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John Ganz Wants to Keep the Party Going – Grub Street
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Illustration: Margalit Cutler
The writer and Unclear and Present Danger podcast co-host John Ganz didnt necessarily expect his first book, When the Clock Broke a history of early-90s conspiracy theories, fringe political figures, and social unease to become a best seller, but thats what has happened. It was a real shock to my publisher, he says. Celebration was in order, and as a native New Yorker, Ganz knows where to go when he wants to indulge, even if that means he ends up picking up a bar tab for all of his friends. I was feeling magnanimous, he says. I kind of regretted it when I saw my credit-card bill, but Ill be okay.
Wednesday, July 3 Today is my birthday. Im turning 39. Never one to abstain, Ive been celebrating for the past three weeks, and its starting to take a toll. I need to flash back for a moment to a meal in June. The New York Times review of my book came out, so I met my best friends Sonia andNatasha Stagg, and Sonias husband, Daniel Schmidt, at the Marlton Hotel Bar for drinks, and then we went to Minetta Tavern. I got us a bottle of Bollinger, we split a dozen oysters, and ordered a bottle of Premier Cru Burgundy, and Sonia and I split the massive cte de boeuf for two (could actually feed four) with marrow bones. Natasha, her twin, got a squab en crote, and Daniel got one of the two burgers on offer. I saw a table get a chocolate souffl and decided we were getting that too. I ordered a Calvados with dessert. This is not how I eat every day: I could neither afford it nor could my body sustain it. But it gives some indication of the way Ive been treating myself lately.
This morning, my stomach is rebelling and I decide to go simple. I make myself one of my favorite comfort foods: pastina, tiny star-shaped pasta that I boil down into a porridge with butter and salt. My plan is to have this be my only meal until dinner. I may also be developing gout. Ive had an unexplained pain in my toe.
My plan to make do with only pastina until dinner does not work. I start to get hungry in the afternoon and look for a snack. All I have in the house are what Ive come to understand are very gout-inducing foods: cans of fish, jars of anchovies, and Schaller & Weber liver pt. My self-diagnosis notwithstanding, I decide to go with the liver on toast.
Im meeting Natasha and my friend Joey Teeling at the Odeon for my birthday dinner. I grew up in New York, and Ive been going to the Odeon since I was a toddler. They used to have a cocktail menu for kids with special colored drinks. When I go with my parents, my mom says, When I was pregnant with you, Basquiat and Andy Warhol were sitting right there. My experience with restaurants in New York is a little melancholy. The places I like close, decline, and change management and menus. But the Odeon stays the same: Its a great institution. Its both comforting and fun.
I get there first. I like to pretend Roya, the Odeons famous hostess, recognizes me. She doesnt; she just has incredible manners. I get there before my friends (Im always punctual) and start with a dry vodka martini. I have to pace myself. Ive rented out the basement bar of Lovely Day for my birthday, which Im sharing with my friend Paulena. Natasha comes in and orders a Campari and soda. Joey orders a cucumber martini. Theres some discussion of oysters, but we get a shrimp cocktail instead and an appetizer portion of steak tartare. I order steak au poivre with frites, my favorite dish since I was young. I get talked into a California Pinot Noir not good for my possible gout. For dessert, we order an affogato, and I have a Fernet Branca to calm my restive stomach.
We walk over to Lovely Day and go down into the bar. I order a tequila on the rocks, which has become my drink this summer. The bar gradually fills with guests, until it gets very full and I lose track of the tequilas. Im told the open tab is about to be spent and add a little more. Eventually, they want us out, and I get a staggering bar tab, which I pay quickly so I dont have to look at it for too long. The remnants of the party tries to go to Time Again Bar, which turns out to be closing, leaving Clandestino as the only option. I dont remember if I have a drink, but I do talk to a girl I have a crush on and even seem to keep her attention from a younger, more handsome rival. She leaves to help a drunk friend into an Uber. Just as I despair of her returning, she rushes back in and asks me to fetch a glass of water for the friend. I am pleased to do this chivalric act. I walk my crush home, and she gives me her number.
Thursday, July 4 Suffice it to say I am not feeling well. Neither is Natasha, who texts me. We decide to ride out the hangover together. I have become obsessed with a Georgian mineral water called Borjomi Im convinced is the only real hangover cure and recently bought two cases of it. Its more mineral than water. But one serving has about a quarter of the daily recommended sodium intake, and Ive become a little concerned that it may not be that healthy. I grab a case of it to take down to Natashas. We watch Sex and the City together, and I fall back asleep. Natasha convinces me some fresh air might help, so we go to Post for breakfast. Our eyes are bigger than our stomachs: I cant finish my biscuits and sausage gravy, and she cant finish her egg-and-bacon sandwich. We decide to go to Great Jones Spa to see if we can sweat out the hangover. The steam room, cold plunge, chamomile tea, and copious amounts of water make some improvement.
On our way back to Natashas,we resort to hair of the dog, buying two large Michelada cans. After more TV, we agree that Italian seems in order. We have given up on doing any Fourth of July activities. We try for Il Buco, but its closed, and instead we sit at the bar at Primi. I order pappardelle with Bolognese sauce and a beer. Natasha has a strange drink that combines a Miller High Life and an Aperol. The pasta is not great its spicy for some reason, which Bolognese should not be but its warm and nourishing, which is what I need. I head home.
Friday, July 5 Every day, I wake up with two strong cups of PG Tips tea with milk and sugar. This is often the only breakfast I have. But recently, the company that makes PG Tips has decided to change the formula, and now it doesnt taste right. I cant understand why they did this. Its a huge problem for me: This is a pillar of my daily life. I have a dwindling supply of the original formula, but after that goes, I dont know what Ill do. Its very unnerving when simple things you take for granted as always being around disappear.
Im still feeling Wednesday a little bit and am taking it easy and watching movies. I decide to order pasta to make up for the disappointment of last night. I go for more comfort food: the penne alla vodka from Tiramisu. Here is another unwelcome change. I grew up here on the Upper East Side, Yorkville to be exact, and that restaurant opened in the 1980s it was named for that decades dessert sensation and was once a bit of a hot spot. But it gently turned into a reliable and slightly dowdy institution, inexpensive and solid. They made great pizza in their wood-burning oven. The dcor hadnt changed much over the years: Venetian masks hung from the walls, which were also lined with wine bottles, and the floors were red brick. I like to say Yorkville is the neighborhood of sublime mediocrity, and Tiramisu was the perfect example of that. Then the building was sold. They moved to a new, slicker location. This great old place that you took for granted as always being there, that I went to since I was a baby, is gone. But the food is still the same, and the delivery is fast. The forkfuls of penne are still hot.
For dinner, Im meeting my friends Will Rahn and Alice Lloyd, who are expecting a baby and have moved from the East 60s to the East 90s for a larger apartment. Will, one of my closest friends since high school, and I used to hang out together at Donohues Steakhouse on Lexington, a perfectly preserved specimen that hasnt changed its menu or customers since the 1950s. Its far from their new place, so we will have to find somewhere new to go, I guess. I see the apartment, and we head to Pascalou on Madison. It happens to be closed, so we cross the street to go to Island, a nautical-themed neighborhood staple. The air conditioner is on the fritz, but the customers are mostly in their 80s and dont seem to mind. I cool down with a gin-and-tonic and order a lobster roll. Will and Alice both get rigatoni. I think they are worried Im lonesome or are preparing for the duties of parenthood, so they invite me back for drinks and cookies.
