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Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Cranney A, Weiler HA, O'Donnell S, Puil L. Am J Clin Nutr. 2008 Aug;88(2):513S-519S. Review. PMID: 18689393 We found inconsistent evidence of an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and bone mineral content in infants and fair evidence of an association with bone mineral content or density in older children and older adults. The evidence of an association between serum 25(OH)D concentration and some clinical outcomes (fractures, performance measures) in postmenopausal women and older men was inconsistent, and the evidence of an association with falls was fair. We found good evidence of a positive effect of consuming vitamin D-fortified foods on 25(OH)D concentrations. The evidence for a benefit of vitamin D on falls and fractures varied. We found fair evidence that adults tolerated vitamin D at doses above current dietary reference intake levels, but we had no data on the association between long-term harms and higher doses of vitamin D.

Dietary Reference Intakes for Vitamin D and Calcium An IOM committee has been named to undertake a study to assess current relevant data and update as appropriate the DRIs for vitamin D and calcium. The review will include consideration of chronic and non-chronic disease indicators. The study will also incorporate, as appropriate, systematic evidence-based reviews of the literature and an assessment of potential indicators of adequacy and of excess intake. Indicators for adequacy and excess will be selected based on the strength and quality of the evidence and the demonstrated public health significance, taking into consideration sources of uncertainty in the evidence.

n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits. Gebauer SK, Psota TL, Harris WS, Kris-Etherton PM. Am J Clin Nutr. 2006 Jun;83(6 Suppl):1526S-1535S. Review. PMID: 16841863 Dietary recommendations have been made for n-3 fatty acids, including {alpha}-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) to achieve nutrient adequacy and to prevent and treat cardiovascular disease. These recommendations are based on a large body of evidence from epidemiologic and controlled clinical studies. The n-3 fatty acid recommendation to achieve nutritional adequacy, defined as the amount necessary to prevent deficiency symptoms, is 0.6-1.2% of energy for ALA; up to 10% of this can be provided by EPA or DHA. To achieve recommended ALA intakes, food sources including flaxseed and flaxseed oil, walnuts and walnut oil, and canola oil are recommended. The evidence base supports a dietary recommendation of {approx}500 mg/d of EPA and DHA for cardiovascular disease risk reduction. For treatment of existing cardiovascular disease, 1 g/d is recommended. These recommendations have been embraced by many health agencies worldwide. A dietary strategy for achieving the 500-mg/d recommendation is to consume 2 fish meals per week (preferably fatty fish). Foods enriched with EPA and DHA or fish oil supplements are a suitable alternate to achieve recommended intakes and may be necessary to achieve intakes of 1 g/d.

Evidence-based decision making on micronutrients and chronic disease: long-term randomized controlled trials are not enough. Ames BN, McCann JC, Stampfer MJ, Willett WC. Am J Clin Nutr. 2007 Aug;86(2):522-3; author reply 523-4. PMID: 17684228

Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? New SA, Robins SP, Campbell MK, Martin JC, Garton MJ, Bolton-Smith C, Grubb DA, Lee SJ, Reid DM. Am J Clin Nutr. 2000 Jan;71(1):142-51. PMID: 10617959 Conclusion: The BMD results confirm our previous work (but at peripheral bone mass sites), and our findings associating bone resorption with dietary factors provide further evidence of a positive link between fruit and vegetable consumption and bone health.

The importance of calcium, potassium, and acid-base homeostasis in bone health and osteoporosis prevention. Tylavsky FA, Spence LA, Harkness L. J Nutr. 2008 Jan;138(1):164S-165S. PMID: 18156418 In concert with the acid-base literature, protein intake is considered to be a net acid-producing substance and thus a net negative risk factor for bone dissolution. However, substantial literature supports the beneficial effects on skeletal metabolism when higher protein levels are consumed in concert with adequate calcium, potassium, and other minerals, regardless of the source of protein (24-26). The Dietary Approaches to Stopping Hypertension (DASH) diet (27) is a calcium-rich diet that emphasizes fruits, vegetables, and low-fat dairy products. This diet underscores the importance of consuming a complement of foods from meats, grains, dairy, fruits, and vegetables as prudent for promoting optimal bone health. In the following articles, Rafferty and Lanham-New carefully review the evidence on the interaction of specific diet components that impact bone health and conclude that a balanced diet with recommended servings of dairy products and a variety of fruits and vegetables is prudent for optimal bone health. Additionally, they comment on future research directions for consideration by the scientific community.

