Displaying publications 1 - 20 of 290 in total

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  1. Jaafar SHS, Hashim R, Hassan Z, Arifin N
    Trop Life Sci Res, 2018 Mar;29(1):195-212.
    PMID: 29644024 MyJurnal DOI: 10.21315/tlsr2018.29.1.13
    This study was conducted to determine the physical and chemical composition of goat milk produced by eight local farms located in the central region of Malaysia. Farms 1 to 4 (F1-SC, F2-SP, F3-SP, F4-SBC) reared Saanen-type goats while farms 5 to 8 (F5-JK, F6-JPEC, F7-JTC, F8-JC), Jamnapari-type goats. The common feedstuffs used in all farms comprised of fresh or silage from Napier grass, feed pellets, and brans while two farms, F5-JK and F6-JPEC supplemented the feeds with soybean-based product. The total solid content, dry matter, and proximate composition of goat milk and feedstuffs from the different farms were determined and the results analysed using principal component analysis. Total solid content of goat milk from the Jamnapari crossbreed had the highest solid content ranging from 11.81% to 17.54% compared to milk from farms with Saanen and Saanen crossbreed (10.95% to 14.63%). Jamnapari-type goats from F5-JK, F6-JPEC, and F8-JC had significantly higher (p < 0.05) milk fat and protein contents (7.36%, 7.14%, and 6.59% fat; 5.08%, 6.19%, and 4.23% protein, respectively) than milk from other farms but, milk produced by Saanen-type goats from F4-SBC contained similar protein content (4.34%) to that from F8-JC. Total ash and carbohydrate contents in milk ranged between 0.67% to 0.86% and 3.26% to 4.71%, respectively, regardless of goat breed. Feeding soybean-based products appear to have a positive influence on milk fat and protein content in Jamnaparitype goats.
    Matched MeSH terms: Carbohydrates
  2. Karupaiah T, Chuah KA, Chinna K, Pressman P, Clemens RA, Hayes AW, et al.
    Sci Rep, 2019 09 20;9(1):13666.
    PMID: 31541144 DOI: 10.1038/s41598-019-49911-6
    We conducted this cross-sectional population study with a healthy multi-ethnic urban population (n = 577) in Malaysia, combining nutritional assessments with cardiometabolic biomarkers defined by lipid, atherogenic lipoproteins, inflammation and insulin resistance. We found diametrically opposing associations of carbohydrate (246·6 ± 57·7 g, 54·3 ± 6·5%-TEI) and fat (total = 64·5 ± 19·8 g, 31·6 ± 5·5%-TEI; saturated fat = 14·1 ± 2·7%-TEI) intakes as regards waist circumference, HDL-C, blood pressure, glucose, insulin and HOMA2-IR as well as the large-LDL and large-HDL lipoprotein particles. Diets were then differentiated into either low fat (LF, <30% TEI or <50 g) or high fat (HF, >35% TEI or >70 g) and low carbohydrate (LC, <210 g) or high carbohydrate (HC, >285 g) which yielded LFLC, LFHC, HFLC and HFHC groupings. Cardiometabolic biomarkers were not significantly different (P > 0.05) between LFLC and HFLC groups. LFLC had significantly higher large-LDL particle concentrations compared to HFHC. HOMA-IR2 was significantly higher with HFHC (1·91 ± 1·85, P 1.7 in the HFHC group was 2.43 (95% CI: 1·03, 5·72) times more compared to LFLC while odds of having large-LDL <450 nmol/L in the HFHC group was 1.91 (95% CI: 1·06, 3·44) more compared to latter group. Our data suggests that a HFHC dietary combination in Malaysian adults is associated with significant impact on lipoprotein particles and insulin resistance.
    Matched MeSH terms: Dietary Carbohydrates/administration & dosage*
  3. Henry CJ, Quek RYC, Kaur B, Shyam S, Singh HKG
    Nutr Diabetes, 2021 01 06;11(1):2.
    PMID: 33414403 DOI: 10.1038/s41387-020-00145-w
    Current international tables published on the glycaemic index (GI) of foods represent valuable resources for researchers and clinicians. However, the vast majority of published GI values are of Western origin, notably European, Australian and North American. Since these tables focus on Western foods with minimal inclusion of other foods from non-Western countries, their application is of limited global use. The objective of this review is to provide the GI values for a variety of foods that are consumed in non-Western countries. Our review extends and expands on the current GI tables in an attempt to widen its application in many other regions of the world.
    Matched MeSH terms: Dietary Carbohydrates/classification*
  4. Li A, Abrahim A, Islam M, Mejías E, Hafizati Abdul Halim N, Frew R, et al.