Saturday, July 6 A friend is visiting from Denmark, and we meet at Film Forum to see The Small Back Room, a Powel and Pressburger movie from the 40s. Afterward, the heat inclines us to sushi, but this is another problem of the ever-changing city. There used to be many Japanese restaurants downtown that were not terribly expensive but were quite good and cozy. Theyve seemingly been replaced by ever-proliferating omakase experiences, some of which are elegant and unaffordable while others are extremely tacky and loud. One of my favorite restaurants, Hasaki, on 9th Street, another non-changer for decades, has come under new management, shortened the sushi bar, and made it omakase-only starting at around $100. Its still pretty good, but it has lost some of its homey, friendly feel. Since the city is empty, we find a table at Tomoe on Thompson Street, which often has a line outside. This means Ive never actually been, but I suppose there must be a reason why. I like that the dcor seems unchanged from its opening and is unpretentious. The service is a little gruff. Promising!
We order a fried soft-shell crab as an appetizer, and I get a selection of nigiri la carte: sea eel, yellowtail, kanpachi, striped jack, mackerel, salmon roe, fatty tuna, and sea urchin. It also has an extensive list of rolls with some interesting options. I get mountain yam with shiso leaf and umeboshi plum. The soft-shell crab, which my friend has never had before apparently, its an American thing is delicious. The sushis presentation is down-home: large slabs over small amounts of rice. Some of it is extremely fresh and flavorful. Other pieces not so much. Im pretty sure the uni was recommended to me to get rid of an old supply, and thats not encouraging. Still, the places charm suffices. We move easily from one carafe of cold sake to two.
Sunday, July 7 I decide to keep it relatively simple for a change. I make myself an omelet. Ive watched the Jacques Ppin video on YouTube a dozen times and still cant make a perfectly shaped French omelet. I always produce a kind of fat, buttery squiggle, but it tastes good. I have a date tonight: The plan is to finish watching The Sorrow and the Pity, Marcel Ophuls four-hour documentary about Vichy France, and then go out to dinner nearby.
We settle on Orsay, a bistro very close to me. Its overpriced and not that good, but it has a welcoming neon sign and a beautiful interior. Like everywhere else, customers are sparse. As a result, the service is perhaps a little too attentive. We convince them to let us share the Dover sole meunire. I have the salade Lyonnaise to start with a poached egg, lardons, and frise. My date has an artichoke vinaigrette. I have a glass of Chablis. The sole is fine. Were having fun, I think, and we share a second glass of wine.
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John Ganz Wants to Keep the Party Going - Grub Street
These power athletes are shifting attitudes about what vegans can look like – Grist
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Eating a plant-based diet is one of the highest-impact actions a person can take to reduce their personal contribution to greenhouse gas emissions. A broader cultural shift toward plants in some of the meat-eatingest countries could lead to more efficient land use, less strain on water systems, and reductions in methane, the potent greenhouse gas that cows famously belch. Still, thats easier said than done. On the individual level, people might have all sorts of reasons for clinging to animal products including the concern that cutting them out will lead to nutritional deficiencies.
But one group of people is challenging the idea that a plant-based diet cant be perfectly sufficient: the swole vegans of powerlifting, strength athletics, and personal training circles. My colleague Joseph Winters wrote a feature last week exploring the stories of some of these stereotype-smashing athletes.
While its difficult to put definitive numbers on the growth of veganism, Winters said, proxies indicate that the diet is gaining popularity generally the plant-based meat market has grown hugely over the past few years, as has the prevalence of vegan restaurants and signups for Veganuary challenges (going vegan for the month of January).
Its definitely more normalized, Winters said, adding that he had a lot of fun finding media coverage of vegan athletes from decades past. A 1974 Time magazine article that he cited in the piece exemplified the scrutiny that vegan and vegetarian athletes have often received; in describing the performance of NBA player Bill Walton, the article noted, The vegetarian tiger played as if he had dined on red meat all week.
I think itd be really weird if outlets covered vegan athletes like that nowadays, Winters said. Enough athletes have proven that you can cut out animal foods from your diet and still perform at a high level.
In fact, one of the nutritionists he spoke to said that intense athletes are of the least concern when it comes to switching to a vegan diet. Because theyre already hyper conscious of protein and micronutrients like iron and B12, they should have little issue getting those things from plants instead of animal products. By contrast, regular Joe vegans might be at risk of deficiencies if they arent accounting for the protein and micronutrients lost by cutting out meat, dairy, and eggs. But another medical source Winters quoted said that most people dont need to worry about hitting their daily protein requirement, as long as theyre eating a diverse diet without too many processed foods whether those foods come from plants or critters.
Personally, I think that Americans obsession with protein is misplaced, and I was very worried that I was going to be feeding that with this article, Winters said. What Americans are more likely to lack is fiber and eating more plants could help with that. (In fact, although this detail didnt make it into the final piece, one of the vegan athletes Winters spoke to eats banana and orange slices with the peels still on, for an extra dose of fiber and micronutrients.)
By and large, the athletes Winters spoke to didnt choose this diet to maximize their physical fitness although many of them are performing at the top of their chosen fields. Theyre vegan mostly for concern about animals and the environment, he said. They also have this other part of their identity thats focused on being an athlete, and they want to show that they dont have to give up that part of themselves. They can have both at the same time.
Vegan strength trainers are just one tiny niche of the population, but, Winters said, theyre contributing to a shift in what people imagine veganism to look like. Its something he also thinks about personally, as a vegan marathon runner and biker.
As a skinny man, I often worry that people think, Oh, thats what happens to you if you go vegan, he joked. But then, I feel like I have good race times, which I can pull out when people doubt my athletic abilities and say, Look, you can still run somewhat fast on a vegan diet. (Let the record show that his half marathon time is 73 minutes far faster than somewhat.)
Weve excerpted Winters piece on swole vegans below. Check out the full story on the Grist site.
Claire Elise Thompson
Over the past two years, Gigi Balsamico has won first place at more than a dozen strongman competitions in the eastern United States: Maidens of Might, Rebel Queen, War of the North, Third Monkey Throwdown. These events typically involve six to eight weight-lifting challenges on which competitors are scored based on criteria like the amount of weight they can handle and how many reps they can do.
Last month, Balsamico came out at the top of her weight class at Delawares Baddest. There, she hoisted four 100- to 150-pound sandbags onto her shoulders after completing six reps of a 315-pound dead lift. As the pice de rsistance, she harnessed herself to a Chevy Silverado which itself was attached to a food truck trailer and dragged it 40 feet in 40 seconds.
Balsamico is also a vegan of 11 years. Its an identity shes vocal about, out of a desire to push back on the notion that you need to eat meat to be strong. When she was a vegan-curious teenager, it gnawed at her that giving up animal products could mean sacrificing sports.
I thought I was going to shrivel away to nothing, Balsamico told Grist. Her Italian, sports-loving family had always eaten meat and dairy. Thats what was always said to me, that you would basically get so skinny and die.
But Balsamicos love for animals compelled her to question these concerns. As a child, tending to neglected horses at a family friends farm prompted her to wonder why people didnt see all animals as beautiful, each with its own unique personality. Horses, cows, sheep, dogs: It was so apparent to me that there was no difference, she said.
