Article

Proximate, Mineral and Procyanidin Content of Certain Foods and Beverages Consumed by the Kuna Amerinds of Panama

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Abstract

The Kuna Amerinds reside chiefly in the San Blas islands (Kuna Yala) on the Caribbean coast of Panama. The diet of this population has not previously been described in detail and composition data for certain foods consumed by this population does not exist or is lacking for certain important nutrients. The protein, fat, moisture, fiber, sugar, mineral and procyanidin content was determined in foods selected because of the frequency with which they are consumed by this population. For that reason, emphasis was given to Tule Masi, a typical Kuna stew-like dish, and cocoa-containing beverages. The foods analyzed were generally low in fat and protein. Potassium and magnesium are present in Tule Masi, common beverages and certain fruits and vegetables at significant levels when considering the preliminary reports on the daily intake of these foods. In addition, preliminary reports indicate that salt use is common, an observation that is supported by the sodium content of the Tule Masi. The cocoa and cocoa beans used in the preparation of beverages are rich in several minerals and procyanidins, as expected. This analysis will allow for the estimation of nutrient intake and subsequent investigations into the relationship between diet and health in this population.

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... We employed both standard dietary assessment instruments and developed new instruments tailored to the Kuna (7,8). We recognized the importance of involving our Kuna colleagues in all aspects of the study. ...
... They begin drinking cocoa when they are weaned and seem to stop drinking cocoa only when they die. From our surveys collected over time, we have consistently observed that the Kuna drink more than five cups of cocoa daily (7,8). Kuna cocoa sources (home-grown and Columbian cocoa powder) were shown to be high in certain flavonoids, especially the flavanols and procyanidins (7,8). ...
... From our surveys collected over time, we have consistently observed that the Kuna drink more than five cups of cocoa daily (7,8). Kuna cocoa sources (home-grown and Columbian cocoa powder) were shown to be high in certain flavonoids, especially the flavanols and procyanidins (7,8). We estimate that the Kuna consume approximately 1,880 mg per day. ...
Article
The Kuna Indians, who reside in an archipelago on the Caribbean Coast of Panama, have very low blood pressure (BP) levels, live longer than other Panamanians, and have a reduced frequency of myocardial infarction, stroke, diabetes mellitus, and cancer-at least on their death certificates. One outstanding feature of their diet includes a very high intake of flavanol-rich cocoa. Flavonoids in cocoa activate nitric oxide synthesis in healthy humans. The possibility that the high flavanol intake protects the Kuna against high BP, ischemic heart disease, stroke, diabetes mellitus, and cancer is sufficiently intriguing and sufficiently important that large, randomized controlled clinical trials should be pursued.
... We learned that Kuna still residing in their indigenous location in the San Blas islands drank cocoa, all locally grown, as their major source of fluid. The cocoa proved to be flavanol-rich [22]. The flavonoids were shown to cause the activation of nitric oxide synthase in healthy volunteers and patients with atherosclerosis [23,24]. ...
... As only Kuna Indians can own land in the San Blas and all but a very small fraction of the residents are Kuna Indians, this allowed us to compare a population characterized by a very high sustained flavonoid intake with another population in which flavonoid intake is more variable, on average much lower. Cocoa obtained in the mainland from grocery stores is flavanol-poor [18,22]. Because there are many risk factors for each of these processes and because death certificates contain little information on risk beyond age and to avoid potentially spurious evidence on risk, we prespecified that a significant outcome from this study would demonstrate a lower frequency of 4 processes in the San Blas --ischemic heart disease, stroke, diabetes mellitus, and cancer. ...
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Substantial data suggest that flavonoid-rich food could help prevent cardiovascular disease and cancer. Cocoa is the richest source of flavonoids, but current processing reduces the content substantially. The Kuna living in the San Blas drink a flavanol-rich cocoa as their main beverage, contributing more than 900 mg/day and thus probably have the most flavonoid-rich diet of any population. We used diagnosis on death certificates to compare cause-specific death rates from year 2000 to 2004 in mainland and the San Blas islands where only Kuna live. Our hypothesis was that if the high flavanoid intake and consequent nitric oxide system activation were important the result would be a reduction in the frequency of ischemic heart disease, stroke, diabetes mellitus, and cancer--all nitric oxide sensitive processes. There were 77,375 deaths in mainland Panama and 558 deaths in the San Blas. In mainland Panama, as anticipated, cardiovascular disease was the leading cause of death (83.4 +/- 0.70 age adjusted deaths/100,000) and cancer was second (68.4 +/- 1.6). In contrast, the rate of CVD and cancer among island-dwelling Kuna was much lower (9.2 +/- 3.1) and (4.4 +/- 4.4) respectively. Similarly deaths due to diabetes mellitus were much more common in the mainland (24.1 +/- 0.74) than in the San Blas (6.6 +/- 1.94). This comparatively lower risk among Kuna in the San Blas from the most common causes of morbidity and mortality in much of the world, possibly reflects a very high flavanol intake and sustained nitric oxide synthesis activation. However, there are many risk factors and an observational study cannot provide definitive evidence.
... The determinants of this effect seem to be predominantly environmental rather than genetic, given that this protection is lost on migration of Kuna Indians to Panama City (48). It has been reported that the typical Kuna diet includes 3 to 4 cups a day of a cocoa beverage (8-10 ounces per cup) made from locally grown cacao that is particularly high in flavanols and procyanidins (50). If one uses an estimate of 30 g of cocoa powder per cup (51,52), 3 to 4 cups of cocoa beverage represents an intake of 1764-2352 mg=day of flavanols and procyanidins (50,53). ...
... It has been reported that the typical Kuna diet includes 3 to 4 cups a day of a cocoa beverage (8-10 ounces per cup) made from locally grown cacao that is particularly high in flavanols and procyanidins (50). If one uses an estimate of 30 g of cocoa powder per cup (51,52), 3 to 4 cups of cocoa beverage represents an intake of 1764-2352 mg=day of flavanols and procyanidins (50,53). Supporting the idea that the low incidence of hypertension of the islanders is due in part to their high-flavanol diets is the observation that when Kuna move to the mainland, they typically develop age-related hypertension (49,54), which cannot be explained from an increase in added salt in the diet as this intake, along with added sugars, is reduced compared to the islander diet. ...
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Advancing age is an independent major risk factor for cardiovascular disease (CVD). Age-associated impairments in the control of inflammation, excessive oxidative stress, and reduced cellular repair can all contribute to the development and progression of CVD. Current recommendations for both the primary and secondary prevention of CVD promote lifestyle modifications that include the adoption of healthy dietary patterns, such as the consumption of diets rich in plant foods, as these have been associated with a lower lifetime risk for the development of CVD. The potential for a diet rich in plant foods to be cardiovascular protective is also supported by prospective studies that suggest the intake of foods providing high amounts of certain phytochemicals, in particular flavanols and procyanidins, reduce the risk for CVD. These observations are further supported by a number of dietary intervention trials that show improvements in vascular function and reduced platelet reactivity following the consumption of high flavanol foods. In the current article we review a selection of these studies, and comment on some of the potential mechanisms that have been postulated to underlie the health effects of flavanol and procyanidin-rich foods.
... In Samoa, relating the psychosocial factors to BP rise was complicated by the complexity of Samoans' acculturation, which included not only a major shift in diet, but also large increases in body weight and adiposity and very large increases in salt intake. 15 In the Kuna, there are important shifts in diet 16 but no increase in body weight or adiposity and no change in salt intake. 10 There are important cultural factors: virtually no Samoans reported feeling anxious, for example 15 ; in contrast, anxiety was a common feature in the positive responses to the mental questions in the Kuna both in the island community and the Panama City suburb, if one accepts a complaint about tending to worry a lot as a sign of anxiety. ...
... Although stress remains an elusive quality to measure, the use of judiciously selected quality-of-life scales, along with instruments designed to examine emotional status and physical symptoms, can provide a useful index for assessing the contribution of these factors to the BP rise that occurs with migration. Our hypothesis is that diet plays the major role in the BP rise, perhaps via the effect of flavanoid-rich cocoa on nitric oxide synthesis, 16,19 but that stress acts as an amplifier in selected individuals. A successful study will have to be designed to make it possible to assess these factors and their interaction. ...
Article
Is migration from isolated indigenous island communities to Panama City associated with an increase in stress? Individuals were randomly sampled from two Kuna communities: 325 individuals in Panama City and 133 on a Caribbean island. Stress was assessed through the Milcom questionnaire, which explores physical symptoms and symptoms relevant to mood and emotional state, and Cantril's ladder, which examines life satisfaction. Physical symptoms were more common in the urban community (p < 0.001), and complaints reflecting mood were also significantly higher on the mainland (p < 0.001); the two measures were highly correlated. While systolic and diastolic blood pressure was higher in the mainland community (p < 0.001), there was no relation between blood pressure level and any index of stress. Despite unambiguous evidence of an increase in stress in migrants to the city, there was no indication that the stress contributed to the rise in blood pressure level. Migration to an urban setting is associated with an increase in physical symptoms and symptoms reflecting depressed mood, suggesting increased stress level. Life satisfaction is less influenced, possibly providing a measure of the degree of stress.
... CO2 analysis was done using CO2 analyzer [24]. Where CO2 analyzer consist of 2 probes where probe 1 is used for measuring CO2 and temperature measurement probe 2 is used to measure the humidity and dew point where the samples stored in PET bottles were exposed to the probe the digital meter in the CO2 analyzer automatically detects the % of dissolved CO2 in the head space. ...
