Dietary Fibers and Nutraceuticals for Primary Cardiovascular Prevention in Children and Adolescents: A Critical Review

Abstract

The roles of dietary fibers and nutraceuticals for primary prevention of cardiovascular disease from childhood are reviewed. Nutrition as an epigenetic modifier and the roles of endothelium, risk factors, epidemiological evidence and Mediterranean diet are critically analysed. Overfeeding in childhood can lead to the development of obesity and/or atherosclerosis in adult life. In particular, a high intake of nutrients affects the in utero programming with the adverse consequences of insulin resistance an endothelial dysfunction that lead to early atherosclerosis. Dietary fibers have important health benefits in childhood and research suggests that they may prevent obesity and lower blood cholesterol levels with a favourable impact on the risk of future cardiovascular disease incidence. However, it is for further studies to assess whether also in Southern European Countries, practicing Mediterranean diet as a normal habit, dietary fibers may contribute to modify the relatively low proportion of hyperlipemia observed in our population.

Share and Cite:

F. Martino, P. Puddu, G. Pannarale and F. Barillà, "Dietary Fibers and Nutraceuticals for Primary Cardiovascular Prevention in Children and Adolescents: A Critical Review," Food and Nutrition Sciences, Vol. 4 No. 7A, 2013, pp. 39-47. doi: 10.4236/fns.2013.47A006.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] C. Napoli, F. P. D’Armiento, F. P. Mancini, J. L. Witztum, G. Palumbo and W. Palinski, “Fatty Streak Formation Occurs in Human Fetal Aortas and Is Greatly Enhanced by Maternal Hypercholesterolemia: Intimal Accumulation of LDL and Its Oxidation Precede Monocyte Recruitment into Early Atherosclerotic Lesions,” Journal Clinical Investigation, Vol. 100, No. 11, 1997, pp. 26802690. doi:10.1172/JCI119813
[2] C. Napoli, J. L. Witztum, F. de Nigris, G. Palumbo, F. P. D’Armiento and W. Palinski, “Intracranial Arteries of Human Fetuses Are More Resistant to Hypercholesterolemia Induced Fatty Streak Formation than Extracranial Arteries,” Circulation, Vol. 99, 1999, pp. 2003-2010. doi:10.1161/01.CIR.99.15.2003
[3] W. Palinski and C. Napoli, “Pathophysiological Events during Pregnancy Influence the Development of Atherosclerosis in Humans,” Trends Cardiovascular Medicine, Vol. 9, No. 7, 1999, pp. 205-214. doi:10.1016/S1050-1738(00)00022-0
[4] H. C. Stary, “Evolution and Progression of Atherosclerotic Lesions in Coronary Arteries of Children and Young Adults,” Arteriosclerosis, Vol. 9, No. 1, 1989, pp. I19I32.
[5] Pathobiological Determinants of Atherosclerosis in Youths (PDAY) Research Group, “Natural History of Aortic and Coronary Atherosclerotic Lesions in Youth. Findings from the PDAY Study,” Arteriosclerosis Thrombosis, Vol. 13, 1993, pp. 1291-1298. doi:10.1161/01.ATV.13.9.1291
[6] G. S. Berenson, S. R. Srinivasan, W. Bao, W. P. Newman, R. E. Tracy and W. A. Wattigney, “Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults. The Bogalusa Heart Study,” New England Journal Medicine, Vol. 338, 1998, pp. 1650-1656. doi:10.1056/NEJM199806043382302
[7] C. Napoli, C. K. Glass, J. L. Witztum, R. Deutsch, F. P. D’Armiento and W. Palinski, “Influence of Maternal Hypercholesterolaemia during Pregnancy on Progression of Early Atherosclerotic Lesions in Childhood: Fate of Early Lesions in Children (FELIC) Study,” Lancet, Vol. 354, No. 9186, 1999, pp. 1234-1241. doi:10.1016/S0140-6736(99)02131-5
[8] H. C. Stary, “Lipid and Macrophage Accumulation in Arteries of Children and the Development of Atherosclerosis,” American Journal Clinical Nutrition, Vol. 72, No. 5, 2000, pp. 1297S-1306S.