Meanwhile, veganism was at the beginning of a surge in popularity concerns over the cruel conditions of factory farming, as well as the impacts of animal agriculture on the climate and environment, were helping to bring the marginalized diet closer to the mainstream. Although estimates vary, peer-reviewed research suggests that the chickens, cows, pigs, and other animals humans raise for meat and dairy contribute up to 20 percent of the planets overall greenhouse gas emissions.
Balsamico cut out all animal products from her diet at the age of 14, justifying the decision to her parents in a 39-minute PowerPoint on the health benefits of plant-based eating. The weight lifting came a couple of years later, mostly out of curiosity: I just wanted to see if I could do it, she said. And she could in 2022, she began winning first place for her age and weight class in every strongman competition she entered, racking up a streak of victories that she has yet to break.
I havent had meat in 11 years of my life, and I can pick up 700 pounds on my back, she told Grist. Balsamico now coaches other aspiring athletes at a gym in Pittsburgh, and is affiliated with an international team of vegan strength competitors called PlantBuilt.
Balsamico and her teammates are just a few of the many plant-based athletes who are using their swole bodies and competition results for social change, showing on social media and through word of mouth that you dont have sacrifice gains slang for muscle mass gained through diet and exercise in order to eat a diet that protects animals and the environment. One block of tofu at a time, theyre defying expectations about whats possible without animal protein and weathering unsolicited criticism from those who insist, against all evidence to the contrary, that soy boys are inherently weak.
Joseph Winters
Read the full piece here to learn more about how endurance athletes, strength builders, and fitness coaches are championing a diet thats lighter on the planet.
Behold: Gigi Balsamico, one of the vegan strength athletes Winters interviewed, pulling a Chevy Silverado and food truck trailer as part of Delawares Baddest, a strength competition she competed in last month.
IMAGE CREDITS
Vision: Lily Lambie-Kiernan / Grist
Spotlight: Lily Lambie-Kiernan / Grist
Parting shot: Courtesy of Gigi Balsamico
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These power athletes are shifting attitudes about what vegans can look like - Grist
Parties in Atlantic City ‘road diet’ lawsuit agree to settlement conference – Press of Atlantic City
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ATLANTIC CITY The parties fighting in court over the citys road diet plans agreed Wednesday to meet for a settlement conference, in an online meeting with Atlantic County Superior Court Assignment Judge Michael Blee.
It was their first court appearance since the Casino Reinvestment Development Authority on June 25 rejected city plans to reduce Atlantic Avenue to two vehicle travel lanes from four.
There have been lots of discussions occurring in real time between the Governors Office, CRDA and the city, said attorney Richard Trenk, who represents the city.
Trenk said the parties all support repaving, traffic light synchronization and other aspects of the road diet plan, and disagree only about restriping to create two vehicle travel lanes and two bike lanes along most of the citys main artery.
The statutory period for the governor to reject CRDAs no vote on the road diet expired Monday, Trenk said.
So now the city has 45 days from Monday to decide whether it will appeal the CRDA decision to the Appellate Division.
We would welcome the opportunity to confer with each other to potentially find common ground to resolve the litigation, said attorney Keith Davis, who represents a group of casinos and AtlantiCare suing to stop the road diet. Our position is CRDA made a final decision which is appealable to the Appellate Division.
Davis also raised the question of what to do about the city having completed Phase 1 from Maine Avenue in the Inlet to Tennessee Avenue in Midtown.
Despite impassioned pleas from city officials, calling for safety to take precedence over all else, the Casino Reinvestment Development Authority rejected a planned road diet to reduce the number of lanes in a section of Atlantic Avenue from four to two.
There is an outstanding issue of the court potentially compelling the city to restripe that section, Davis said.
In May, Blee issued a preliminary injunction to stop the city from completing Phase 2 from Tennessee to Albany avenues.
Trenk asked Blee to decide whether to order a permanent injunction, so he could potentially appeal that as well.
The road diet is a more than $20 million city project to repave Atlantic Avenue in its entirety and restripe it to include two vehicle lanes of travel rather than the current four vehicle lanes in most places.
Mayor Marty Small Sr. has championed the plan, which is funded by a mix of federal and state grants, saying it is needed for pedestrian and driver safety.
But the casinos and AtlantiCare sued last year to stop the restriping, saying it would impede traffic flow and harm casino business and patient safety. They also argued the CRDA had jurisdiction over changes in traffic patterns in the Tourism District, which includes Atlantic Avenue, but the CRDA had not reviewed and approved the project.
In March, the CRDA was allowed to join the lawsuit, and in June the CRDA board voted down the road diet plans.
CRDA attorney Rudy Randazzo, however, cautioned a settlement conference will only be helpful if someone from the Governors Office participates.
A judge on Tuesday granted the Casino Reinvestment Development Authority a preliminary injunction, temporarily stopping Phase 2 of the Atlantic Avenue "road diet" that is working to reduce the number of vehicle travel lanes from four to two in most areas.
The CRDA is more than willing to engage in efforts to reconcile the parties or settle here, but given the political realities Im not sure how effective it would be to have a judicially managed conference, Randazzo said.
We have reached out to the Governors Office, Trenk said. I think most public officials would participate in good faith. There is no downside to trying, right?
It might make sense to have someone from DOT (the state Department of Transportation) there if possible, Davis said, because the Phase 2 plans are before the DOT for approval now and the DOT could answer questions about how a compromise might impact the citys funding.
City officials have said they qualified for millions in federal funding administered by the state by committing to restricting vehicle lanes.
Blee said he would be in touch soon about potential dates for the settlement conference.
REPORTER: Michelle Brunetti Post
609-841-2895
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Parties in Atlantic City 'road diet' lawsuit agree to settlement conference - Press of Atlantic City
For a healthy diet, theres no one-size-fits-all – HSPH News
Diet Comments Off on For a healthy diet, theres no one-size-fits-all – HSPH News
July 11, 2024New diet trends to protect health and extend longevity continue to emergebut theres no one-size-fits-all diet thats best for everyone, according to Harvard T.H. Chan School of Public Healths Frank Hu.
Hu, professor of nutrition and epidemiology and chair of the Department of Nutrition, was among the experts quoted in a July 3 GQ article about eating to live longer.
The good news is there are different [dietary] patterns that can help prevent chronic disease and improve longevity, he said. Most of those patterns are comprised of the same basic principles, including eliminating processed foods like packaged snacks and soda and consuming healthy carbs and fats, like brown rice and olive oil.
You dont have to follow a rigid regimen, Hu said. Basically, you want to eat whole foods: fruits and vegetables, whole grains, nuts, legumes, and seeds.
Read the GQ article: Whats the Best Diet for Longevity?
Photo:iStock/jenifoto
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For a healthy diet, theres no one-size-fits-all - HSPH News
Maximize memory function with a nutrient-rich diet – The Daily News Online
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Maximize memory function with a nutrient-rich diet - The Daily News Online
Lipidome changes due to improved dietary fat quality inform cardiometabolic risk reduction and precision nutrition – Nature.com
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Study designs and populations DIVAS trial
Lipidomics analysis was performed in a subset of participants (n=113 of 195) from the DIVAS trial, a 16-week, single-blind randomized controled parallel trial (registered at http://www.clinicaltrials.gov under accession number NCT01478958). The DIVAS trial was conducted according to the guidelines of the Declaration of Helsinki, and favorable ethical opinion for conduct was given by the West Berkshire Local Research Ethics Committee (09/H0505/56) and the University of Reading Research Ethics Committee (09/40). All individuals provided written informed consent before participating. This study recruited men and women aged between 21 and 60 years and with estimated moderate CVD risk who were randomized to one of three isoenergetic diets: rich in SFAs, rich in MUFAs or rich in mixed UFAs including both MUFAs and omega-6 PUFAs. The target compositions (percent total energy of total fat:SFA:MUFA:PUFA) were 36:17:11:4 for the SFA-rich diet (n=38), 36:9:19:4 for the MUFA-rich diet (n=39) and 36:9:13:10 for the mixed UFA-rich diet (n=36). We collapsed the MUFA-rich and mixed UFA-rich diets into one UFA-rich diet arm for the generation of the MLS.