Article
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The present study was conducted with the objective of utilizing new varieties of guava (BAARI Payera-4) fruit in the production of carbonated drinks and also evaluation of different properties such as physico-chemical and sensory characteristics with respect to the different guava juice concentrations (10%, 15%, and 20% of juice) and TSS (10°, 12° and 15° Brix), respectively. This variety is selected for the preparation of carbonated fruit drinks because of its refreshing acidic taste, seedless with good keeping quality and also delicious fruit with good aroma. The extracted fruit juice subjected to carbonation. The physicochemical factors such as viscosity, TSS, acidity, pH, color, ascorbic acid, volume of CO2 and sugars were studied and the changes were observed. The sensory evaluation study was done with hedonic scale to find the best combination of juice concentration and TSS. The obtained results of physiochemical parameters showed that guava juice level at 20% with 12°Bx (Sample T6) had received highest ascorbic acid 28.87 mg/100g, high acidity 0.51%, high color value ΔE 4.60 and highest volume of CO2. Data also revealed that sample T6 found to be superior among all with respect to sensory qualities such as color, flavor, appearance, taste and overall acceptability. In conclusion, the overall assessment pointed that the resulting carbonated drinks developed from BARI Payera-4, sample T6 was best for all physicochemical characteristics and, in general, resulted in good sensory behavior, indicating that it could be a promising alternative to synthetic soft drinks.
... The factors involved are clearly environmental, rather than genetic, as this protection is lost on migration to urban Panama City [6]. One possible contributor is dietary: the indigenous Kuna living in the San Blas drink large amounts of cocoa rich in a subclass of flavonoids known as flavanols [7]. ...
Article
Consumption of flavonoid-rich beverages, including tea and red wine, has been associated with a reduction in coronary events, but the physiological mechanism remains obscure. Cocoa can contain extraordinary concentrations of flavanols, a flavonoid subclass shown to activate nitric oxide synthase in vitro. To test the hypothesis that flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in humans. The study prospectively assessed the effects of Flavanol-rich cocoa, using both time and beverage controls. Participants were blinded to intervention; the endpoint was objective and blinded. Pulse wave amplitude was measured on the finger in 27 healthy people with a volume-sensitive validated calibrated plethysmograph, before and after 5 days of consumption of Flavanol-rich cocoa [821 mg of flavanols/day, quantitated as (-)-epicatechin, (+)-catechin, and related procyanidin oligomers]. The specific nitric oxide synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) was infused intravenously on day 1, before cocoa, and on day 5, after an acute ingestion of cocoa. Four days of flavanol-rich cocoa induced consistent and striking peripheral vasodilation (P = 0.009). On day 5, pulse wave amplitude exhibited a large additional acute response to cocoa (P = 0.01). L-NAME completely reversed this vasodilation (P = 0.004). In addition, intake of flavanol-rich cocoa augmented the vasodilator response to ischemia. Flavanol-poor cocoa induced much smaller responses (P = 0.005), and none was induced in the time-control study. Flavanol-rich cocoa also amplified the systemic pressor effects of L-NAME (P = 0.005). In healthy humans, flavanol-rich cocoa induced vasodilation via activation of the nitric oxide system, providing a plausible mechanism for the protection that flavanol-rich foods induce against coronary events.
... No rise in blood pressure with age has been described in Kuna Indians, as well [44,45], a small population of Amerinds living in the San Blas island chain off the Coast of Panama. Besides their active lifestyle, they drink large amounts of cocoa, rich in flavonoids [46]. This demonstrates that a In the present study, estimates of BP at rest were based on an average of two pressure readings during a single visit. ...
Article
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Purpose Today’s children experience an increasing deficiency in physical activity accompanied by increasing evidence of cardiovascular risk factors such as overweight and elevated blood pressure. Therefore, 3-year-old children were included in a controlled prospective study to assess the efficacy of a preventive regular exercise program on blood pressure (BP) regulation and motor skills. Methods 160 children (INT) in 17 nursery schools participated in a regular exercise program. 105 comparable individuals served as controls (CON). BP was measured at rest and during standardized ergometric exercise. Motor testing included jumping, running, and balance skills. Results Prior to intervention, both groups were comparable in all measurements. After 2 years, both groups improved in all tests with significant differences between the two groups. Diastolic BP (dBP) was significantly lower in INT when compared with CON at rest and during standardized exercise (62 ± 11 vs. 68.8 ± 11 mmHg). After 2 years, dBP decreased during exercise in INT when compared with dBP at rest. In contrast, there was an increase in dBP during exercise in CON. INT came off better in balance (195 vs. 139 cm; p < 0.001), jumping (103.9 vs. 83.7 cm; p < 0.001), and 6-m running (2.2 vs. 2.62 s; p < 0.001). Conclusions In very young children, 2 years of regular exercise had beneficial effects on BP at rest and BP regulation during exercise and motor skills. Therefore, children should be encouraged to exercise regularly to prevent cardiovascular risk factors such as arterial hypertension and morbidity and mortality in later life.
... The Kuna Indians of the San Blas islands of Panama consume an average of three 10-ounce cups of cocoa beverage daily, ingesting approximately 1880 mg of procyanidins (39,162). The prevalence of hypertension among the Kuna islanders is very low (2.2%) and blood pressure (BP) does not increase with age (104). ...
Article
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Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks.
... The importance of these biochemicals has been recorded by various scientists (Sreedevi & Chaturvedi, 1993; Mathews et al. 1999; Kalita et al., 2007; Hussain et al., 2009a). Besides these biochemicals, the moisture, fiber, and ash contents and the energy values of individual vegetable and plant species have also been regarded important to the human health and the soil quality (Wahrmund-Wyle et al., 2000; Chevaux et al., 2001; Cummings et al., 2004; Mcsweeney et al., 2005; Hussain et al., 2010a,b). Kohat is a medium sized town in Khyber Pukhtonkhowa Province of Pakistan. ...
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Eight vegetable species viz., Solanum melongena, Trianthema portulacastrum, Abelmoschus esculentus, Spinacia oleracea, Praecitrullus fistulosus, Luffa acutangula, Cucurbita moschata and Cucumis sativus were evaluated for their nutritional values using standard techniques for proximate, macro and micronutrient analysis. In proximate analysis, ash, carbohydrate, proteins, fiber, fats and moisture (both dry and wet) were assayed while Cu, Ni, Zn, Pb, Co, Cd, Fe, Cr, Ca and Na were evaluated in micronutrients analysis using AOAC methods and atomic absorption spectrometric techniques. The species showed variable results in proximate analysis, however, Cucurbita moschata have revealed higher percentage of carbohydrates, fibers, and energy values. The results showed that Trianthema portulacastrum (a wild vegetable) had the highest concentrations of the micronutrients like Cu, Zn, and Fe compared to the other seven species while it had highest concentration of Ca. Proximate and nutrient analysis of such wild and cultivated vegetables can help us to determine the health benefits achieved from their use in marginal communities.
... Bei den Kuna-Indianern, die auf einer Inselkette an der Küste Panamas leben, wird nicht nur selten ein hoher BD gefunden, sondern bei ihnen ist auch mit zunehmendem Alter kein BD-Anstieg nachweisbar [8,9]. Sie trinken jedoch täglich reichliche Mengen Kakao, der reich an Flavonoiden ist [10]. Ergebnisse: Nach der 6-wöchigen Schokoladeneinnahme waren der systolische und diastolische BD in Ruhe niedriger (127 ± 9/84 ± 9 mmHg) als bei der Eingangsuntersuchung (130 ± 11/87 ± 9 mmHg). ...
Article
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Einleitung: Der Blutdruck (BD) kann neben einer medikamentösen Therapie auch durch nichtmedikamentöse Maßnahmen wie Sport und Gewichtsreduktion günstig beeinflusst werden. Ob auch durch polyphenolreiche dunkle Schokolade ein günstiger Effekt auf die BD Regulation erzielt werden kann, sollte in der folgenden Studie untersucht werden. Da insbesondere auch der BD bei Belastung, unabhängig vom BD in Ruhe, besser mit Endorganveränderungen sowie zukünftiger kardiovaskulärer Morbidität und Mortalität assoziiert ist, wurde die Wirkung dunkler Schokolade auf das BD-Verhalten nicht nur in Ruhe, sondern insbesondere auch während körperlicher Belastung untersucht. Methodik: 34 normotensive, gesunde Männer (40 ± 12 Jahre) nahmen täglich 100 g Bitterschokolade (Kakaoanteil 70 %) über einen Zeitraum von 6 Wochen ein. Der BD wurde vor Studienbeginn und nach 6 Wochen in Ruhe sowie während und nach standardisierter submaximaler Belastung auf dem Fahrradergometer (50–100 Watt, Steigerungsstufen 10 Watt/ Minute) gemessen. Ergebnisse: Nach der 6-wöchigen Schokoladeneinnahme waren der systolische und diastolische BD in Ruhe niedriger (127 ± 9/84 ± 9 mmHg) als bei der Eingangsuntersuchung (130 ± 11/87 ± 9 mmHg). Während der Ergometrie (100 Watt) war eine Senkung des systolischen BD von 167 ± 17 auf 162 ± 18 mmHg (p = 0,001) und des diastolischen BD von 87 ± 10 auf 83 ± 11 mmHg (p = 0,011) zu verzeichnen. Das Körpergewicht war nach dem Beobachtungszeitraum unverändert, Schlussfolgerung: Durch regelmäßige Einnahme polyphenolreicher dunkler Schokolade kann nicht nur der BD in Ruhe, sondern insbesondere auch während einer Belastung selbst bei Normotonikern weiter gesenkt werden. Potenzielle Nebenwirkungen wie Gewichtszunahme und Verschlechterung des Lipid- und Glukosestoffwechsels wurden nicht gefunden.