Vieth R, Fraser D. Vitamin D insufficiency: no recommended dietary allowance exists for this nutrient. CMAJ. 2002 Jun 11;166(12):1541-2. PMID: 12074121 In fact, current recommendations for vitamin D are not designed to ensure anything. They are simply based on the old, default strategy for setting a nutritional guideline, which is to recommend an amount of nutrient similar to what healthy people are eating. This approach underlies the circular logic behind a familiar refrain about nutrition: "If you eat a good diet, you won't need supplements." By this logic, the answer to the question, "How much nutrient do you need?" is, "Whatever healthy people happen to be eating." The essential point, lost in the confusing terminology of modern nutrient recommendations, is that a recommended daily allowance (RDA) does not yet exist for vitamin D. Instead, the recommendations for it are referred to as "adequate intake" (AI).12,13 The AI for young adults (5 µg or 200 IU) was chosen to approximate twice the average vitamin D intake reported by 52 young women in a questionnaire-based study reported from Omaha, Neb., in 1997.13,14 Because the available evidence was acknowledged as weak, the Food and Nutrition Board of the US Institute of Medicine called its recommendation an AI.

A review of scientific research and recommendations regarding eggs. Kritchevsky SB. J Am Coll Nutr. 2004 Dec;23(6 Suppl):596S-600S. Review. PMID: 15640512 For much of the past 40 years, the public has been warned away from eggs because of a concern over coronary heart disease risk. This concern is based on three observations: 1. eggs are a rich source of dietary cholesterol; 2. when fed experimentally, dietary cholesterol increases serum cholesterol and; 3. high serum cholesterol predicts the onset of coronary heart disease. However, data from free-living populations show that egg consumption is not associated with higher cholesterol levels. Furthermore, as a whole, the epidemiologic literature does not support the idea that egg consumption is a risk factor for coronary disease. Within the nutritional community there is a growing appreciation that health derives from an overall pattern of diet rather than from the avoidance of particular foods, and there has been a shift in the tone in recent dietary recommendations away from "avoidance" messages to ones that promote healthy eating patterns. The most recent American Heart Association guidelines no longer include a recommendation to limit egg consumption, but recommend the adoption of eating practices associated with good health. Based on the epidemiologic evidence, there is no reason to think that such a healthy eating pattern could not include eggs.

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March 27, 2009 - A significant decrease in serum 25-hydroxyvitamin D (25[OH]D) levels has led to an increase in vitamin D insufficiency in the US population, especially in racial and ethnic groups, according to results of a population-based study reported in the March 23 issue of the Archives of Internal Medicine. "Vitamin D insufficiency has been associated with increases in cardiovascular disease, cancer, and infection," write Adit A. Ginde, MD, from the Department of Emergency Medicine at the University of Colorado Denver School of Medicine, Aurora, Colorado, and colleagues. "Vitamin D supplementation appears to mitigate the incidence and adverse outcomes of these diseases and may reduce all-cause mortality." [...] "These findings have important implications for health disparities and public health," the study authors conclude. "Our data provide additional evidence that current recommendations for vitamin D supplementation (200-600 IU/d) are inadequate to achieve optimal serum 25(OH)D levels in most of the US population." They add that large, randomized controlled trials of higher doses of vitamin D supplementation are needed to evaluate their effect on general health and mortality.

