Malnutrition is prevalent in gastrointestinal (GI) cancer patients, possibly due to inflammation and altered fatty acids (FA). There is a lack of research describing nutritional decline in these patients during chemotherapy. We described changes in nutritional, inflammatory, and FA status over time and factors relating to change in nutritional status according to tumor presence in 41 GI cancer patients undergoing first-line treatment over four chemotherapy visits, using linear mixed effects models. At baseline, 53% of patients were malnourished. Over time, there was a decrease in the proportion of malnourished vs. well-nourished individuals (beta= -0.564, p < 0.01). Median concentrations of plasma linoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid, total n-3, total n-6 and total plasma phospholipid FA increased over time. Changes over time in nutritional status based on weight (p < 0.001), fat free mass (FFM) measured by bioelectrical impedance analysis (BIA, p = 0.02), and skinfold anthropometry (FSA, p = 0.04) were significantly dependent on tumor presence. There were positive associations between weight and total n-3 (beta = 0.02, p < 0.01), FFM and IL-6 (BIA, beta = 0.028, p = 0.02; FSA, beta = 0.03, p = 0.02), and FFM and total n-6 (BIA, beta = 0.003, p = 0.01). Changes in nutritional status during chemotherapy were negatively impacted by tumor presence, and were associated with increasing concentrations of cytokines and FA.

Background: Thiamin, a water-soluble B-complex vitamin, functions as a coenzyme in macronutrient oxidation and in the production of cellular ATP. Data suggest that thiamin depletion occurs in heart failure (HF). Therefore, thiamin supplementation in HF patients may improve cardiac function. Objective: We sought to determine whether oral thiamin supplementation improves left ventricular ejection fraction (LVEF), exercise tolerance, and quality of life among patients with HF and reduced LVEF. Methods: In this prospective, multicenter, double-blind, placebo-controlled randomized trial, eligible ambulatory patients with HF and reduced LVEF were recruited from 4 academic and community hospitals between 2010 and 2015. Participants were randomly assigned to receive either 200 mg oral thiamin mononitrate per day or placebo for 6 mo. Results: Sixty-nine patients (mean +/- SD age: 64 +/- 12 y; 83% men; LVEF: 37% +/- 11%) were randomly assigned: 34 received placebo and 35 received thiamin supplementation. Erythrocyte thiamin pyrophosphate and urine thiamin concentrations were significantly higher in the supplemented group than in the placebo group at 6 mo (P = 0.02 and <0.001, respectively). At 6 mo, LVEF was significantly higher in the placebo group than in the thiamin group (38%; 95% CI: 36%, 39% compared with 35%; 95% CI: 33%, 37%, P = 0.047) after adjusting for baseline measurements. There were no significant differences in Minnesota Living with Heart Failure score, distance walked in 6 min, and N-terminal prohormone of brain natriuretic peptide concentrations between the 2 groups. One patient (2.9%) in the thiamin-supplemented group and none in the control group died at 6 mo. Conclusions: In ambulatory patients with HF and reduced LVEF, thiamin supplementation for 6 mo did not improve LVEF, quality of life, or exercise capacity, despite increases in thiamin concentrations. These findings do not support routine thiamin supplementation in the treatment of HF and reduced LVEF.

