Cited by 1,098Adipokines, Inflammation, and Metabolic DiseasesNutritional Studies and DietFatty Acid Research and Health

Dietary factors and low-grade inflammation in relation to overweight and obesity

Open access
Calder, Philip C., Ahluwalia, Namanjeet, Brouns, Fred, Buetler, Timo, Clement, Karine, Cunningham, Karen, Esposito, Katherine, Jönsson, Lena S. +14 more·2011·British Journal of Nutrition

Abstract

Low-grade inflammation is a characteristic of the obese state, and adipose tissue releases many inflammatory mediators. The source of these mediators within adipose tissue is not clear, but infiltrating macrophages seem to be especially important, although adipocytes themselves play a role. Obese people have higher circulating concentrations of many inflammatory markers than lean people do, and these are believed to play a role in causing insulin resistance and other metabolic disturbances. Blood concentrations of inflammatory markers are lowered following weight loss. In the hours following the consumption of a meal, there is an elevation in the concentrations of inflammatory mediators in the bloodstream, which is exaggerated in obese subjects and in type 2 diabetics. Both high-glucose and high-fat meals may induce postprandial inflammation, and this is exaggerated by a high meal content of advanced glycation end products (AGE) and partly ablated by inclusion of certain antioxidants or antioxidant-containing foods within the meal. Healthy eating patterns are associated with lower circulating concentrations of inflammatory markers. Among the components of a healthy diet, whole grains, vegetables and fruits, and fish are all associated with lower inflammation. AGE are associated with enhanced oxidative stress and inflammation. SFA and trans -MUFA are pro-inflammatory, while PUFA, especially long-chain n -3 PUFA, are anti-inflammatory. Hyperglycaemia induces both postprandial and chronic low-grade inflammation. Vitamin C, vitamin E and carotenoids decrease the circulating concentrations of inflammatory markers. Potential mechanisms are described and research gaps, which limit our understanding of the interaction between diet and postprandial and chronic low-grade inflammation, are identified.

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Registry

Crossref · 10.1017/s0007114511005460

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Claims the paper makes

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  • Findingreasoning

    Variation in concentrations of most inflammatory mediators among non-obese or obese individuals is at least 10-fold.

    “The variation in concentrations of most mediators among non-obese or obese individuals is at least 10-fold.”
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    • Rests on an assumption: Chronic low-grade inflammation is characterized by raised concentrations of inflammatory markers in the systemic circulation.
  • Interpretationreasoning

    There is substantial overlap in inflammatory mediator concentrations between non-obese and obese persons.

    “Hence, there is a substantial overlap between non-obese and obese persons.”
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  • Premisecitation

    White adipose tissue synthesises and releases the pro-inflammatory cytokine TNF-a.

    “who showed that white adipose tissue synthesises and releases the pro-inflammatory cytokine TNF-a.”
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  • Interpretationcitation

    Adipose tissue may be a major source of pro-inflammatory mediators that initiate chronic inflammation, insulin resistance and atherosclerosis in obesity.

    “Based on these data, it was suggested that adipose tissue plays an important immune role and may be a major source of pro-inflammatory mediators which initiate the development of chronic inflammation, insulin resistance and atherosclerosis, all of which are characteristics of the metabolic dysregulation associated with obesity.”
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  • Premisecitation

    BMI and other obesity measures such as waist circumference are positively related to circulating concentrations of CRP and other inflammatory markers.

    “However, there is a positive relationship between BMI and other measures of obesity such as waist circumference and circulating concentrations of CRP and other inflammatory markers (7) .”
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    Premisecitation

    Abdominal obesity is a risk factor for type 2 diabetes, hypertension, dyslipidaemia and CVD, and probably for obesity-associated hepatic diseases.

    “Abdominal obesity is a risk factor for type 2 diabetes, hypertension, dyslipidaemia and CVD (50) , and also probably obesityassociated hepatic diseases (non-alcoholic fatty liver disease and non-alcoholic steatohepatitis).”
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    Premisecitation

    Macrophages accumulate in adipose tissue in obesity and may be major contributors to adipokine production.

    “It is now recognised that macrophages accumulate in the adipose tissue in obesity (10,11) (Fig. 1) and that these may represent major contributors to the production of adipokines (12,13) .”
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    Most studies identifying roles of adipose hormones were performed in rodents, and their immune and insulin-sensitising effects in humans remain unclear.

    “It should be noted that most studies identifying the roles of these hormones have been performed in rodents and the immune and insulin-sensitising effects of these hormones in humans remain unclear (20,21) .”
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    Premisecitation

    The anatomical location of adipose tissue is of paramount importance for its physiological function, gene expression, and responses to insulin, catecholamines, sex hormones and cortisol.

    “It appears that the anatomical localisation of adipose tissue is of paramount importance in relation to its physiological function, i.e. handling of lipids (lipogenesis, lipolytic activity), expression of multiple genes, and response to insulin, catecholamines, sex hormones and cortisol (51) .”
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    Premisecitation

    In obesity, adipose tissue becomes a major producer of inflammatory mediators, creating a chronic local and systemic inflammatory milieu, although liver and lymphoid organs are usually major production sites.

    “It should be noted that the liver and the lymphoid organs are usually the major production sites of these inflammatory mediators but in obesity, adipose tissue becomes a major producer resulting in a chronic and constant local and systemic inflammatory milieu (Table 2).”
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    TNF-a expression is elevated in adipocytes of obese and insulin-resistant mice, and insulin sensitivity improves after anti-TNF-a antibody administration.

    “The expression of TNF-a is elevated in adipocytes of obese and insulin-resistant mice, while insulin sensitivity is improved following administration of anti-TNF-a antibodies.”
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    Abdominal, central, visceral or android obesity increases risk for diabetes and atherosclerosis, whereas lower-body or gynoid obesity does not appear to have major metabolic consequences.

    “accumulation of adipose tissue in the thorax and abdomen (variously termed abdominal, central, visceral, splanchnic or android obesity) results in an increased risk for diabetes and atherosclerosis, while excess adipose tissue in the lower part of the body (termed gynoid obesity) does not appear to be associated with major metabolic consequences (44,45) .”
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    Visfatin and resistin contribute to insulin resistance, while omentin appears to be an insulin sensitiser.

    “Similarly, visfatin (16) and resistin (17) contribute to the development of insulin resistance, while omentin (18,19) appears to be an insulin sensitiser.”
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    Premisecitation

    Leptin appears pro-inflammatory, while adiponectin appears anti-inflammatory and insulin-sensitising.

    “Leptin appears to be pro-inflammatory (14) , while adiponectin appears to be anti-inflammatory and insulin-sensitising (15) .”
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    Premisecitation

    Adipokines are substances produced by adipose tissue that circulate in blood and exert systemic hormonal effects.