[9] R. Ross, “Atherosclerosis, an Inflammatory Disease,” New England Journal Medicine, Vol. 340, 1999, pp. 115126. doi:10.1056/NEJM199901143400207
[10] J. A. Attaman, T. L. Toth, J. Furtado, H. Campos, R. Hauser and J. E. Chavarro, “Dietary Fat and Semen Quality among Men Attending a Fertility Clinic,” Human Reproduction, Vol. 27, No. 5, 2012, pp. 1466-1474. doi:10.1093/humrep/des065
[11] R. Nistala, M. R. Hayden, V. G. DeMarco, E. J. Henriksen, D. T. Lackland and J. R. Sowers, “Prenatal Programming and Epigenetics in the Genesis of the Cardiorenal Syndrome,” Cardiorenal Medicine, Vol. 1, No. 4, 2011, pp. 243-254. doi:10.1159/000332756
[12] J. K. Kim, M. Samaranayake and S. Pradhan, “Epigenetic Mechanisms in Mammals,” Cellular Molecular Life Science, Vol. 66, No. 4, 2009, pp. 596-612. doi:10.1007/s00018-008-8432-4
[13] B. T. Heijmansa, E. W. Tobia, A. D. Steinb, H. Putterc, G. J. Blauwd and E. S. Sussere, “Persistent Epigenetic Differences Associated with Prenatal Exposure to Famine in Humans,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 105, No. 44, 2008, pp. 17046-17049. doi:10.1073/pnas.0806560105
[14] V. E. A. Russo, R. A. Martienssen and A. D. Riggs, “Epigenetic Mechanisms of Gene Regulation,” Cold Spring Harbor Laboratory Press, Plainview, 1996.
[15] C. Napoli, A. Casamassimi, V. Crudele, T. Infante and C. Abbondanza, “Kidney and Heart Interactions during Cardiorenal Syndrome: A Molecular and Clinical Pathogenic Framework,” Future Cardiology, Vol. 7, No. 4, 2011, pp. 485-497. doi:10.2217/fca.11.24
[16] B. E. Bernstein, A. Meissner and E. S. Lander, “The Mammalian Epigenome,” Cell, Vol. 128, No. 4, 2007, pp. 669-681. doi:10.1016/j.cell.2007.01.033
[17] M. Rodriguez-Porcel, L. O. Lerman, J. Herrmann, T. Sawamura, C. Napoli and A. Lerman, “Hypercholesterolemia and Hypertension Have Synergistic Deleterious Effects on Coronary Endothelial Function,” Arteriosclerosis Thrombosis Vascular Biology, Vol. 23, 2003, pp. 885-891. doi:10.1161/01.ATV.0000069209.26507.BF
[18] J. C. Fruchart, M. C. Nierman, E. S. Stroes, J. J. Kastelein and P. Duriez, “New Risk Factors for Atherosclerosis and Patient Risk Assessment,” Circulation, Vol. 109, pp. III15III19.