In the DIVAS dietary intervention trial, all participants diets were isoenergetic and provided 36% of total energy (percent total energy) from fats. Nonfat macronutrient intake and sources were consistent between the intervention and control diets. However, different spreads, oils, dairy products and snacks were used to modify the diets SFA:UFA ratio. The control diet was high in saturated fat (SFA-rich diet; 17% of total energy from SFAs and 15% of total energy from UFAs; n=38 with lipidomics data). In the intervention diet, 8% of total energy from SFAs was substituted for 8% of total energy from UFAs (UFA-rich diet; 9% of total energy from SFAs and 23% of total energy from UFAs; n=75 with lipidomics data). The analysis of 4-day weighed diet diaries indicated successful implementation of these dietary targets over the intervention period (Fig. 2a)29,35. The SFA:MUFA:omega-6-PUFA content in percent total energy in the control group was 17:11:4 and was either 9:19:4 or 9:13:10 in the intervention group arms with different MUFA:PUFA ratios. The omega-3-PUFA content was standardized across all diet groups. Extensive sensitivity analyses revealed that our analysis workflow yielded highly consistent results in the two intervention arms. Therefore, we present comparisons between the control group (high SFA intake) and a pooled intervention group (high UFA intake). We collapsed the MUFA-rich and mixed UFA-rich diet into one UFA-rich diet arm to generate the MLS.
All participants were nonsmokers; were not pregnant or lactating; had normal blood biochemistry and liver and kidney function; did not take dietary supplements or medication for hypertension, raised lipids or inflammatory disorders; had no prior diagnosis of MI, stroke or diabetes; did not consume excessive amounts of alcohol (males: less than 21U per week; females: less than 14U per week) and performed fewer than three 30-min sessions of aerobic exercise per week. The trial was single blinded, and randomization was conducted by a study researcher using minimization stratified for sex, age, BMI and estimated CVD risk. The participants were unaware of the assigned intervention diet and were asked to replace habitually consumed sources of exchangeable fats with study foods (spreads, oils, dairy products and commercially available snacks) of specific fatty acid composition provided free of charge.
Dietary guidance was provided at baseline and throughout the study via 1:1 verbal and written instructions. Compliance was monitored through weighed 4-day diet diaries (weeks 0, 8 and 16), records of study food intake and plasma phospholipid fatty acids as short-term biomarkers of intake (weeks 0 and 16). Observed fatty acid intake compositions were largely in line with the defined target fatty acid compositions35. Body weight, which was to remain constant, was monitored every 4 weeks, and changes were addressed with advice to the participants to adapt study food or carbohydrate consumption and/or activity levels. Fasting blood samples were taken at baseline and after 16 weeks at a similar time of day, and blood fractions were immediately separated and stored at 80C.
The EPIC-Potsdam cohort study is a prospective cohort study that recruited 27,548 participants (16,644 women and 10,904 men of primarily Middle European ancestry, age range: 3565 years) from the general population of Potsdam, Germany, and the surrounding geographical area from 1994 to 1998. Follow-up occurred every 23 years by mailed questionnaires and, if necessary, by telephone. Response rates ranged between 90% and 96% per follow-up round. The study protocol was approved by the ethics committee of the Medical Society of the State of Brandenburg, Germany, and all participants provided a statement of written informed consent before enrollment.
Incident CVD was defined as incidence of primary nonfatal and fatal MI and stroke (International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes: I21 for acute MI, I63.0 to I63.9 for ischemic stroke, I61.0 to I61.9 for intracerebral hemorrhage, I60.0 to I60.9 for subarachnoid hemorrhage and I64.0 to I64.9 for unspecified stroke). Incidence of CVD was captured by participants self-reports or based on information from the death certificates, which were validated by contacting the treating physicians. Inquired information included ICD-10 code, date of occurrence and further information on symptoms and diagnosis criteria. For MI, diagnostic criteria included clinical symptoms, electrocardiograms, cardiac enzymes and known coronary heart disease. For stroke, diagnosis was based on anamnesis, clinical symptoms, computed tomography/magnetic resonance tomography, angiogram, lumbar puncture, echocardiogram, Doppler and electrocardiogram plus imaging techniques if available. Participants with silent cardiovascular events that had not been documented within 28days after occurrence were excluded as nonverifiable cases from all analyses.
Information on incidence of T2D was systematically acquired through self-report of a diagnosis, T2D-relevant medication or dietary treatment due to T2D diagnosis during follow-up. Additionally, death certificates and information from tumor centers, physicians or clinics that provided assessments for other diagnoses were screened for indication of incident T2D. For participants who were classified as potential cases based on that information, a standard inquiry form was sent to the treating physician. Only physician-verified cases with a diagnosis of T2D (ICD-10 code E11) and a diagnosis date after the baseline examination were considered confirmed incident cases of T2D.
Nested casecohorts were constructed for efficient study of molecular phenotypes. From all participants who provided blood at baseline (n=26,437), a random sample (subcohort, n=1,262) was drawn, which served as a common reference population for both endpoints. For each endpoint, all incident cases that occurred in the full cohort until a specified censoring date were included in the analysis. After excluding prevalent cases of the respective outcomes, the analytical sample for T2D comprised 1,886 participants, including 775 incident cases (26 cases in the subcohort), and the analytical sample for CVD comprised 1,671 participants, including 551 incident cases (28 cases in the subcohort). Follow-up was defined as the time between enrollment and study exit determined by diagnosis of the respective disease, death, dropout or final censoring date, whichever came first. Endpoint-specific censoring dates were 30 November 2006 for stroke and MI and 31 August 2005 for T2D.
Anthropometric and blood pressure measurements were conducted according to a standardized protocol65,66. Information on lifestyle and education was obtained using computer-assisted personal interviews. These included information on recreational physical activity, smoking status, average alcohol intake and educational attainment. Participants were categorized as hypertensive at study baseline if they had a systolic blood pressure of 140mmHg, diastolic blood pressure of 90mmHg, reported prior diagnosis of hypertension or current antihypertensive medication use. At baseline, trained study personnel obtained 30ml of peripheral venous blood from each participant. Blood was partitioned into serum, plasma (with 10% of total volume citrate) and blood cells and was subsequently separately stored in tanks of liquid nitrogen at 196C or in deep freezers at 80C until the time of analysis. Plasma samples, from which aliquots were drawn for the lipidomics measurements in 2016, were never or only once thawed and refrozen during storage (93 samples were defrosted and refrozen once for aliquoting for unrelated analysis).