    “The discovery of leptin introduced the concept of 'adipocytokines' or 'adipokines', substances produced by adipose tissue and which circulate in the bloodstream, so exerting systemic effects as hormones (9) .”
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    Leptin is produced and secreted by white adipose tissue.

    “Leptin is produced and secreted by white adipose tissue.”
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    Premisecitation

    IL-6 and TNF-a appear to be synthesised equally by different adipose tissue sites.

    “In contrast to such distributions, there are reports that IL-6 and TNF-a seem to be equally synthesised by the different sites (28,36,53 -59) .”
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    Interpretationcitation

    These cellular alterations occur in co-cultures without direct cell contact, suggesting soluble factors play a key role, though direct cell-cell interaction cannot be excluded.

    “These cellular alterations are induced in co-cultures without direct cellular contact, suggesting the key role of soluble factors, although it cannot be excluded that a direct cell -cell interaction also plays a role in modifying pre-adipocyte or adipocyte biology.”
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    Interpretationreasoning

    Adipose tissue of obese subjects could be hypoxic in some areas, inducing local chemokine expression.

    “Adipose tissue of obese subjects could be hypoxic in some areas and a local expression of chemokines could be induced.”
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    Human pre-adipocytes exposed to medium from human macrophages acquire a pro-inflammatory phenotype, secrete IL-6 and IL-8, grow well but differentiate poorly.

    “In the presence of a medium derived from human macrophages, human pre-adipocytes showed a drastic change in their phenotype, acquiring a pro-inflammatory phenotype and secreting significant amounts of IL-6 and IL-8, and they grew well (87) , but differentiated poorly (87,88) .”
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    Interpretationcitation

    Pro-inflammatory T-lymphocytes are present in visceral adipose tissue and may contribute to local inflammatory cell activation before macrophages appear, suggesting a role in initiation and perpetuation of adipose tissue inflammation and insulin resistance.

    “Most recently, it has been shown that pro-inflammatory T-lymphocytes are present in visceral adipose tissue and may contribute to local inflammatory cell activation before the appearance of macrophages, suggesting that these cells could play an important role in the initiation and perpetuation of adipose tissue inflammation as well as the development of insulin resistance (69) .”
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    Premisecitation

    TNF-a and IL-6 have specific effects on adipocyte functions, including increased lipolysis, modified secretion and induced insulin resistance.

    “The specific effects of TNF-a and IL-6 on different adipocyte functions (increased lipolysis, modification of adipocyte secretion patterns and induction of adipocyte insulin resistance) have been shown (86) .”
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    HIF-1a is overexpressed in subcutaneous adipose tissue of obese subjects and decreases during weight reduction.

    “Hypoxia-inducible factor-1a, a transcription factor normally induced by hypoxia, is overexpressed in the subcutaneous adipose tissue of obese subjects and its expression is decreased during weight reduction (31) .”
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    SAA and leptin production by adipose tissue depends on adipocyte size.

    “SAA and leptin production by adipose tissue depends on adipocyte size (18,19,23,62) .”
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    Isolated adipocytes from obese subjects overexpress and secrete SAA and leptin abundantly, while adiponectin secretion is suppressed.

    “SAA is overexpressed and secreted in abundance by isolated adipocytes from obese subjects, as is leptin, while secretion of adiponectin is suppressed.”
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    CD3-positive T-lymphocytes are present in human adipose tissue, and RANTES and its receptor CCR5 are expressed in visceral adipose tissue of morbidly obese patients.

    “Furthermore, Wu et al. (71) demonstrated the presence of CD3-positive T-lymphocytes in human adipose tissue and described the expression of RANTES, a T-cell-specific chemokine, and its respective receptor CCR5 in the visceral adipose tissue of morbidly obese patients.”
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    Premisecitation

    Adipose tissue macrophages can be pro- or anti-inflammatory depending on degree and evolution of obesity, with weight gain shifting macrophages from M2 anti-inflammatory to M1 pro-inflammatory phenotype in mice.

    “Although these macrophages express activation markers, they could be pro-or antiinflammatory depending on the degree of obesity and its evolution as suggested by studies in mice showing that weight gain is accompanied by transformation from a macrophagic M2 (anti-inflammatory) phenotype towards an M1 (proinflammatory) profile (75) (Fig. 3) (76) .”
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    Premisecitation

    Leptin is preferentially expressed and secreted by subcutaneous adipose tissue, while adiponectin, visfatin, omentin, resistin, PAI-1, IL-8, IL-7, IL-1a, MCP-1, TGF-b, growth-related oncogene, CCL5 and MIP-1b are expressed more in abdominal fat.

    “Thus, leptin is preferentially expressed and secreted by subcutaneous adipose tissue (52) , while the expression of adiponectin, visfatin, omentin, resistin, PAI-1, IL-8, IL-7, IL-1a, MCP-1, TGF-b, growth-related oncogena, CCL5 and MIP-1b is higher in abdominal fat.”
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    Premisecitation

    Leptin, which has indirect chemoattractant properties, is induced by hypoxia.

    “It should be noted that leptin, which possesses indirect chemoattractant properties, is induced by hypoxia (83) .”
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    Premisecitation

    In mice, macrophage infiltration of obese adipose tissue is accompanied or preceded by T-lymphocyte influx, and T-cells may have a key early role.

    “More recent studies in mice have suggested that the infiltration of obese adipose tissue by macrophages is accompanied or even preceded by an influx of T-lymphocytes (68 -71) and that T-cells have a key early role (69) .”
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    Premisecitation

    Adiponectin overexpression in apoE2/2 mice reduces lesion size after acute ischaemic myocardial infarction, increases angiogenesis and reduces atheromatous plaque size.

    “Overexpression of adiponectin results in diminished size of the lesions observed following acute ischaemic myocardial infarction, increased angiogenic properties and reduced size of atheromatous plaques in the genetically predisposed apoE 2/2 mouse (103) .”
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    After bariatric surgery, IL-6 concentration dropped slowly while SAA and CRP dropped more quickly.

    “After the surgery, the concentration of IL-6 dropped slowly while the concentrations of SAA and CRP dropped more quickly (126) .”
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    Proinflammatory cytokine signalling activates IKKb and JNK1, which phosphorylate Ser307 of IRS-1, preventing insulin receptor tyrosine phosphorylation and downstream signalling.

    “Proinflammatory cytokine signalling usually activates the kinases IkB kinase b and C-jun N-terminal kinase 1, both of which in turn phosphorylate the Ser 307 residue of insulin receptor substrate (IRS)-1.This prevents the phosphorylation of tyrosine residues of IRS-1 by the insulin receptor and the downstream signalling cascade.”
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    IL-6 induces SOCS3 via the STAT3-mTOR pathway.

    “Induction of suppressor of cytokine signalling 3 by IL-6 occurs via the signal transducer and activator of transcription 3 (STAT3) mammalian target of rapamycin (mTOR) pathway (132) .”
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    Interpretationreasoning

    Mitigation of systemic inflammation during weight loss is associated with changes in adipose tissue inflammatory gene expression and may be linked to altered inflammatory protein secretion.

