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Obesity Reviews , , 1: Aim to eat four to five servings each of fruits and vegetables daily. These factors together, however, do not explain the large variation between populations in colorectal cancer rates. Summary of strength of evidence on lifestyle factors and risk of developing cardiovascular diseases. Intake of fruits and vegetables and risk of breast cancer: Prostate cancer incidence rates are strongly affected by diagnostic practices and therefore difficult to interpret, but mortality rates show that death from prostate cancer is about 10 times more common in North America and Europe than in Asia There is also consistent evidence that consuming drinks and foods at a very high temperature increases the risk for these cancers


Cardiovascular disease

Plants produce anthocyanins as a protective mechanism against environmental stressors, such as ultraviolet light, cold temperatures, and drought. This production of anthocyanins in roots, stems, and especially leaf tissues is believed to provide resistance against these environmental hazards. For example, Red Delicious apples provide more anthocyanins than Fuji apples; black raspberries are a far richer source than red raspberries; and Concord grapes are a much more concentrated source than red grapes.

While the answers to how and why anthocyanins may help prevent disease remain undiscovered or unexplained, the literature to date is intriguing, and most researchers are calling for more studies to explore the potential health benefits of these naturally occurring compounds. Cardiovascular Disease Several studies have found an association between the consumption of anthocyanin-rich foods and CVD protection.

The researchers found that consuming anthocyanin-rich strawberries and blueberries once per week was associated with a significant reduction in death from CVD and coronary artery disease. The decreased risk of CVD may be due, in part, to a reduction in arterial stiffness and blood pressure. As part of the Twins UK study of 1, women aged 18 to 75, researchers found that a higher intake of anthocyanins was associated with significantly lower central systolic blood pressure and arterial pressure.

The authors suggested that consuming one to two portions of berries per day might be an important strategy for lowering CVD risk. A study of rats fed a red cabbage extract rich in anthocyanins recently provided the first piece of evidence that an anthocyanin extract protected against hypercholesterolemia induced by an atherogenic diet and related cardiac oxidative stress. Laboratory studies suggest that anthocyanins and their metabolites, which are produced by gut microflora, may decrease inflammatory markers associated with increased CVD risk.

Cancer Anthocyanins and anthocyanin-rich extracts in cell culture and in animals have anticarcinogenic activities. While laboratory studies have provided some insight into how they may work, the exact mechanism or mechanisms for how these dietary compounds prevent cancer is unclear.

Laboratory studies that used a variety of cancer cells have indicated that anthocyanins not only act as antioxidants, they also activate detoxifying enzymes; prevent cancer cell proliferation; induce cancer cell death apoptosis ; have anti-inflammatory effects; have antiangiogenesis effects ie, they inhibit the formation of new blood vessels that encourage tumor growth ; prevent cancer cell invasion; and induce differentiation the more differentiated the cancer cell, the less likely it is to grow and spread.

In animal studies, anthocyanins inhibit cancer development in animals given carcinogens and in those with a hereditary predisposition to cancer. In cell culture, anthocyanins from an anthocyanin-enriched purple sweet potato stopped the reproduction of colon cancer cells and initiated cancer cell death.

Two studies from Italy found no relationship between anthocyanin intake and the risk of oral, pharyngeal, or prostate cancer. Cognitive Function With regard to cognitive function, research suggests that flavonoids, including anthocyanins, have the ability to enhance memory and help prevent age-related declines in mental functioning.

Several other studies have found that berries, most notably blueberries, which are rich in anthocyanins, can effectively reverse age-related deficits in certain aspects of working memory.

Anthocyanins and other flavonoids are thought to work by inhibiting neuroinflammation, activating synaptic signaling, and improving blood flow to the brain. The authors of a recent review on the subject suggested that the consumption of flavonoid-rich fruits such as berries, apples, and citrus throughout life potentially could limit or even reverse age-dependent deteriorations in memory and cognition.

As of now, however, there are no human studies to prove a causal relationship between the consumption of anthocyanins, or any flavonoid, and cognitive functioning.

Whether the consumption of flavonoid-rich foods can have a beneficial effect on cognition also may depend on when in life exposure occurs. For anthocyanin-rich berries, she recommends keeping frozen ones on hand. While Blumberg admits that the medical community has limited knowledge of the mechanisms of action and health benefits of anthocyanins, he questions the wisdom of waiting for definitive research when clients may benefit from increased consumption of anthocyanin-rich foods now.