    Food Chem, 2024 Feb 15;434:137451.
    PMID: 37748289 DOI: 10.1016/j.foodchem.2023.137451
    One of the most common types of adulteration of honey involves the addition of invert sugar syrups. A new method was developed to measure the stable isotope ratios of carbon and carbon-bound non-exchangeable (CBNE) hydrogen from specific molecular positions in fructose and glucose in honey. This was achieved through periodate oxidation of the sugars to produce formaldehyde, followed by reaction with ammonia to form hexamethylenetetramine (HMT). The preparation was simplified, optimized, and validated by isotopic analysis of replicate syntheses of HMT from fructose, glucose, sugar syrup and a representative authentic honey sample. The optimized method had a repeatability standard deviation from 1.5‰ to 3.0‰ and from 0.1‰ to 0.4‰ for δ2H and δ13C, respectively. This methodology has advantages over alternative isotopic methods, for measuring CBNE hydrogen isotope ratios in sugars, in terms of time, sensitivity and operability and offers a complementary method to differentiate authentic honey from invert sugar syrups.
    Matched MeSH terms: Carbohydrates/analysis
  5. Chua CP
    Med J Malaysia, 1975 Dec;30(2):98-101.
    PMID: 1228389
    Matched MeSH terms: Dietary Carbohydrates/adverse effects
  6. Shyam S, Wai TN, Arshad F
    Asia Pac J Clin Nutr, 2012;21(2):201-8.
    PMID: 22507605
    This paper outlines the methodology to add glycaemic index (GI) and glycaemic load (GL) functionality to food DietPLUS, a Microsoft Excel-based Malaysian food composition database and diet intake calculator. Locally determined GI values and published international GI databases were used as the source of GI values. Previously published methodology for GI value assignment was modified to add GI and GL calculators to the database. Two popular local low GI foods were added to the DietPLUS database, bringing up the total number of foods in the database to 838 foods. Overall, in relation to the 539 major carbohydrate foods in the Malaysian Food Composition Database, 243 (45%) food items had local Malaysian values or were directly matched to International GI database and another 180 (33%) of the foods were linked to closely-related foods in the GI databases used. The mean ± SD dietary GI and GL of the dietary intake of 63 women with previous gestational diabetes mellitus, calculated using DietPLUS version3 were, 62 ± 6 and 142 ± 45, respectively. These values were comparable to those reported from other local studies. DietPLUS version3, a simple Microsoft Excel-based programme aids calculation of diet GI and GL for Malaysian diets based on food records.
    Matched MeSH terms: Dietary Carbohydrates/adverse effects; Dietary Carbohydrates/analysis*; Dietary Carbohydrates/metabolism
  7. Eugene M. Obeng, Chan, Yi Wei, Siti Nurul Nadzirah Adam, Clarence M. Ongkudon
    MyJurnal
    Cellulases have been vital for the saccharification of lignocellulosic biomass into reduced sugars to produce biofuels and other essential biochemicals. However, the sugar yields achievable for canonical cellulases (i.e. endoglucanases, exoglucanases and β-glucosidases) have not been convincing in support of the highly acclaimed prospects and end-uses heralded. The persistent pursuit of the biochemical industry to obtain high quantities of useful chemicals from lignocellulosic biomass has resulted in the supplementation of cellulose-degrading enzymes with other biological complementation. Also, chemical additives (e.g. salts, surfactants and chelating agents) have been employed to enhance the stability and improve the binding and overall functionality of cellulases to increase product titre. Herein, we report the roadmap of cellulase-additive supplementations and the associated yield performances.
    Matched MeSH terms: Carbohydrates
  8. Chang LF, Vethakkan SR, Nesaretnam K, Sanders TA, Teng KT
    J Clin Lipidol, 2016 09 17;10(6):1431-1441.e1.
    PMID: 27919361 DOI: 10.1016/j.jacl.2016.09.006
    BACKGROUND: Current dietary guidelines recommend the replacement of saturated fatty acids (SAFAs) with carbohydrates or monounsaturated fatty acids (MUFAs) based on evidence on lipid profile alone, the chronic effects of the mentioned replacements on insulin secretion and insulin sensitivity are however unclear.