    “Overall, the mitigation of the systemic inflammatory profile observed during weight loss is associated with modifications of adipose tissue inflammatory gene expression, and this may be linked with altered profiles of inflammatory protein secretion.”
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    Premisecitation

    ROS are critical to TNF-a effects on insulin signalling, and mitochondrial dysfunction is involved.

    “There is convincing evidence that reactive oxygen species (ROS) are critical to the effects of TNF-a on insulin signalling (136) , and also that mitochondrial dysfunction is involved (137) .”
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    Weight loss induced by gastric bypass reduces circulating visfatin and TNF-a.

    “Weight loss induced by gastric bypass reduced the circulating concentrations of visfatin (123) and TNF-a (124,125) .”
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    Interpretationcitation

    Macrophage accumulation is more abundant in abdominal than subcutaneous adipose tissue, which could explain some risks of intra-abdominal fat.

    “Macrophage accumulation is more abundant in the abdominal adipose tissue (65) than in the subcutaneous tissue, and this could explain some of the risks associated with the accumulation of intra-abdominal fat.”
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    Premisecitation

    During weight-loss programmes, concentrations of many inflammatory molecules and endothelial risk factors decrease and adiponectin increases, sometimes with improved insulin sensitivity.

    “A reduction in concentrations of numerous inflammatory molecules and endothelial risk factors, and an increase in adiponectin concentration have been observed during weight-loss programmes, and these are sometimes associated with improvement of insulin sensitivity (111) .”
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    Interpretationreasoning

    In cardiovascular disease, adipokines can be considered risk factors and may directly favour initiation and progression of atherosclerosis.

    “In the cardiovascular field, they can be considered as risk factors, and even directly play a pathophysiological role favouring the initiation and progression of atherosclerosis.”
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    Premisecitation

    In diabetic or glucose-intolerant patients, adipose-produced mediators such as CCL5, IL-1b, IL-8 and oxidative stress markers are increased, and insulin therapy reduces their circulating concentrations.

    “Several inflammatory mediators produced by adipose tissue, such as CCL5, IL-1b and IL-8, as well as markers of oxidative stress, are increased in diabetic or glucose-intolerant patients, and the amelioration of hyperglycaemia by insulin therapy reduces circulating concentrations of these molecules (104,105) .”
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    Interpretationreasoning

    Because abdominal adipose tissue is partly drained by the portal system, adipokines, high NEFA fluxes and hormones from adipose tissue could contribute to altered hepatic function in obese subjects.

    “Since the abdominal adipose tissue is partly drained by the portal system, it cannot be excluded that some adipokines, together with high NEFA fluxes and hormones delivered by the adipose tissue, could contribute to the alteration of hepatic function observed in obese subjects, the mechanism of which needs to be better dissected.”
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    Premisecitation

    TLR-4 is expressed by adipocytes and overexpressed during obesity.

    “TLR-4 is expressed by adipocytes and is overexpressed during obesity (96) .”
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    Premisecitation

    After 4 weeks, 100 inflammation-linked genes were modified, with 41% increased and 59% decreased.

    “The expression of 100 genes linked to inflammatory processes was modified after 4 weeks (41 % increased and 59 % decreased).”
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    Mature adipocytes in culture with medium from activated macrophages show increased lipolysis and insulin resistance in addition to a pro-inflammatory state.

    “Other than the proinflammatory state, increased lipolysis and resistance to insulin have been observed (89,90) .”
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    Premisereasoning

    Anti-inflammatory treatment did not significantly decrease circulating TNF-a, MCP-1, or IL-8, indicating no general down-regulation of pro-inflammatory cytokines.

    “There was no significant decrease in circulating TNF-a, MCP-1 or IL-8 concentrations, which indicates that there was no general down-regulation of pro-inflammatory cytokines.”
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    Interpretationreasoning

    Overall, studies of anti-inflammatory therapy support inflammatory mediators as contributors to insulin resistance pathogenesis but do not provide clear evidence of a critical pathogenic role of TNF-a or IL-1.

    “The overall conclusion is that results of studies of anti-inflammatory therapy generally support the concept of inflammatory mediators as contributors to the pathogenesis of insulin resistance, but have as yet not provided clear evidence of a critical pathogenic role of TNF-a or IL-1.”
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    Premisecitation

    Salicylates are weak inhibitors of IKKb and serine phosphorylation of IRS proteins.

    “The longest experience is with the use of salicylates which are weak inhibitors of IkB kinase b and of serine phosphorylation of IRS proteins (143,144) .”
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    Premisecitation

    STAMP2 has been proposed as a major determinant of the postprandial inflammatory response, blocking activated inflammatory signalling in adipocytes and possibly macrophages.

    “A six-transmembrane protein of prostate 2 (STAMP2) has been proposed as a major determinant of the postprandial inflammatory response (170) , acting to block activated inflammatory signalling pathways in adipocytes and possibly in macrophages.”
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    Premisecitation

    Hepatocytes, adipocytes, muscle cells and endothelium synthesise inflammatory mediators, but local activated macrophages appear dominant in synthesis/secretion, leading to spillover into general circulation.

    “Hepatocytes, adipocytes, muscle cells and the endothelium are sites of inflammatory mediator synthesis, but local activated macrophages appear to be the dominant site of synthesis and secretion, which leads to spillover into the general circulation (66,67,142) .”
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    Premisecitation

    Ageing is accompanied by a low-grade chronic inflammatory state, shown by 2- to 4-fold increases in serum levels of several inflammatory mediators in older persons.

    “Ageing is accompanied by a low-grade, chronic inflammatory state clearly shown by 2-to 4-fold increases in serum levels of several inflammatory mediators in older persons (173) .”
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    Postprandial hyperglycaemia can suppress antioxidant capacity and its ability to curb an inflammatory reaction.

    “Postprandial hyperglycaemia can suppress antioxidant capacity (169) and thus its ability to curb an inflammatory reaction.”
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    • Rests on an assumption: Hyperglycaemia induces free radicals that initiate an inflammatory reaction.
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    Interpretationreasoning

    Liver cell functions may be affected by inflammatory mediators released from abdominal adipose tissue because of their blood link.

    “In addition to paracrine effects, it is conceivable that the functions of liver cells are affected by inflammatory mediators released from the abdominal adipose tissue because of their blood link.”
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    Premisecitation

    Obesity is an important determinant of the magnitude of the postprandial inflammatory response, perhaps more important than specific meal components.

    “Obesity is considered an important determinant of the magnitude of the postprandial inflammatory response (163) , perhaps being more important than any specific component of a meal inducing the response.”
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    Premisecitation

    Anti-inflammatory treatment significantly decreased systemic CRP and IL-6 but did not change insulin resistance.