... In contrast to migrated Kuna Indians to urban areas, Kuna Indians living on the San Blas Islands off the coast of Panama show low blood pressure (BP), even with increasing age, and have lower frequency of diabetes mellitus, cancer, and cardiovascular diseases (19). Causal research for this cardiovascular protection focused on environmental factors including nutrition and revealed that island-dwelling Kuna drink daily more than five cups of cocoa with high concentrations of flavanols and procyanidins (19)(20)(21). Starting from evidence based on further research on the vascular effects of CF, the European Food Safety Authority (EFSA) stated Abbreviations: ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blockers; BP, blood pressure (SBP, systolic blood pressure; DBP, diastolic blood pressure); CF, cocoa-derived flavanols; dHGE, dynamic handgrip exercise; FMD, flow-mediated dilation; NIRS, Near-infrared spectroscopy; T2DM, type 2 diabetes mellitus. that CF help to preserve endothelium-dependent vasodilation in healthy populations, if taken in quantities exceeding 200 mg CF daily. ...
Article
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Introduction: Patients with type 2 diabetes mellitus are at high risk to develop vascular complications resulting in high morbidity and mortality. Cocoa flavanols are promising nutraceuticals with possible beneficial vascular effects in humans. However, limited research is currently available on the vascular effects in a diabetic population with inconsistent results. Possible reasons for this inconsistency might be heterogeneity in the given intervention (dose per time and day, single dose vs. split-dose, placebo formula) and the studied population (blood pressure at baseline, duration of diabetes, use of vasoactive antihypertensive and antidiabetic drugs, sex). Therefore, we aimed to develop a randomized, double-blinded, placebo-controlled cross-over trial to investigate whether cocoa flavanols have an acute impact on blood pressure and vascular reactivity in patients with type 2 diabetes with and without arterial hypertension. Methods and Analysis: We will include participants in four groups: (i) patients with type 2 diabetes without arterial hypertension, (ii) patients with type 2 diabetes with arterial hypertension and 1 antihypertensive drug, (iii) non-diabetic participants with essential hypertension and 1 antihypertensive drug, and (iv) healthy controls. All participants will complete the same protocol on both testing days, consuming high-flavanol cocoa extract (790 mg flavanols) or placebo. Macrovascular endothelial function (flow-mediated dilation) and blood pressure will be measured before and after capsule ingestion. Forearm muscle vasoreactivity (near-infrared spectroscopy) and brachial artery blood flow (echo-doppler) will be assessed in response to a dynamic handgrip exercise test after capsule ingestion. Data will be analyzed with a random intercept model in mixed models. Clinical Trial Registration: www.Clinicaltrials.gov , identifier: NCT03722199.
... The importance of these biochemicals has been recorded by various scientists (Sreedevi & Chaturvedi, 1993; Mathews et al. 1999; Kalita et al., 2007; Hussain et al., 2009a). Besides these biochemicals, the moisture, fiber, and ash contents and the energy values of individual vegetable and plant species have also been regarded important to the human health and the soil quality (Wahrmund-Wyle et al., 2000; Chevaux et al., 2001; Cummings et al., 2004; Mcsweeney et al., 2005; Hussain et al., 2010a,b). Kohat is a medium sized town in Khyber Pukhtonkhowa Province of Pakistan. ...
Article
Full-text available
Eight vegetable species viz., Solanum melongena, Trianthema portulacastrum, Abelmoschus esculentus, Spinacia oleracea, Praecitrullus fistulosus, Luffa acutangula, Cucurbita moschata and Cucumis sativus were evaluated for their nutritional values using standard techniques for proximate, macro and micronutrient analysis. In proximate analysis, ash, carbohydrate, proteins, fiber, fats and moisture (both dry and wet) were assayed while Cu, Ni, Zn, Pb, Co, Cd, Fe, Cr, Ca and Na were evaluated in micronutrients analysis using AOAC methods and atomic absorption spectrometric techniques. The species showed variable results in proximate analysis, however, Cucurbita moschata have revealed higher percentage of carbohydrates, fibers, and energy values. The results showed that Trianthema portulacastrum (a wild vegetable) had the highest concentrations of the micronutrients like Cu, Zn, and Fe compared to the other seven species while it had highest concentration of Ca. Proximate and nutrient analysis of such wild and cultivated vegetables can help us to determine the health benefits achieved from their use in marginal communities.
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A large body of evidence supports that the dietary intake of polyphenols - particularly of flavonoids and the specific class of flavonoids named flavanols - might be able to exert some beneficial vascular effects and reduce the risk for cardiovascular morbidity and mortality. The review of epidemiological and mechanistic studies supports the role of flavonoids, particularly cocoa and tea flavanols, in protecting the cardiovascular system against cardiovascular disease. Nevertheless, flavonoids are an heterogeneous group of natural molecules differently represented in fruit and vegetables and definitive data on cardiovascular benefits are lacking. The weakness of the available data include few and very small studies, no crossover designed studies and a wide range of dose and type of flavonoids tested. Thus, although flavonoid-rich foods and beverages are likely to protect cardiovascular system, further research is needed to characterize the mechanism of action on flavanol-rich foods. Long-term clinical trials are also needed to definitively clarify the benefits deriving from long-term consumption of flavanol-rich foods, particularly focussing on the lowest effective levels as well as synergism or antagonistic actions between different classes of flavonoids commonly found in foods.
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Traditional chocolate is derived from the cocoa bean, which is one of the most concentrated sources of flavanols, a subgroup of the natural antioxidant plant compounds called flavonoids. Accumulating evidence from the past 10 years demonstrates that moderate consumption of chocolate, especially dark chocolate, may exert protective effects against the development of cardiovascular disease. Several mechanisms have been proposed to explain this positive influence, including metabolic, antihypertensive, anti-inflammatory, and anti-thrombotic effects, as well as effects on insulin sensitivity and vascular endothelial function. Should these results be confirmed in randomised, controlled, cross-over, multi-dose trials, then the pleasure associated with chocolate consumption might also be justified from health and psychological perspectives. However, since dark chocolate has substantially higher levels of flavonoids than milk chocolate, and milk proteins may inhibit absorption of flavonoids, it might be preferable to consume dark chocolate than the white (milk) variety.
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Epidemiological and medical anthropological investigations suggest that flavanol-rich foods exert cardiovascular health benefits. Endothelial dysfunction, a prognostically relevant key event in atherosclerosis, is characterized by a decreased bioactivity of nitric oxide (NO) and impaired flow-mediated vasodilation (FMD). We show in healthy male adults that the ingestion of flavanol-rich cocoa was associated with acute elevations in levels of circulating NO species, an enhanced FMD response of conduit arteries, and an augmented microcirculation. In addition, the concentrations and the chemical profiles of circulating flavanol metabolites were determined, and multivariate regression analyses identified (–)-epicatechin and its metabolite, epicatechin-7-O-glucuronide, as independent predictors of the vascular effects after flavanol-rich cocoa ingestion. A mixture of flavanols/metabolites, resembling the profile and concentration of circulating flavanol compounds in plasma after cocoa ingestion, induced a relaxation in preconstricted rabbit aortic rings ex vivo, thus mimicking acetylcholine-induced relaxations. Ex vivo flavanol-induced relaxation, as well as the in vivo increases in FMD, were abolished by inhibition of NO synthase. Oral administration of chemically pure (–)-epicatechin to humans closely emulated acute vascular effects of flavanol-rich cocoa. Finally, the concept that a chronic intake of high-flavanol diets is associated with prolonged, augmented NO synthesis is supported by data that indicate a correlation between the chronic consumption of a cocoa flavanol-rich diet and the augmented urinary excretion of NO metabolites. Collectively, our data demonstrate that the human ingestion of the flavanol (–)-epicatechin is, at least in part, causally linked to the reported vascular effects observed after the consumption of flavanol-rich cocoa. • cardiovascular disease • endothelial function • nitric oxide synthase
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Diet patterns are widely recognized as contributors to hypertension. Widely studied potential contributors include intake of sodium, potassium, magnesium, calcium, soluble fiber, omega-3 fatty acids, alcohol, protein, and calories. We add to that list the effect of dietary flavanols present in certain cocoas, which have sufficient activity on vascular nitric oxide to influence blood pressure control. Kuna Indians who live on islands near Panama have little age-related rise in blood pressure or hypertension. On migration to Panama City, blood pressure rises with age, and the frequency of essential hypertension matches urban levels elsewhere. We have identified a specific food that probably makes an important contribution to cardiovascular status. Island-dwelling Kuna drink more than 5 cups of flavanol-rich cocoa per day and incorporate that cocoa into many recipes. Mainland Kuna ingest little cocoa, and what they take is commercially available and flavanol-poor. The flavanol-rich cocoa activates nitric oxide synthase in vitro and in intact humans in the doses that the Kuna employ. Vasodilator responses to flavonoid-rich cocoa are prevented or reversed by the arginine analog, N-nitro-L-arginine methyl ester. Island-dwelling Kuna have a 3-fold larger urinary nitrate:nitrite than do Mainland dwellers. As endothelial dysfunction is central to current thinking on cardiovascular pathophysiology, a food that enhances endothelial function could have broad implications. The list of candidate conditions that might be influenced is impressive, ranging from atherosclerosis and diabetes mellitus to hypertension and preeclampsia, to vascular dementias and end-stage renal disease. The next decade will be interesting.