    OBJECTIVE: To assess the chronic effects of the substitution of refined carbohydrate or MUFA for SAFA on insulin secretion and insulin sensitivity in centrally obese subjects.

    METHODS: Using a crossover design, randomized controlled trial in abdominally overweight men and women, we compared the effects of substitution of 7% energy as carbohydrate or MUFA for SAFA for a period of 6 weeks each. Fasting and postprandial blood samples in response to corresponding SAFA, carbohydrate, or MUFA-enriched meal-challenges were collected after 6 weeks on each diet treatment for the assessment of outcomes.

    RESULTS: As expected, postprandial nonesterified fatty acid suppression and elevation of C-peptide, insulin and glucose secretion were the greatest with high-carbohydrate (CARB) meal. Interestingly, CARB meal attenuated postprandial insulin secretion corrected for glucose response; however, the insulin sensitivity and disposition index were not affected. SAFA and MUFA had similar effects on all markers except for fasting glucose-dependent insulinotropic peptide concentrations, which increased after MUFA but not SAFA when compared with CARB.

    CONCLUSION: In conclusion, a 6-week lower-fat/higher-carbohydrate (increased by 7% refined carbohydrate) diet may have greater adverse effect on insulin secretion corrected for glucose compared with isocaloric higher-fat diets. In contrast, exchanging MUFA for SAFA at 7% energy had no appreciable adverse impact on insulin secretion.