    “However, although there was a significant decrease in systemic CRP and IL-6 concentrations in response to anti-inflammatory treatment, there was no change in insulin resistance (homeostasis model assessment index and euglycaemichyperinsulinaemic clamp studies).”
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  • May combine two claims.

    Premisecitation

    Daily recombinant human IL-1ra injections for 13 weeks decreased glycated Hb and enhanced endogenous insulin production in a controlled double-blind trial.

    “A first controlled double-blind trial was performed with daily injections of recombinant human IL-1ra for 13 weeks.This resulted in decreased glycated Hb levels and enhanced endogenous insulin production (148) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [148]

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  • May combine two claims.

    Premisecitation

    In elderly people, physical activity is inversely associated with inflammatory markers, independent of BMI, and the association is suggested to be dose-dependent.

    “Rather consistent inverse, BMI-independent, associations are found and the associations are suggested to be dosedependent; the more physically active the person, the lower the inflammatory markers (208,224) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [208] source

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    • cites [224] source

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  • May combine two claims.

    Premisecitation

    In elderly participants, training significantly reduced inflammatory markers without changes in BMI or body fat.

    “Several training interventions have not produced changes in basal IL-6 or CRP concentrations (213 -218) , while significant reductions in inflammatory markers have been observed following training without changes in BMI or body fat in elderly participants (219,220) .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [219] source

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    • cites [220] source

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  • May combine two claims.

    Premisecitation

    Plasma IL-6 increases exponentially with exercise and relates to exercise intensity, duration, muscle mass recruited, and endurance capacity.

    “Plasma IL-6 increases in an exponential fashion with exercise and is related to exercise intensity, duration, the mass of muscle recruited and endurance capacity.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [206]

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    • cites [207]

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    • cites [208] source

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  • May combine two claims.

    Premisecitation

    CRP, IL-6, and TNF-a are negatively associated with muscle strength.

    “Other studies have also shown a negative association of CRP, IL-6 and TNF-a with muscle strength (228,232) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [228]

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    • cites [232]

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  • May combine two claims.

    Premisecitation

    In 1020 participants aged 65 years and older, functional fitness was inversely associated with IL-6 and IL-1ra but not with CRP, TNF-a, IL-10, or IL-1b.

    “Functional fitness was inversely associated with IL-6 and IL-1ra concentrations (but not with CRP, TNF-a, IL-10 or IL-1b) in a prospective population-based study of 1020 participants aged 65 years and older (223,231) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [223]

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    • cites [231]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Muscle-derived IL-6 and other cytokines are suggested to mediate health-beneficial effects of exercise and protect against diseases associated with low-grade inflammation.

    “IL-6 and other cytokines that are produced and released by skeletal muscles have been suggested to be involved in mediating the health-beneficial effects of exercise and to play important roles in the protection against diseases associated with low-grade inflammation.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [206]

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    • cites [207]

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    • cites [208] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VO2max attained during graded maximal exercise to voluntary exhaustion is considered the single best indicator of cardiorespiratory fitness.

    “Maximal oxygen consumption (VO 2max ) attained during a graded maximal exercise to voluntary exhaustion is considered as the single best indicator of cardiorespiratory fitness (197) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [197]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Physical inactivity and obesity are modifiable behavioural risk factors for a wide range of chronic diseases, particularly CVD.

    “Physical inactivity and obesity are also increasingly recognised as modifiable behavioural risk factors for a wide range of chronic diseases, and in particular for CVD (195) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [195]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physiological concentrations of IL-6 stimulate circulating IL-1ra and IL-10 and inhibit TNF-a production.

    “(2) Physiological concentrations of IL-6 stimulate the appearance in the circulation of the anti-inflammatory cytokines IL-1ra and IL-10 and inhibit the production of the proinflammatory cytokine TNF-a.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [206]

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    • cites [207]

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    • cites [208] source

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  • May combine two claims.

    Premisecitation

    In cardiac rehabilitation patients, exercise training reduced median CRP by 41%, while CRP did not change in non-exercisers.

    “In a relatively large intervention study of exercise training on cardiac rehabilitation patients, the median CRP concentration was reduced by 41 %, while CRP concentrations did not change in subjects who did not exercise (236) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [236]

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  • May combine two claims.

    Interpretationcitation

    Inflammatory mediators influence pathological processes or act as sensitive markers of subclinical disorders in the elderly.

    “This indicates that these inflammatory mediators influence pathological processes or act as very sensitive markers of subclinical disorders in the elderly (173) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [173] source

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  • May combine two claims.

    Premisecitation

    In men, cardiorespiratory fitness is inversely associated with CRP concentration and prevalence of elevated CRP.

    “Cross-sectional studies in men from the Aerobics Center Longitudinal Study have demonstrated that cardiorespiratory fitness levels are inversely associated with CRP concentration and also the prevalence of elevated CRP concentrations (248) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [248]

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  • May combine two claims.

    Premisecitation

    Reduced energy intake is paramount compared with the nature of low-energy food; decreased inflammatory markers occur with low-energy fat-rich and low-energy carbohydrate-rich diets.

    “Early studies have shown that reduced energy intake is paramount compared with the nature of low-energy food, i.e. decreased concentrations of inflammatory markers are observed with a low-energy, fat-rich as well as with a low-energy, carbohydrate-rich diet (279) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [279] source

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  • May combine two claims.

    Premisecitation

    Cardiorespiratory fitness is inversely associated with fibrinogen and white blood cell count.

    “Analyses with fibrinogen and white blood cell count showed similar results (249) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [249] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In NHANES, both fitness and BMI were independently associated with increased fasting insulin and CRP concentrations.

    “Both fitness and BMI were independently associated with increased fasting insulin and CRP concentrations.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [250]

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  • May combine two claims.

    Interpretationcitation

    Both fitness and fatness are associated with systemic inflammatory status, with relative contributions possibly dependent on age, disease status, and sex.

    “The review concluded that both fitness and fatness are associated with systemic inflammatory status, although the relative contributions of both may be dependent on age, disease status and sex.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [198]

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  • May combine two claims.

    Premisecitation

    In overweight adolescents, CRP but not C3, C4, or ceruloplasmin was associated with muscle strength after controlling for confounders including body fat and fat-free mass; no association in normal-weight.

    “Nevertheless, when stratifying according to overweight status, CRP (but not C3, C4 or ceruloplasmin) concentration was associated with muscle strength in overweight, but not in normal-weight, adolescents after controlling for potential confounders, including body fat and fat-free mass (260) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [260]

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  • May combine two claims.

    Premisecitation

    In 9-year-old Swedish children, total physical activity was unrelated to CRP, fibrinogen, C3, or C4, but exercise was related.

    “In this study of 9-year-old Swedish children, total physical activity was unrelated to CRP, fibrinogen, C3 or C4 concentrations, but exercise was.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [257]

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  • May combine two claims.