Plasma concentrations of standard blood lipids (total cholesterol, HDL-C, triglycerides, HbA1c, glucose and hsCRP) were measured at the Department of Internal Medicine, University of Tbingen, with an automatic ADVIA 1650 analyzer (Siemens Medical Solutions) in 2007. All biomarker measurements conducted in plasma, including the lipidomics measurements (detailed below), were corrected for the dilution introduced by citrate volume to improve comparability with concentrations measured in EDTA-plasma reported in the literature. Laboratory measurements were conducted by experienced technical personnel following the manufacturers instructions. Single imputation based on linear regression was used to impute missing covariate information (participants with missing data for: waist circumference, n=2; BMI, n=12; standard blood lipids (triglycerides, HDL-C and triglycerides), n=82; and blood pressure, n=148).
The NHS recruited 121,701 female nurses aged 3055 years in 1976 (ref. 67). A subset of 32,826 nurses provided blood samples in 1989 or 1990, of whom 18,743 provided a second blood sample in 2000 or 2001. The NHSII cohort was established in 1989 and recruited 116,429 female nurses aged 2542 years. In NHSII, blood samples from 29,611 participants were collected between 1996 and 1999. The standardized blood collection procedure is described elsewhere37. Participants reported their usual intake of a standard portion of each item in the FFQ (frequency ranging from never to more than six times per day) during the past year every 4 years. The reproducibility and validity of the FFQ has been extensively documented68,69,70. The NHSs were approved by the Human Research Committee at the Brigham and Womens Hospital, Boston, MA, and participants provided written informed consent.
We computed the intake of individual nutrients by multiplying the frequency of consumption of each food by the nutrient content of the specified portion based on food composition data from the US Department of Agriculture and data from manufacturers. Intake of carbohydrate, fat and protein was expressed as nutrient densities (that is, percent energy)71. In a validation study comparing energy-adjusted macronutrient intake assessed by the FFQ with four 1-week diet records, the Pearson correlation coefficients were 0.61 for total carbohydrates, 0.52 for total protein and 0.54 for total fat70.
Participants who reported a stroke were asked for permission to review their medical records. For both nonfatal and fatal strokes, available medical records related to the clinical event, such as imaging and autopsy reports, were reviewed by physicians who were blind to participant risk factor status. Strokes were defined according to the National Survey of Stroke criteria and were classified as ischemic or hemorrhagic72,73. The ischemic stroke lipidomics casecontrol study in the NHS/NHSII cohorts used in our analyses included 968 participants with lipidomics data to construct the rMLS (484 casecontrol pairs). Matching factors included age, fasting, smoking status, race, ethnicity and season of blood collection.
In NHS/NHSII cohorts, T2D incidence was detected based on self-reported diagnosis and was confirmed by a validated supplementary questionnaire74. Before 1998, confirmation of T2D incidence relied on the National Diabetes Data Group criteria and from 1998 onward relied on the American Diabetes Association diagnostic criteria. Validation studies in the NHS have demonstrated the validity of the supplementary questionnaires to adjudicate T2D diagnosis, showing that more than 97% of participants with self-reported T2D detected by questionnaires were reconfirmed through medical record review by endocrinologists blinded to questionnaire information74,75.
We also designed a 1:1-matched nested casecontrol study for lipidomics and T2D. Matching factors were age, race, ethnicity and season of blood collection. The T2D casecontrol study in NHS included 1,456 participants (728 matched casecontrol pairs) with baseline lipidomics data to construct the rMLS. A subset of casecontrol pairs had repeated lipidomics data approximately 10 years apart to construct the rMLS based on fasting (8h) blood samples from both times (1989/1990 and 2000/2001). In the repeated blood sampling study, all participants remained diabetes free until after the second blood collection, and all incident T2D cases occurred between 2002 and 2008.
The study protocols were approved by the Institutional Review Boards of Brigham and Womens Hospital and Harvard T.H. Chan School of Public Health. Participants completion of questionnaires was considered as implied consent.
The PREDIMED study was a multicenter dietary intervention trial with 7,447 participants in three intervention arms and demonstrated cardiometabolic risk reduction by a Mediterranean diet intervention (www.predimed.es; ISRCTN registry: ISRCTN35739639)33,76. The PREDIMED trial received ethical approval from the Institutional Review Board of the Hospital Clinic in Barcelona, Spain, 16 July 2002. The PREDIMED trial inclusion criteria were either prevalence of T2D or prevalence of three or more major cardiovascular risk factors (smoking, dyslipidemia, hypertension and adiposity). Besides the low-fat diet control group, the Mediterranean diet intervention included two arms (one particularly high in extra virgin olive oil and the other particularly high in tree nut intake) that we pooled into one Mediterranean diet group for our primary analyses. Preintervention blood samples were taken after an overnight fast by trained study personnel according to a standard protocol and fractioned, and the EDTA-plasma was stored at 80C in deep freezers.
The PREDIMED T2D casecohort study with available lipidomics data comprised 694 randomly selected participants (approximately 20% of participants) who fulfilled inclusion criteria, that is, no prevalent T2D at recruitment and available plasma samples and all incident T2D cases during a median of 3.8 years of intervention (n=251; per casecohort design 53 incident T2D cases were randomly included in the subcohort). The analytical sample was restricted to participants with complete data on lipid metabolites in the rMLS (n=678, including 211 participants with incident T2D). Of those, 468 participants (including 148 participants with subsequent T2D incidence) had additional plasma samples and lipidomics profiles from 1 year after recruitment.
The PREDIMED CVD casecohort study with lipidomics data comprised 791 randomly selected participants with available plasma samples at recruitment (approximately 10% of the eligible participants) and all incident CVD cases during a median of 3.8 years of intervention (n=231). After excluding participants with missing rMLS lipid metabolite values, the analytical sample comprised 871 participants, including 215 participants with incident CVD. Of those, 736 participants (including 136 participants with subsequent CVD incidence) had additional plasma samples and lipidomics profiles from 1 year after recruitment. The study protocols were approved by the Institutional Review Boards at all study locations (PREDIMED) and the Harvard T.H. Chan School of Public Health (PREDIMED casecontrol subproject). All participants gave written informed consent.
The LIPOGAIN-2 study was a 12-week, double-blind, parallel-group randomized trial focusing on overweight individuals. In this manuscript, only the first phase of the trial, consisting of an 8-week overfeeding period, was used.
Participants aged between 20 and 55 years with a BMI ranging from 25 to 32kgm2 were eligible. Exclusion criteria were diabetes (fasting glucose of >7mM on two occasions) or liver disease, pregnancy, lactation, alcohol abuse, claustrophobia, abnormal clinical chemistry test results, use of drugs influencing energy metabolism, use of omega-3 supplements or extreme diets, regular heavy exercise (>3h per week), intolerance to gluten, egg or milk protein and implanted metals. Participants were required to fast overnight for 10 to 12h and avoid physical exercise and alcohol for 48h before measurements were taken.
The trial took place at Uppsala University Hospital in Uppsala, Sweden, from August 2014 to June 2015. Participants were assigned to groups through a computer-generated list, which was prepared by a statistician not involved in the study, and stratified for sex, age and BMI. This study is registered on http://www.clinicaltrials.gov under the identifier NCT02211612 and was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent before inclusion, and the study was approved by the Regional Ethical Review Board in Uppsala (Dnr 2014/186).