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A low sodium diet has often been implicated in the protection of low blood pressure populations from hypertension, but several other dietary factors, including those as yet unidentified, may also be involved. The Kuna Indians of Panama are free of hypertension and cardiovascular disease, but this is changing with migration to urban areas. We compared the indigenous diet of Kuna Indians living on remote islands in Panama (Ailigandi), whose lifestyle is largely hunter-gatherer, with those who have moved to a suburb of Panama City (Vera Cruz). Between April and October 1999, members of a Kuna research team administered a 118-item food frequency questionnaire to133 adult Kuna from Ailigandi and 183 from Vera Cruz. Single 24-hour urine collections and nonfasting blood samples were obtained. The Kuna in Ailigandi reported consuming a 10-fold higher amount of cocoa-containing beverages, 4 times the amount of fish, and twice the amount of fruit as urban Kuna (P<0.05 by t test). Salt added was ample among those living in Ailigandi and Vera Cruz according to both self-report (7.1+/-1.1 and 4.6+/-0.3 tsp weekly) and urinary sodium levels (177+/-9 and 160+/-7 mEq Na/g creatinine), respectively. The low blood pressure of island-dwelling Kuna does not seem to be related to a low salt diet. Among dietary factors that varied among migrating Kuna, the notably higher intake of flavanol-rich cocoa is a potential candidate for further study.
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The aim of this study was to characterize the physico-chemical properties of cocoa fibre (CF), to analyze its polyphenolic content and antioxidant capacity in vitro, and to investigate the effect of the administration of a polyphenolic extract of this cocoa fiber on the antioxidant capacity of the serum in rats. Dietary fiber (DF) composition and polyphenolic (PP) content of the cocoa fiber were analyzed. The antioxidant capacity of the CF was determined by means of its reduction power (FRAP) and the capacity to scavenge free radicals (ABTS). To evaluate the bioavailability and the antioxidant capacity in vivo of the phenolic compounds of CF, an extract of these compounds was administred in the stomach of the rats with a gastric probe (100 mg PP/kg), taking blood samples at different time intervals. Sera were analyzed by HPLC to determine the presence/absence of PP or PP-metabolites. In orther to evaluate the antioxidant capacity of the serum FRAP and ABTS methods were used. Cocoa fiber was an excellent source of DF, with a high content of total dietary fiber (TDF), over 60% of the dry matter, made up mainly of insoluble dietary fiber (IDF; 83% of TDF). This fiber had just 1.15% of polyphenols, with low antioxidant activity. After intragastric administration of the PP-rich fraction a fast and measurable absorption of the CF polyphenols was observed, being epicatechin the main PP in blood. The absorption of this PP confers a significant, although transitory increase of the serum antioxidant capacity 10-45 minutes post-gavage; after this time, the antioxidant capacity progressively decreased reaching basal levels after 6 h. Cocoa fiber can be considered as an excellent source of DF, mainly insoluble dietary fiber; therefore, it could be used as an ingredient in fiber-rich functional foods. Besides the benefits derived from its high fiber content, the CF would provide protection against oxidative damage by means of its content in phenolic compounds (epicatechin) wich are absorbed maintaining the antioxidant properties in vivo.
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Cocoa has been consumed for at least 2500 years, and for long time it has been regarded as a medicine. Arterial function is of paramount importance for the proper function and integrity of the cardiovascular system. Dark chocolate and flavonoid-rich cocoa have beneficial acute and short-term effects on endothelial function and wave reflections in normal individuals, in adults with cardiovascular risk factors, and in patients with coronary artery disease. Furthermore, dark chocolate and flavonoid-rich cocoa may have a blood pressure-lowering effect. These effects can be attributed to flavonoids and are mainly mediated through increased nitric oxide bioavailability. Further research is needed to demonstrate whether these effects of chocolate on arterial function are translated into clinical benefit.
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Fruits and vegetables have historically been considered rich sources of essential dietary micronutrients, soluble fiber, and antioxidants. More recently they are have been recognized as important sources for a wide array of phytochemicals that individually, or in combination, may benefit vascular health. Flavonoids are the largest, and most widely distributed class of phytochemicals, and can be further subdivided into several different sub-classes. Several epidemiology studies have observed an inverse association between flavonoid intake and risk of cardiovascular mortality. One sub-class of flavonoids, the flavanols, is found in foods such as grapes, red wine, tea, cocoa and chocolate; however, it is important to note that common food processing practices can significantly reduce the levels of these compounds found in finished food products. Recent studies have examined the potential of flavanol-rich cocoa and chocolates to influence vascular health. In this review, we discuss evidence for the hypothesis that the consumption of flavanol-rich cocoa can reduce the risk for cardiovascular disease through a multiplicity of mechanisms, including changes in oxidant defense mechanisms, vascular reactivity, cytokine production, and platelet function.
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nvestigación realizada en el ámbito de la Toxicología Alimentaria, basándose en los resultados obtenidos por dos encuesta (Doreste 87 y ENLA 2000) sobre Epidemiología Nutricional realizadas en Canarias, y en relación con los grupos de alimentos más consumidos por esta población. Se valoran la concentración de Hg, Pb, Cd, Fe, Cu, Zn y Mn en cada grupo de estos alimentos y además se establece la ingesta dietética de cada metal. Los métodos analíticos fueron realizados por espectrofotometría de absorción atómica. Los resultados obtenidos evidencian que la ingesta en Canarias no supera los PTWI (Provisonal Tolerable Weekly Intake) fijados por la FAO/OMS para los metales incluidos en el estudio e incluso cumplen con la IDR (Ingesta Diaria Recomendable) establecidos para el resto de los metales estudiados.
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The heart of palm is a food extracted from several species of palm trees. Only 10–20% of the raw material is transformed into canned hearts of palm, therefore this agro-industry generates a large quantity of solid residue. The aim of this work was to extract and characterise a juice produced from this solid residue. This extract is compared with the traditional fruit juices (orange and pineapple juices), obtaining higher contents of minerals, such as magnesium (22.80 mg/100 g) and potassium (276.90 mg/100 g), phenolic compounds (gallic, 3,4-dihydroxybenzoic, chlorogenic, syringic and caffeic acids) and high free radical scavenging capacity (expressed as 2,2-diphenyl-1-picrylhydrazyl), which suggest high antioxidant activity. Additionally, a new soft drink was formulated using this king palm juice as its main ingredient. The soft drink samples formulated with this juice had high sensory acceptability and high intention of consumption, which suggests an important and low-cost application for this industrial residue.
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High blood pressure is an important risk factor for cardiovascular disease attributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular related deaths in Western populations. Epidemiological studies suggest that cocoa rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Previous meta-analyses have shown that cocoa-rich foods may reduce blood pressure. Recently additional trials had conflicting results. To determine the effect of flavanol-rich chocolate or cocoa products on blood pressure in people with or without hypertension. We searched the following electronic databases from inception to November 2011: Cochrane Hypertension Group Specialised Register, CENTRAL, MEDLINE and EMBASE. In addition we searched international trial registries, and the reference lists of review articles and included trials. Randomised controlled trials (RCT) investigating the effects of chocolate or cocoa products on systolic and diastolic blood pressure in adults for a minimum of two weeks duration. Two authors independently extracted data and assessed the risk of bias in each trial in consultation with a third author. Random effects meta-analyses on all studies fitting the inclusion criteria were conducted using Review Manager version 5.1 and Stata version 12. Heterogeneity was explored by subgroup analyses and univariate meta-regression analysis of several variables including dosage of flavanol content (total or monomers) in chocolate or cocoa products, blinding, baseline blood pressure, theobromine content, sugar content, body-mass-index (BMI), duration and age. Twenty studies met the inclusion criteria. Meta-analyses of the 20 studies involving 856 mainly healthy participants revealed a statistically significant blood pressure reducing effect of flavanol-rich cocoa products compared with control in short-term trials of 2-18 weeks duration: Mean difference SBP (95%CI): -2.77 (-4.72, -0.82) mm Hg, p=0.005, n=20; mean difference DBP (95%CI): - 2.20 (-3.46, -0.93) mm Hg, p=0.006, n=19 available for DBP.Trials provided participants with 30-1080 mg of flavanols (mean=545.5 mg) in 3.6-105 g of cocoa products per day in the active intervention group. In half of the trials (n=10) the active group consumed 500-750 mg of flavanols per day. The control group received either a flavanol-free product (n=12) or a low-flavanol containing cocoa powder (6.4 and 41 mg flavanols, n=8). Subgroup meta-analysis of trials with a flavanol-free control group revealed a significant blood pressure reducing effect, in contrast to trials using a low-flavanol product in the control group. This analysis may have been confounded by trial duration and the level of blinding of participants.Trial duration was short (mean 4.4 weeks, range 2-8 weeks, n=19, and one trial of 18 weeks). A significant blood pressure reducing effect was evident in trials of 2 weeks duration (n=9), but not in trials of >2 weeks duration (n=11). It is important to note that seven out of the nine trials (78%) of 2 weeks duration also had a flavanol-free control group. Therefore, subgroup analysis by duration might be confounded by flavanol dosage used in the control groups, and the level of blinding of participants.Adverse effects including gastrointestinal complaints and distaste of the trial product were reported by 5% of patients in the active cocoa intervention group and 1% of patients in the control groups. Flavanol-rich chocolate and cocoa products may have a small but statistically significant effect in lowering blood pressure by 2-3 mm Hg in the short term.Our findings are limited by the heterogeneity between trials, which was explored by univariate meta-regression and subgroup analyses. Subgroup meta-analysis of trials using a flavanol-free control group revealed a significant blood pressure reducing effect of cocoa, whereas analysis of trials using a low-flavanol control product did not. While it appears that shorter trials of 2 weeks duration were more effective, analysis may be confounded by type of control and unblinding of participants, as the majority of 2-week trials also used a flavanol-free control and unblinding of participants. Results of these and other subgroup analyses based on, for example, age of participants, should be interpreted with caution and need to be confirmed or refuted in trials using direct randomized comparison.Long-term trials investigating the effect of cocoa products are needed to determine whether or not blood pressure is reduced on a chronic basis by daily ingestion of cocoa. Furthermore, long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products.
