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1.  Non-Soy Legume Consumption Lowers Cholesterol Levels: A Meta-Analysis of Randomized Controlled Trials 
Background and Aims
Studies evaluating the effect of legume consumption on cholesterol have focused on soybeans, however non-soy legumes, such as a variety of beans, peas, and some seeds, are commonly consumed in Western countries. We conducted a meta-analysis of randomized controlled trials evaluating the effects of non-soy legume consumption on blood lipids.
Methods and Results
Studies were retrieved by searching MEDLINE (from January 1966 through July 2009), EMBASE (from January 1980 to July 2009), and the Cochrane Collaboration's Central Register of Controlled Clinical Trials using the following terms as medical subject headings and keywords: fabaceae not soybeans not isoflavones and diet or dietary fiber and cholesterol or hypercholesterolemia or triglycerides or cardiovascular diseases. Bibliographies of all retrieved articles were also searched. From 140 relevant reports, 10 randomized clinical trials were selected which compared a non-soy legume diet to control, had a minimum duration of 3 weeks, and reported blood lipid changes during intervention and control. Data on sample size, participant characteristics, study design, intervention methods, duration, and treatment results were independently abstracted by 2 investigators using a standardized protocol. Data from 10 trials representing 268 participants were examined using a random-effects model. Pooled mean net change in total cholesterol for those treated with a legume diet compared to control was −11.8 mg/dL (95% confidence interval [CI], −16.1 to −7.5); mean net change in low density lipoprotein cholesterol was −8.0 mg/dL (95% CI, −11.4 to −4.6).
Conclusion
These results indicate that a diet rich in legumes other than soy decreases total and LDL cholesterol.
doi:10.1016/j.numecd.2009.08.012
PMCID: PMC2888631  PMID: 19939654
legumes; fabaceae; meta-analysis; randomized controlled trial; cholesterol; cardiovascular diseases
2.  Association of inflammation and endothelial dysfunction with metabolic syndrome, prediabetes and diabetes in adults from Inner Mongolia, China 
Background
We examined the association of biomarkers of inflammation and endothelial dysfunction with diabetes and metabolic syndrome (MetS) in persons from Inner Mongolia.
Methods
A cross-sectional study was conducted among 2,536 people aged 20 years and older from Inner Mongolia, China. Overnight fasting blood samples were obtained to measure plasma concentrations of high sensitivity C-reactive protein (hsCRP), soluble inter-cellular adhesion molecule-1 (sICAM-1), sE-selectin, angiotensin II, high density lipoprotein cholesterol, triglycerides, and blood glucose. Waist circumference and blood pressure were measured by trained staff. MetS was defined according to the modified ATP III definition for Asians. Elevated level of the biomarker was defined as values in the upper tertile of the distribution. Participants were categorized into one of four groups based on the presence or absence of metabolic and glycemic abnormalities: 1) free of prediabetes, diabetes and MetS (reference group), 2) prediabetes or diabetes only, 3) MetS without prediabetes or diabetes, and 4) MetS plus prediabetes or diabetes. The multivariable models are adjusted for age, gender, smoking, drinking, family history of hypertension, and body mass index.
Results
Among study participants, 18.5% had prediabetes, 3.6% had diabetes, and 27.4% of the entire study population had 3 or more components of the MetS. Elevated hsCRP was associated with an increased odds of prediabetes or diabetes only, MetS without prediabetes or diabetes, and MetS plus prediabetes or diabetes with multivariable adjusted odds ratios (95% confidence intervals) of 2.3 (1.7-3.1), 3.0 (2.4-3.8), and 5.8 (4.5-7.5), respectively. Elevated sICAM-1 was associated with increased odds (95% CI) of prediabetes or diabetes only (2.1, 1.6-2.9) and MetS plus prediabetes or diabetes (4.2, 3.2-5.3) but was not associated with MetS alone. Elevated sE-selectin was associated with a modestly increased risk of MetS (OR 1.7, 95% CI 1.4-2.2). Elevated levels of Angiotensin II were not associated with the MetS plus prediabetes or diabetes in this study.
