction and weight loss increase insulin sensitivity, the effects of modifying macronutrient composition on insulin sensitivity are uncertain. The purpose of this study is to determine the effects on insulin sensitivity of a carbohydrate-rich diet (CARB; similar to the Dietary Approaches to Stop Hypertension [DASH] diet), a protein-rich diet (PROT; protein predominantly from plant sources), and an Unsaturated Fat–rich diet (UNSAT; predominantly monoUnsaturated). RESEARCH DESIGN AND METHODS This study was a randomized, controlled, three-period, crossover feeding study. The study participants were 164 individuals with pre- or stage 1 hypertension without diabetes. Diets were administered for 6 weeks each, with a washout period between diets of 2–4 weeks. Weight was held constant throughout the study. For our primary outcome, we calculated the quantitative insulin sensitivity check index (QUICKI) using the end-of-period fasting serum glucose and insulin. QUICKI is a validated measure of insulin sensitivity. The primary analyses used generalized estimating equations. RESULTS At baseline, mean (SD) BMI was 30.2 (6.1) kg/m 2 , and mean (SD) QUICKI was 0.35 (0.04). The UNSAT diet increased QUICKI by 0.005, more than the CARB diet ( P = 0.04). PROT had no significant effect compared with CARB. CONCLUSIONS A diet that partially replaces carbohydrate with Unsaturated Fat may improve insulin sensitivity in a population at risk for cardiovascular disease. Given the well-recognized challenges of sustaining weight loss, our results suggest an alternative approach for improving insulin sensitivity.
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effect of a high protein diet on kidney function in healthy adults results from the omniheart trial
American Journal of Kidney Diseases, 2013Co-Authors: Stephen P Juraschek, Lawrence J Appel, Cheryl A M Anderson, Edgar R MillerAbstract:Background Consumption of a diet high in protein can cause glomerular hyperfiltration, a potentially maladaptive response, which may accelerate the progression of kidney disease. Study Design An ancillary study of the OmniHeart trial, a randomized 3-period crossover feeding trial testing the effects of partial replacement of carbohydrate with protein on kidney function. Setting & Participants Healthy adults (N=164) with prehypertension or stage 1 hypertension at a community-based research clinic with a metabolic kitchen. Intervention Participants were fed each of 3 diets for 6 weeks. Feeding periods were separated by a 2- to 4-week washout period. Weight was held constant on each diet. The 3 diets emphasized carbohydrate, protein, or Unsaturated Fat; dietary protein was either 15% (carbohydrate and Unsaturated Fat diets) or 25% (protein diet) of energy intake. Outcomes Fasting serum creatinine, cystatin C, and β 2 -microglobulin levels, estimated glomerular filtration rate (eGFR). Measurements Serum creatinine, cystatin C, and β 2 -microglobulin collected at the end of each feeding period. Results Baseline cystatin C-based eGFR was 92.0±16.3 (SD) mL/min/1.73 m 2 . Compared with the carbohydrate and Unsaturated Fat diets, the protein diet increased cystatin C-based eGFR by ∼4 mL/min/1.73 m 2 ( P Limitations Participants did not have kidney disease at baseline. Conclusions A healthy diet rich in protein increased eGFR. Whether long-term consumption of a high-protein diet leads to kidney disease is uncertain.
Frank M Sacks - One of the best experts on this subject based on the ideXlab platform.
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effects of dietary macronutrients on serum urate results from the omniheart trial
The American Journal of Clinical Nutrition, 2021Co-Authors: Matthew J Belanger, Frank M Sacks, Lawrence J Appel, Edgar R Miller, Christina C Wee, Kenneth J Mukamal, Robert H Shmerling, Hyon K Choi, Stephen P JuraschekAbstract:Background Dietary recommendations to prevent gout emphasize a low-purine diet. Recent evidence suggests that the Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate while also improving blood pressure and lipids. Objective To compare the effects of DASH-style diets emphasizing different macronutrient proportions on serum urate reduction. Methods We conducted a secondary analysis of the Optimal Macronutrient Intake Trial to Prevent Heart Disease feeding study, a 3-period, crossover design, randomized trial of adults with prehypertension or hypertension. Participants were provided with 3 DASH-style diets in random order, each for 6 wk. Each DASH-style diet emphasized different macronutrient proportions: a carbohydrate-rich (CARB) diet, a protein-rich (PROT) diet, and an Unsaturated Fat-rich (UNSAT) diet. In the PROT diet, approximately half of the protein came from plant sources. We compared the effects of these diets on serum urate at weeks 4 and 6 of each feeding period. Results Of the 163 individuals included in the final analysis, the mean serum urate at baseline was 5.1 mg/dL. Only the PROT diet reduced serum urate from baseline at the end of the 6-wk feeding period (-0.16 mg/dL; 95% CI: -0.28, -0.04; P = 0.007). Neither the CARB diet (-0.03 mg/dL; 95% CI: -0.14, 0.09; P = 0.66) nor the UNSAT diet (-0.01 mg/dL; 95% CI: -0.12, 0.09; P = 0.78) reduced serum urate from baseline. The PROT diet lowered serum urate by 0.12 mg/dL (95% CI: -0.20, -0.03; P = 0.006) compared with CARB and by 0.12 mg/dL (95% CI: -0.20, -0.05; P = 0.002) compared with UNSAT. Conclusions A DASH-style diet emphasizing plant-based protein lowered serum urate compared with those emphasizing carbohydrates or Unsaturated Fat. Future trials should test the ability of a DASH-style diet emphasizing plant-based protein to lower serum urate and prevent gout flares in patients with gout. This trial was registered at clinicaltrials.gov as NCT00051350.