    Matched MeSH terms: Dietary Carbohydrates*
  9. Lee MK, Li X, Yap ACS, Cheung PCK, Tan CS, Ng ST, et al.
    Front Pharmacol, 2018;9:461.
    PMID: 29867469 DOI: 10.3389/fphar.2018.00461
    Lignosus rhinocerotis has a long history of use by the indigenous community within East Asia to treat a range of health conditions including asthma and chronic cough. To date, there is limited scientific evidence to support its therapeutic effects in relieving these airways conditions. In this study, we examined the effects of the different molecular weight fractions [high-molecular-weight (HMW), medium-molecular-weight (MMW), and low-molecular-weight (LMW)] obtained from the cold water sclerotial extract (CWE) of L. rhinocerotis on airways patency using airway segments isolated from Sprague Dawley rat in an organ bath set-up. It is demonstrated that the HMW and MMW fractions exhibited higher efficacy in relaxing the pre-contracted airways when compared to the CWE and LMW fraction. In addition, the HMW fraction markedly supressed carbachol-, 5-hydroxytrptamine-, and calcium-induced airway contractions. CWE demonstrated a lower efficacy than the HMW fraction but it also significantly attenuated carbachol- and calcium-induced airway contractions. Results showed that the bronchorelaxation effect of CWE and fractions is mediated via blockade of extracellular Ca2+ influx. The composition analysis revealed the following parts of carbohydrate and proteins, respectively: HMW fraction: 71 and 4%; MMW fraction: 35 and 1%; and LMW fraction: 22 and 0.3%. Our results strongly suggest that the polysaccharide-protein complex or proteins found in the HMW and MMW fractions is likely to contribute to the bronchorelaxation effect of CWE.
    Matched MeSH terms: Carbohydrates
  10. Khoo CG, Dasan YK, Lam MK, Lee KT
    Bioresour Technol, 2019 Nov;292:121964.
    PMID: 31451339 DOI: 10.1016/j.biortech.2019.121964
    Algae biomass comprises variety of biochemicals components such as carbohydrates, lipids and protein, which make them a feasible feedstock for biofuel production. However, high production cost mainly due to algae cultivation remains the main challenge in commercializing algae biofuels. Hence, extraction of other high value-added bioproducts from algae biomass is necessary to enhance the economic feasibility of algae biofuel production. This paper is aims to deliberate the recent developments of conventional technologies for algae biofuels production, such as biochemical and chemical conversion pathways, and extraction of a variety of bioproducts from algae biomass for various potential applications. Besides, life cycle evaluation studies on microalgae biorefinery are presented, focusing on case studies for various cultivation techniques, culture medium, harvesting, and dewatering techniques along with biofuel and bioenergy production pathways. Overall, the algae biorefinery provides new opportunities for valorisation of algae biomass for multiple products synthesis.
    Matched MeSH terms: Carbohydrates
  11. Chan PM, Kanagasabapathy G, Tan YS, Sabaratnam V, Kuppusamy UR
    PMID: 24371454 DOI: 10.1155/2013/304713
    Amauroderma rugosum is a wild mushroom that is worn as a necklace by the indigenous communities in Malaysia to prevent fits and incessant crying by babies. The aim of this study was to investigate the nutritive composition and antioxidant potential and anti-inflammatory effects of A. rugosum extracts on LPS-stimulated RAW264.7 cells. Nutritional analysis of freeze-dried mycelia of A. rugosum (KUM 61131) from submerged culture indicated a predominant presence of carbohydrates, proteins, dietary fibre, phosphorus, potassium, and sodium. The ethanol crude extract (EE), its hexane (HF), ethyl acetate (EAF), and aqueous (AF) fractions of mycelia of A. rugosum grown in submerged culture were evaluated for antioxidant potential and anti-inflammatory effects. EAF exhibited the highest total phenolic content and the strongest antioxidant activity based on 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) assays. HF showed dose-dependent inhibition of NO production in LPS-stimulated RAW264.7 cells and NO radical scavenging activity. Gas chromatographic analysis of HF revealed the presence of ethyl linoleate and ergosterol, compounds with known anti-inflammatory properties. In conclusion, the nutritive compositions and significant antioxidant potential and anti-inflammatory effects of mycelia extracts of A. rugosum have the potential to serve as a therapeutic agent or adjuvant in the management of inflammatory disorders.
    Matched MeSH terms: Carbohydrates
  12. Sharifah Azizah, T.N., Nik Shanita, S., Hasnah, H.
    MyJurnal