    Interpretationcitation

    Exercise is uniquely positioned to reduce inflammation, and small non-significant reductions in CRP may contribute to clinical benefits by reducing cardiovascular and metabolic risk.

    “Nevertheless, exercise is uniquely positioned to reduce inflammation, and even small non-significant reductions in CRP levels may contribute to clinical benefits by reducing cardiovascular and metabolic risk (222) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [222]

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  • May combine two claims.

    Premisecitation

    In multivariate analyses of 2120 Finns, determinants of CRP included obesity and smoking in men, and obesity, oral contraceptive use, and physical activity in women.

    “CRP levels in 2120 Finns were associated with obesity indices and physical activity among both sexes (247) ; in multivariate analyses, the determinants of CRP concentration included obesity and smoking in men, and obesity, oral contraceptive use and physical activity in women.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [247]

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  • May combine two claims.

    Premisecitation

    The inverse association between Mediterranean diet and IL-6 was independent of known CVD risk factors and persisted in within-pair twin comparison.

    “This association was independent of several known cardiovascular risk factors, and persisted when twins within pairs were compared, suggesting that the results were not confounded by shared environmental and genetic factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [282] source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    CRP, C3, and ceruloplasmin but not C4 were negatively associated with muscle strength after controlling for confounders, but not after adjusting for body fat.

    “CRP, C3 and ceruloplasmin (but not C4) concentrations were negatively associated with muscle strength after controlling for sex, age, pubertal status, weight, height, socio-economic status and cardiorespiratory fitness, but did not remain when adjusting for body fat.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Sirtuin activation improves metabolic efficiency, strengthens cell stress defences, and dampens inflammatory activities by decreasing NF-kB activation.

    “As a consequence, metabolic efficiency is improved, cell defences against stress are strengthened and inflammatory activities are dampened, notably by decreasing the activation of NF-kB (271 -274) .”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [271]

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    • cites [272]

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    • cites [273]

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    • cites [274] source

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  • May combine two claims.

    Premisecitation

    Resveratrol interacts with sirtuins and promotes their deacetylase activity.

    “Resveratrol, present in red wine, was found to directly or indirectly interact with sirtuins and promote their deacetylase activity.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    In healthy men and women, BMI but not previous year or current physical activity predicted CRP concentration.

    “In another study in healthy men and women, BMI, but not previous year or current physical activity, predicted CRP concentration (245) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [245]

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  • May combine two claims.

    Premisecitation

    After stratifying by fitness and weight, weight remained significantly associated with CRP but fitness did not.

    “However, when patients with low, moderate and high fitness were further stratified as normal, overweight or obese, weight remained significantly associated with CRP, but fitness did not.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [250]

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  • May combine two claims.

    Interpretationreasoning

    Overall, there are no consistent data that tea consumption (black or green) has a beneficial effect on inflammatory status, and longer-duration studies are needed.

    “Overall, there are no consistent data that tea consumption (black or green) has a beneficial effect on inflammatory status, but studies of longer duration than those currently reported need to be performed.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    In a subsample of 690 healthy women from the Nurses' Health Study, AHEI and alternate Mediterranean diet index scores were negatively associated with CRP, IL-6, sE-selectin and sICAM-1, and these associations persisted after adjustment for confounders including BMI.

    “The key findings were that the AHEI and alternate Mediterranean diet index scores were negatively associated with CRP, IL-6, sE-selectin and sICAM-1 concentrations, and that these associations persisted upon adjustment for potential confounding variables including BMI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [285] source

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  • May combine two claims.

    Premisecitation

    Consumption of a Western diet rich in Maillard reaction products correlates with impaired glucose metabolism, insulin resistance, and increased risk of cardiovascular and renal disease associated with metabolic syndrome and related conditions.

    “In fact, consumption of a Western diet rich in these products was found to correlate with impaired glucose metabolism, insulin resistance and increased risk of cardiovascular and renal disease associated with the metabolic syndrome and related conditions (449,450) .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [449] source

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    • cites [450] source

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  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In 5089 non-diabetic MESA participants, a fats and processed meats pattern was positively associated with CRP and IL-6; a beans, tomatoes and refined grains pattern was positively related to sICAM-1; a whole grains and fruit pattern was inversely associated with CRP, IL-6 and sICAM-1; and a vegetables and fish pattern was inversely related to IL-6.

    “The fats and processed meats pattern (fats, oils, processed meats, fried potatoes, salty snacks and desserts) was positively associated with CRP and IL-6 concentrations.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [306]

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  • May combine two claims.

    Premisecitation

    In 120 premenopausal obese women, a two-year multidisciplinary intervention with a low-energy Mediterranean-style diet and increased physical activity reduced CRP, IL-6 and IL-18 and increased adiponectin compared with control.

    “Significant reduction in several markers of inflammation (CRP, IL-6 and IL-18) and an increase in adiponectin concentration were noted in the Mediterranean diet group compared with the control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [111] source

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  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In overweight and obese subjects, a hypoenergetic diet with whole-grain foods decreased CRP by 38% independent of weight loss, but did not change IL-6, TNF-a or PAI-1 activity over 12 weeks.

    “CRP concentration decreased by 38 % (CRP at baseline 5•9-6•0 mg/l) in the whole-grain group independent of the observed weight loss (319) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [319] source

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  • May combine two claims.

    Premisecitation

    In postmenopausal Iranian women with metabolic syndrome, soya nuts but not soya protein reduced plasma CRP, TNF-a and IL-18 concentrations.

    “In one study, reduced plasma CRP, TNF-a and IL-18 concentrations were reported in postmenopausal Iranian women with the metabolic syndrome consuming soya nuts but not soya protein (347) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [347]

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  • May combine two claims.

    Premisecitation

    Regular consumption of alcohol-containing beverages such as wine or beer has been reported to be inversely associated with several markers of low-grade inflammation in a dose-dependent manner, with moderate daily intake (1-2 drinks/d) often associated with decreased inflammatory markers, although not in all studies.

    “The regular consumption of alcohol-containing beverages such as wine or beer has been reported to be inversely associated with several markers of low-grade inflammation, in a dose-dependent manner: i.e. moderate daily intake (1 -2 drinks/d) was often found to be associated with decreased concentrations of inflammatory markers, although this was not the case in all studies (Table 10) (418 -432) .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [418]

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    • cites [419]

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    • cites [420]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Endogenous advanced glycation end products are formed by at least three mechanisms: enhanced carbohydrate or lipid substrate availability, increased oxidative metabolism, and increased non-oxidative metabolism.

    “AGE are formed within the body (endogenous AGE) due to at least three mechanisms (460) :”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [460]

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  • May combine two claims.

    Premisecitation

    Among 1922 women from the Nurses' Health Study, highest AHEI adherence was associated with 24% higher total adiponectin, 32% higher HMW adiponectin, 16% lower resistin, 41% lower CRP and 19% lower sE-selectin than lowest adherence.