[19] G. K. Hansson, “Inflammation, Atherosclerosis, and Coronary Artery Disease,” New England Journal Medicine, Vol. 352, 2005, pp. 1685-1695. doi:10.1056/NEJMra043430
[20] Y. Aggoun, D. Bonnet and D. Sidi, “Arterial Mechanical Changes in Children with Familial Hypercholesterolemia,” Arteriosclerosis Thrombosis Vascular Biology, Vol. 20, 2000, pp. 2070-2075. doi:10.1161/01.ATV.20.9.2070
[21] G. Arcaro, B. M. Zenere and D. Travia, “Non-Invasive Detection of Early Endothelial Dysfunction in Hypercholesterolaemic Subjects,” Atherosclerosis, Vol. 114, No. 2, 1995, pp. 247-254. doi:10.1016/0021-9150(94)05489-6
[22] M. J. Jarvisalo, L. Jartti and K. Nanto-Salonen, “Increased Aortic Intima-Media Thickness. A Marker of Preclinical Atherosclerosis in High-Risk Children,” Circulation, Vol. 104, 2001, pp. 2943-2947. doi:10.1161/hc4901.100522
[23] J. E. Deanfield, J. P. Halcox and T. J. Rabelink, “Endothelial Function and Dysfunction: Testing and Clinical Relevance,” Circulation, Vol. 115, 2007, pp. 1285-1295.
[24] F. Martino, L. Loffredo, R. Carnevale, V. Sanguigni, E. Martino and E. Catasca, “Oxidative Stress Is Associated with Arterial Dysfunction and Enhanced Intima-Media Thickness in Children with Hypercholesterolemia: The Potential Role of Nicotinamide-Adenine Dinucleotide Phosphate Oxidase,” Pediatrics, Vol. 122, No. 3, 2008, pp. e648-e655. doi:10.1542/peds.2008-0735
[25] O. T. Raitakari, M. Juonala and M. Kahonen, “Cardiovascular Risk Factors in Childhood and Carotid Artery Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study,” Journal American Medical Association, Vol. 290, No. 17, 2003, pp. 2277-2283. doi:10.1001/jama.290.17.2277
[26] W. P. Newman III, D. S. Freedman, A. W. Voors, P. D. Gard, S. R. Srinivasan and J. L. Cresanta, “Relation of Serum Lipoprotein Levels and Systolic Blood Pressure to Early Atherosclerosis. The Bogalusa Heart Study,” New England Journal Medicine, Vol. 314, 1986, pp. 138-144. doi:10.1056/NEJM198601163140302
[27] M. C. Corretti, T. J. Anderson, E. J. Benjamin, D. Celermajer, F. Charbonneau and M. A. Creager, “Guidelines for the Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery: A Report of the International Brachial Artery Reactivity Task Force,” Journal American College Cardiology, Vol. 39, No. 2, 2002, pp. 257-265. doi:10.1016/S0735-1097(01)01746-6
[28] R. Joannides, W. E. Haefeli, L. Linder, V. Richard, E. H. Bakkali and C. Thuillez, “Nitric Oxide Is Responsible for Flow-Dependent Dilatation of Human Peripheral Conduit Arteries in Vivo,” Circulation, Vol. 91, 1995, pp. 13141319. doi:10.1161/01.CIR.91.5.1314
[29] H. Cai and D. G. Harrison, “Endothelial Dysfunction in Cardiovascular Diseases: The Role of Oxidant Stress,” Circulation Research, Vol. 87, 2000, pp. 840-846. doi:10.1161/01.RES.87.10.840
[30] F. Violi, V. Sanguigni, R. Carnevale, A. Plebani, P. Rossi and A. Finocchi, “Hereditary Deficiency of gp91(phox) Is Associated with Enhanced Arterial Dilatation: Results of a Multicenter Study,” Circulation, Vol. 120, 2009, pp. 1616-1622. doi:10.1161/CIRCULATIONAHA.109.877191
[31] L. Loffredo, F. Martino, R. Carnevale, P. Pignatelli, E. Catasca, M. L. Perri, C. M. Calabrese, M. M. Palumbo, F. Baratta, M. Del Ben, F. Angelico and F. Violi, “Obesity and Hypercholesterolemia Are Associated with NOX2 Generated Oxidative Stress and Arterial Dysfunction,” Journal Pediatrics, Vol. 161, No. 6, 2012, pp. 1004-1009. doi:10.1016/j.jpeds.2012.05.042