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Contrary to a recent deluge of scientific and popular publications, the island-dwelling Kuna people of Ailigandi, San Blas Panama do not consume large amounts of locally derived cacao beverages. This paper introduces new research on the actual consumption of Theobroma cacao among the people of Ailigandi. The chocolate tree, Theobroma cacao, is of great cultural importance for Kuna people, and its fruits are used within multiple contexts as an irreplaceable element of Kuna identity and cultural life. However, cacao cultivation has become dramatically more difficult because of the numerous fungal pathogens that attack the tree. Despite the constraints this has placed on local cacao production, recent studies suggest that Kuna people consume large amounts of local cacao. This research evaluates the livelihood strategies and dietetic intake of the Kuna in a cross-cultural context. Findings suggest that recent studies may have misunderstood the local reality in their depictions of the Kuna people of Ailigandi as prolific consumers of locally derived cacao. Using a methodology that incorporates a local nomenclature, I found that the actual consumption of locally grown cacao among Kuna people is negligible, notwithstanding the claims of researchers whose work is largely funded by an industrial chocolate manufacturer.
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Budu is a fish product which is used as one of the condiments in daily Malaysian dish. As part of a safety evaluation of ingredients for use in everyday dishes, there is a need to determine its nutrient composition and toxicological profile. This study documented its biochemical profile in terms of macronutrients, food additives and heavy metals. The biological activity of budu was investigated in terms of its cytotoxic effects and antioxidant capacity. The macronutrients of budu were determined by proximate analysis. Both budu samples from Bachok and Tumpat, Kelantan showed high moisture contents. Detected food additives were colourants (Sunset Yellow FCF) and preservatives (benzoic acid). Heavy metals (mercury and lead) were not detected in both samples. All parameters in the biochemical profile conformed to the regulations of the Malaysian Food Act 1983. When investigated with the MTT (Microculture Tetrazolium Test) Assay, aqueous extracts of both samples did not exhibit significant cytotoxic effects on HepG2 cells at low (60 μg/ml), moderate (500 μg/ml) or high (2000 μg/ml) concentrations. Weak antioxidant capacities were detected in the aqueous extract of both budu samples by the FRAP (Ferric Reducing Antioxidant Power) Assay. However, this capacity was not significant when the aqueous extract was tested in the presence of HepG2 cells. In conclusion, budu was considered not cytotoxic to HepG2 cells and had weak antioxidant capacities.
Chapter
Cacao trees originated in river valleys of South America and, by the seventh century AD, the Mayan Indians had brought them north into Mexico. Apart from the Mayans, many other Central American Indians including the Aztecs and the Toltecs seem to have at first domesticated and then cultivated cacao trees, and the word chocolate (the beverage) derives from xhocolatl (approximate spelling) or cacahuatl, both originating from the Aztec language. There are several mixtures of cacao described in ancient texts, for ceremonial, medicinal and culinary purposes. Some mixtures included maize, chili, vanilla (Vanilla planifolia), peanut butter and honey. Archaeological evidence of the use of cacao, while relatively sparse, has come from the recovery of whole cacao beans in Uaxactun, Guatemala and from the preservation of wood fragments of the cacao tree at the Belize sites (ex British Honduras). In addition, analysis of residues from ceramic vessels has found traces of theobromine and caffeine in early formative vessels from Puerto Escondido, Honduras (1100-900 BC) and in middle formative vessels from Colha, Belize (600-400 BC) [1], [2].
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Experimental and clinical evidences reported that polyphenols-rich natural products, like nutraceuticals and food supplements, may offer opportunities for prevention and treatment of type 2 diabetes, due to their biological properties. Natural products have been suggested to modulate the carbohydrate metabolism by various mechanisms, such as restoring beta-cells integrity and physiology, enhancing insulin releasing activity, and the glucose using. The endothelium plays a pivotal role in the arterial homeostasis, and insulin resistance is the most important pathophysiological feature in various prediabetic and diabetic states. Reduced nitric oxide bioavailability with endothelial dysfunction is considered the earliest step in the pathogenesis of atherosclerosis. Further, insulin resistance could account, at least in part, for the endothelial dysfunction. Endothelial dysfunction has been considered an important and independent predictor of future development of cardiovascular risk and events. Cocoa and flavonoids from cocoa might positively modulate these mechanisms with a putative role in cardiometabolic protection.
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Every company can point to a growth strategy. Far fewer, however, systematically implement them; instead, they spend their time on incremental innovations, or rely on acquisitions. Organic, internal growth, accomplished through product line renewal and new service development, is essential to the long-term vitality of corporations across all industries. This book takes on the challenge large corporations have in generating internal innovation-developing new product lines that address new market applications and provide the corporation with new streams of revenue. It integrates the key disciplines-new product strategy, user research, concept development and prototyping, market testing, and business modeling-needed for enterprise growth. The book illustrates its framework with in-depth examples of companies that have leveraged their core technologies to new markets and new types of uses in order to generate impressive results, including IBM, Honda, and Mars. Many of these examples contain templates that readers can use in their own projects. The book ends by addressing the human side of new market applications, providing advice on what executives and innovation team leaders must do to execute the steps of the book's framework for new market applications development.
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Epidemiological studies reported an inverse relationship between flavonoid ingestion and cardiovascular disease. In our studies, short-term administration of flavonoid-rich dark chocolate significantly improved insulin sensitivity and endothelial function in healthy and hypertensive subjects. Because insulin sensitivity is also dependent on nitric oxide bioavailability, the effects offlavonoids on vascular function and insulin resistance might also be linked from a mechanistic point of view. Nevertheless, although cocoa-based products seem to offer fascinating health benefits from foods, before recommending chocolate ingestion in usual diet, critical attention must be paid to the flavanol content and to the balance between benefits and calories.
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Fifty different vegetables included in daily schedule of diet and sold in the biggest supermarkets of Lithuania were analyzed for their nutritional values using standard techniques. In proximate analysis ash, fibre, proteins, fats and moisture were assayed and energetic values were calculated. The vegetable species showed variable results in proximate analysis, but all of investigated vegetables contributed to nutrition values. Moisture content was high ranging from 66.10% in garlic to 96.32% in celery. Crude protein, crude fibre, crude fats and ash were in range from 0.03 to 7.41%, 0.06 to 1.86%, 0.03 to 0.77% and 2.89 to 17.31% respectively. The results showed that almost all vegetables contain appreciable amount of essential nutrients.
Chapter
Cocoa and chocolate have a rich history of use as both a medicine and a vehicle to deliver other medicines. This was, and still is in some communities, in the context of a traditional medicine popular in Central America. In addition, many of these uses were transferred and modified for approximately four centuries in Europe after New World contact. Interestingly, chocolate was consumed predominantly as a beverage; its now-familiar solid format appeared later as a result of food manufacturing innovation in Europe during the 19th century. However, the standard cocoa and chocolate beverage formats we are familiar with bear little, if any, resemblance to the recipes developed by ancient Central Americans. Dillinger et al. (1) convincingly illustrate the versatility of cocoa and chocolate as medical and nutritional uses in their research. As shown in Table 1, the number of different indications, multiplied by different preparations in the accompanying text, is impressive. Continuing research by Dillinger et al. and others on the use of these products by the native populations before European contact may provide additional and important insights on cocoa’s cultural origins and geographical aspects and its medical uses (L. Grivetti and H. Yana-Shapiro, personal communication).
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Diabetes is one of the world’s leading causes of mortality. Failure to control diabetes could lead to the development of peripheral vascular and cardiovascular complications. In vitro and animal studies suggest that polyphenols in cocoa and chocolate have the potential to protect against diabetes and diabetes-related complications via a variety of molecular and physiological mechanisms. However, data from human and epidemiological studies remain limited. Further research is required before a definite role for polyphenol-rich cocoa or chocolate in preventing and managing diabetes-related complications is established.