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dietary Unsaturated Fat increases hdl metabolic pathways involving apoe favorable to reverse cholesterol transport
JCI insight, 2019Co-Authors: Allyson Morton, Jeremy D Furtado, Carlos O Mendivil, Frank M SacksAbstract:BACKGROUND. HDL that contains apolipoprotein E (apoE) is a subspecies especially active in steps in reverse cholesterol transport, a process that brings cholesterol from peripheral cells to the liver. Here, we studied the effect of dietary Unsaturated Fat compared with carbohydrate on the metabolism of HDL containing apoE. METHODS. We enrolled 9 adults who were overweight or obese and had below-average HDL-cholesterol in a crossover study of a high-Fat diet, primarily Unsaturated, and a low-Fat, high-carbohydrate diet. A metabolic tracer study was performed after each diet period. RESULTS. Dietary Fat increased the secretion, metabolism, and clearance of HDL subspecies containing apoE. Dietary Fat increased the rate of clearance of large cholesterol-rich HDL containing apoE and increased their conversion to small HDL containing apoE, indicating selective cholesterol ester delivery to the liver. The high-Unsaturated-Fat diet did not affect the metabolism of HDL lacking apoE. CONCLUSION. HDL containing apoE is a diet-responsive metabolic pathway that renders HDL more biologically active in reverse cholesterol transport. This may be a mechanism by which Unsaturated Fat protects against coronary heart disease. Protein-based HDL subspecies such as HDL containing apoE may be used to identify additional atheroprotective treatment targets not evident in the total HDL-cholesterol measurement. TRIAL REGISTRATION. ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01399632","term_id":"NCT01399632"}}NCT01399632. FUNDING. NIH and the National Center for Advancing Translational Science.
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the effects of carbohydrate Unsaturated Fat and protein intake on measures of insulin sensitivity results from the omniheart trial
Diabetes Care, 2013Co-Authors: Meghana D Gadgil, Frank M Sacks, Lawrence J Appel, Cheryl A M Anderson, Edgar R Miller, Edwina H YeungAbstract:OBJECTIVE Impaired insulin sensitivity increases the risk of cardiovascular disease. Although calorie restriction and weight loss increase insulin sensitivity, the effects of modifying macronutrient composition on insulin sensitivity are uncertain. The purpose of this study is to determine the effects on insulin sensitivity of a carbohydrate-rich diet (CARB; similar to the Dietary Approaches to Stop Hypertension [DASH] diet), a protein-rich diet (PROT; protein predominantly from plant sources), and an Unsaturated Fat–rich diet (UNSAT; predominantly monoUnsaturated). RESEARCH DESIGN AND METHODS This study was a randomized, controlled, three-period, crossover feeding study. The study participants were 164 individuals with pre- or stage 1 hypertension without diabetes. Diets were administered for 6 weeks each, with a washout period between diets of 2–4 weeks. Weight was held constant throughout the study. For our primary outcome, we calculated the quantitative insulin sensitivity check index (QUICKI) using the end-of-period fasting serum glucose and insulin. QUICKI is a validated measure of insulin sensitivity. The primary analyses used generalized estimating equations. RESULTS At baseline, mean (SD) BMI was 30.2 (6.1) kg/m 2 , and mean (SD) QUICKI was 0.35 (0.04). The UNSAT diet increased QUICKI by 0.005, more than the CARB diet ( P = 0.04). PROT had no significant effect compared with CARB. CONCLUSIONS A diet that partially replaces carbohydrate with Unsaturated Fat may improve insulin sensitivity in a population at risk for cardiovascular disease. Given the well-recognized challenges of sustaining weight loss, our results suggest an alternative approach for improving insulin sensitivity.