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Are omega-3 fatty acids options for prevention and treatment of cognitive decline and dementia? Cederholm T, Palmblad J. Curr Opin Clin Nutr Metab Care. 2009 Dec 16. [Epub ahead of print] PMID: 20019606 PURPOSE OF REVIEW: To report recent data on the potential role of omega-3 fatty acids (n-3 FA) found in oily fish, especially docosahexaenoic acid (DHA), to prevent and treat cognitive decline and Alzheimer's disease. RECENT FINDINGS: Observational studies still provide conflicting results, in which the majority indicate beneficial effects on cognition, both when assessed as a continuous variable or as incident dementia, mainly Alzheimer's disease. Experimental studies have demonstrated potentially ameliorating effects of eicosapentaenoic acid (EPA) and DHA on amyloid fragment formation, signal transduction including upregulation of the apolipoprotein receptor SorLA, as well as on angiogenesis. The role of EPA and DHA metabolites on Alzheimer's disease pathology is under investigation. Recently, three randomized intervention studies, with duration up to 6 months have been reported. In contrast to a small study from Taiwan, no positive overall effects were reported from the Swedish OmegAD Study or from a Dutch study, although post hoc analyses indicate that selected individuals with mild forms of Alzheimer's disease or cognitive decline may respond to treatment. SUMMARY: No firm conclusions can be drawn. Based on epidemiological data, fish including oily fish could be advised as part of a balanced diet for public health purpose, although the evidence for better cognition is only fairly consistent. It is unlikely that n-3 FA will emerge as a treatment option in general for improving cognitive function in patients with Alzheimer's disease. n-3 FA, especially DHA, may turn out as an adjuvant therapy in selected cases. Further long-term intervention studies on individuals with mild cognitive reductions are awaite"

A diet rich in coconut oil reduces diurnal postprandial variations in circulating tissue plasminogen activator antigen and fasting lipoprotein (a) compared with a diet rich in unsaturated fat in women. Müller H, Lindman AS, Blomfeldt A, Seljeflot I, Pedersen JI. J Nutr. 2003 Nov;133(11):3422-7. PMID: 14608053 In conclusion, our results indicate that a coconut oil-based diet (HSAFA-diet) lowers postprandial t-PA antigen concentration, and this may favorably affect the fibrinolytic system and the Lp(a) concentration compared with the HUFA-diet. The proportions of dietary saturated fatty acids more than the percentage of saturated fat energy seem to have a beneficial influence on Lp(a) levels. The connection between Lp(a) and atherosclerosis is not entirely understood. Different studies have provided strong evidence that Lp(a) level is an independent risk factor for developing coronary artery disease in men (47,48), but the question of causality continues to be debated. Recent data suggest that Lp(a) might be atherogenic (49), in particular when combined with other risk factors. High levels of Lp(a) combined with other risk factors such as the ratio of plasma total/HDL cholesterol have been shown to increase the risk for coronary heart diseases (50). It has also been reported that when substantial LDL cholesterol reductions were obtained in men with coronary heart disease, persistent elevations of Lp(a) were no longer atherogenic or clinically threatening (51). In conclusion, the present results show that the HSAFA-diet lowered postprandial t-PA antigen and thus potentially improved fibrinolysis compared with the HUFA-diet. Diets with either high or low levels of saturated fatty acids from coconut oil beneficially decrease Lp(a) compared with a HUFA-diet. The proportions of dietary saturated fatty acids more than the percentage of saturated fat energy may be of importance if the goal is to decrease Lp(a).