Chapter
Flavanol-rich chocolate and cocoa products may have a small but significant effect on blood pressure. The blood pressure–reducing effect of cocoa is more pronounced in systolic hypertension than systolic prehypertension and normotension, but is independent of diastolic status. Even a small daily dosage of cocoa flavanols (e.g., 6 g of dark chocolate) appears to have a beneficial effect on blood pressure. Higher sugar content in chocolate appears to attenuate the blood pressure–lowering effect of cocoa, particularly in overweight and obese individuals. Our analysis indicates cocoa to be more effective in reducing blood pressure in younger individuals in the short term compared with older individuals.
Chapter
Background: High blood pressure is an important risk factor for cardiovascular disease, contributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular-related deaths in Western populations. Epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Here we update previous meta-analyses on the effect of cocoa on blood pressure. Objectives: To assess the effects on blood pressure of chocolate or cocoa products versus low-flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer. Search methods: This is an updated version of the review initially published in 2012. In this updated version, we searched the following electronic databases from inception to November 2016: Cochrane Hypertension Group Specialised Register, CENTRAL, MEDLINE and Embase. We also searched international trial registries, and the reference lists of review articles and included trials. Selection criteria: Randomised controlled trials (RCTs) investigating the effects of chocolate or cocoa products on systolic and diastolic blood pressure in adults for a minimum of two weeks duration. Data collection and analysis: Two review authors independently extracted data and assessed the risks of bias in each trial. We conducted random-effects meta-analyses on the included studies using Review Manager 5. We explored heterogeneity with subgroup analyses by baseline blood pressure, flavanol content of control group, blinding, age and duration. Sensitivity analyses explored the influence of unusual study design. Main results: Thirty-five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, we added 17 trials (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review.Trials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. The control group received either a flavanol-free product (n = 26 treatment comparisons) or a low-flavanol-containing cocoa powder (range 6.4 to 88 mg flavanols (mean = 55 mg, 13 treatment comparisons; 259 mg, 1 trial).Meta-analyses of the 40 treatment comparisons involving 1804 mainly healthy participants revealed a small but statistically significant blood pressure-reducing effect of flavanol-rich cocoa products compared with control in trials of two to 18 weeks duration (mean nine weeks):Mean difference systolic blood pressure (SBP) (95% confidence interval (CI): -1.76 (-3.09 to -0.43) mmHg, P = 0.009, n = 40 treatment comparisons, 1804 participants;Mean difference diastolic blood pressure (DBP) (95% CI): -1.76 (-2.57 to -0.94) mmHg, P < 0.001, n = 39 treatment comparisons, 1772 participants.Baseline blood pressure may play a role in the effect of cocoa on blood pressure. While systolic blood pressure was reduced significantly by 4 mmHg in hypertensive people (n = 9 treatment comparisons, 401 participants), and tended to be lowered in prehypertensive people (n= 8 treatment comparisons, 340 participants), there was no significant difference in normotensive people (n = 23 treatment comparisons, 1063 participants); however, the test for subgroup differences was of borderline significance (P = 0.08; I(2) = 60%), requiring further research to confirm the findings.Subgroup meta-analysis by blinding suggested a trend towards greater blood pressure reduction in unblinded trials compared to double-blinded trials, albeit statistically not significant. Further research is needed to confirm whether participant expectation may influence blood pressure results. Subgroup analysis by type of control (flavanol-free versus low-flavanol control) did not reveal a significant difference.Whether the age of participants plays a role in the effect of cocoa on blood pressure, with younger participants responding with greater blood pressure reduction, needs to be further investigated.Sensitivity analysis excluding trials with authors employed by trials sponsoring industry (33 trials, 1482 participants) revealed a small reduction in effect size, indicating some reporting bias.Due to the remaining heterogeneity, which we could not explain in terms of blinding, flavanol content of the control groups, age of participants, or study duration, we downgraded the quality of the evidence from high to moderate.Results of subgroup analyses should be interpreted with caution and need to be confirmed or refuted in trials using direct randomised comparisons.Generally, cocoa products were highly tolerable, with adverse effects including gastrointestinal complaints and nausea being reported by 1% of participants in the active cocoa intervention group and 0.4% of participants in the control groups (moderate-quality evidence). Authors' conclusions: This review provides moderate-quality evidence that flavanol-rich chocolate and cocoa products cause a small (2 mmHg) blood pressure-lowering effect in mainly healthy adults in the short term.These findings are limited by the heterogeneity between trials, which could not be explained by prespecified subgroup analyses, including blinding, flavanol content of the control groups, age of participants, or study duration. However, baseline blood pressure may play a role in the effect of cocoa on blood pressure; subgroup analysis of trials with (pre)hypertensive participants revealed a greater blood pressure-reducing effect of cocoa compared to normotensive participants with borderline significance.Long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products.
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Previous studies with plant sterols (PS) and cocoa flavanols (CF) provide support for their dietary use in maintaining cardiovascular health. This double-blind, placebo-controlled, cross-over study evaluated the efficacy of daily consumption of a cocoa flavanol-containing dark chocolate bar with added PS on serum lipids, blood pressure, and other circulating cardiovascular health markers in a population with elevated serum cholesterol. We recruited 49 adults (32 women, 17 men) with serum total cholesterol concentrations of 5.20-7.28 mmol/L and blood pressure of < or = 159/99 mm Hg. Following a 2-wk lead-in utilizing the AHA style diet, participants were randomized into 2 groups and instructed to consume 2 cocoa flavanol-containing dark chocolate bars per day with (1.1 g sterol esters per bar) or without PS. Each 419-kJ bar was nutrient-matched and contained approximately 180 mg CF. Participants consumed 1 bar 2 times per day for 4 wk then switched to the other bar for an additional 4 wk. Serum lipids and other cardiovascular markers were measured at baseline and after 4 and 8 wk. Blood pressure was measured every 2 wk. Regular consumption of the PS-containing chocolate bar resulted in reductions of 2.0 and 5.3% in serum total and LDL cholesterol (P < 0.05), respectively. Consumption of CF also reduced systolic blood pressure at 8 wk (-5.8 mm Hg; P < 0.05). Results indicate that regular consumption of chocolate bars containing PS and CF as part of a low-fat diet may support cardiovascular health by lowering cholesterol and improving blood pressure.
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Cocoa butter is the major commercial product from seeds of Theobroma cacao (cacao). However, most cacao breeding programs have only considered as selection criteria total seed yield per plant and disease resistance. Progress in cocoa butter yield might be possible if variability for fat content exists and its associations with the other production components are established. The average fat content in dry unfermented seeds for 490 accessions of the Centro de Pesquisa do Cacau germplasm collection in Ilhéus, Bahia, Brazil was 53.2%, ranging from 45.4% in CC 57 to 60.3% in NA 312. Fat content averaged over series indicated that genotypes originally collected in the Upper Amazonian region had higher fat levels, while the Trinitario-Criollo and Bahian genotypes tended to have lower fat content. When considering total fat yield plant^-1 an opposite trend arose with the series with low fat content having the highest total fat yield. The correlation between fat content and fat yield plant^-1 was not significant, while there was a significant negative correlation between dry seed yield plant^-1 and fat content. Despite the significant negative association between fat content and dry seed yield plant^-1, the correlation coefficient was rather low, and genotypes could be identified with both high fat content and dry seed yield. A significant pollen effect on fat content was observed based on a complete diallel crossing scheme between three genotypes with high and three with low levels. The average fat content values in progenies were similar to the average of the parents, and the segregation range transgressed the distribution of the parents.
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Monomeric and oligomeric procyanidins present in cocoa liquors and chocolates were separated and quantified in four different laboratories using a normal-phase high-performance liquid chromatography (HPLC) method with fluorescence detection. Procyanidin standards through decamers were obtained by extraction from cocoa beans, enrichment by Sephadex LH-20 gel permeation chromatography, and final purification by preparative normal-phase HPLC. The purity of each oligomeric fraction was assessed using HPLC coupled to mass spectrometry. A composite standard was then prepared, and calibration curves were generated for each oligomeric class using a quadratic fit of area sum versus concentration. Results obtained by each of the laboratories were in close agreement, which suggests this method is reliable and reproducible for quantification of procyanidins. Furthermore, the procyanidin content of the samples was correlated to the antioxidant capacity measured using the ORAC assay as an indicator for potential biological activity. Keywords: HPLC; procyanidins; cocoa; chocolate; quantification; antioxidant
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Epidemiologic studies have shown inverse associations between dietary polyphenols and mortality from coronary heart disease. However, the basis for this protective association is uncertain. Food polyphenols reportedly have antioxidant properties and decrease platelet function in vitro. This study sought to evaluate whether consumption of a polyphenol-rich cocoa beverage modulates human platelet activation and primary hemostasis. Peripheral blood was obtained from 30 healthy subjects before and 2 and 6 h after ingestion of a cocoa beverage (n = 10), a caffeine-containing control beverage (n = 10), or water (n = 10). Platelet activation was measured in terms of expression of activation-dependent platelet antigens and platelet microparticle formation by using fluorescent-labeled monoclonal antibodies and flow cytometry. Primary platelet-related hemostasis was measured with a platelet function analyzer. Ex vivo epinephrine- or ADP-stimulated expression of the fibrinogen-binding conformation of glycoprotein IIb-IIIa was lower 2 and 6 h after consumption of cocoa than before consumption. Cocoa consumption also decreased ADP-stimulated P-selectin expression. In contrast, epinephrine-induced platelet glycoprotein IIb-IIIa expression increased after consumption of the caffeine-containing beverage but not after water consumption. Platelet microparticle formation decreased 2 and 6 h after cocoa consumption but increased after caffeine and water consumption. Primary hemostasis in response to epinephrine in vitro was inhibited 6 h after cocoa consumption. The caffeine-containing beverage inhibited ADP-induced primary hemostasis 2 and 6 h after consumption. Cocoa consumption suppressed ADP- or epinephrine-stimulated platelet activation and platelet microparticle formation. Cocoa consumption had an aspirin-like effect on primary hemostasis.