[32] A. Keys, J. T. Anderson and F. Grande, “Prediction of Serum-Cholesterol Responses of Man to Changes in Fats in the Diet,” Lancet, Vol. 273, No. 7003, 1957, pp. 959966. doi:10.1016/S0140-6736(57)91998-0
[33] M. Mancini and J. Stamler, “Diet for Preventing Cardiovascular Diseases: Light from Ancel Keys, Distinguished Centenarian Scientist,” Nutrition Metabolism Cardiovascular Disease, Vol. 14, No. 1, 2004, pp. 52-57. doi:10.1016/S0939-4753(04)80047-4
[34] Framingham Heart Study, Framingham, 2013. http://www.framinghamheartstudy.org
[35] W. P. Newman, D. S. Freedman and A. W. Voors, “Relation of Serum Lipoprotein Levels and Systolic Blood Pressure to Early Atherosclerosis. The Bogalusa Heart Study,” New England Journal Medicine, Vol. 314, 1986, pp. 138-144. doi:10.1056/NEJM198601163140302
[36] R. M. Lauer and W. R. Clarke, “Use of Cholesterol Measurements in Childhood for the Prediction of Adult Hypercholesterolemia. The Muscatine Study,” The Journal of American Medical Association, Vol. 264, No. 23, 1990, pp. 3034-3038. doi:10.1001/jama.1990.03450230070031
[37] M. Juonala, J. S. Viikari, T. Ronnemaa, J. Marniemi, A. Jula and B. M. Loo, “Associations of Dyslipidemias from Childhood to Adulthood with Carotid Intima-Media Thickness, Elasticity, and Brachial Flow-Mediated Dilatation in Adulthood. The Cardiovascular Risk in Young Finns Study,” Arteriosclerosis Thrombosis Vascular Biology, Vol. 28, 2008, pp. 1012-1017. doi:10.1161/ATVBAHA.108.163329
[38] S. S. Gidding, C. A. McMahan, H. C. McGill, L. A. Colangelo, P. J. Schreiner and O. D. Williams, “Prediction of Coronary Artery Calcium in Young Adults Using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Risk Score: The CARDIA Study,” Archives of Internal Medicine, Vol. 166, No. 21, 2006, pp. 2341-2347. doi:10.1001/archinte.166.21.2341
[39] L. Dauchet, P. Amouyel and J. Dallongeville, “Fruits, Vegetables and Coronary Heart Disease,” Nature Review Cardiology, Vol. 6, 2009, pp. 599-608.
[40] R. Grant, A. Bilgin and C. Zeuschner, “The Relative Impact of a Vegetable-Rich Diet on Key Markers of Health in a Cohort of Australian Adolescents,” Asia Pacific Journal of Clinical Nutrition, Vol. 17, No. 1, 2008, pp. 107118.
[41] W. C. Willett, F. Sacks and A. Trichopoulou, “Mediterranean Diet Pyramid: A Cultural Model for Healthy Eating,” The American Journal of Clinical Nutrition, Vol. 61, Suppl. 6, 1995, pp. 1402S-1406S.
[42] C. M. Kastorini, H. J. Milionis, K. Esposito, D. Giugliano, J. A. Goudevenos and D. B. Panagiotakos, “The Effect of Mediterranean Diet on Metabolic Syndrome and Its Components. A Meta-Analysis of 50 Studies and 534,906 Individuals,” Journal of the American College of Cardiology, Vol. 57, No. 11, 2011, pp. 1299-1313. doi:10.1016/j.jacc.2010.09.073
[43] A. J. Nordmann, K. Suter-Zimmermann, H. C. Bucher, I. Ihai, K. R. Tuttle and R. Estruch, “Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors,” The American Journal of Medicine, Vol. 124, No. 9, 2011, pp. 841-851. doi:10.1016/j.amjmed.2011.04.024
[44] R. Estruch, E. Ros, J. Salas-Salvadó, M. I. Covas, D. Corella and F. Arós, “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet,” The New England Journal of Medicine, Vol. 368, 2013, pp. 1279-1290. doi:10.1056/NEJMoa1200303
[45] C. Lazarou, D. B. Panagiotakos and A. L. Matalas, “Lifestyle Factors Are Determinants of Children’s Blood Pressure Levels: The CYKIDS Study,” Journal of Human Hypertension, Vol. 23, No. 7, 2009, pp. 456-463.