BACKGROUND:Thiamin is a required coenzyme in energy production reactions that fuel myocardial contraction. Therefore, thiamin deficiency (TD) may aggravate cardiac dysfunction in patients with systolic heart failure (HF). OBJECTIVE:To determine the prevalence of TD in ambulatory participants with HF as well as the relationships between thiamin status and HF severity, dietary thiamin intake, diuretic use, and circulating neurohormones. DESIGN:A cross-sectional study comparing the prevalence of TD in ambulatory patients with HF with that of controls. Demographic, anthropometric, nutrition, medication use, and heart function data were collected from direct interviewing, questionnaires, and medical records. Blood samples were obtained to measure levels of neurohormones and assess TD. PARTICIPANTS/SETTING:Fifty age-matched control participants without HF and 100 outpatients with HF and reduced left ventricular function were recruited from clinics at St Michael's Hospital, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada, between September 2009 and February 2011. MAIN OUTCOME MEASURES:To assess TD, erythrocyte thiamin pyrophosphate (TPP) was measured using high-performance liquid chromatography. TD was defined as TPP<6.07 μg/dL (180 nmol/L). STATISTICAL ANALYSES PERFORMED:Prevalence rates were analyzed using χ2 test. Nonparametric statistics (Jonckheere-Terpstra, Kruskal-Wallis, Spearman's correlation) were used to assess TPP levels in relation to HF severity, medication use and plasma concentrations of F2-isoprostanes, norepinephrine, and N-terminal pro-brain natriuretic peptide (NT-proBNP). RESULTS:There was no significant difference in the prevalence of TD in outpatients with HF (6%) and controls (6%) (P=0.99). No relationship was found between heart function, thiamin intake, use or dose of diuretics, and TD. A positive relationship was observed between erythrocyte TPP and F2-isoprostane levels (rs=0.22, P=0.03) but not between erythrocyte TPP and norepinephrine (P=0.45) and NT-proBNP (P=0.58). CONCLUSION:The prevalence of TD was low in ambulatory HF participants suggesting that, unlike hospitalized patients, ambulatory patients may be at a low risk for TD.

Background: B vitamin deficiency has been previously reported to be prevalent in patients with heart failure.However, clinical trials investigating the potential of B vitamin supplementation have failed to show benefit and have suggested some evidence of harm.Negative findings have been hypothesized to be the result of an anti-angiogenic effect associated with B vitamin supplementation.Objective: The current study aimed to determine the impact of vitamin B6 supplementation alone or in combination with folate and B12 on the angiogenic response in a rodent model of hind limb ischemia.Methods: Rats were divided randomly into three groups and fed one of three diets: control diet (CON), high B6 diet (HB6) or high B6+folate+B12 diet (TV).Following five weeks of diet therapy, ischemia was surgically induced in the hind limb.Changes in perfusion and markers of the angiogenic response were studied at either 5 (early) or 10 (late) weeks.Result: Circulating EPCs were reduced in HB6 animals, a finding that reached significance for the TV animals.Quantitative polymerase chain reaction analysis revealed a decline in VEGF and eNOS expression in HB6 and TV groups at week 10.Contrast enhanced ultrasound of the hind limb revealed a significant reduction in perfusion in HB6 and TV animals in comparison to CON at 10 weeks.B vitamin supplementation had no impact on EPC apoptosis or differentiation. Conclusion:Taken together, these results support a negative impact of B vitamin supplementation on the recovery of perfusion following ischemic injury which may be the result of a down-regulation of chemotactic gene expression, leading to lowered EPC recruitment from the bone marrow to the site of ischemic injury.

Background & aims: Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management.Design: 30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls.Results: Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 +/- 0.8 vs 1.6 +/- 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 +/- 2.7 vs 7.9 +/- 4 mu mol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 +/- 3.8% to 6.5 +/- 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes.Conclusion: Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. (C) 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

The management of heart failure (HF) represents a significant challenge for both patients as well as the healthcare system in industrialized countries. Thiamin is a required coenzyme in the energy-producing reactions that fuel myocardial contraction. Therefore, thiamin deficiency (TD) may contribute to myocardial weakness by limiting the energy available for contraction. Previous studies have reported a wide range in the prevalence of TD in patients with HF (3–91 %). The impact of thiamin supplementation in patients with HF is inconclusive. Studies conducted to date are limited by their small sample size, indirect methods of assessing thiamin concentration, methodological inconsistencies, use of impractical means of thiamin supplementation, a focus on hospitalized patients, and lack a robust technique for the assessment of cardiac function. Future large prospective studies and randomized controlled trials are needed to improve our understanding of any change in nutritional requirements associated with chronic disease as well as the clinical benefit of supplementation.