Conclusions
Diabetes and the MetS are common in the Inner Mongolia population. The biomarkers of inflammation and endothelial dysfunction are associated with increased risk for diabetes and MetS in this population. These results are consistent with results from other populations.
doi:10.1186/1472-6823-11-16
PMCID: PMC3204247  PMID: 21989115
metabolic syndrome; diabetes; inflammation; endothelial dysfunction; C-reactive protein; intercellular adhesion molecule-1; E-selectin
3.  Exercise Without Weight Loss Does Not Reduce C-Reactive Protein: The INFLAME Study 
Purpose
Numerous cross-sectional studies have observed an inverse association between CRP and physical activity. Exercise-training trials have produced conflicting results, but none of these studies were specifically designed to examine CRP. The objective of the Inflammation and Exercise study (INFLAME) was to examine whether aerobic exercise training without dietary intervention can reduce CRP in individuals with elevated C-reactive protein (CRP).
Methods
The study was a randomized, controlled trial of 162 sedentary men and women with elevated CRP (≥2.0 mg/L). Participants were randomized into a non-exercise control group or an exercise group that trained for 4 months. The primary outcome was change in CRP.
Results
The study participants had a mean (SD) age of 49.7 (10.9) years and a mean body mass index of 31.8 (4.0) kg/m2. The median (IQR) and mean baseline CRP levels were 4.1 (2.5, 6.1) and 4.8 (3.4) mg/L, respectively. In the exercise group, median exercise compliance was 99.9%. There were no differences in median (IQR) change in CRP between the control and exercise groups (0.0 [−0.5, 0.9] versus 0.0 [−0.8, 0.7] mg/L, p=0.4). The mean (95% CI) change in CRP adjusted for gender and baseline weight was similar in the control and exercise groups with no significant difference between groups (0.5 [−0.4, 1.3] versus 0.4 [−0.5, 1.2] mg/L, p=0.9). Change in weight was correlated with change in CRP.
Conclusions
Exercise training without weight loss is not associated with a reduction in CRP.
doi:10.1249/MSS.0b013e3181c03a43
PMCID: PMC2919641  PMID: 19952828
cardiorespiratory fitness; physical activity; inflammatory markers; Inflammation and Exercise study
4.  Metabolic Syndrome and Diabetes, Alone and in Combination, as Predictors of Cardiovascular Disease Mortality Among Men 
Diabetes Care  2009;32(7):1289-1294.
OBJECTIVE
To examine cardiovascular disease (CVD) mortality risk in men with diabetes only, metabolic syndrome only, and concurrent metabolic syndrome and diabetes.
RESEARCH DESIGN AND METHODS
We examined CVD mortality risk by metabolic syndrome and diabetes status in men from the Aerobics Center Longitudinal Study (ACLS) (mean ± SD age 45.1 ± 10.2 years). Participants were categorized as having neither diabetes nor metabolic syndrome (n = 23,770), metabolic syndrome only (n = 8,780), diabetes only (n = 532), or both (n = 1,097). The duration of follow-up was 14.6 ± 7.0 years with a total of 483,079 person-years of exposure and 1,085 CVD deaths.
RESULTS
Age-, examination year–, and smoking-adjusted CVD death rates (per 1,000 man-years) in men with neither metabolic syndrome nor diabetes, metabolic syndrome only, diabetes only, and both were 1.9, 3.3, 5.5, and 6.5, respectively. CVD mortality was higher in men with metabolic syndrome only (hazard ratio 1.8 [95% CI 1.5–2.0]), diabetes only (2.9 [2.1–4.0]), and both (3.4 [2.8–4.2]) compared with men with neither. The presence of metabolic syndrome was not associated (1.2 [0.8–1.7]) with higher CVD mortality risk in individuals with diabetes. In contrast, the presence of diabetes substantially increased (2.1 [1.7–2.6]) CVD mortality risk in individuals with metabolic syndrome.
CONCLUSIONS
The presence of diabetes was associated with a threefold higher CVD mortality risk, and metabolic syndrome status did not modify this risk. Our findings support the fact that physicians should be aggressive in using CVD risk–reducing therapies in all diabetic patients regardless of metabolic syndrome status.
doi:10.2337/dc08-1871
PMCID: PMC2699717  PMID: 19366967
5.  Exercise dose and quality of life: Results of a randomized controlled trial 
Archives of internal medicine  2009;169(3):269-278.
Background
Improved quality of life (QOL) is a purported benefit of exercise despite few randomized controlled trials (RCTs) and no dose-response trials.
Methods
The effect of 50%, 100%, and 150% of the NIH Consensus Development Panel physical activity dose on QOL was examined in a six-month RCT. Participants were 430 sedentary postmenopausal women (BMI 25.0-43.0 kg/m2) with elevated systolic blood pressure randomized to a non-exercise control group (n=92) or 1 of 3 exercise groups: exercise energy expenditure of 4 (n=147), 8 (n=96), or 12 (n=95) kcal/kg/week. Eight aspects of physical and mental QOL were measured at baseline and month 6 with the SF-36.