    The aim of this study was to determine the specific content and type of sugars in selected commercial and traditional kuih in Klang Valley. The selection of the kuih was based on the validated Food Frequency Questionnaire (FFQ) for sugar. The selected commercial kuih was doughnut coated with sugar (Big Apple) while the ten traditional kuih samples consisted of kuih bingka ubi, kuih kasui, kuih keria, kuih koci, kuih lapis, kuih lopes, kuih onde-onde, kuih sagu, kuih seri muka and kuih talam. The doughnut coated with sugar (Big Apple) was purchased from Big Apple Donuts and Coffee franchise at two different locations, while the traditional kuih were randomly bought from stalls, cafeterias and restaurants around Kuala Lumpur and Rawang. The types and amount of sugar were determined using High Performance High Chromatography (HPLC) with a refractive index (RI) detector. Results showed that doughnut coated with sugar (Big Apple) has the highest starch content (22.6±0.3 g/100g) and kuih keria contained the highest available carbohydrate (41.5±1.7 g/100g), comprising of 24.2±2.4 g/100g total sugar and 17.3±0.7 g/100g of starch. The least available carbohydrate content was found in kuih talam (20.0±0.5 g/100g), which was 50% lower than the one in kuih keria. Major individual sugars detected in all kuih samples were consisted of sucrose (60.0%), glucose (16.2%), fructose (14.0%), maltose (9.5%) and lactose (0.3%). Majority of the kuih samples (90.9%) in this study can be categorized as medium sugar while only kuih keria was categorized as high sugar. Based on the two main ingredients (sugar and flour) used in the preparation of kuih, results showed that all kuih samples can be categorized as medium sugarmedium starch. In conclusion, this study served as a guideline by locals in selecting kuih of
    different sugar levels.
    Matched MeSH terms: Dietary Carbohydrates
  13. Nik-Hussein NN, Razak IA, Karim MN
    Singapore Dent J, 1988 Dec;13(1):24-6.
    PMID: 3154999
    The sugar content of twenty-four liquid medicines commonly prescribed for infants and young children were measured and the type of sugars present were also identified in four randomly selected samples. All the liquid medicines tested contained sugar, in the range of 29.4% to 61.2%. Sucrose appeared to be the most commonly used sugar. Whilst it is agreed that sucrose makes the medicine more acceptable to children, its continual use by the pharmaceutical industry should be discontinued due to its harmful effect on the dental health of children, particularly those taking these syrup-based medicines on prolonged basis. Sugar-free alternatives such as sorbitol or saccharin should be used instead.
    Matched MeSH terms: Carbohydrates/analysis*
  14. Aishah Faiqah Mohd Yusof, Prabhakaran P, Nur Diyana Azli, Norrakiah Abdullah Sani, Wan Syaidatul Aqma
    Sains Malaysiana, 2017;46:903-908.
    Pacifier nipples are in permanent contact with saliva and with the oral microflora therefore, act as a favoured site for the growth of biofilms. This research was conducted to identify the bacterial biofilms that has been found on the pacifiers that collected from local child nursery and to analyse the formation of biofilms by Cronobacter sp. during growth in infant formula milk. Pacifiers collected were analysed to obtain colony forming unit (CFU) and isolated bacteria were identified using several biochemical tests according to Bergey's Manual. Biofilm assay of three Cronobacter sp. were conducted using 24 wells microtiter plate and stained with 1% of crystal violet solution at different time interval: 6, 12, 18 and 24 h. The hydrophobicity of the bacterial cell suspension was evaluated using bacterial adhesion to hydrocarbons (BATH) method. Extracellular polymeric substances (EPS) analysis was done to identify percentage of carbohydrate and protein content by using phenol sulphuric acid method and Bradford method, respectively. The results obtained showed that the normal microflora bacteria were the most abundant microorganisms that were found on the pacifier with the main genus isolated was Staphylococcus sp., Enterobacteriaceae sp. and Clostridium sp. Based on biofilm and EPS analysis, Cronobacter sakazakii formed a strong biofilms after 18 h, with carbohydrate was identified as main component of EPS.
    Matched MeSH terms: Carbohydrates
  15. Sundaram CS, Kumar JS, Kumar SS, Ramesh PLN, Zin T, Rao USM
    Med J Malaysia, 2020 11;75(6):677-684.
    PMID: 33219177
    INTRODUCTION: Brassica oleracea var acephala was studied for preliminary phytochemical screening. The results showed that the ethanolic crude extract of the leaf contain high phytochemical activity hence B.oleracea var acephala is rich in flavonoids, phenolic compounds, carbohydrates and phytosterols.