PURPOSE:To report on the perceived level of preparedness of dietetic internship (DI) graduates for entrance into practice as dietitians.METHODS:Graduates of an Ontario based, nonintegrated DI program from 2007-2011 who were at least 1 year postgraduation were surveyed to determine their level of perceived preparedness for practice using an electronic, content validated, self-administered questionnaire.RESULTS:Of 38 eligible graduates, 23 (61%) responded. Seventy-five percent of respondents were working as clinical dietitians, and 30% were working as community dietitians. Eighty-five percent of graduates reported feeling well or very well prepared for practice. Clinical and professional practice tasks were scored highest in terms of preparedness (ratings above 4.5/5) and research-related tasks such as using the research literature (4.1/5), making evidence-based decisions (4.2/5), and engaging in practice-based research (4.1/5) scored lower. Training gaps identified by 32% of respondents included community nutrition and management skill training.CONCLUSIONS:Overall, results indicate that this DI program provides a positive training experience that prepares its graduates for entrance into practice as dietitians. Qualitative comments identifying gaps and improvements have guided changes to the curriculum including strengthening community-based placements. Post-graduate surveys represent an important tool in assuring that training programs evolve to meet the needs of students entering the workforce.

Surgery induces a state of insulin resistance (IR) which may be aggravated by current fasting practices. Oral preoperative carbohydrate (CHO) loading may reduce postoperative IR and subsequently complications. The current study was designed to determine whether CHO loading would blunt the development of postoperative IR, reduce preoperative discomfort and improve clinical outcomes in elective coronary artery bypass or spinal surgical patients. Thirty‐eight patients were randomized to receive a CHO supplement the evening before (100g CHO) and two hours prior to surgery (50g CHO) or fast for 12 hours preoperatively. Insulin sensitivity was measured using the short insulin tolerance test and homeostasis model assessment (HOMA). Patient discomfort was measured immediately before surgery using visual analog scales. Insulin sensitivity was not significantly different between groups. However, the treated group experienced a significantly smaller rise in glucose levels following surgery (p=0.03) and had higher postoperative HOMA‐β scores (p=0.02). Supplemented patients were also significantly less thirsty (p=0.01), hungry (p=0.04) and anxious (p=0.01) before surgery and experienced a significantly shorter hospital stay (p=0.008). CHO loading improved outcomes, warranting re‐evaluation of fasting practices in this population. This research was supported by a CIHR student fellowship.

Recent evidence from the NORVIT trial suggests an increased risk of adverse cardiac events in patients receiving vitamin B6 supplementation in combination with folic acid and B12. An anti-angiogenic effect of B6 supplementation was proposed as one possible explanation for the observed results. Therefore, we hypothesized that supplementation with vitamin B6 alone would result in an impaired angiogenic response to ischemia, that would be reflected in reduced blood flow and endothelial progenitor cell (EPC) numbers, and that this effect would be enhanced when B6 was provided with B12 and folate. Male Sprague Dawley rats (280-300g) were randomly assigned to one of three diet groups: Control (CON)(7 mg/kg diet vitamin B6) (n=20), High B6 (HB6) (35 mg/kg/diet B6) (n=14) and a tri-vitamin group (TV)(B6-35mg/kg, B12-358μg/kg and Folic Acid-3.6mg/kg diet)(n=17). Following five weeks of diet therapy, animals underwent ligation of the left common iliac artery. Subsequently, the angiogenic response was monitored at day 1 and at day 35 using contrast enhanced ultrasound (CEU) to assess tissue perfusion. The number of circulating EPCs as a percentage of the white cell mononuclear fraction was determined using FACS. Animals in each treatment group had similar food intakes and rates of weight gain throughout the experimental period. No differences in blood flow were observed between treatments on day one post ischemia (p=0.9). At day 35 post ischemia, CEU perfusion revealed a significant improvement in microvascular blood flow in both HB6 and CON animals (p=0.004 & p<0.001 respectively). However, the improvement in blood flow was significantly larger in CON in comparison with HB6 (p=0.02). In contrast, blood flow in TV animals showed no improvement over the study period (p=0.9) and was significantly lower than CON (p=0.002) but not HB6 (p=0.09). EPC numbers were significantly reduced in TV animals but not B6 supplemented animals alone in comparison with CON (p=0.01 & p=0.15 respectively). These results suggest that both vitamin B6 supplementation alone or in combination with B12 and folate resulted in an impaired adaptive angiogenic response following ischemia resulting in reduced tissue perfusion and reduced circulating EPC numbers.