Results
Change in all mental and physical aspects of QOL, except body pain, was dose-dependent (trend analyses were significant and exercise dose was a significant predictor of QOL change; p-values<0.05). Change (95% confidence interval) in QOL for the control, 4, 8, and 12 kcal/kg/week groups, respectively, were: physical functioning 2.5 (-0.1-5.1), 4.7 (2.7-6.8), 6.3 (3.7-8.8), 8.2 (5.6-10.7); role physical 2.6 (-2.7-7.9), 8.9 (4.8-13.1), 9.7 (4.5-14.8), 13.1 (7.8-18.3); bodily pain 2.6 (-1.0-6.3), 4.1 (1.3-7.0). 2.4 (-1.1-6.0), 6.8 (3.3-10.4); general health 1.5 (-0.8-3.9), 5.5 (3.6-7.4), 4.7 (2.4-7.1), 7.8 (5.4-10.1); mental health 0.6 (-1.4-2.6), 4.4 (2.8-6.0), 3.6 (1.6-5.5), 4.2 (2.2-6.2); role emotional 4.2 (-0.5-8.9), 8.6 (4.9-12.3), 9.4 (4.8-14.0), 14.6 (9.9-19.2); social functioning -0.4 (-3.3-2.5), 4.5 (2.2-6.8), 5.0 (2.1-7.9), 8.7 (5.9-11.6); vitality 4.6 (1.6-7.6), 9.8 (7.5-12.2), 9.1 (6.1-12.0), 11.7 (8.8-14.7). Controlling for weight change did not attenuate the exercise-QOL association.
Conclusion
Exercise-induced QOL improvements were dose-dependent and independent of weight change.
doi:10.1001/archinternmed.2008.545
PMCID: PMC2745102  PMID: 19204218
Quality of Life; physical activity; dose-response; exercise training; SF-36
6.  Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women 
PLoS ONE  2009;4(2):e4515.
Background
It has been suggested that exercise training results in compensatory mechanisms that attenuate weight loss. However, this has only been examined with large doses of exercise. The goal of this analysis was to examine actual weight loss compared to predicted weight loss (compensation) across different doses of exercise in a controlled trial of sedentary, overweight or obese postmenopausal women (n = 411).
Methodology/Principal Findings
Participants were randomized to a non-exercise control (n = 94) or 1 of 3 exercise groups; exercise energy expenditure of 4 (n = 139), 8 (n = 85), or 12 (n = 93) kcal/kg/week (KKW). Training intensity was set at the heart rate associated with 50% of each woman's peak VO2 and the intervention period was 6 months. All exercise was supervised. The main outcomes were actual weight loss, predicted weight loss (exercise energy expenditure/ 7700 kcal per kg), compensation (actual minus predicted weight loss) and waist circumference. The study sample had a mean (SD) age 57.2 (6.3) years, BMI of 31.7 (3.8) kg/m2, and was 63.5% Caucasian. The adherence to the intervention was >99% in all exercise groups. The mean (95% CI) weight loss in the 4, 8 and 12 KKW groups was −1.4 (−2.0, −0.8), −2.1 (−2.9, −1.4) and −1.5 (−2.2, −0.8) kg, respectively. In the 4 and 8 KKW groups the actual weight loss closely matched the predicted weight loss of −1.0 and −2.0 kg, respectively, resulting in no significant compensation. In the 12 KKW group the actual weight loss was less than the predicted weight loss (−2.7 kg) resulting in 1.2 (0.5, 1.9) kg of compensation (P<0.05 compared to 4 and 8 KKW groups). All exercise groups had a significant reduction in waist circumference which was independent of changes in weight.
Conclusion
In this study of previously sedentary, overweight or obese, postmenopausal women we observed no difference in the actual and predicted weight loss with 4 and 8 KKW of exercise (72 and 136 minutes respectively), while the 12 KKW (194 minutes) produced only about half of the predicted weight loss. However, all exercise groups had a significant reduction in waist circumference which was independent of changes in weight.
Trial Registration
ClinicalTrials.gov NCT 00011193
doi:10.1371/journal.pone.0004515
PMCID: PMC2639700  PMID: 19223984

Results 1-6 (6)