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dietary interventions that lower lipoproteins containing apolipoprotein c iii are more effective in whites than in blacks results of the omniheart trial
The American Journal of Clinical Nutrition, 2010Co-Authors: Jeremy D Furtado, Lawrence J Appel, Vincent J Carey, Hannia Campos, Anne E Sumner, Frank M SacksAbstract:Background: Blacks have lower average triglyceride and LDL cholesterol concentrations than do whites but higher rates of coronary heart disease. Apolipoprotein (apo) C-III in VLDL and LDL stimulates atherogenic processes in vascular cells. In blacks, the concentration of lipoproteins with apo C-III is unknown, and the response to dietary strategies that lower triglyceride and apo C-III has not been investigated Objective: We compared the concentration of and dietary effects on apo C-III–containing lipoproteins in blacks and whites. Design: In a randomized, 3-period feeding study [OmniHeart (Optimal Macronutrient Intake Trial to Prevent Heart Disease)], we measured lipoprotein concentrations in 89 blacks and 73 whites who consumed self-selected diets (baseline) and after 3 healthful diets emphasizing carbohydrate, Unsaturated Fat, or protein. Participants had prehypertension or hypertension, and 79% were overweight or obese. Results: While consuming self-selected diets, blacks had lower apo C-III in total plasma, VLDL, and LDL than did whites. Unsaturated Fat and protein diets lowered plasma apo C-III (16% and 18%, respectively) and triglyceride (12% and 21%, respectively) in whites but not in blacks, reducing racial differences. Most important, blacks had a lower concentration of atherogenic LDL with apo C-III at baseline and after study diets (34–41% lower, P < 0.02). The molar ratio of apo E to apo B was higher in blacks than in whites in total plasma and LDL at baseline and after the study diets. Conclusions: Blacks have lower concentrations of atherogenic lipoproteins that contain apo C-III than do whites when consuming diverse diets and an attenuated dietary response of triglyceride and apo C-III. Dietary efforts to lower triglyceride and apo C-III may be more effective in whites than in blacks. The OmniHeart Trial was registered at www.clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00051350","term_id":"NCT00051350"}}NCT00051350.
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associations between macronutrient intake and self reported appetite and fasting levels of appetite hormones results from the optimal macronutrient intake trial to prevent heart disease
American Journal of Epidemiology, 2009Co-Authors: Frank M Sacks, Cheryl A M Anderson, Edgar R Miller, Thomas P Erlinger, Jeannette M Beasley, B A Ange, Janet T Holbrook, Lawrence J AppelAbstract:The effects of macronutrients on appetite are controversial. Some research suggests a satiety hierarchy in which protein is more satiating than carbohydrate and carbohydrate is more satiating than Fat (1). Short-term ( 2 weeks) corroborate findings from shorter-term studies in settings of weight loss and maintenance of weight loss (4, 5). Other research suggests that there is no difference among macronutrients (6). Public perception is that Fat is more satiating than protein and carbohydrate (7). Although clinical trials provide some evidence that short-term exposure to diets rich in protein may reduce appetite (2–5), mechanisms are unclear. One possible explanation is that dietary protein affects concentrations of appetite hormones. Under this scenario, appetite hormones are mediating variables. Leptin purportedly decreases food intake by signaling the availability of energy reserves (8). Obestatin and ghrelin are products of the same gene but may have opposing effects on weight regulation, according to data from animal models (9); while obestatin may reduce energy intake, ghrelin probably promotes meal initiation (10). Our purpose in this study was to compare the effects of 3 healthy diets, each emphasizing a different macronutrient, on self-reported appetite and fasting levels of selected appetite hormones. We hypothesized that a protein-rich diet, compared with a diet rich in carbohydrate and another diet rich in Unsaturated Fat, would decrease self-reported appetite, increase leptin and obestatin levels, and reduce ghrelin levels.
Edgar R Miller - One of the best experts on this subject based on the ideXlab platform.