The safety and efficacy of B vitamin supplementation has recently come into question. We have observed an impaired angiogenic response in animals provided with B6 supplementation alone or in combination with folic acid or B12. Therefore, the aim of this study is to investigate the impact of vitamin B6 deficiency on the angiogenic response to ischemia in vivo. Male Sprague-Dawley rats (180-200g) were randomized to either a B6 deficient diet (DEF)(0mg B6/kg diet; n= 22), control diet (CON)(7mg B6/kg diet; n=20), or a control diet pair fed (PF, n=17) to the B6 deficient group for five weeks prior to ligation of the left common iliac artery. Following ligation, animals continued on their respective diet treatment for 35 days during which time tissue perfusion was measured at days 1,7,14 and 35 days using contrast enhanced ultrasound (CEU) and laser doppler perfusion imaging (LDPI). Exercise capacity at day 35 was measured using a rodent treadmill. At post ligation days 3 and 35, endothelial progenitor cell (EPC) numbers were measured using fluorescence activated cell sorting (FACS). Blood samples confirmed B6 deficiency. DEF and PF consumed significantly less diet in comparison with CON (p<0.001 respectively) and subsequently weighed significantly less at day 35 (p<0.001 respectively). Blood flow improved in all animals over the experimental period (p<0.001). A significant treatment effect was also observed (p=0.008) with DEF animals demonstrating an early rise in flow at day one post ligation which was significantly different than CON (p=0.03) as well as at day 7 (p=0.02). Blood flow was also significantly higher in DEF in comparison with PF at day 7 (p=0.02). Blood flow was not different between groups at days 14 or 35. No significant differences were observed in either LDPI parameters (p=0.5) or in exercise capacity (p=0.6) between treatments. Post-surgery DEF and PF animals had a significantly higher percent of peripheral EPCs compared to CON (both p<0.05). Migration of EPCs between groups did not differ at Day 35; however, results approached significance post-surgery (p=0.08). Our results support an early, enhanced angiogenic response in B6 deficient animals. Differences in blood flow between PF and DEF support that this was not simply an effect of malnutrition. An early increase in EPC numbers provides mechanistic support for the observed improvement in blood flow. These studies complement earlier findings and help to define the role of B vitamin use in ischemic disease.

Recent evidence suggests an increased risk of adverse cardiac events in patients receiving vitamin B6 supplementation in combination with folic acid and B12. Preliminary in vivo work in our lab supports an anti-angiogenic effect of B vitamins as one possible explanation for these findings. The current study was designed to elucidate a possible mechanism for the observed anti-angiogenic effect. We hypothesized that single or combination B vitamin supplementation would reduce the degree of endogenous upregulation of pro-angiogenic genes endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) in response to acute ischemia. This study employs a rodent model of unilateral hind limb ischemia-induced angiogenesis. Male Sprague Dawley rats (280-300g) were randomized to receive one of the following 3 diets (n=12 each): control (7 mg B6/kg diet), high vitamin B6 (HB6) supplemented (35 mg B6/kg diet), or trivitamin (TV) supplemented (35 mg B6/kg diet, 2.3 ìg B12/day, and 4.6 ìg folate/day). Following five weeks of diet therapy, animals underwent ligation of the left common iliac artery. Subsequently, animals were sacrificed at day 35 and hind limb muscle tissue was harvested. eNOS and VEGF mRNA in the tissue samples were quantified using qRT-PCR. TV supplementation significantly reduced mRNA expression in the ischemic limb relative to the contralateral, non-ischemic limb in comparison with controls for both eNOS and VEGF by 2.7 and 1.7 fold respectively (p < .001). HB6 supplementation significantly reduced eNOS expression by 2.1 fold (p < .001), but the difference in VEGF expression did not reach statistical significance. The results from this study demonstrate that dietary supplementation of B vitamins, particularly a combination of folate and vitamins B6 and B12, reduces the endogenous upregulation of pro-angiogenic genes eNOS and VEGF in response to acute ischemia in the rat. These results add mechanistic support to our preliminary work supporting an anti-angiogenic effect of B vitamins in vivo.