[46] A. F. G. Cicero and S. Ertek, “Natural Sources of Antidyslipidaemic Agents: Is There an Evidence-Based Approach for Their Prescription?” Mediterranean Journal of Nutrition and Metabolism, Vol. 1, No. 2, 2008, pp. 85-93. doi:10.1007/s12349-008-0011-6
[47] R. L. Bailey, J. J. Gahche and C. V. Lentino, “Dietary Supplement Use in the United States, 2003-2006,” The Journal of Nutrition, Vol. 141, No. 2, 2011, pp. 261-266. doi:10.3945/jn.110.133025
[48] American Dietetic Association. Fiber Evidence Analysis Project, “ADA Evidence Analysis Library Web site. &highlight_fiber&home_1,” 2008. http://www.adaevidencelibrary.com/topic.cfm?cat_1586
[49] Food and Nutrition Board, Institute of Medicine, “Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids,” National Academies Press, Washington DC, 2005.
[50] M. L. Gurr and N. G. Asp, “Dietary Fibre,” International Life Science Press, Washington DC, 1994.
[51] J. Anderson, P. Baird, R. Davis, S. Ferreri, M. Knudtson, and A. Koraym, “Health Benefits of Dietary Fiber,” Nutrition Reviews, Vol. 67, No. 4, 2009, pp. 188-205. doi:10.1111/j.1753-4887.2009.00189.x
[52] C. L. Dikeman and G. C. Fahey, “Viscosity as Related to Dietary Fiber: A Review,” Critical Review Food Science Nutrition, Vol. 46, No. 8, 2006, pp. 649-663. doi:10.1080/10408390500511862
[53] T. Mizutani and T. Mitsuoka, “Effect of Konjac Mannan on Spontaneous Liver Tumorigenesis and Fecal Flora in C3H/He Male Mice,” Cancer Letters, Vol. 17, No. 1, 1982, pp. 27-32. doi:10.1016/0304-3835(82)90104-5
[54] Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report,” Pediatrics, Vol. 128, Suppl. 5, 2011, pp. S213-S256. doi:10.1542/peds.2009-2107C
[55] A. L. Catapano, Z. Reiner, G. de Backer, I. Graham, M. R. Taskinen and O. Wiklund, “ESC/EAS Guidelines for the Management of Dyslipidaemias. The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS),” Atherosclerosis, Vol. 217, Suppl. 1, 2011, pp. 3-46.
[56] S. Hasani-Ranjbar, N. Nayebi and L. Moradi, “The Efficacy and Safety of Herbal Medicines Used in the Treatment of Hyperlipidemia: A Systematic Review,” Current Pharmacology Research, Vol. 16, No. 26, 2010, pp. 2935-2947.
[57] M. P. McGowan and S. Proulx, “Nutritional Supplements and Serum Lipids: Does Anything Work?” Current Atherosclerosis Reports, Vol. 11, No. 6, 2009, pp. 470-476. doi:10.1007/s11883-009-0070-2
[58] J. Y. Kim and O. Kwon, “Culinary Plants and Their Potential Impact on Metabolic Overload,” Annals of the New York Academy Sciences, Vol. 1229, 2011, pp. 133-139. doi:10.1111/j.1749-6632.2011.06090.x
[59] Z. B. Yu, S. P. Han, G. Z. Zhu, C. Zhu, X. J. Wang and X. G. Cao, “Birth Weight and Subsequent Risk of Obesity: A Systematic Review and Meta-Analysis,” Obesity Reviews, Vol. 12, No. 7, 2011, pp. 525-542. doi:10.1111/j.1467-789X.2011.00867.x
[60] OKkio alla SALUTE, “Sintesi Dei Risultati,” 2012. www.epicentro.iss.it/okkioallasalute/
[61] J. L. Slavin, “Dietary Fiber and Body Weight,” Nutrition, Vol. 21, No. 3, 2005, pp. 411-418. doi:10.1016/j.nut.2004.08.018
[62] A. L. Rogovik and R. D. Goldman, “Should Weight-Loss Supplements Be Used for Pediatric Obesity?” Canadian Family Physician, Vol. 55, No. 3, 2009, pp. 257-259.