Anthocyanins in cardiovascular disease. Mol Nutr Food Res. Concentrations of anthocyanins in common foods in the United States and estimation of normal consumption. J Agric Food Chem. Flavonoid intake and cardiovascular disease mortality: Am J Clin Nutr. Prospective study of alcohol consumption and risk of coronary disease in men. Habitual intake of flavonoid subclasses and incident hypertension in adults.

Animal studies have shown that both prebiotics and probiotics can decrease the activity of proinflammatory cytokines and NF-kB, and increase levels of anti-inflammatory TGF-beta within the gut mucosa.

Both prebiotics and probiotics appear to interact directly with gut epithelium cells to block pathogens from entering. Clinical trials have helped corroborate the anti-inflammatory effects of prebiotics seen in laboratory studies. Infants and children with diarrheal illness showed marked improvement in symptoms eg, decreased diarrhea, vomiting, fever when given supplemental inulin.

Administered to patients with ulcerative colitis or precancerous colon polyps, inulin improved measures of disease activity and reduced levels of intestinal proinflammatory proteins. The results have been mixed but generally support a role for probiotics in decreasing disease activity and improving clinical symptoms. In addition, consuming cultured dairy foods has been found to alleviate symptoms of IBD, ulcerative colitis, and pouchitis.

Anti-Inflammatory Foods and Dietary Patterns Various foods and dietary patterns are effective in reducing the underlying inflammatory processes associated with chronic disease. A diet high in fruits and vegetables may be one of the best defenses against chronic inflammation. Fruits and vegetables are a highly bioavailable source of vitamins, minerals, fiber, and polyphenols with anti-inflammatory activity. A cross-sectional study investigating self-reported fruit and vegetable intake among adults found that individuals reporting the highest consumption more than two servings of fruit and three servings of vegetables daily had significantly lower plasma levels of proinflammatory CRP, IL-6, and TNF-alpha as well as decreased biomarkers of oxidative stress.

Four to five servings daily each of fruits and vegetables are recommended to combat inflammation and chronic disease. The Mediterranean diet is characterized by the generous consumption of vegetables, fruits, grains, legumes, and nuts; a minimal intake of red meat and whole-fat dairy products; increased fish consumption; moderate red wine intake; and liberal use of olive oil in cooking and food preparation.

Compared with Western diets, the Mediterranean diet is rich in fiber, polyphenols, antioxidants, and omega-3 fatty acids and low in saturated fat and refined carbohydrate. Data from epidemiologic and clinical studies have demonstrated that consuming a Mediterranean-type diet reduces plasma levels of proinflammatory biomarkers, including endothelial adhesion molecules, CRP, TNF-alpha, and NF-kB.

High-fiber, low-GI foods appear to have a beneficial effect on inflammatory biomarkers. Adhering to a low-GI diet for one year resulted in significantly lower plasma levels of CRP in a clinical randomized trial of subjects with type 2 diabetes compared with adhering to high-GI and low-carbohydrate diets.

Whole grain foods consist of the unaltered grain with intact bran and germ components, which are valuable sources of fiber, phytochemicals, vitamins, and minerals.

Prospective and clinical studies have suggested that consuming whole grain foods such as oats, barley, and brown rice may help decrease inflammation associated with metabolic syndrome, diabetes, and cardiovascular disease. Weight loss is known to have beneficial effects on metabolic syndrome, type 2 diabetes, and other chronic conditions.

Additional research is needed to identify the independent and interactive effects of foods and nutrients and to evaluate the protective role of supplements in fighting inflammation. Clinical Recommendations There are many simple dietary strategies that may effectively reduce levels of chronic inflammation and decrease disease risk. In addition, they may be unaware of the role diet plays in affecting the inflammatory processes underlying many chronic illnesses.

Dietitians can support their clients and patients by emphasizing dietary changes that will help reduce inflammation levels in the body and begin to restore normal immune function. Encouraging clients to increase their intake of fruits, vegetables, whole grains, nuts, olive oil, and fatty fish is a positive message that can accompany advice to reduce their consumption of refined starches and sweets, and foods laden with trans and saturated fat.

Focusing on personalized goals and setting achievable objectives eg, eat an extra serving of fruit at lunch is key to helping clients make lasting dietary changes that will combat inflammation and enhance overall health. The right foods can help reduce the amount of inflammation in the body and improve health. Here are 10 suggestions for clients and patients for eating to decrease inflammation:. Boost consumption of fruits and vegetables.

Aim to eat four to five servings each of fruits and vegetables daily. Choose fruits and vegetables that are deep green, orange, yellow, and purple, since these have the greatest nutritional value.