In January 2009, registered dietitians (RDs) at St Michael's Hospital (Toronto, Ontario, Canada) were granted approval for nonmedication order entry of physician-approved nutrition-related orders for the patients to whom RDs provided care. The aim of this project was to document any changes in the numbers and types of diet order errors and time delays that were associated with this policy change. A retrospective chart audit was conducted to document the error rate in 672 nutrition-related orders placed before, and in 633 orders placed after, implementation of RD diet order entry on high-risk inpatient units. Error rates for all nutrition-related orders decreased by 15% after RD order entry access (P<0.01). Error rates for diet orders entered by RDs were significantly lower in comparison with those entered by clerical assistants or registered nurses (P<0.001). Time delays for orders electronically entered were reduced by 39% (from 9.1 to 5.7 hours; P<0.01). Allowing RDs access to the electronic order entry system has improved overall timeliness of nonmedication order entries and improved patient safety by decreasing error rates in diet orders. This study supports this institutional policy change and provides evidence that RDs have the knowledge and skills to accurately process nonmedication order entries for the patients they have assessed. Finally, the current findings support the need for ongoing education and training of all health professionals in nonmedication order entry to reduce errors and improve safety.

Heart failure (HF) is the leading cause of morbidity and mortality in industrialized countries, creating a significant burden on both the healthcare system and quality of life. Research efforts continue to explore new pharmaceutical or surgically based approaches to HF management, but the role of nutrition as an adjunct therapy has been largely ignored. Elderly age, anorexia, malabsorption, premature satiety, and disease severity are among the factors identified as contributing to reduced nutrient intakes in patients with HF. These factors suggest that patients with HF are at increased risk of multiple‐nutrient deficiencies, including B vitamins. B vitamins may be of particular therapeutic interest because of their key roles as cofactors in energy‐producing pathways. Recently, impaired stores of high‐energy compounds have been linked with myocardial dysfunction and prognosis in patients with HF. Therefore, deficiencies of B vitamins might contribute to reduced energy stores and disease progression. This review summarizes the existing literature both with respect to the prevalence of B vitamin deficiency as well as evidence from supplementation trials in patients with HF. The findings suggest that most of the literature in this area has focused on thiamin deficiency in patients with HF, whereas other B vitamins remain largely unstudied. Although few sporadic trials suggest a role for B vitamins in the management of HF, none are conclusive. Therefore, there is a need for larger, more robust trials to assist in defining the B vitamin requirements as well as the impact of supplementation on both morbidity and mortality in patients with HF.

Culturally appropriate nutrition education materials are in high demand for the large and growing population of Latinos in the U.S. This study assessed older Latino adult responses to consumer messages, graphics, and foods included in the draft MyPlate for Older Adults mini‐poster for Latinos, MiPlato para Adultos Mayores (MPAM). Six focus groups (FGs) were conducted by trained moderators and a nutritionist observer with a convenience sample of 47 Latinos, 60 years or older, in 3 Florida counties. Two FGs were offered per county (one each in English and Spanish) to 35 women and 12 men, representing 9 Caribbean and Latin American countries. Discussions were tape‐recorded, transcribed, and analyzed for common themes. Participants found MPAM to be informative, appealing, and culturally appropriate. They made recommendations for additional foods including papaya and fresh fish, and reduction in size of the red meat graphic. Daily food group recommendations were found to be practical. Participants liked the variety of silhouettes depicting physically active older adults and consumer messages were found to be clear, useful, and well organized. MPAM is being incorporated into lessons and educational materials for older Latino adults. The mini‐poster can be used by nutrition educators to teach MyPlate concepts to older Latino adults in a variety of educational settings. Funding provided by IFAS Dean for Extension, UF.