    “After adjustment for age and energy intake, women with the highest adherence to the AHEI had 24 % higher median total adiponectin and 32 % higher median high-molecular-weight adiponectin concentrations, as well as 16 % lower resistin, 41 % lower CRP and 19 % lower sE-selectin concentrations than did women with the lowest adherence to the AHEI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [301]

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  • May combine two claims.

    Premisecitation

    In PREDIMED, 772 asymptomatic high cardiovascular risk subjects assigned to two Mediterranean diets had significant reductions in serum IL-6, sICAM-1 and sVCAM-1, while CRP was reduced only in the olive-oil-supplemented Mediterranean diet.

    “Both Mediterranean diets were beneficial in terms of significant reductions in serum IL-6, sICAM-1 and sVCAM-1 concentrations, while CRP concentration was reduced only in the Mediterranean diet supplemented with olive oil.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [293] source

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  • May combine two claims.

    Premisecitation

    In the same study, a Western pattern was positively related to CRP, IL-6, sE-selectin, sICAM-1 and sVCAM-1 after adjustment for all confounders except BMI; with BMI adjustment, coefficients remained significant for CRP, sE-selectin, sICAM-1 and sVCAM-1.

    “The Western pattern showed a positive relationship with CRP, IL-6, sE-selectin, sICAM-1 and sVCAM-1 after adjustment for all confounders except BMI; with further adjustment for BMI, the coefficients remained significant for CRP, sE-selectin, sICAM-1 and sVCAM-1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [303]

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  • May combine two claims.

    Interpretationreasoning

    Overall, soya protein does not affect markers of inflammation; soyabean processing may affect anti-inflammatory potential; and health status of subjects might determine anti-inflammatory efficacy of specific foods.

    “Overall, these data suggest that soya protein does not affect markers of inflammation, that soyabean processing may affect the anti-inflammatory potential of soyabean constituents and that the health status of the study subjects might determine the anti-inflammatory efficacy of specific foods.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim.

    Premisecitation

    In healthy young males, oxidised LDL from those on a Mediterranean-style or low-fat high-carbohydrate diet decreased TNF-a-induced VCAM-1 and E-selectin expression in human umbilical endothelial cells in vitro.

    “Oxidised LDL from subjects on either the Mediterranean diet or the high-carbohydrate diet decreased TNF-a-induced VCAM-1 and E-selectin expression in human umbilical endothelial cells in vitro.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [290]

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  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Schulze et al. identified a dietary pattern high in sugar-sweetened soft drinks, refined grains, diet soft drinks and processed meat and low in wine, coffee, cruciferous vegetables and yellow vegetables that was significantly associated with increased CRP, IL-6, sTNFR2, sE-selectin, sICAM-1 and sVCAM-1, and with increased diabetes risk.

    “Using data from the Nurses' Health Study, Schulze et al. (304) identified a dietary pattern that was significantly associated with increased concentrations of CRP, IL-6, sTNFR2, sE-selectin, sICAM-1 and sVCAM-1.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [304] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Vegetarians may differ from non-vegetarians in lifestyle factors other than diet, such as physical activity, smoking and socio-economic class.

    “However, it is important to recognise that vegetarians may differ from non-vegetarians in aspects of lifestyle other than diet such as physical activity, smoking behaviour and socio-economic class.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    In NHANES III, HEI score was negatively correlated with CRP after adjustment for several CVD risk factors including BMI and waist:hip ratio; the association was significant in women only.

    “Using the data from NHANES III on a representative sample of the US population, Ford et al. (300) found a negative correlation between the HEI and CRP concentration after adjustment for several CVD risk factors including BMI and waist:hip ratio; when stratified by sex this finding was significant in women only.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [300]

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  • May combine two claims.

    Interpretationreasoning

    Current evidence for specific effects of single vegetable and fruit varieties is not convincing, while a high overall intake of vegetables and fruits seems associated with a lower state of inflammation.

    “In conclusion, current evidence for specific effects of single vegetable and fruit varieties is not convincing, while a high overall intake of vegetables and fruits seems to be associated with a lower state of inflammation.”
    Quote in the paperSubstantial claim
  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In 180 metabolic syndrome subjects, a two-year Mediterranean-style diet reduced body weight more and decreased CRP, IL-6, IL-7 and IL-18 and improved endothelial function compared with a prudent control diet.

    “After 2 years, body weight decreased more in the intervention group and inflammatory markers (CRP, IL-6, IL-7 and IL-18) decreased and endothelial function improved, compared with the control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [284]

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  • May combine two claims.

    Interpretationreasoning

    Cell-surface RAGE induces pro-inflammatory signalling, whereas soluble RAGE prevents this by sequestering ligands away from cell-surface RAGE.

    “Thus, the cell-surface RAGE appears to be involved in inducing pro-inflammatory signalling while the soluble form of RAGE appears to prevent this, by seques-tering ligands away from the cell-surface RAGE.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    In long-term haemodialysis and peritoneal dialysis patients, circulating advanced glycation end products correlated significantly with the advanced glycation end product content of a regular diet and with blood urea nitrogen level.

    “This study showed that circulating AGE correlated significantly with the AGE content of a regular diet, as estimated by means of 3 d dietary records and food questionnaires, as well as with blood urea N level (459) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [459] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Malondialdehyde and 4-hydroxy-2-nonenal are the main aldehydes generated during lipid peroxidation of n-6 polyunsaturated fatty acids, whereas 4-hydroxy-2-hexanal is predominant from n-3 polyunsaturated fatty acids.

    “Malondialdehyde and 4-hydroxy-2-nonenal are the main aldehydes generated during lipid peroxidation of n-6 PUFA (468) , whereas 4-hydroxy-2-hexanal is the predominant compound derived from the oxidation of n-3 PUFA (469) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [468] source

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    • cites [469] source

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  • May combine two claims.

    Premisecitation

    In healthy younger and older human subjects, dietary advanced glycation end products, but not energy intake, correlated with serum advanced glycation end product levels and markers of oxidative stress, which in turn correlated with serum C-reactive protein concentration and insulin resistance.

    “In healthy younger (aged , 45 years) and older (aged .60 years) human subjects, dietary AGE, but not energy intake, correlated with serum AGE levels and markers of oxidative stress (8-isoprostanes), which in turn correlated with serum CRP concentration and insulin resistance (514 -521) (Table 12).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [514] source

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    • cites [515]

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    • cites [516]

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    • cites [517]

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    • cites [518]

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    • cites [519]

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    • cites [520]

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    • cites [521]

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  • May combine two claims.

    Interpretationcitation

    Taken together, the studies show that dietary advanced glycation end product content correlates with circulating levels of advanced glycation end products and with markers of inflammation, oxidative stress, endothelial dysfunction and renal function.