    MATERIALS AND METHODS: The ethanolic extract was used to synthesise copper nanoparticles. The copper nanoparticles were successfully synthesised from copper sulphate solution which was identified by the colour change from dark green colour of the extract. Thus the B.oleracea var acephala is a good source to synthesis copper nanoparticles. The synthesised copper nanoparticles were characterised using Scanning Electron Microscope (SEM) analysis. The SEM image displayed the high-density nanoparticles synthesised by leaf extracts and that the nanoparticles were crystals in shape.

    RESULTS: The copper nanoparticles (CNP) bind to the leaf extract. B.oleracea var acephala also has shown the antimicrobial and antioxidant activity. A comparative study was done between ethanolic its crude extract and nanoparticles. Both extracts exhibited zone of inhibition and better antioxidant potential but the CuNPs shows major zone of inhibition and showed more antioxidant activity. Anticancer activity of B.oleracea var acephala against Cervical HeLa cell line was confirmed using ethanolic crude extract and CNP. The results showed that HeLa cells proliferation was inhibited with increasing concentration of ethanolic crude extract and copper nanoparticles. From the results, it was seen that percentage viability of the cancer cells decreased with increased concentration of the samples whereas cytotoxicity against HeLa cell lines increased with the increased concentration of the samples.

    CONCLUSION: Thus B.oleracea var acephala possesses anticancer activity against HeLa cell lines.

    Matched MeSH terms: Carbohydrates
  16. Nurdianah, H.F., Ahmad Firdaus, A.H., Eshaifol Azam, O., Wan Adnan, W.O.
    MyJurnal
    Bee pollen is considered as one of the functional foods due to its complex biochemical
    properties. Bee pollen which is collected from pollen grains from various botanical sources
    contains almost a complete nutrition such as carbohydrates, proteins, amino acids, vitamins
    and minerals. Its beneficial effect on health is thought to be due to the presence of phenolic
    compounds with its antioxidant activity. Antioxidant activities of ethanolic bee pollen extract
    (BPE) from three species of Malaysian stingless bee; Trigona thoracica, Trigona itama and
    Trigona apicalis in this study were measured using DPPH-HPLC method and gallic acid (GA)
    as a standard reference. The percentage of DPPH inhibition by T. apicalis BPE at 1 mg/mL
    showed the highest inhibition (39%, GA equivalent to 0.3 mg/mL) compared with T. itama
    (14.3%, GA equivalent to 0.1 mg/mL) and T. thoracica (6.7%, GA equivalent to 0.05 mg/mL).
    Our result was the first in reporting antioxidant activity of BPE measured using DPPH-HPLC
    method from three different species of Malaysian stingless bee.
    Matched MeSH terms: Carbohydrates
  17. Lay MM, Karsani SA, Banisalam B, Mohajer S, Abd Malek SN
    Biomed Res Int, 2014;2014:410184.
    PMID: 24818141 DOI: 10.1155/2014/410184
    In recent years, the utilization of certain medicinal plants as therapeutic agents has drastically increased. Phaleria macrocarpa (Scheff.) Boerl is frequently used in traditional medicine. The present investigation was undertaken with the purpose of developing pharmacopoeial standards for this species. Nutritional values such as ash, fiber, protein, fat, and carbohydrate contents were investigated, and phytochemical screenings with different reagents showed the presence of flavonoids, glycosides, saponin glycosides, phenolic compounds, steroids, tannins, and terpenoids. Our results also revealed that the water fraction had the highest antioxidant activity compared to the methanol extract and other fractions. The methanol and the fractionated extracts (hexane, chloroform, ethyl acetate, and water) of P. macrocarpa seeds were also investigated for their cytotoxic effects on selected human cancer cells lines (MCF-7, HT-29, MDA-MB231, Ca Ski, and SKOV-3) and a normal human fibroblast lung cell line (MRC-5). Information from this study can be applied for future pharmacological and therapeutic evaluations of the species, and may assist in the standardization for quality, purity, and sample identification. To the best of our knowledge, this is the first report on the phytochemical screening and cytotoxic effect of the crude and fractionated extracts of P. macrocarpa seeds on selected cells lines.
    Matched MeSH terms: Carbohydrates/analysis
  18. Mojani, M.S., Ghasemzadeh, A., Rahmat, A., Loh, S.P., Ramasamy, R.
    MyJurnal
    In current work, the nutritional composition, bioactive compounds, total phenolic contents and anti-oxidant activity of young Malaysian ginger rhizome were investigated. Proximate analysis and high performance liquid chromatography (HPLC) recruited to determine nutritional composition and bioactive compounds. The total flavonoid (TF) and total phenolic contents (TPC) of ginger rhizome were determined by aluminium chloride calorimetric assay and Folin-Ciocalteau reagent, respectively. 2,2’-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging method were used to measure antioxidant capacity. The rhizome contained high moisture content and low level of carbohydrate and energy. 6-gingerol was the most abundant component in the selected ginger, and total flavonoid and phenolic content were reported to be 3.66±0.45 mg gallic acid/g and 10.22±0.87 mg quercetin/g of dry weight of rhizome, respectively. The rhizome also showed lower antioxidant activity than controls, with the IC 50 value of 46.5 vs. 15.5 for α-tocopherol and 22 for BHT. The results of this study predicted that the young ginger rhizome originated from Malaysia may exhibit anti-oxidative and anti-inflammatory potentials due to high levels of gingerols, total flavonoid and phenolic compounds and antioxidant capacity.
    Matched MeSH terms: Carbohydrates
  19. Mente A, Dehghan M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al.
    Lancet Diabetes Endocrinol, 2017 10;5(10):774-787.
    PMID: 28864143 DOI: 10.1016/S2213-8587(17)30283-8
    BACKGROUND: The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries.