In total, 61 participants were randomized to receive muffins made with either refined sunflower oil, which is high in PUFAs (specifically linoleate 18:2n-6), or refined palm oil rich in SFAs (mainly palmitate 16:0) for 8 weeks. Participant body weight was monitored weekly when they visited the clinic to receive their muffins, which were prepared in large batches under controlled conditions in a metabolic kitchen at Uppsala University. These muffins, identical in composition except for the type of fat, were added to the participants regular diets to be eaten at any time of the day. Their number was adjusted weekly by plus or minus one muffin per day based on the rate of weight gain, with the goal being an average weight gain of 3% (equivalent to about 2.90.5 muffins or approximately 40g of oil per day). The muffins comprised 51% fat, 44% carbohydrates and 5% protein by energy percentage. One participant was removed due to missing sphingolipid measurements.
Lipidomics analysis was performed with Metabolons Complex Lipid Panel for the EPIC-Potsdam cohort and the DIVAS trial separately. In brief, the platform generates concentrations of molecular species and nearly complete fatty acid composition per lipid class in plasma. The lipid fraction is extracted with methanol:dichloromethane, concentrated under nitrogen and reconstituted in ammonium acetate dichloromethane:methanol (BUME extraction). Extracts are then infused into the ionization source of a Sciex SelexION-5500 QTRAP mass spectrometer operated in multiple reaction monitoring mode with positive/negative switching. Lipid classes are subsequently separated by differential mobility spectrometry. Using 1,100 multiple reaction monitorings, lipid mass and characteristic fragments are determined with the help of more than 50 isotopically labeled internal standards that are simultaneously introduced with the biological sample. Molecular species are quantified by taking the ratio of the signal intensity of each target compound to that of its assigned internal standard and multiplying by the concentration of internal standard added to the sample77.
The Complex Lipid Panel produced measurements for 14 lipid classes (cholesteryl esters, monoglycerides, ceramides, dihydroceramides, lactosylceramides, hexosylceramides, sphingomyelins, lysophosphatidylethanolamines, lysophosphatidylcholines, diglycerides, triglycerides, phosphatidylcholines, phosphatidylethanolamines and phosphatidylinositol). For phosphatidylethanolamines, species from the two subclasses phosphatidylethanolamine ether and phosphatidylethanolamine plasmalogen were detected. Measured concentrations of molecular species were used to calculate within-class fatty acid sums (summing all concentrations of molecular species containing a specific fatty acid within a lipid class). Within-class fatty acid sums are synonymous with molecular species level in lipid classes containing only one reported variable fatty acid per molecule (one-fatty-acid-containing classes: cholesteryl esters, monoglycerides, ceramides, dihydroceramides, lactosylceramides, hexosylceramides, sphingomeylins, lysophosphatidylethanolamines and lysophosphatidylcholines).
For comparability with the species-level lipidomics in the PREDIMED trial and NHS/NHS2 cohorts (see below), we further calculated the species level for those classes with more than one fatty acid per molecule (that is, diglycerides, triglycerides, phosphatidylcholines, phosphatidylethanolamines and phosphatidylinositol) by summing all species with the same total atomic mass and degree of saturation of the contained fatty acids (that is, isobaric species). We used the updated shorthand notations from the LIPIDMAPS initiative where applicable78. We only refer to the shorthand notations of fatty acids for brevity. According to the manufacturer, the median coefficient of variation of species at a 1M concentration in serum or plasma was approximately 5%. Several lipid species had higher percentages of missing values because they were likely below the lower limit of quantification. Lipid species with more than 70% missing values were excluded, while missing values in the remaining lipid species were imputed using the Quantile Regression Imputation of Left-Censored data approach from the R package imputeLCMD (https://CRAN.R-project.org/package=imputeLCMD).
At the Broad Institute, plasma polar and nonpolar lipids were identified using a Shimadzu Scientific Instrument Nexera x2 U-HPLC system, which was linked to a Thermo Fisher Scientific Exactive Plus Orbitrap mass spectrometer. Lipids were extracted from the plasma (10l) using 190l of isopropanol that had 1,2-didodecanoyl-sn-glycero-3-phosphocholine as an internal standard, supplied by Avanti Polar Lipids. After centrifugation (10min, 9,000g, room temperature), the supernatants (2l) were directly injected onto a 1002.1mm ACQUITY BEH C8 column (1.7m) from Waters. The column was flushed isocratically at a flow rate of 450lmin1 for 1min at 80% of mobile phase A (95:5:0.1 (vol/vol/vol) of 10mmoll1 ammonium acetate:methanol:acetic acid), succeeded by a linear gradient to 80% of mobile phase B (99.9:0.1 (vol/vol) methanol:acetic acid) for 2min and a linear gradient to 100% mobile phase B over 7min and finally maintained at 100% mobile phase B for 3min.
Mass spectrometry analyses were performed in positive ion mode using electrospray ionization and full scan analysis over m/z 2001,100 at a resolution of 70,000 and a data acquisition rate of 3Hz. The following other mass spectrometry parameters were used: ion spray voltage at 3.0kV, capillary and probe heater temperature at 300C, sheath gas at 50, auxiliary gas at 15 and S-lens RF level at 60. Progenesis QI software (NonLinear Dynamics) was used to process raw data for feature alignment, nontargeted signal detection and signal integration. Targeted processing of a subset of lipids was conducted using TraceFinder software (version 3.2; Thermo Fisher Scientific). Lipids were characterized by their headgroup, overall acyl carbon content and total acyl double bond content79. The Broad Institute metabolomics data in NHS/NHSII were measured in several casecontrol studies. Within each casecontrol study, lipid species with more than 70% missing values were excluded, whereas missing values in remaining lipid metabolites were imputed with half the minimal measured value. Due to the platform evolution in the NHS/NHSII cohorts, some metabolite levels were not measured in specific casecontrol studies. For calculation of the rMLS, nonmeasured values of specific metabolites in specific casecontrol studies were substituted with the median of all measured values across the whole dataset (only applicable to the rMLS diet substitution models in the NHS/NHSII cohorts).
Sphingolipids from serum were extracted using butanolmethanol methods80,81. Sphingolipids were detected and quantified using ultraperformance liquid chromatography/tandem mass spectrometry, as previously described82.
All lipidomics variables in all study samples were log transformed.
We assessed the difference in postintervention within-class fatty acid sum concentrations between the SFA-rich and UFA-rich diets via linear regression models with trial arm coded as an indicator variable (SFA-rich diet as a reference) and adjusted for respective baseline concentrations in addition to age, BMI and sex. All lipids that were statistically significantly different between the diets after controlling for an FDR83 at 5% were used for calculating the MLS (Supplementary Tables 10 and 11). Using the estimated intervention effects as weights, we calculated the MLS in the DIVAS trial and, again, used linear regression to estimate baseline-adjusted differences in MLS between the diets. For the analyses of sphingolipids, sphingolipid score and apolipoprotein B in the LIPOGAIN-2 trial, we used the same approach as in the DIVAS trial. The models were similarly adjusted for age, sex and BMI.
Using the estimated intervention effects as weights, we calculated the MLS in the EPIC-Potsdam cohort and divided the score by the observed diet effect on the MLS in the DIVAS trial so that one unit increase in the MLS corresponds to the magnitude of the DIVAS diet intervention effect. Like the above approach, we estimated the diet effect on other risk biomarkers (HbA1c, fasting glucose, total triglycerides, HDL-C, non-HDL-C and hsCRP) and applied the respective observed effect as a scale for the hypothetical DIVAS intervention effect in the EPIC-Potsdam cohort.