"Largest-ever meta-analysis finds CRP is unlikely to be causal for CVD December 21, 2009 | Lisa Nainggolan Cambridge, UK - In the largest and most comprehensive meta-analysis to date looking at C-reactive-protein (CRP) levels and risk of coronary heart disease (CHD) and stroke, British researchers conclude that CRP is unlikely to be a causal factor for cardiovascular disease [1]. Although CRP concentration was linearly associated with CHD, stroke, and vascular mortality, as well as nonvascular mortality, statistical adjustment for conventional cardiovascular risk factors "resulted in considerable weakening of associations," note the scientists of the Cambridge-based Emerging Risk Factors Collaboration (ERFC), who report their findings online December 21, 2009 in the Lancet. In an editorial accompanying the paper [2], Drs S Matthijs Boekholdt and John JP Kastelein (Academic Medical Center, Amsterdam, the Netherlands) say the UK authors "are to be commended for this impressive data set." Although the findings "add weight to the evidence of noncausality" for a role of CRP in the development of cardiovascular disease, "the debate can be resolved only by randomized trials with agents that specifically target CRP, and such compounds are currently under development," say the Dutch doctors. Commenting on the new meta-analysis for heartwire, Dr Paul Ridker (Brigham and Women's Hospital, Boston, MA), a long-time advocate of CRP and the lead investigator of the JUPITER trial, said: "Whether or not CRP is 'causal' for heart disease is neither the crucial issue at hand nor relevant for public health. What is crucial is getting international agreement that CRP identifies higher-risk individuals who would not otherwise qualify for a life-saving therapy, and then showing that such individuals clearly benefit from treatment. The new meta-analysis demonstrates the former, and JUPITER demonstrates the latter." "

"Wednesday, December 9, 2009 By Amy Norton NEW YORK (Reuters Health) - Supplements containing soy isoflavones may do little to preserve women's bone mass after menopause. In a study of more than 200 women ages 46 to 65, researchers found that the soy supplement did not appear to ward off bone-density loss over 3 years. In general, women on the supplement showed the same degree of bone loss as those given a placebo -- though there was some evidence that a higher dose helped protect bone density in the hip. The findings, reported in the American Journal of Clinical Nutrition, add to a conflicting body of research on soy and postmenopausal bone health. Some studies have suggested that soy-based foods, isolated soy protein or isoflavone-containing supplements may be beneficial, while others have found no advantage. Isoflavones are natural chemicals found in soybeans and certain other plant foods that are structurally similar to estrogen, and may have certain estrogen-like effects in the human body. Since declining estrogen levels after menopause spur bone-density loss, isoflavone supplements could theoretically protect women's bone mass. The current findings, however, do not support that theory."

"Grains might have been an important part of human diets much further back in our history than previous research has suggested. Although cupcakes and crumpets were still a long way off during the Middle Stone Age, new evidence suggests that at least some humans of that time period were eating starchy, cereal-based snacks as early as 105,000 years ago. The findings, gleaned from grass seed residue found on ancient African stone tools, are detailed online Thursday in Science. Researchers have assumed that humans were foraging for fruits, nuts and roots long before 100,000 years ago, but cereal grains are quite a new addition to the early prehistoric gastronomic picture. "This broadens the timeline for the use of grass seeds by our species," Julio Mercader, an assistant professor at University of Calgary's Department of Archeology and author of the paper, said in a prepared statement. "

Introduction: nutritional and functional roles of eggs in the diet. Applegate E. J Am Coll Nutr. 2000 Oct;19(5 Suppl):495S-498S. Review. PMID: 11022998 For years, eggs have been held up as a powerhouse of nutrition. This reputation has been due to eggs' exceptional nutrition profile as a nutrient-dense food containing high quality protein and a substantial amount of many essential vitamins and minerals. Unfortunately their position on the nutrition pedestal fell with the discovery that they are also a source of dietary cholesterol. The most recent scientific research not only returns eggs to their golden past, but elevates their position as a functional food and ultimately provides more reasons than ever to consume eggs. In February 2000, scientists convened at a conference in Amelia Island, Florida, to discuss the latest research about the role of eggs in disease prevention and the promotion of health. This supplement of the Journal of the American College of Nutrition (JACN) presents compelling scientific evidence about eggs' functional food attributes, reaffirms that eggs have a minimal effect on blood cholesterol levels and presents new research on the contribution of eggs to the American diet. For health professionals, this issue provides a new scientifically based viewpoint on eggs and their role in health and nutrition, a viewpoint that should be imparted to all consumers in an effort to ensure optimal health and well-being.

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