Patients report changes in their perception of food tastes following cardiac surgery. This study was designed to explore changes in taste sensitivity following coronary artery bypass graft (CABG) surgery. Detection and recognition thresholds for sweet (sucrose), salty (sodium chloride), sour (citric acid), and bitter (quinine hydrochloride) were determined using the multiple forced-choice ascending concentration series method at baseline (presurgical), discharge, 5 weeks, and 16 weeks post-CABG. Demographic and gastrointestinal data were also obtained. Mixed-model analyses for repeated measures were performed using the baseline scores as reference. Thirty-three patients (mean age=61.8±8 years), consented to participate in the study between January 2003 and January 2006, with 13 completing all visits. Detection and recognition thresholds for sweet were significantly lower at discharge compared with baseline (1.7±1.2 vs 2.43±1.4 and 5.1±1.8 vs 5.5±1.3, respectively; P<0.05). This difference remained significant 4 months after surgery. Detection and recognition thresholds for salt also declined with time, with significant differences at 4 months post-surgery (2.3±2.0 vs 1.8±1.5; P<0.001 and 5.3±1.3 vs 4.2±2.2; P<0.05, respectively). The same trends were noted for the detection of sour and the recognition of bitter. Patients undergoing CABG demonstrated stable or improved taste sensitivity during the recovery period. Further studies aimed at clarifying the relationships between the biological state, taste sensitivity, reported taste changes, and food intake will help to clarify the clinical impact of taste changes and subsequently to guide clinical nutrition care.

The impact of heart failure and its treatment on specific nutrient requirements is unknown. Furthermore, depletion of water-soluble B vitamins that play key roles in the production of cellular energy in patients with heart failure can contribute to depletion of energy reserves observed in the failing heart. A cross-sectional study recently reported that approximately one third of hospitalized patients with heart failure had tissue levels suggestive of thiamin deficiency (vitamin B-1). Riboflavin (vitamin B-2) and pyridoxine (vitamin B-6) are similar to thiamin in that they are water-soluble, subject to renal excretion, have limited tissue storage, and are dependent on intake. Therefore, it was hypothesized that the status of these B vitamins may also be adversely affected by heart failure. As a result, the prevalence of patients at risk of vitamin B-2 (erythrocyte glutathione reductase activity coefficient > or = 1.2) and B-6 deficiency (plasma B-6 < or = 20 nmol/L) was determined in a cross-section of 100 patients hospitalized with heart failure between April 2001 and June 2002 as well as in a group of volunteers without heart failure. Twenty-seven percent of patients with heart failure had biochemical evidence of vitamin B-2 deficiency, while 38% had evidence of B-6 deficiency. These prevalence rates were significantly higher than those observed in the volunteers without heart failure (2% and 19%, respectively; P < or = 0.02). Use of common B-vitamin-containing supplements by patients with heart failure did not significantly reduce deficiency rates in comparison with those who did not use supplements (B-2 P=0.38 or B-6 P=0.18)). Finally, while 80% of patients with heart failure took diuretics, neither the dose nor the duration of furosemide use was related to the presence of either B-2 or B-6 deficiency. Given the physiologic importance of these vitamins, further investigations aimed at determining the effect of heart failure on specific nutrient requirements as well as the safety and efficacy of B-vitamin supplementation are warranted.

Participants will understand the components of an aggressive dietary strategy that can be used by patients to reduce cardiovascular risk factors.

Secondary prevention strategies aimed at the reduction of modifiable risk factors can improve outcomes and improve prognosis in high risk cardiovascular patients. Reduced endothelial progenitor cell (EPC) number and functionality, as observed in type II diabetes, reflects increased cardiac risk but nutritional modulation may positively influence endothelial function. Therefore, we hypothesize that an aggressive dietary intervention, the modified Portfolio Diet, would increase the number and/or functionality of EPCs in diabetic patients post-CABG. Methods: 22 patients with type II diabetes, 6 weeks post bypass surgery received detailed individualized dietary counseling on the modified Portfolio Diet: a low cholesterol, low saturated fat diet that includes viscous fibres (8g/1000 kcal as psyllium and β-glucan), soy protein (17g/1000kcal) and almonds (22g/1000kcal). EPCs were isolated by Ficol gradient prior to study entry and at study completion (week 0 vs. week 4) and cultured on fibronectin coated culture...