    “Taken together, these studies show that dietary AGE content correlates with circulating levels of AGE and with markers of inflammation, oxidative stress, endothelial dysfunction and renal function.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cooking was shown to increase the bioavailability of some nutrients, especially proteins from some plant sources.

    “However, cooking was also shown to increase the bioavailability of some nutrients, especially proteins derived from some plant sources (451) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [451]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Advanced lipoxidation end products are derived from lipid oxidation rather than from sugars and sugar breakdown products.

    “The so-called advanced lipoxidation end products (ALE) are similar to AGE but, rather than originating from sugars and sugar breakdown products, ALE are derived from lipid oxidation (467) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [467]

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  • May combine two claims.

    Premisecitation

    In non-diabetic peritoneal dialysis patients randomly assigned to high- or low-advanced glycation end product diets for 4 weeks, serum advanced glycation end product levels correlated with advanced glycation end product consumption and with blood urea nitrogen, serum creatinine, total protein, albumin and phosphorus, and advanced glycation end product restriction profoundly reduced circulating AGE

    “Likewise, in non-diabetic patients on maintenance peritoneal dialysis randomly assigned to two groups consuming either a high-or low-AGE diet for 4 weeks, serum AGE levels correlated with AGE consumption as well as with blood urea N, serum creatinine, total protein, albumin and P, with AGE restriction profoundly reducing circulating AGE (523) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [523]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    At present, RAGE seems to be the only advanced glycation end product receptor involved in cell activation.

    “At present, RAGE seems to be the only receptor involved in cell activation (140) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [140] source

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  • May combine two claims.

    Premisecitation

    AGE-R1, AGE-R2 and AGE-R3 behave as an advanced glycation end product-receptor complex and exert a predominant scavenging function.

    “On the other hand, AGE-R1, AGE-R2 and AGE-R3 seem to behave as an AGE-receptor complex rather than individual receptor molecules and exert a predominant scavenging function (482,483) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [482]

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    • cites [483]

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  • May combine two claims.

    Interpretationcitation

    Accumulation of endogenous and exogenous advanced glycation end products may be favoured by reduced kidney clearance in renal failure and by impaired detoxification.

    “Finally, accumulation of both endogenous and exogenous AGE may be favoured by reduced kidney clearance as in the case of renal failure (466) and by impaired detoxification caused by the utilisation of cofactors of detoxifying enzymes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [466]

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  • May combine two claims.

    Premisecitation

    Serum advanced glycation end product levels were directly related to degree of renal dysfunction, and renal advanced glycation end product excretion was inversely correlated with degree of renal dysfunction.

    “Moreover, the serum AGE levels were directly related to the degree of renal dysfunction, as estimated by the increase in albuminuria and the decrease in creatinine clearance, and renal AGE excretion was inversely correlated with the degree of renal dysfunction.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [456]

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    Premisecitation

    Reactive oxygen species can trigger proinflammatory signalling pathways causing MAPK-dependent activation of transcription factors such as NF-kB and consequent modulation of pro-inflammatory cytokine gene expression.

    “ROS can trigger proinflammatory signalling pathways causing MAPK-dependent activation of transcription factors such as NF-kB (474 -476) and consequent modulation of the gene expression of several pro-inflammatory cytokines (474,475,477) .”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [474]

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    • cites [477]

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    Premisecitation

    In spontaneously diabetic db/db mice and normal mice fed high-fat diets, feeding a low-advanced glycation end product diet reduced serum advanced glycation end product levels and improved insulin sensitivity compared with a high-advanced glycation end product diet.

    “In spontaneously diabetic db/db mice (507) and in normal mice fed high-fat diets (508) , feeding of a low-AGE diet reduced serum AGE levels and improved insulin sensitivity, compared with a high-AGE diet.”
    Quote in the paperSubstantial claim0 of 2 sources checked
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    Premisecitation

    Class A and B scavenger receptors participate in atherogenesis, with SR-AI/II and CD36 pro-atherogenic and SR-BI protective.

    “Finally, the participation of class A and B scavenger receptors in the process of atherogenesis has been clearly established by a large body of experimental studies, with scavenger receptor AI (SR-AI) and II and CD36 showing a predominant pro-atherogenic role and scavenger receptor BI (SR-BI) exerting a protective function towards lesion development (487) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [487] source

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  • May combine two claims.

    Premisecitation

    RAGE is implicated in atherogenesis and diabetic complications, based on animal studies showing that soluble RAGE inhibits atherosclerosis and nephropathy while RAGE overexpression or ablation affects these conditions.

    “Among the AGE receptors, RAGE was shown to be implicated in atherogenesis, based on the observations that soluble RAGE, which is able to bind circulating AGE and other RAGE ligands, and therefore to prevent their pro-inflammatory effects, inhibited the development of atherosclerosis in diabetic apoE 2/2 mice (489)”
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    • cites [490] source

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    • cites [491]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Carboxymethyllysine can originate from both sugars and lipid oxidation products.

    “Some reaction products, such as carboxymethyllysine, can originate from both sugars and lipid oxidation products (470) , and have been called 'either advanced glycation and lipoxidation end products' (466) .”
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    • cites [466]

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  • May combine two claims.

    Premisecitation

    In genetically hypercholesterolaemic apoE-/- mice, low advanced glycation end product content in the diet attenuated development of atherosclerosis after streptozotocin-induced diabetes and neointimal formation after arterial injury.

    “Likewise, in genetically hypercholesterolaemic apoE 2/2 mice, low AGE content in the diet attenuated the development of atherosclerosis after induction of diabetes with streptozotocin (511) and neointimal formation after arterial injury (512) .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [511]

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    • cites [512]

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  • May combine two claims.

    Interpretationcitation

    Acute studies show that after a high-advanced glycation end product meal there is typically an elevation of inflammatory markers in the hours after consumption, and this increase does not occur with a low-advanced glycation end product meal.

    “Although these have been conducted in a variety of subject/patient groups, they show rather similar effects: typically, there is an elevation of various inflammatory markers (CRP, cytokines and soluble adhesion molecules) in the hours after consumption of a high-AGE meal, and this increase does not occur with a low-AGE meal (see Table 12).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Table 12

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  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    AGE-R1 plays a protective role, as indicated by resistance to oxidant and inflammatory injury in mesangial cells overexpressing this receptor and by associations of low AGE-R1 expression with diabetic nephropathy and complications.

    “Also AGE-R1 seems to play a protective role, as indicated by resistance to oxidant and inflammatory injury in mesangial cells overexpressing this receptor (482,502) .”
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    • cites [502]

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    • cites [504]

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  • May combine two claims.

    Premisecitation

    Galectin-3 exerts a prevailing protective role, as indicated by reports that galectin-3 ablation accelerates glomerulopathy, increases advanced glycation end product levels, and accelerates ageing.