[63] P. Samuel, D. R. Keast, C. L. Williams and S. J. Bartholmey, “Dietary Fiber and Its Role in Childhood Obesity,” The FASEB Journal, Vol. 14, 2003, p. A746.
[64] J. Keithley and B. Swanson, “Glucomannan and Obesity: A Critical Review,” Alternate Therapy Health Medicine, Vol. 11, No. 6, 2005, pp. 30-34.
[65] C. J. McNeal, T. Dajani, D. Wilson, A. E. CassidyBushrow and B. Dickerson, “Hypercholesterolemia in Youth: Opportunities and Obstacles to Prevent Premature Atherosclerotic Cardiovascular Disease,” Current Atherosclerosis Reports, Vol. 12, No. 1, 2010, pp. 20-28. doi:10.1007/s11883-009-0072-0
[66] S. R. Daniels, F. R. Greer and the Committee on Nutrition, “Lipid Screening and Cardiovascular Health in Childhood,” Pediatrics, Vol. 122, No. 1, 2008, pp. 198-208. doi:10.1542/peds.2008-1349
[67] L. Iughetti, “Drugs for Children with Hypercholesterolemia: Be Cautious,” Journal of Pediatric Endocrinology and Metabolism, Vol. 22, No. 6, 2009, pp. 483-485. doi:10.1515/JPEM.2009.22.6.483
[68] L. Iughetti, P. Bruzzi and B. Predieri, “Evaluation and Management of Hyperlipidemia in Children and Adolescents,” Current Opinion in Pediatrics, Vol. 22, No. 4, 2010, pp. 485-493.
[69] AAP (American Academy of Pediatrics), “Committee on Nutrition,” Cholesterol in Childhood, 2011. http://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Pages/Committee-On-Nutrition.aspx
[70] NCEP (National Cholesterol Educational Program), 2013. http://www.nhlbi.nih.gov/about/ncep/ncep_pd.htm
[71] W. L. Haskell, G. A. Spiller, C. D. Jensen, B. K. Ellis and J. E. Gates, “Role of Water-Soluble Dietary Fiber in the Management of Elevated Plasma Cholesterol in Healthy Subjects,” The American Journal of Cardiology, Vol. 69, No. 5, 1992, pp. 433-439. doi:10.1016/0002-9149(92)90980-D
[72] D. J. A. Jenkins, C. W. C. Kendall and V. Vuksan, “Viscous Fibers, Health Claims, and Strategies to Reduce Cardiovascular Disease Risk,” The American Journal of Clinical Nutrition, Vol. 71, No. 2, 2000, pp. 401-402.
[73] V. Vuksan, J. Sievenpiper and Z. Xu, “Konjac-Mannan and American Ginsing: Emerging Alternative Therapies for Type 2 Diabetes Mellitus,” Journal of the American College of Nutrition, Vol. 20, Suppl. 5, 2001, pp. 370S380S.
[74] A. Arvill and L. Bodin, “Effect of Short-Term Ingestion of Kojac Glucomannan on Serum Cholesterol in Healthy Men,” The American Journal of Clinical Nutrition, Vol. 61, No. 3, 1995, pp. 585-659.