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effects of dietary macronutrients on serum urate results from the omniheart trial
The American Journal of Clinical Nutrition, 2021Co-Authors: Matthew J Belanger, Frank M Sacks, Lawrence J Appel, Edgar R Miller, Christina C Wee, Kenneth J Mukamal, Robert H Shmerling, Hyon K Choi, Stephen P JuraschekAbstract:Background Dietary recommendations to prevent gout emphasize a low-purine diet. Recent evidence suggests that the Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate while also improving blood pressure and lipids. Objective To compare the effects of DASH-style diets emphasizing different macronutrient proportions on serum urate reduction. Methods We conducted a secondary analysis of the Optimal Macronutrient Intake Trial to Prevent Heart Disease feeding study, a 3-period, crossover design, randomized trial of adults with prehypertension or hypertension. Participants were provided with 3 DASH-style diets in random order, each for 6 wk. Each DASH-style diet emphasized different macronutrient proportions: a carbohydrate-rich (CARB) diet, a protein-rich (PROT) diet, and an Unsaturated Fat-rich (UNSAT) diet. In the PROT diet, approximately half of the protein came from plant sources. We compared the effects of these diets on serum urate at weeks 4 and 6 of each feeding period. Results Of the 163 individuals included in the final analysis, the mean serum urate at baseline was 5.1 mg/dL. Only the PROT diet reduced serum urate from baseline at the end of the 6-wk feeding period (-0.16 mg/dL; 95% CI: -0.28, -0.04; P = 0.007). Neither the CARB diet (-0.03 mg/dL; 95% CI: -0.14, 0.09; P = 0.66) nor the UNSAT diet (-0.01 mg/dL; 95% CI: -0.12, 0.09; P = 0.78) reduced serum urate from baseline. The PROT diet lowered serum urate by 0.12 mg/dL (95% CI: -0.20, -0.03; P = 0.006) compared with CARB and by 0.12 mg/dL (95% CI: -0.20, -0.05; P = 0.002) compared with UNSAT. Conclusions A DASH-style diet emphasizing plant-based protein lowered serum urate compared with those emphasizing carbohydrates or Unsaturated Fat. Future trials should test the ability of a DASH-style diet emphasizing plant-based protein to lower serum urate and prevent gout flares in patients with gout. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets enriched with carbohydrate protein or Unsaturated Fat on circulating short chain Fatty acids results from the omniheart randomized trial
The American Journal of Clinical Nutrition, 2020Co-Authors: Noel T Mueller, Stephen P Juraschek, Edgar R Miller, Mingyu Zhang, Lawrence J AppelAbstract:BACKGROUND: Short chain Fatty acids (SCFAs; e.g., acetate, propionate, and butyrate) are produced by microbial fermentation of fiber in the colon. Evidence is lacking on how high-fiber diets that differ in macronutrient composition affect circulating SCFAs. OBJECTIVES: We aimed to compare the effects of 3 high-fiber isocaloric diets differing in %kcal of carbohydrate, protein, or Unsaturated Fat on circulating SCFAs. Based on previous literature, we hypothesized that serum acetate, the main SCFA in circulation, increases on all high-fiber diets, but differently by macronutrient composition of the diet. METHODS: OmniHeart is a randomized crossover trial of 164 men and women (≥30 y old); 163 participants with SCFA data were included in this analysis. We provided participants 3 isocaloric high-fiber (∼30 g/2100 kcal) diets, each for 6 wk, in random order: a carbohydrate-rich (Carb) diet, a protein-rich (Prot) diet (protein predominantly from plant sources), and an Unsaturated Fat-rich (Unsat) diet. We used LC-MS to quantify SCFA concentrations in fasting serum, collected at baseline and the end of each diet period. We fitted linear regression models with generalized estimating equations to examine change in ln-transformed SCFAs from baseline to the end of each diet; differences between diets; and associations of changes in SCFAs with cardiometabolic parameters. RESULTS: From baseline, serum acetate concentrations were increased by the Prot (β: 0.24; 95% CI: 0.12, 0.35), Unsat (β: 0.21; 95% CI: 0.10, 0.33), and Carb (β: 0.12; 95% CI: 0.01, 0.24) diets; between diets, only Prot compared with Carb was significant (P = 0.02). Propionate was decreased by the Carb (β: -0.10; 95% CI: -0.16, -0.03) and Unsat (β: -0.10; 95% CI: -0.16, -0.04) diets, not the Prot diet; between diet comparisons of Carb vs. Prot (P = 0.006) and Unsat vs. Prot (P = 0.002) were significant. The Prot diet increased butyrate (β: 0.05; 95% CI: 0.00, 0.09) compared with baseline, but not compared with the other diets. Increases in acetate were associated with decreases in insulin and glucose; increases in propionate with increases in leptin, LDL cholesterol, and blood pressure; and increases in butyrate with increases in insulin and glucose, and decreases in HDL cholesterol and ghrelin (Ps < 0.05). CONCLUSIONS: Macronutrient composition of high-fiber diets affects circulating SCFAs, which are associated with measures of appetite and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets and macronutrient substitution on bloating findings from the omniheart trial
Clinical and translational gastroenterology, 2020Co-Authors: Mingyu Zhang, Stephen P Juraschek, Lawrence J Appel, Edgar R Miller, Pankaj J Pasricha, Noel T MuellerAbstract:OBJECTIVES: To examine the effects of high-fiber, isocaloric, macronutrient substitutions on bloating. METHODS: The OmniHeart study is a randomized 3-period crossover feeding trial conducted from April 2003 to June 2005. Participants were provided 3 isocaloric versions of high-fiber (∼30 g per 2,100 kcal) diet, each different in carbohydrate, protein, and Unsaturated Fat composition. Each feeding period lasted for 6 weeks with a 2- to 4-week washout period between diets. Participants reported the presence and severity of bloating at baseline (participants were eating their own diet) and at the end of each feeding period. RESULTS: One hundred sixty-four participants were included in the analysis (mean age: 53.1 years; 45% women; 55% black). The prevalence of bloating at baseline and at the end of the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich diet period was 18%, 24%, 33%, and 30%, respectively. Compared with baseline, the relative risk of bloating for the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich high-fiber diet was 1.34 (95% confidence interval [CI]: 0.93, 1.92), 1.78 (95% CI: 1.32, 2.40), and 1.63 (95% CI: 1.17, 2.26), respectively. The protein-rich diet increased the risk of bloating more than the carbohydrate-rich diet (relative risk = 1.40; 95% CI: 1.03, 1.88). Bloating did not significantly vary between protein-rich vs Unsaturated Fat-rich or Unsaturated Fat-rich vs carbohydrate-rich diets. Black participants compared with non-black participants had a higher risk of bloating after all 3 versions of the high-fiber OmniHeart diet (P-value for interaction = 0.012). DISCUSSION: Substitution of protein with carbohydrate may be an effective strategy to decrease bloating among individuals experiencing gastrointestinal bloating from a high-fiber diet.