We assessed the association between MLS and incident CVD and T2D with Cox proportional hazards models. The casecohort design was accounted for by assigning weights as proposed by Prentice. Age was the underlying time variable, with entry time as age at baseline and exit time as age at event or censoring. The fully adjusted model included age (years), sex, waist circumference (cm), height (cm), leisure-time physical activity (average h per week), highest achieved education level (three categories: primary school, secondary school/high school and college/higher education degree), fasting status at blood draw (three categories: overnight fast, only drink and unfasted), total energy intake (gday1), blood pressure (systolic and diastolic; mmHg), smoking status (four categories: never, former, current smoker (<20Uday1) and current smoker (20Uday1)), alcohol intake (six sex-specific categories: none, low, moderately low, moderately high, high and very high), antihypertensive medication (yes/no), lipid-lowering medication (yes/no) and acetylsalicylic acid medication (yes/no) as covariates. Models for CVD were additionally adjusted for prevalent T2D. To check if the presentation of stratified results was warranted, we tested the potential for effect measure modification by sex by including MLSsex interaction terms into the multivariable-adjusted model.
The rMLS was constructed with the same weights as were used in the EPIC-Potsdam cohort; however, those lipids that were not available in the Broad Institute lipidomics data in the NHS/NHSII cohorts and PREDIMED trial were either skipped or, where possible, imputed using regression weights from the EPIC-Potsdam cohort. In detail, the Broad Institute lipidomics datasets available in the NHS/NHSII cohorts and the PREDIMED trial offer species-level lipidomics in those lipid classes that contain more than one fatty acid residue per molecule, whereas the platform used in the EPIC-Potsdam cohort and the DIVAS trial generated resolution down to the molecular species level, indicating all fatty acid residues per molecule (with the exception of triglycerides). We calculated species levels in the EPIC-Potsdam cohort and used these to predict within-class fatty acid sums. These lipid species-specific weights were then applied to generate a predicted value of the missing lipid variable in the PREDIMED trial and the NHS/NHSII cohorts, where possible.
Diet and lipidomics profiles were available from 10,894 women in the NHS (n=7,479) and NHSII (n=3,415) cohorts. For macronutrient substitution modeling, we used the average of the macronutrient intakes derived from the two FFQs closest to the blood collection that was used in the dietary substitution analyses (NHS cohort: 1986 and 1990; NHSII cohort: 1995 and 1999). We then included all dietary macronutrient variables (as percent total energy) except for saturated fat in a linear model with the variance standardized MLS as outcome, adjusting for total energy intake excluding alcohol (kcalday1), alcohol intake (gday1), BMI (kgm2), age (years) and diet quality (AHEI without alcohol points). Macronutrient intake was scaled to 8% of total energy. Therefore, effect estimates from this linear model can be interpreted as the association of substituting 8% of total energy from SFAs with 8% of total energy from other macronutrients. Conditional logistic regression models were used to assess the associations of the rMLS with the risk of developing stroke and T2D.
We further assessed the correlation of the rMLS with established diet quality indices, including LCDs84, the aMed85 and the AHEI86. For the general LCD, participants were divided into 11 strata based on percentage of energy from each total fat, protein and carbohydrates. Points were assigned descending from 10 for the highest stratum in fat and protein to 0 for the lowest. For carbohydrates, scoring was reversed, with the lowest intake receiving 10 points and the highest receiving 0. We applied the same methodology to compute two additional LCD scores: one animal based and one vegetable based. The animal-based LCD score was based on the percentage of energy derived from carbohydrates, animal protein and animal fat. Conversely, the vegetable-based LCD score was calculated from the energy percentages from carbohydrates, vegetable protein and vegetable fat84.
The aMed score, adapted from Trichopoulou et al.87, includes vegetables (excluding potatoes), fruits, nuts, whole grains, legumes, fish and the ratio of monounsaturated to saturated fats along with red and processed meats and alcohol. Participants scoring above the median intake in these categories received 1 point, except for red and processed meats where scoring below the median earned a point; all others received 0. Alcohol intake scoring awarded 1 point for daily consumption between 5 and 15g. The aMed score ranges from 0 to 9, with higher scores indicating greater adherence to the Mediterranean diet85.
The AHEI was developed after a comprehensive literature review and consultations with nutrition researchers to identify dietary factors consistently linked with a reduced risk of chronic diseases in clinical and epidemiological research. Beneficial AHEI components include vegetables, fruits, whole grains, nuts, legumes, long-chain omega-3 PUFAs and total PUFAs, whereas adverse components comprise sugar-sweetened beverages, red and processed meats, trans-fats and sodium. Moderate alcohol consumption scores highest, with high consumption scoring lowest. Each AHEI component is rated from 0 (worst) to 10 (best), resulting in a total score ranging from 0 (no adherence) to 110 (perfect adherence)86.
Risk associations with stroke and T2D in the nested 1:1-matched casecontrol studies were assessed with conditional logistic regressions adjusted for age, BMI, alcohol intake, diet quality and smoking. Analyses on 10-year change in MLS were further adjusted for status after 10 years of these variables (except age).
We used Prentice-weighted Cox proportional hazards regression to assess the association between the rMLS and the risk of incident disease endpoints in PREDIMED. The interaction analyses were performed in the subsamples with two lipidomics profiles (preintervention and 1-year into the intervention). The interaction model contained a three-way interaction term between Mediterranean diet intervention and the repeated rMLS measurements (preintervention rMLSMediterranean diet intervention1-year intervention rMLS) along with the main effect terms and were adjusted for age and sex. The results of the interaction analyses informed the subsequent stratified analyses according to the Mediterranean diet intervention. The Cox models in the intervention strata were adjusted for age, sex and preintervention BMI.
We estimated a network model of conditional dependencies, where edges represent covariance between two lipids that could not be explained by adjustment for any subset of other lipids. To this end, we applied an order-independent implementation of the causal structure learning PC algorithm88. The resulting network graphically encoded the family of causal models that could have generated the observed conditional independence structure, that is, the skeleton of the data-generating directed acyclic graph. Within this network, we identified clusters of lipids using the Louvain modularity detection algorithm. The Louvain method is a fast heuristic algorithm for detecting communities in large networks by optimizing modularity. It iteratively merges nodes into communities to maximize within-community links compared to between-community links38.
We then calculated cluster-specific lipid scores using the same weights as for the full MLS and associated the resulting scores with risk of cardiometabolic diseases in the same way as the full MLS. We furthermore applied the NetCoupler algorithm (netcoupler.github.io/NetCoupler/) to identify those lipiddisease connections that could not be attributed to the influence of related MLS lipids. The algorithm uses the conditional independence network to detect links between individual lipids and disease incidence that could not be explained by confounding influences through other lipids. By definition, at least one subset of direct neighbors is sufficient to block confounding from the whole network. However, sufficient adjustment sets cannot be unambiguously read from the graph because the edges are not directed. Therefore, the NetCoupler algorithm iterates for each lipid through adjustment for all possible combinations of direct network neighbors. A lipid is then only classified as a direct effector if the association with disease incidence is robust across all these submodels39,40.
All analyses were performed using R (version 4.3.0). Further information on used R packages is reported in Supplementary Table 13.
Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.
Read More..Mediterranean Diet and Omega-3 Supplements Shown to Reduce Acne Severity – Dermatology Times
Diet Comments Off on Mediterranean Diet and Omega-3 Supplements Shown to Reduce Acne Severity – Dermatology Times
Following a Mediterranean diet and taking omega-3 supplements may help reduce acne severity in patients with mild to moderate cases, according to new research published in the Journal of Cosmetic Dermatology.1 The study also showed that increased omega-3 levels led to improved clinical appearance and quality of life.