    METHODS: We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events.

    FINDINGS: Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all ptrend<0·0001). Higher carbohydrate intake was associated with lower total cholesterol, LDL cholesterol, and ApoB, but also with lower HDL cholesterol and ApoA1, and higher triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ApoB-to-ApoA1 ratio (all ptrend<0·0001, apart from ApoB [ptrend=0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol.

    INTERPRETATION: Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk.

    FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments).

    Matched MeSH terms: Dietary Carbohydrates/adverse effects
  20. Swaminathan S, Dehghan M, Raj JM, Thomas T, Rangarajan S, Jenkins D, et al.
    BMJ, 2021 02 03;372:m4948.
    PMID: 33536317 DOI: 10.1136/bmj.m4948
    OBJECTIVE: To evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study.

    DESIGN: Prospective cohort study.

    SETTING: PURE study in 21 countries.

    PARTICIPANTS: 148 858 participants with median follow-up of 9.5 years.

    EXPOSURES: Country specific validated food frequency questionnaires were used to assess intakes of refined grains, whole grains, and white rice.

    MAIN OUTCOME MEASURE: Composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios were estimated for associations of grain intakes with mortality, major cardiovascular events, and their composite by using multivariable Cox frailty models with random intercepts to account for clustering by centre.

    RESULTS: Analyses were based on 137 130 participants after exclusion of those with baseline cardiovascular disease. During follow-up, 9.2% (n=12 668) of these participants had a composite outcome event. The highest category of intake of refined grains (≥350 g/day or about 7 servings/day) was associated with higher risk of total mortality (hazard ratio 1.27, 95% confidence interval 1.11 to 1.46; P for trend=0.004), major cardiovascular disease events (1.33, 1.16 to 1.52; P for trend<0.001), and their composite (1.28, 1.15 to 1.42; P for trend<0.001) compared with the lowest category of intake (<50 g/day). Higher intakes of refined grains were associated with higher systolic blood pressure. No significant associations were found between intakes of whole grains or white rice and health outcomes.

    CONCLUSION: High intake of refined grains was associated with higher risk of mortality and major cardiovascular disease events. Globally, lower consumption of refined grains should be considered.

    Matched MeSH terms: Dietary Carbohydrates/adverse effects*
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