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the effects of carbohydrate Unsaturated Fat and protein intake on measures of insulin sensitivity results from the omniheart trial
Diabetes Care, 2013Co-Authors: Meghana D Gadgil, Frank M Sacks, Lawrence J Appel, Cheryl A M Anderson, Edgar R Miller, Edwina H YeungAbstract:OBJECTIVE Impaired insulin sensitivity increases the risk of cardiovascular disease. Although calorie restriction and weight loss increase insulin sensitivity, the effects of modifying macronutrient composition on insulin sensitivity are uncertain. The purpose of this study is to determine the effects on insulin sensitivity of a carbohydrate-rich diet (CARB; similar to the Dietary Approaches to Stop Hypertension [DASH] diet), a protein-rich diet (PROT; protein predominantly from plant sources), and an Unsaturated Fat–rich diet (UNSAT; predominantly monoUnsaturated). RESEARCH DESIGN AND METHODS This study was a randomized, controlled, three-period, crossover feeding study. The study participants were 164 individuals with pre- or stage 1 hypertension without diabetes. Diets were administered for 6 weeks each, with a washout period between diets of 2–4 weeks. Weight was held constant throughout the study. For our primary outcome, we calculated the quantitative insulin sensitivity check index (QUICKI) using the end-of-period fasting serum glucose and insulin. QUICKI is a validated measure of insulin sensitivity. The primary analyses used generalized estimating equations. RESULTS At baseline, mean (SD) BMI was 30.2 (6.1) kg/m 2 , and mean (SD) QUICKI was 0.35 (0.04). The UNSAT diet increased QUICKI by 0.005, more than the CARB diet ( P = 0.04). PROT had no significant effect compared with CARB. CONCLUSIONS A diet that partially replaces carbohydrate with Unsaturated Fat may improve insulin sensitivity in a population at risk for cardiovascular disease. Given the well-recognized challenges of sustaining weight loss, our results suggest an alternative approach for improving insulin sensitivity.
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effect of a high protein diet on kidney function in healthy adults results from the omniheart trial
American Journal of Kidney Diseases, 2013Co-Authors: Stephen P Juraschek, Lawrence J Appel, Cheryl A M Anderson, Edgar R MillerAbstract:Background Consumption of a diet high in protein can cause glomerular hyperfiltration, a potentially maladaptive response, which may accelerate the progression of kidney disease. Study Design An ancillary study of the OmniHeart trial, a randomized 3-period crossover feeding trial testing the effects of partial replacement of carbohydrate with protein on kidney function. Setting & Participants Healthy adults (N=164) with prehypertension or stage 1 hypertension at a community-based research clinic with a metabolic kitchen. Intervention Participants were fed each of 3 diets for 6 weeks. Feeding periods were separated by a 2- to 4-week washout period. Weight was held constant on each diet. The 3 diets emphasized carbohydrate, protein, or Unsaturated Fat; dietary protein was either 15% (carbohydrate and Unsaturated Fat diets) or 25% (protein diet) of energy intake. Outcomes Fasting serum creatinine, cystatin C, and β 2 -microglobulin levels, estimated glomerular filtration rate (eGFR). Measurements Serum creatinine, cystatin C, and β 2 -microglobulin collected at the end of each feeding period. Results Baseline cystatin C-based eGFR was 92.0±16.3 (SD) mL/min/1.73 m 2 . Compared with the carbohydrate and Unsaturated Fat diets, the protein diet increased cystatin C-based eGFR by ∼4 mL/min/1.73 m 2 ( P Limitations Participants did not have kidney disease at baseline. Conclusions A healthy diet rich in protein increased eGFR. Whether long-term consumption of a high-protein diet leads to kidney disease is uncertain.
J L Firkins - One of the best experts on this subject based on the ideXlab platform.