Diets high in processed foods and dairy products are known to increase the risk for acne, but there has been little research on how dietary interventions could help alleviate the severity of symptoms.
In the pursuit of skin health, and particularly in a juvenile patient cohort, such as acne vulgaris, clinicians and patients are more than ever seeking treatment approaches that go beyond the conventional options of topical and systemic prescription medications, the authors wrote. As the understanding of the interplay between so-called exposome factors and skin health deepens, there is increasing evidence pointing to the pivotal role of nutrition in shaping dermatoses.
Investigators from the University Hospital at Ludwig Maximilian University of Munich conducted a study to assess EPA and DHA levels in patients with acne, as well as to examine the effect of dietary interventions and supplementation on clinical severity. The single-center intervention study occurred over a 16 week period .
The study cohort included 60 patients who were not currently taking a prescription medication, of which 23 had acne comedonica and 37 had acne papulopustulosa. For the study, patients adhered to a Mediterranean diet that focused on plants and unprocessed, seasonal, nutrient-dense ingredients. Patients were encouraged to make homemade meals and limit ultra-processed foods, dairy products, and meat.
Study participants also took 2 different doses of oral algae-derived omega-3 supplements throughout the study period: 600mg of DHA and 300mg of EPA for weeks 1 through 8; and 800mg of DHA and 400mg of EPA for weeks 8 through 16. Patients were evaluated at 4 follow-up visits: baseline, week 6, week 12, and week 16.
At baseline, 98.3% of patients had an EPA/DHA deficit. Investigators found that mean HS-omega 3 index scores rose from 4.9% at the first follow-up visit to 8.3% at the fourth follow-up visit. Patients with acne comedonica had higher indices at the fourth follow-up visit compared to patients with acne papulopustulosa. There were also objective improvements in inflammatory and non-inflammatory lesions.
Additionally, although self-reported appearance in 4 patients worsened, patients overall quality of life improved. This was particularly seen in patients with acne papulopustulosa. No adverse events were reported during the study period.
Study limitations include an inability to provide each patient with meals and supplements due to time constraints, potential recall bias due to self-reported adherence to dietary recommendations, and a predominance of female participants, though the authors noted that this may not have significantly impacted the studys results.
Lifestyle interventions, including dietary recommendations, should not be considered in opposition to prescription medications, but rather as a valuable adjunct to any modern acne treatment plan, Anne Guertler, MD, a corresponding author on the study, said in a release.2 Future studies should build on the foundation laid by our current findings in a randomized, placebo-controlled design to improve dietary recommendations for acne patients.
References
[This article was originally published by our sister publication, Drug Topics.]
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Mediterranean Diet and Omega-3 Supplements Shown to Reduce Acne Severity - Dermatology Times
Mediterranean Diets Benefit Childrens Heart Health as Well as Adults – Technology Networks
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Children can reap the benefits of the Mediterranean diet just as well as adults, according to a new meta-analysis.
Researchers from the University of the Americas, Ecuador, reviewed nine previously published clinical trials which assessed how Mediterranean diets can affect cardiovascular health among children and adolescents.
The authors found that just eight weeks of Mediterranean-style nutrition was associated with a significant reduction in blood pressure and total cholesterol.
The results were published in JAMA Network Open.
Prior to the work of the University of the Americas researchers, there were several hundred published studies on the effects of the Mediterranean diets on the cardiometabolic health of children. There was no known meta-analysis of this literature, however.
To undertake this mammoth review, the researchers sifted through the available studies to find nine randomized controlled clinical trials. These robust studies accounted for 577 participants (59.6% girls, 40.4% boys) with an average age of 11 years. Six of the trials focused on children who were overweight; one trial enrolled children with prediabetes; the other two studies involved apparently healthy children.
After assessing the results of all nine trials, the researchers found that, compared to the control groups which didnt consume a Mediterranean diet, the children who did try the famed European regimen experienced a significant reduction in systolic blood pressure, blood lipids and total cholesterol. The Med-dieting children also experienced an increase in high-density lipoproteins, which are often known as good cholesterol.
The researchers believe these changes may be explained by the low levels of saturated fats and higher levels of mono- and poly-unsaturated fats (from olive oil, nuts, fish, etc.) typically found in Mediterranean meals.
The diets absence of ultra-processed foods the class of artificially altered food thought tocontribute to the rise of obesity, cardiovascular disease and cancers seen in the Western world may also have contributed to the health benefits seen in the children.
While the authors do acknowledge the caveats of their analysis mainly, the small number of trials involved they nonetheless conclude that Mediterranean diet-based interventions could be vital in curbing cases of atherosclerosis and cardiovascular diseases that some children would otherwise have gone on to develop in later life. Mediterranean diet-based interventions in schools and hospitals could, they say, be a valuable tool for preventing these illnesses and optimizing cardiometabolic health in the younger population.
Reference: Lpez-Gil JF,Garca-Hermoso A,Martnez-Gonzlez M,Rodrguez-Artalejo F. Mediterranean Diet and Cardiometabolic Biomarkers in Children and Adolescents:A Systematic Review and Meta-Analysis.JAMA Netw Open.2024. doi:10.1001/jamanetworkopen.2024.21976
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Mediterranean Diets Benefit Childrens Heart Health as Well as Adults - Technology Networks
Triad woman loses 70 pounds after switching to a plant-based diet – WFMYNews2.com
Diet Comments Off on Triad woman loses 70 pounds after switching to a plant-based diet – WFMYNews2.com
Wanda Hammock experienced high cholesterol and knew she needed to change her eating habits. She switched to a plant-based diet after facing a diabetes diagnosis.
CASWELL COUNTY, N.C. We all know about the importance of maintaining a healthy diet.
It helps boost your energy, supports weight loss, and helps protect you against many diseases.
One type of diet, Cone Health providers say can be beneficial, is a plant-based diet.
A Caswell County woman knows about the diet all too well. Wanda Hammock experienced high cholesterol and knew she needed to change her eating habits.
She switched to a plant-based diet in 2022 after facing a diabetes diagnosis.
She says the switch to eating healthy happened gradually.
"It was difficult at first because it was changing my habit. I am a busy person so I was eating on the run a lot. I was eating a lot of convenience foods, hitting the drive-thru - that sort of thing. I had to change my habits to start doing more meal prep for when I would eat and where I would eat," Hammock said.
Hammock said she began to eat more salads and beans by eliminating fast foods and processed foods.
Because of the diet, her health has improved.
She is much more happy and has lost over 70 pounds in 13 months.
"My lab work is phenomenal at this point - when I started this," Hammock said.
Dr. Gebre Nida, a diabetologist with Cone Health, works with more than 200 patients benefiting from the diet.
He says 93% of people in the world are medically unhealthy and that the top five medical conditions including diabetes benefit from a whole food plant-based diet.
"Keep foods simple from the ground or from the farmer as much as possible, instead of from the factories," Nida said.
He said the diet can help your body fight inflammation, giving you a good medical advantage.
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Triad woman loses 70 pounds after switching to a plant-based diet - WFMYNews2.com
Warsaw road diet work delayed – News on the Neck
Diet Comments Off on Warsaw road diet work delayed – News on the Neck
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Warsaw road diet work delayed - News on the Neck