Original articleEffects of a hypoenergetic diet associated with açaí (Euterpe oleracea Mart.) pulp consumption on antioxidant status, oxidative stress and inflammatory biomarkers in overweight, dyslipidemic individuals
Graphical abstract
Introduction
The prevalence of obesity has increased worldwide. In the year 2017, elevated body mass index (BMI) ranked fourth among risk factors for mortality, mainly due to its effects on cardiovascular diseases (CVD) [1]. In Brazil, 2016 research data from the Telephone-based Surveillance of Chronic Diseases (VIGITEL) revealed that more than half of the population was overweight, with 18.9% of Brazilians being classified as obese [2]. Obesity influences the development of many risk factors associated with CVD, such as dyslipidemia, systemic arterial hypertension (SAH), insulin resistance, and type 2 diabetes mellitus [3]. Oxidative stress and inflammation also contribute to the development of these diseases [4].
The accumulation of adipose tissue promotes changes in adipokine secretion, as well as infiltration and activation of macrophages within the tissue [5]. There is a resulting increase in the expression of pro-inflammatory cytokines, such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α), and in the production of reactive oxygen species (ROS) by the infiltrated macrophages [5]. The main enzymatic antioxidants system includes superoxide dismutase, catalase, glutathione peroxidase, and reduced glutathione; whereas dietary antioxidant compounds, such as vitamin E, vitamin C, carotenoids, uric acid, and polyphenols, are part of the non-enzymatic system. Together, they act through mechanisms to prevent and control ROS formation [5], [6].
Dietary patterns characterized by higher consumption of fruits, vegetables, whole grains, low-fat dairy products, and lean meats are associated with a lower risk of all-cause morbidity and mortality [7]. Bioactive compounds, such as polyphenols found in fruits and vegetables, are also associated with beneficial effects on improvements in CVD risk factors, inhibiting inflammation and platelet aggregation, regulating lipid metabolism and intestinal microbiota, and eliminating free radicals [8].
Açaí (Euterpe oleracea Mart.), is a typical fruit from the Amazon Region of Brazil, which is rich in polyphenols, such as anthocyanins (cyanidin-3-glucoside and cyanidin 3-rutinoside), oleic acid, fibers, and phytosterols. It has attracted interest due to its antioxidant potential [9], [10], [11]. In vitro studies in experimental models have demonstrated that açaí has antioxidant [9], [12], anti-inflammatory [13], and lipid-profile-improving effects [14]. Studies with humans, however, are still limited [15], [16], [17].
Although it is a highly caloric fruit, açaí may be part of a healthy balanced diet, and it may be useful in weight-loss programs. As previously shown, this fruit is rich in monounsaturated fatty acids and fibers which may act by stimulating metabolism, promoting satiety, and improving bowel function. Furthermore, the anthocyanins present in açaí may have antioxidant and anti-inflammatory effects and be beneficial to individuals who are overweight.
Considering the presence of a high quantity and variety of compounds present in açaí and their possible effects on protecting against oxidative stress and inflammation, the objective of this study was to evaluate the effects of a hypoenergetic diet associated with açaí consumption on oxidative stress and antioxidant status and inflammatory biomarkers in overweight, dyslipidemic individuals.
Section snippets
Population
Two hundred and twenty-four volunteers were recruited at the Clinical Nutrition Research and Extension Center of the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro (Rio de Janeiro, RJ, Brazil), from October 2016 to February 2018. Of the 224 individuals screened, 131 were eligible to participate in the study. Selection criteria were: adults with BMI ≥25 kg/m2 [18], both sexes, ages 20 to 59, and at least one lipid profile alteration according to the
Results
Two hundred and twenty-four volunteers were recruited, 93 (41.5%) of which did not meet eligibility criteria. One hundred and twenty-five volunteers, with an average age of 39.8 ± 10.7, 76% (n = 95) of which were women and 24% (n = 30) of which were men, participated in the run-in period. Table 1 shows the anthropometric, arterial pressure, biochemical characteristics of the volunteers who participated in the run in. Significant reductions in body mass and BMI were observed. There was a
Discussion
With the aim of reducing loss of follow-up during the clinical trial and adapting volunteers to the study, a 30-day run in period was conducted, during which volunteers received HD only. Notwithstanding the implementation of this period, we were unable to avoid a 34.3% loss of follow-up. High withdrawal rates have similarly been observed in dietary intervention studies. In a retrospective clinical trial, Inelmen et al. [26] observed a 1-year-drop-out rate of 77.3% in a sample of 383 overweight
Conclusion
This study showed that the addition of 200 g of açaí to a hypoenergetic diet, reduced oxidative stress and improved inflammatory status in overweight individuals with dyslipidemia.
Author contributions
Gláucia Maria Moraes de Oliveira and Glorimar Rosa were responsible for study design, analyzed and interpretation of the results and writing of the manuscript. Luciana Nicolau Aranha was responsible for recruiting and care of patients, laboratory analysis, analyzed and interpretation of the results and the writing of the manuscript. Mariana Gomes Silva and Sofia Kimi Uehara assisted in recruiting and care of patients. Ronir Raggio Luiz assisted interpretation of the results. José Firmino
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
This study was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES).
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