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investigating Unsaturated Fat monensin or bromoethanesulfonate in continuous cultures retaining ruminal protozoa ii interaction of treatment and presence of protozoa on prokaryotic communities
Journal of Dairy Science, 2009Co-Authors: S K R Karnati, Zhongtang Yu, J L FirkinsAbstract:Abstract Increasing the consistency of responses to reduce emissions of ruminal methane and nitrogenous wastes into the environment using microbial inhibitors requires an accurate assessment of microbial community profiles. In addition to direct inhibition of methanogens by feed additives, protozoa are often targeted for inhibition because their close physical association with endo- and ectosymbionts stimulates methanogenesis in the rumen. In this study, we first modified a continuous culture system to maintain a diverse protozoal population (faunated subperiod) and then selectively effluxed them without using any chemical agents (defaunated subperiod). In both subperiods, Unsaturated Fat (potentially inhibitory to ciliate protozoa, methanogens, and gram-positive bacteria), monensin (assumed to inhibit gram-positive bacteria), and bromoethanesulfonate (BES; a potent inhibitor of methanogens) were used to suppress the respective functional groups of microorganisms. Changes in microbial populations were determined using denaturing gradient gel electrophoresis, followed by cloning and DNA sequencing of the excised bands. Neither monensin nor Unsaturated Fat consistently affected methanogen populations under our conditions in either the faunated or defaunated subperiods. When BES was administered, bands presumptively linked to protozoa-associated methanogens in the faunated subperiod disappeared in the defaunated subperiod. However, there was no noticeable adaptation of the sensitive methanogens to BES. The effect of dietary treatments on bacterial populations in the fermenters was harder to ascertain because of the overriding period effect caused by a different inoculum in each period. Defaunation selectively decreased the intensity of bands associated with ruminococci and clostridia but seemed to increase some Butyrivibrio and related populations. Presence of protozoa influenced both bacterial and archaeal populations, probably by selective predation, competition for substrate, or through symbiotic interactions.
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investigating Unsaturated Fat monensin or bromoethanesulfonate in continuous cultures retaining ruminal protozoa i fermentation biohydrogenation and microbial protein synthesis
Journal of Dairy Science, 2009Co-Authors: S K R Karnati, J T Sylvester, Claudio Vaz Di Mambro Ribeiro, L E Gilligan, J L FirkinsAbstract:Abstract Methane is an end product of ruminal fermentation that is energetically wasteful and contributes to global climate change. Bromoethanesulfonate, animal-vegetable Fat, and monensin were compared with a control treatment to suppress different functional groups of ruminal prokaryotes in the presence or absence of protozoa to evaluate changes in fermentation, digestibility, and microbial N outflow. Four dual-flow continuous culture fermenter systems were used in 4 periods in a 4×4 Latin square design split into 2 subperiods. In subperiod 1, a multistage filter system (50-μm smallest pore size) retained most protozoa. At the start of subperiod 2, conventional filters (300-μm pore size) were substituted to efflux protozoa via filtrate pumps over 3 d; after a further 7 d of adaptation, the fermenters were sampled for 3 d. Treatments were retained during both subperiods. Flow of total N and digestibilities of NDF and OM were 18, 16, and 9% higher, respectively, for the defaunated subperiod but were not different among treatments. Ammonia concentration was 33% higher in the faunated fermenters but was not affected by treatment. Defaunation increased the flow of nonammonia N and bacterial N from the fermenters. Protozoal counts were not different among treatments, but bromoethanesulfonate increased the generation time from 43.2 to 55.6h. Methanogenesis was unaffected by defaunation but tended to be increased by Unsaturated Fat. Defaunation did not affect total volatile Fatty acid production but decreased the acetate:propionate ratio; monensin increased production of isovalerate and valerate. Biohydrogenation of Unsaturated Fatty acids was impaired in the defaunated fermenters because effluent flows of oleic, linoleic, and linolenic acids were 60, 77, and 69% higher, and the ratio of vaccenic acid:Unsaturated FA ratio was decreased by 34% in the effluent. This ratio was increased in both subperiods with the added Fat diet, indicating an accumulation of intermediates of biohydrogenation. However, the flow of 18:2 conjugated linoleic acid was unaffected by defaunation or by treatments other than added Fat. The flows of trans -10, trans -11, and total trans -18:1 Fatty acids were not affected by monensin or faunation status.