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A joint AOAC/AACC (American Association of Cereal Chemists) collaborative study of methods for the determination of soluble, insoluble, and total dietary fiber (SDF, IDF, and TDF) was conducted with 11 participating laboratories. The assay Is based on a modification of the AOAC TDF method 985.29 and the SDF/IDF method collaboratively studied recently by AOAC. The principles of the method are the same as those for the AOAC dietary fiber methods 985.29 and 991.42, Including the use of the same 3 enzymes (heat-stable α-amylase, protease, and amyloglucosldase) and similar enzyme Incubation conditions. In the modification, minor changes have been made to reduce analysis time and to Improve assay precision: (1) MES-TRIS buffer replaces phosphate buffer; (2) one pH adjustment step Is eliminated; and (3) total volumes of reaction mixture and filtration are reduced. Eleven collaborators were sent 20 analytical samples (4 cereal and grain products, 3 fruits, and 3 vegetables) for duplicate blind analysis. The SDF, IDF, and TDF content of the foods tested ranged from 0.53 to 7.17, 0.59 to 60.53, and 1.12 to 67.56 g/100 g, respectively. The respective average RSDR values for SDF, IDF, and TDF determinations by direct measurements were 13.1, 5.2, and 4.5%. The TDF values calculated by summing SDF and IDF were in excellent agreement with the TDF values measured independently. The modification did not alter the method performance with regard to mean dietary fiber values, yet It generated lower assay variability compared with the unmodified methods. The method for SDF, IDF, and TDF (by summing SDF and IDF) has been adopted first action by AOAC International.
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Objective. —To assess the effects of supplementation with oral potassium on blood pressure in humans.Design. —Meta-analysis of randomized controlled trials.Data Sources. —English-language articles published before July 1995.Study Selection. —Thirty-three randomized controlled trials (2609 participants) in which potassium supplementation was the only difference between the intervention and control conditions.Data Extraction. —Using a standardized protocol, 2 of us independently abstracted information on sample size, duration, study design, potassium dose, participant characteristics, and treatment results.Results. —By means of a random-effects model, findings from individual trials were pooled, after results for each trial were weighted by the inverse of its variance. An extreme effect of potassium in lowering blood pressure was noted in 1 trial. After exclusion of this trial, potassium supplementation was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic blood pressure of-3.11 mm Hg (-1.91 to-4.31 mm Hg) and-1.97 mm Hg (-0.52 to-3.42 mm Hg), respectively. Effects of treatment appeared to be enhanced in studies in which participants were concurrently exposed to a high intake of sodium.Conclusions. —Our results support the premise that low potassium intake may play an important role in the genesis of high blood pressure. Increased potassium intake should be considered as a recommendation for prevention and treatment of hypertension, especially in those who are unable to reduce their intake of sodium.
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A multitude of methods exists at present for the solubilization of biological tissues for atomic absorption analysis. We have examined several common methods of wet ashing using NBS bovine liver in order to determine which acids, acid combinations, or bases should be used as digesting agents for accurate and precise measurement of iron, copper, zinc, and manganese. Nitric acid proved to be the most effective wet ashing agent. With nitric acid, mean concentrations for iron, copper, and zinc differed from NBS certified values by less than 1.5% while those for manganese differed by 4%.
Article
The content of the potentially anticarcinogenic flavonoids quercetin, kaempferol, myricetin, apigenin, and luteolin of 28 vegetables and 9 fruits was determined by RP-HPLC with UV detection. Fresh foods were purchased in a supermarket, agrocery, and a street market and combined to composites. Processed foods were purchased additionally. Sampling was carried out in spring, summer, winter, and spring of the following year. Quercetin levels in the edible parts of most vegetables were generally below 10 mg/kg except for onions (284-486 mg/kg), kale (110 mg/kg), broccoli (30 mg/kg), French beans (32-45 mg/kg), and slicing beans (28-30 mg/kg). Kaempferol could only be detected in kale (211 mg/kg), endive (15-91 mg/kg), leek (11-56 mg/kg), and turnip tops (31-64 mg/kg). In most fruits the quercetin content averaged 15 mg/kg, except for different apple varieties in which 21-72 mg/kg was found. The content of myricetin, luteolin, and apigenin was below the limit of detection (
Article
Mitochondrial DNA (mtDNA) haplotype diversity was determined for 63 Chibcha-speaking Kuna Amerinds sampled widely across their geographic range in eastern Panamá. The Kuna data were compared with mtDNA control region I sequences from two neighboring Chibchan groups, the Ngöbé and the Huetar; two Amerind groups located at the northern and southern extremes of Amerind distribution, the Nuu-Chah-Nulth of the Pacific Northwest and the Chilean Mapuche; and with a single Na-Dene group, the Haida of the Pacific Northwest. The Kuna exhibited low levels of mitochondrial diversity as had been reported for the other two Chibchan groups and, furthermore, carried only two of the four Amerind founding lineages first reported by Schurr and coworkers (Am. J. Hum. Genet. 1990; 46: 613-623). We posit that speakers of modern Chibchan languages (henceforth referred to as the Chibcha) passed through a population bottleneck caused either by ethnogenesis from a small founding population and/or subsequent European conquest and colonization. Using the approach of Harpending et al. (Curr. Anthropol. 1993; 34: 483-496), we estimated a Chibchan population bottleneck and subsequent expansion approximately 10,000 years before present, a date consistent with a bottleneck at the time of Chibchan ethnogenesis. The low mtDNA diversity of Kuna Amerinds, as opposed to the generally high levels of mtDNA variation detected in other Amerind groups, demonstrates the need for adequate sampling of cultural or racial groups when attempting to genetically characterize human populations.
Article
The genetic diversity of nine Amerindian tribes (Boruca, Bokota, Bribrí, Cabecar, Guatuso, Guaymí, Huetar, Kuna and Teribe) from Costa Rica and Panama were analyzed using 48 loci of enzymatic systems, blood groups and serum proteins. The average heterozygosity (H) and the frequency of polymorphisms (P) for this assemblage are relatively low (H = -0.055; P = 0.217). The genetic differentiation within tribes is also low with the exception of the Cabecar (Gst = 0.049). However it is high between tribes (Gst = 0.073). These populations have some racial admixture and negro and caucasian genes are present in different frequencies (1-30%) depending on their ecological and cultural background. Mating systems and random genetic drift should explain these results. In a broad sense the genetic diversity of these Chibchan tribes are similar to others from South America which use different languages.
Article
Flavonoids are polyphenolic antioxidants naturally present in vegetables, fruits, and beverages such as tea and wine. In vitro, flavonoids inhibit oxidation of low-density lipoprotein and reduce thrombotic tendency, but their effects on atherosclerotic complications in human beings are unknown. We measured the content in various foods of the flavonoids quercetin, kaempferol, myricetin, apigenin, and luteolin. We then assessed the flavonoid intake of 805 men aged 65-84 years in 1985 by a cross-check dietary history; the men were then followed up for 5 years. Mean baseline flavonoid intake was 25.9 mg daily. The major sources of intake were tea (61%), onions (13%), and apples (10%). Between 1985 and 1990, 43 men died of coronary heart disease. Fatal or non-fatal myocardial infarction occurred in 38 of 693 men with no history of myocardial infarction at baseline. Flavonoid intake (analysed in tertiles) was significantly inversely associated with mortality from coronary heart disease (p for trend = 0.015) and showed an inverse relation with incidence of myocardial infarction, which was of borderline significance (p for trend = 0.08). The relative risk of coronary heart disease mortality in the highest versus the lowest tertile of flavonoid intake was 0.42 (95% CI 0.20-0.88). After adjustment for age, body-mass index, smoking, serum total and high-density-lipoprotein cholesterol, blood pressure, physical activity, coffee consumption, and intake of energy, vitamin C, vitamin E, beta-carotene, and dietary fibre, the risk was still significant (0.32 [0.15-0.71]). Intakes of tea, onions, and apples were also inversely related to coronary heart disease mortality, but these associations were weaker. Flavonoids in regularly consumed foods may reduce the risk of death from coronary heart disease in elderly men.
Article
To study the association between dietary intake of flavonoids and subsequent coronary mortality. A cohort study based on data collected at the Finnish mobile clinic health examination survey from 1967-72 and followed up until 1992. 30 communities from different parts of Finland. 5133 Finnish men and women aged 30-69 years and free from heart disease at baseline. Dietary intake of flavonoids, total mortality, and coronary mortality. In women a significant inverse gradient was observed between dietary intake of flavonoids and total and coronary mortality. The relative risks between highest and lowest quarters of flavonoid intake adjusted for age, smoking, serum cholesterol concentration, blood pressure, and body mass index were 0.69 (95% confidence interval 0.53 to 0.90) and 0.54 (0.33 to 0.87) for total and coronary mortality, respectively. The corresponding values for men were 0.76 (0.63 to 0.93) and 0.78 (0.56 to 1.08), respectively. Adjustment for intake of antioxidant vitamins and fatty acids weakened the associations for women; the relative risks for coronary heart disease were 0.73 (0.41 to 1.32) and 0.67 (0.44 to 1.00) in women and men, respectively. Intakes of onions and apples, the main dietary sources of flavonoids, presented similar associations. The relative risks for coronary mortality between highest and lowest quarters of apple intake were 0.57 (0.36 to 0.91) and 0.81 (0.61 to 1.09) for women and men, respectively. The corresponding values for onions were 0.50 (0.30 to 0.82) and 0.74 (0.53 to 1.02), respectively. The results suggest that people with very low intakes of flavonoids have higher risks of coronary disease.