Ten servings per day may sound like too much, but serving sizes are small: Cook with olive oil as much as possible and use it to make salad dressings. Virgin olive oil is best since it has more inflammation-fighting antioxidants than refined olive oil. Snack on walnuts instead of chips. Walnuts provide fiber, minerals, antioxidants, and the kinds of fatty acids that are good for your heart.

Eat a whole grain cereal such as oatmeal for breakfast, and replace refined grains with whole grains, such as substituting brown rice for white rice. Eat fatty fish such as salmon two to three times per week to get more omega-3 fatty acids.

Wild salmon has more omega-3s than farmed salmon. Eat fewer fast foods. Many tend to be cooked in oils that contain trans fatty acids, which increase inflammation. If you eat at fast-food restaurants, order a grilled chicken sandwich or salad with vinaigrette dressing. Replace white potatoes with sweet potatoes. Cut down on sugary drinks such as juice, soda, and punch. Add small amounts of cider, fruit juice, or wedges of lemon or orange to plain water to enhance the flavor.

Eat more lentils and beans. Try black beans and brown rice sautéed with onions and garlic and seasoned with cumin. Munch on dark chocolate and fresh raspberries for dessert. Both are loaded with antioxidants. Learning Objectives After completing this continuing education course, nutrition professionals should be better able to:. Assess the potential benefits of anti-inflammatory foods and nutrients to clients and patients.

Abdominal obesity has which of the following effects? It increases circulating levels of C-reactive protein CRP. It decreases circulating levels of proinflammatory cytokines. It decreases fat cell necrosis. It normalizes adipose cell adipokine activity. Foods rich in polyphenols help fight inflammation by which of the following mechanisms? They decrease anti-inflammatory cytokine production. They inhibit enzymes involved in prostaglandin and leukotriene synthesis.

They reduce omega-6 to omega-3 fatty acid ratios. What are the two types of adaptive immunity? Innate and receptive b. Humoral and cell mediated c. Antigenic and phagocytic d. Based on this article, which of the following statements about metabolic syndrome is true? Which of the following is true of prebiotics and probiotics, based on this article? Both are strains of lactobacillus bacteria. Both are found in foods and are available as dietary supplements.

Neither is effective in reducing gastrointestinal disease activity. Both can be obtained by eating cultured dairy foods. Which of the following are two examples of proinflammatory cytokines? CRP and serum amyloid A b. Interleukin 6 and tumor necrosis factor alpha c. Transforming growth factor beta and nuclear factor kappa B NF-kB d. Fibrinogen and clotting factor VII. Suppression of proinflammatory eicosanoids b. Conversion of linoleic acid to arachidonic acid c.

Strengthening of the gut mucosa d. Stimulation of collagen synthesis. Acute phase reactants are biomarkers of chronic inflammation. A positive acute phase reactant has which of the following effects? Decreases during chronic inflammation b. Increases during chronic inflammation c. Increases when inflammation subsides d. Decreases when proinflammatory cytokines are released.

A diet low in refined carbohydrate and that limits high glycemic index foods may reduce inflammation in which of the following ways?

By stimulating interleukin 1 secretion b. By decreasing free radical production c. By shutting off CRP synthesis in the liver d. By increasing NF-kB transcription factor activity. Which of the following causes difficulty in evaluating the effects of vitamin E on inflammation? Alpha-tocopherol enhances the activity of gamma-tocopherol. Few foods contain vitamin E. Vitamin E is poorly absorbed. The vitamin E supplements evaluated in clinical trials typically are composed of only alpha-tocopherol.

Inflammation and metabolic disorders. Inflammatory disease processes and interactions with nutrition. Atherosclerosis, cancer, wound healing, and inflammation—shared or parallel evolution. J Clin Exp Cardiolog. Metabolic Syndrome and Cardiovascular Disease. Tian B, Brasier AR. Identification of a nuclear factor kappa B-dependent gene network. Recent Prog Horm Res. Inflammatory cytokines in nonpathological states.

Fisher P, Abbas A. University of California, San Francisco website. Accessed May 25, Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. Cancer Epidemiol Biomarkers Prev. Vykoukal D, Davies MG. Vascular biology of metabolic syndrome.

Inflammation, stress, and diabetes. Inflammation and cardiovascular disease mechanisms. Am J Clin Nutr. Why cancer and inflammation? Yale J Biol Med. Inflammation, a key event in cancer development. Fontana L, Klein S. Aging, adiposity, and calorie restriction. Carbohydrate nutrition and inflammatory disease mortality in older adults. Dietary carbohydrate and high-sensitivity C-reactive protein in at-risk women and men. Trans-fatty acids induce pro-inflammatory responses and endothelial cell dysfunction.

Chait A, Kim F.

Cardiovascular disease