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effects of degree of Fat saturation on fiber digestion and microbial protein synthesis when diets are fed twelve times daily
Journal of Animal Science, 2000Co-Authors: B S Oldick, J L FirkinsAbstract:Three Holstein heifers and one nonlactating cow, fitted with ruminal and duodenal cannulas, were arranged in a 4 x 4 Latin square design to determine the effects of degree of Fat saturation on ruminal neutral detergent fiber digestion and microbial protein synthesis and to determine whether changes in the efficiency of microbial protein synthesis were related to protozoal populations in the rumen. Corn silage-based diets contained no added Fat or 4.85% of diet dry matter as partially hydrogenated tallow, tallow, or animal-vegetable Fat. Iodine values of Fat sources were 12.8, 50.6, and 109.7 for partially hydrogenated tallow, tallow, and animal-vegetable Fat, respectively. Cattle were fed every 2 h and consumed 1.5% of body weight as dry matter daily. Ruminal neutral detergent fiber digestibility was decreased by added Fat but was not affected by increasing iodine value. Flows of microbial N and non-NH3-nonmicrobial N to the duodenum were not affected by treatment. Ruminal protozoa concentration decreased linearly as the iodine value of Fats increased. The efficiency of microbial protein synthesis was increased and protozoa concentrations tended to decrease when Fat was fed. Decreased ruminal protozoa concentration may have decreased intraruminal N recycling. Biohydrogenation of added Fat may result in a low ruminal concentration of Unsaturated Fatty acids when cows are fed frequently, reducing the negative effects of Unsaturated Fat sources on ruminal neutral detergent fiber digestibility. Protozoa were inhibited by Unsaturated Fat, but it is not clear if biohydrogenation and frequent feeding lessened inhibition.
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effects of dietary macronutrients on serum urate results from the omniheart trial
The American Journal of Clinical Nutrition, 2021Co-Authors: Matthew J Belanger, Frank M Sacks, Lawrence J Appel, Edgar R Miller, Christina C Wee, Kenneth J Mukamal, Robert H Shmerling, Hyon K Choi, Stephen P JuraschekAbstract:Background Dietary recommendations to prevent gout emphasize a low-purine diet. Recent evidence suggests that the Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate while also improving blood pressure and lipids. Objective To compare the effects of DASH-style diets emphasizing different macronutrient proportions on serum urate reduction. Methods We conducted a secondary analysis of the Optimal Macronutrient Intake Trial to Prevent Heart Disease feeding study, a 3-period, crossover design, randomized trial of adults with prehypertension or hypertension. Participants were provided with 3 DASH-style diets in random order, each for 6 wk. Each DASH-style diet emphasized different macronutrient proportions: a carbohydrate-rich (CARB) diet, a protein-rich (PROT) diet, and an Unsaturated Fat-rich (UNSAT) diet. In the PROT diet, approximately half of the protein came from plant sources. We compared the effects of these diets on serum urate at weeks 4 and 6 of each feeding period. Results Of the 163 individuals included in the final analysis, the mean serum urate at baseline was 5.1 mg/dL. Only the PROT diet reduced serum urate from baseline at the end of the 6-wk feeding period (-0.16 mg/dL; 95% CI: -0.28, -0.04; P = 0.007). Neither the CARB diet (-0.03 mg/dL; 95% CI: -0.14, 0.09; P = 0.66) nor the UNSAT diet (-0.01 mg/dL; 95% CI: -0.12, 0.09; P = 0.78) reduced serum urate from baseline. The PROT diet lowered serum urate by 0.12 mg/dL (95% CI: -0.20, -0.03; P = 0.006) compared with CARB and by 0.12 mg/dL (95% CI: -0.20, -0.05; P = 0.002) compared with UNSAT. Conclusions A DASH-style diet emphasizing plant-based protein lowered serum urate compared with those emphasizing carbohydrates or Unsaturated Fat. Future trials should test the ability of a DASH-style diet emphasizing plant-based protein to lower serum urate and prevent gout flares in patients with gout. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets enriched with carbohydrate protein or Unsaturated Fat on circulating short chain Fatty acids results from the omniheart randomized trial
The American Journal of Clinical Nutrition, 2020Co-Authors: Noel T Mueller, Stephen P Juraschek, Edgar R Miller, Mingyu Zhang, Lawrence J AppelAbstract:BACKGROUND: Short chain Fatty acids (SCFAs; e.g., acetate, propionate, and butyrate) are produced by microbial fermentation of fiber in the colon. Evidence is lacking on how high-fiber diets that differ in macronutrient composition affect circulating SCFAs. OBJECTIVES: We aimed to compare the effects of 3 high-fiber isocaloric diets differing in %kcal of carbohydrate, protein, or Unsaturated Fat on circulating SCFAs. Based on previous literature, we hypothesized that serum acetate, the main SCFA in circulation, increases on all high-fiber diets, but differently by macronutrient composition of the diet. METHODS: OmniHeart is a randomized crossover trial of 164 men and women (≥30 y old); 163 participants with SCFA data were included in this analysis. We provided participants 3 isocaloric high-fiber (∼30 g/2100 kcal) diets, each for 6 wk, in random order: a carbohydrate-rich (Carb) diet, a protein-rich (Prot) diet (protein predominantly from plant sources), and an Unsaturated Fat-rich (Unsat) diet. We used LC-MS to quantify SCFA concentrations in fasting serum, collected at baseline and the end of each diet period. We fitted linear regression models with generalized estimating equations to examine change in ln-transformed SCFAs from baseline to the end of each diet; differences between diets; and associations of changes in SCFAs with cardiometabolic parameters. RESULTS: From baseline, serum acetate concentrations were increased by the Prot (β: 0.24; 95% CI: 0.12, 0.35), Unsat (β: 0.21; 95% CI: 0.10, 0.33), and Carb (β: 0.12; 95% CI: 0.01, 0.24) diets; between diets, only Prot compared with Carb was significant (P = 0.02). Propionate was decreased by the Carb (β: -0.10; 95% CI: -0.16, -0.03) and Unsat (β: -0.10; 95% CI: -0.16, -0.04) diets, not the Prot diet; between diet comparisons of Carb vs. Prot (P = 0.006) and Unsat vs. Prot (P = 0.002) were significant. The Prot diet increased butyrate (β: 0.05; 95% CI: 0.00, 0.09) compared with baseline, but not compared with the other diets. Increases in acetate were associated with decreases in insulin and glucose; increases in propionate with increases in leptin, LDL cholesterol, and blood pressure; and increases in butyrate with increases in insulin and glucose, and decreases in HDL cholesterol and ghrelin (Ps < 0.05). CONCLUSIONS: Macronutrient composition of high-fiber diets affects circulating SCFAs, which are associated with measures of appetite and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT00051350.