[75] H. L. Chen, W. H. H. Sheu, T. S. Tai, Y. P. Liaw and Y. C. Chen, “Konjac Supplement Alleviated Hypercholesterolemia and Hyperglycemia in Type 2 Diabetic Subjects. A randomized Double-Blind Trial,” Journal of the American Collage of Nutrition, Vol. 22, No. 1, 2003, pp. 36-42.
[76] F. Martino, E. Martino, F. Morrone, E. Carnevali, R. Forcone and T. Niglio, “Effect of Dietary Supplementation with Glucomannan on Plasma Total Cholesterol and Low Density Lipoprotein Cholesterol in Hypercholesterolemic Children,” Nutrition, Metabolism & Cardiovascular Diseases, Vol. 15, No. 3, 2005, pp. 174-180. doi:10.1016/j.numecd.2004.04.004
[77] C. Stefanutti and F. Mazza, “Multiple Lipid Lowering Treatment in Pediatric Patients with Hyperlipidemia,” Medical Chemistry, Vol. 8, No. 6, 2012, pp. 1171-1181.
[78] N. Sood, W. L. Baker and C. I. Coleman, “Effect of Glucomannan on Plasma Lipid and Glucose Concentrations, Body Weight, and Blood Pressure: Systematic Review and Meta-Analysis,” The American Journal of Clinical Nutrition, Vol. 88, No. 4, 2008, pp. 1167-1175.
[79] F. Violi, “Nutraceuticals Special Issue,” Cardiovascular Therapy, Vol. 128, 2010, pp. 185-245,e01-e52.
[80] V. Vuksan, J. L. Sievenpiper, R. Owen, J. A. Swilley, P. Spadafora and D. J. Jenkins, “Beneficial Effects of Viscous Dietary Fiber from Konjac-Mannan in Subjects with the Insulin Resistance Syndrome,” Diabetes Care, Vol. 23, No. 1, 2000, pp. 9-14. doi:10.2337/diacare.23.1.9
[81] I. Gouni-Berthold, “Policosanol: Clinical Pharmacology and Therapeutic Significance of a New Lipid-Lowering Agent,” American Heart Journal, Vol. 143, No. 2, 2002, pp. 356-365. doi:10.1067/mhj.2002.119997
[82] F. Martino, P. E. Puddu, G. Pannarale, C. Colantoni, E. Martino, T. Niglio, C. Zanoni and F Barillà, “Low Dose Chromium-Polynicotinate or Policosanol Is Effective in Hypercholesterolemic Children only in Combination with Glucomannan,” Atherosclerosis, Vol. 228, No. 1, 2013, pp. 198-202. doi:10.1016/j.atherosclerosis.2013.02.005
[83] M. de Bock, J. G. B. Derraik, C. M. Brennan, J. B. Biggs, G. C. Smith, D. Cameron-Smith, C. R. Wall and W. S. Cutfield, “Psyllium Supplementation in Adolescents Improves Fat Distribution and Lipid Profile: A Randomized, Participant-Blinded, Placebo-Controlled, Crossover Trial,” PLoS One, Vol. 7, No. 7, 2012, Article ID: e41735. doi:10.1371/journal.pone.0041735
[84] B. A. Dennison and D. M. Levine, “Randomized, Double-Blind, Placebo-Controlled, Two-Period Crossover Clinical Trial of Psyllium Fiber in Children with Hypercholesterolemia,” The Journal of Pediatrics, Vol. 123, No. 1, 1993, pp. 24-29.
[85] F. Martino, P. E. Puddu, G. Pannarale, C. Colantoni, C. Zanoni, E. Martino and F. Barillà, “Arterial Blood Pressure and Serum Lipids in a Population of Children and Adolescents from Southern Italy: The Calabrian Sierras Community Study (CSCS),” International Journal Cardioliology, 2012. doi:10.1016/j.ijcard.2012.11.045

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.