Article
Epidemiological studies suggested that consumption of fruit and vegetables may protect against stroke. The hypothesis that dietary antioxidant vitamins and flavonoids account for this observation is investigated in a prospective study. A cohort of 552 men aged 50 to 69 years was examined in 1970 and followed up for 15 years. Mean nutrient and food intake was calculated from cross-check dietary histories taken in 1960, 1965, and 1970. The association between antioxidants, selected foods, and stroke incidence was assessed by Cox proportional hazards regression analysis. Adjustment was made for confounding by age, systolic blood pressure, serum cholesterol, cigarette smoking, energy intake, and consumption of fish and alcohol. Forty-two cases of first fatal or nonfatal stroke were documented. Dietary flavonoids (mainly quercetin) were inversely associated with stroke incidence after adjustment for potential confounders, including antioxidant vitamins. The relative risk (RR) of the highest vs the lowest quartile of flavonoid intake ( > or = 28.6 mg/d vs <18.3 mg/d) was 0.27 (95% confidence interval [CI], 0.11 to 0.70). A lower stroke risk was also observed for the highest quartile of beta-carotene intake (RR, 0.54; 95% CI, 0.22 to 1.33). The intake of vitamin C and vitamin E was not associated with stroke risk. Black tea contributed about 70% to flavonoid intake. The RR for a daily consumption of 4.7 cups or more of tea vs less than 2.6 cups of tea was 0.31 (95% CI, 0.12 to 0.84). The habitual intake of flavonoids and their major source (tea) may protect against stroke.
Article
Flavonols and flavones are subgroups of flavonoids and are found in tea, vegetables, fruits, and red wine. Because they have antioxidant properties, we investigated whether intake of these dietary compounds is associated with a lower risk for fatal and nonfatal coronary heart disease. Prospective cohort study. United States. 34,789 male health professionals, 40 to 75 years of age, who responded to a questionnaire in 1986. In 1986 and 1990, detailed, 131-item questionnaires were used to assess dietary intake of flavonols and flavones. Between 1986 and 1992, 496 patients received a new diagnosis of nonfatal myocardial infarction. The relative risk for nonfatal myocardial infarction was 1.08 (95% Cl, 0.81 to 1.43) for the highest (median, 40.0 mg/d) compared with the lowest (median, 7.1 mg/d) quintiles for intake of flavonols and flavones after adjustment for age, obesity, smoking, intake of vitamin E, intake of alcohol, diabetes, hypertension, hypercholesterolemia, and family history of coronary heart disease. Among the 4814 men who reported that they had previously had coronary heart disease, we found a modest but nonsignificant inverse association between intake of flavonols and flavones and subsequent coronary mortality rates (relative risk, 0.63 [Cl, 0.33 to 1.20] for the highest compared with the lowest quintile for intake of flavonoids). The data do not support a strong inverse association between intake of flavonoids and total coronary heart disease, but they do not exclude the possibility that flavonoids have a protective effect in men with established coronary heart disease.
Article
The indigenous Kuna who live on islands in the Panamanian Caribbean were among the first communities described with little age-related rise in blood pressure or hypertension. Our goals in this study were to ascertain whether isolated island-dwelling Kuna continue to show this pattern, whether migration to Panama City and its environs changed the patterns, and whether the island-dwelling Kuna have maintained their normal blood pressure levels despite partial acculturation, reflected in an increased salt intake. We enrolled 316 Kuna participants who ranged in age from 18 to 82 years. In 50, homogeneity was confirmed by documentation of an O+ blood group. In 92 island dwellers, diastolic hypertension was not identified and blood pressure levels were as low in volunteers over 60 years of age as in those between 20 and 30 years of age. In Panama City, conversely, hypertension prevalence was 10.7% and exceeded 45% in those over 60 years of age (P < .01), blood pressure levels were higher in the elderly, and there was a statistically significant positive relationship between age and blood pressure (P < .01). In Kuna Nega, a Panama City suburb designed to maintain a traditional Kuna lifestyle but with access to the city, all findings were intermediate. Sodium intake and excretion assessed in 50 island-dwelling Kuna averaged 135 +/- 15 mEq/g creatinine per 24 hours, exceeding substantially other communities free of hypertension and an age-related rise in blood pressure. Despite partial acculturation, the island-dwelling Kuna Indians are protected from hypertension and thus provide an attractive population for examining alternative mechanisms.
Article
It is known that obesity, sodium intake, and alcohol consumption factors influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we assessed the effects of dietary patterns on blood pressure. We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg. For three weeks, the subjects were fed a control diet that was low in fruits, vegetables, and dairy products, with a fat content typical of the average diet in the United States. They were then randomly assigned to receive for eight weeks the control diet, a diet rich in fruits and vegetables, or a "combination" diet rich in fruits, vegetables, and low-fat dairy products and with reduced saturated and total fat. Sodium intake and body weight were maintained at constant levels. At base line, the mean (+/-SD) systolic and diastolic blood pressures were 131.3+/-10.8 mm Hg and 84.7+/-4.7 mm Hg, respectively. The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more, respectively, than the control diet (P<0.001 for each); the fruits-and-vegetables diet reduced systolic blood pressure by 2.8 mm Hg more (P<0.001) and diastolic blood pressure by 1.1 mm Hg more than the control diet (P=0.07). Among the 133 subjects with hypertension (systolic pressure, > or =140 mm Hg; diastolic pressure, > or =90 mm Hg; or both), the combination diet reduced systolic and diastolic blood pressure by 11.4 and 5.5 mm Hg more, respectively, than the control diet (P<0.001 for each); among the 326 subjects without hypertension, the corresponding reductions were 3.5 mm Hg (P<0.001) and 2.1 mm Hg (P=0.003). A diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure. This diet offers an additional nutritional approach to preventing and treating hypertension.
Article
Flavonoids, a group of phenolic compounds found in fruits and vegetables, are known to have antioxidant properties. They prevent low density lipoprotein oxidation in vitro and thus may play a role in the prevention of coronary heart disease (CHD). In 1986, in a prospective study of 34,492 postmenopausal women in Iowa, the authors examined the association of flavonoid intake with CHD and stroke mortality. Over 10 years of follow-up, 438 deaths from CHD and 131 deaths from stroke were documented. Total flavonoid intake was associated with a decreased risk of CHD death after adjusting for age and energy intake (p for trend = 0.04). This association was attenuated after multivariate adjustment. However, decreased risk was seen in each category of intake compared with the lowest. Relative risks and 95% confidence intervals of CHD death from lowest to highest intake category were 1.0, 0.67 (95% confidence interval (Cl) 0.49–0.92), 0.56 (95% Cl 0.39–0.79), 0.86 (95% Cl 0.63–1.18), and 0.62 (95% Cl 0.44–0.87).There was no association between total flavonoid intake and stroke mortality (p for trend = 0.83). Of the foods that contributed the most to flavonoid intake in this cohort, only broccoli was strongly associated with reduced risk of CHD death. The data of this study suggest that flavonoid intake may reduce risk of death from CHD in postmenopausal women. Am J Epidemiol 1999; 149:943–9.
Dietary antioxidant #avonoids and risk of coronary heart disease: the Zutphen elderly study
  • M G L Hertog
  • E J M Feskens
  • P C H Hollman
  • M B Katan
  • D Kromhout
Hertog, M. G. L., Feskens, E. J. M., Hollman, P. C. H., Katan, M. B., and Kromhout, D. (1993). Dietary antioxidant #avonoids and risk of coronary heart disease: the Zutphen elderly study. ¸ancet 342, 1007}1011. FOOD COMPOSITION OF THE KUNA DIET
A clinical trial of the e!ects of dietary patterns on blood pressure Genetic diversity and racial mixture in Amerindians from Nutrient database for three selected major ingredi-ents used in the NCA
  • L J Appel
  • T J Moore
  • E Obarzanek
  • W M Vollmer
  • L P Svetky
  • F M Sacks
Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetky, L. P., Sacks, F. M. et al. (1997). A clinical trial of the e!ects of dietary patterns on blood pressure. N. Engl. J. Med. 336(16), 1117}1124. Barrantes, R. (1993). Genetic diversity and racial mixture in Amerindians from Costa Rica and Panama. Rev. Biol. ¹rop. 41(3A), 379}384. Batista, O., Kolman, C. J., and Bermingham, E. (1995). Mitochondrial DNA diversity in the Kuna Amerinds of Panama. Hum. Mol. Genet. 4(5), 921}929. CMA*Chocolate Manufacturers Association. (1997). Nutrient database for three selected major ingredi-ents used in the NCA/CMA recipe modeling database: chocolate liquor, cocoa powder, and cocoa butter.
Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women
  • Yochum
Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen elderly study
  • Hertog