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effects of high fiber diets and macronutrient substitution on bloating findings from the omniheart trial
Clinical and translational gastroenterology, 2020Co-Authors: Mingyu Zhang, Stephen P Juraschek, Lawrence J Appel, Edgar R Miller, Pankaj J Pasricha, Noel T MuellerAbstract:OBJECTIVES: To examine the effects of high-fiber, isocaloric, macronutrient substitutions on bloating. METHODS: The OmniHeart study is a randomized 3-period crossover feeding trial conducted from April 2003 to June 2005. Participants were provided 3 isocaloric versions of high-fiber (∼30 g per 2,100 kcal) diet, each different in carbohydrate, protein, and Unsaturated Fat composition. Each feeding period lasted for 6 weeks with a 2- to 4-week washout period between diets. Participants reported the presence and severity of bloating at baseline (participants were eating their own diet) and at the end of each feeding period. RESULTS: One hundred sixty-four participants were included in the analysis (mean age: 53.1 years; 45% women; 55% black). The prevalence of bloating at baseline and at the end of the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich diet period was 18%, 24%, 33%, and 30%, respectively. Compared with baseline, the relative risk of bloating for the carbohydrate-rich, protein-rich, and Unsaturated Fat-rich high-fiber diet was 1.34 (95% confidence interval [CI]: 0.93, 1.92), 1.78 (95% CI: 1.32, 2.40), and 1.63 (95% CI: 1.17, 2.26), respectively. The protein-rich diet increased the risk of bloating more than the carbohydrate-rich diet (relative risk = 1.40; 95% CI: 1.03, 1.88). Bloating did not significantly vary between protein-rich vs Unsaturated Fat-rich or Unsaturated Fat-rich vs carbohydrate-rich diets. Black participants compared with non-black participants had a higher risk of bloating after all 3 versions of the high-fiber OmniHeart diet (P-value for interaction = 0.012). DISCUSSION: Substitution of protein with carbohydrate may be an effective strategy to decrease bloating among individuals experiencing gastrointestinal bloating from a high-fiber diet.
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effect of a high protein diet on kidney function in healthy adults results from the omniheart trial
American Journal of Kidney Diseases, 2013Co-Authors: Stephen P Juraschek, Lawrence J Appel, Cheryl A M Anderson, Edgar R MillerAbstract:Background Consumption of a diet high in protein can cause glomerular hyperfiltration, a potentially maladaptive response, which may accelerate the progression of kidney disease. Study Design An ancillary study of the OmniHeart trial, a randomized 3-period crossover feeding trial testing the effects of partial replacement of carbohydrate with protein on kidney function. Setting & Participants Healthy adults (N=164) with prehypertension or stage 1 hypertension at a community-based research clinic with a metabolic kitchen. Intervention Participants were fed each of 3 diets for 6 weeks. Feeding periods were separated by a 2- to 4-week washout period. Weight was held constant on each diet. The 3 diets emphasized carbohydrate, protein, or Unsaturated Fat; dietary protein was either 15% (carbohydrate and Unsaturated Fat diets) or 25% (protein diet) of energy intake. Outcomes Fasting serum creatinine, cystatin C, and β 2 -microglobulin levels, estimated glomerular filtration rate (eGFR). Measurements Serum creatinine, cystatin C, and β 2 -microglobulin collected at the end of each feeding period. Results Baseline cystatin C-based eGFR was 92.0±16.3 (SD) mL/min/1.73 m 2 . Compared with the carbohydrate and Unsaturated Fat diets, the protein diet increased cystatin C-based eGFR by ∼4 mL/min/1.73 m 2 ( P Limitations Participants did not have kidney disease at baseline. Conclusions A healthy diet rich in protein increased eGFR. Whether long-term consumption of a high-protein diet leads to kidney disease is uncertain.