    “Conversely, galectin-3 was proposed to exert a prevailing protective role as indicated by reports that galectin-3 ablation resulted in (1) the acceleration of glomerulopathy induced by diabetes (496) , (2) increased AGE levels (497) and ( 3) accelerated ageing (498) .”
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    • cites [497]

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  • May combine two claims.

    Premisecitation

    Studies in experimental animals and human volunteers show that absorption of ingested Maillard reaction products is variable and dependent on the Maillard reaction product.

    “Studies in experimental animals fed or injected with radiolabelled protein-bound AGE and human volunteers receiving diets enriched with MRP or specific AGE have shown that absorption of ingested MRP is variable and dependent on the MRP (464,465,527 -529) .”
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    • cites [465] source

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    • cites [527] source

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    • cites [528] source

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    • cites [529] source

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  • May combine two claims.

    Premisecitation

    Highly cross-linked advanced glycation end products and melanoidins are predominantly excreted in faeces, while absorbed Maillard reaction products are generally rapidly excreted by the kidney with limited accumulation in tissues and organs.

    “Highly cross-linked AGE and melanoidins were predominantly excreted in the faeces while absorbed MRP were in general rapidly excreted by the kidney, with limited accumulation in tissues and organs (465,528 -531) .”
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    • cites [528] source

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    • cites [529] source

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    • cites [530] source

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    • cites [531] source

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  • May combine two claims.

    Premisecitation

    In human intervention studies, conjugated linoleic acid, especially the trans-10,cis-12 isomer, increases CRP concentration but not cytokine or soluble adhesion molecule concentrations.

    “two studies demonstrate that CLA, especially the trans-10, cis-12 isomer, increases CRP concentration, but not the concentrations of cytokines or soluble adhesion molecules (593,594)”
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    • cites [593] source

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    • cites [594] source

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    Premisecitation

    Pyrraline and free pentosidine are readily absorbed and excreted in urine.

    “Both pyrraline and pentosidine, the latter only in free form, were readily absorbed and excreted in the urine (532,533) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [532]

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    • cites [533]

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  • May combine two claims.

    Premisecitation

    Only high-molecular-weight serum fractions from diabetic nephropathy patients stimulate RAGE, and supramolecular complexes are a prerequisite for RAGE binding.

    “Penfold et al. (535) recently showed that only serum fractions isolated from diabetic patients with nephropathy containing high-molecular-weight proteins (. 50 kD) were able to stimulate RAGE but not medium-or low-molecular-weight serum fractions, in line with mechanistic studies that showed no binding of carboxymethyllysine-modified proteins to RAGE (536 -538) , and that supramolecular complexes”
    Quote in the paperSubstantial claim0 of 8 sources checked
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    • cites [536] source

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    • cites [538]

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    • cites [539]

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  • May combine two claims.

    Interpretationreasoning

    Dietary advanced glycation end products, even if absorbed, would have little effect on inflammatory processes via RAGE activation in target tissues, because free advanced glycation end product-modified amino acids are unlikely to be incorporated into nascent proteins.

    “Together this suggests that dietary AGE, even if they are absorbed from the gut, would have little effect on inflammatory processes via RAGE activation in target tissues, since it appears highly unlikely that free AGE-modified amino acids would be incorporated into nascent proteins.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    A recent study in obese children found lower circulating advanced glycation end product levels compared with lean controls while inflammatory markers were significantly elevated in obese children.

    “In addition, a recent study in obese children found lower circulating AGE levels compared with lean controls while inflammatory markers were significantly elevated in obese children (517) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [517]

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  • May combine two claims.

    Premisecitation

    Saturated fatty acids, especially lauric acid, activate TLR-4 and thereby induce NF-kB activity.

    “activated directly by SFA, especially lauric acid (12 : 0), via TLR-4 and through this mechanism induce NF-kB activity (574,575)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [574]

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  • May combine two claims.

    Premisecitation

    Circulating advanced glycation end product levels were inversely correlated with mortality in haemodialysis patients, probably due to better nutritional status.

    “In contrast to the aforementioned reports, circulating AGE levels could not be identified as an independent risk factor for cardiovascular or renal outcomes in diabetic subjects with diabetic nephropathy (524) , and circulating AGE levels were even inversely correlated with mortality in haemodialysis patients, the latter most probably due to a better nutritional status (525) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • May combine two claims.

    Premisecitation

    EPA or DHA concentration in granulocyte membranes is inversely associated with CRP concentration; the effect of DHA is stronger than that of EPA.

    “The concentration of either EPA or DHA in granulocyte membranes was inversely associated with CRP concentration in one study (374) ; the effect of DHA was stronger than that of EPA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [374] source

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  • May combine two claims.

    Premisecitation

    In Zhao et al., the alpha-linolenic acid diet produced greater decreases in inflammatory markers than the linoleic acid diet: 75%, 80%, 37.5% and 12% decreases in CRP, sVCAM-1, sICAM-1 and sE-selectin concentrations, respectively.

    “The changes in inflammatory markers seen with the a-linolenic acid diet were greater than with the linoleic acid diet (75, 80, 37•5 and 12 % decreases in CRP, sVCAM-1, sICAM-1 and sE-selectin concentrations, respectively).”
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    • cites [606]

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  • May combine two claims.

    Premisecitation

    Clinical trials have demonstrated anti-inflammatory effects and clinical benefit from fish oil administration in rheumatoid arthritis, inflammatory bowel diseases and childhood asthma.

    “Furthermore, clinical trials have demonstrated anti-inflammatory effects and clinical benefit from fish oil administration in diseases with a frank inflammatory basis including rheumatoid arthritis (615) , inflammatory bowel diseases (616) and childhood asthma (617) .”
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  • May combine two claims.

    Premisecitation

    In an elderly Italian population, plasma EPA is inversely associated with IL-6 concentration and positively associated with IL-10 and TGFb concentrations.

    “In an elderly Italian population, plasma EPA was inversely associated with IL-6 concentration and positively associated with the concentrations of the anti-inflammatory cytokines IL-10 and TGFb (578) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [578] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Ferrucci et al., plasma arachidonic acid is positively associated with TGF-b concentration.

    “Ferrucci et al. (578) reported no association between arachidonic acid in plasma and CRP, TNF-a, IL-1b, IL-10 and sIL-6R concentrations, while there was an inverse association with IL-6 and IL-1ra concentrations and a positive association with TGF-b”
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    • cites [578] source

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  • May combine two claims.

    Interpretationreasoning

    Decreasing saturated fatty acid status while increasing n-6 PUFA status might reduce low-grade inflammation.

    “This suggests that decreasing SFA status while increasing n-6 PUFA status might reduce low-grade inflammation.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Observations that PGE2 can exert anti-inflammatory effects and that arachidonic acid gives rise to lipoxin A4 have challenged the earlier view that arachidonic acid enhances inflammation.

    “However, observations that classical pro-inflammatory mediators such as PGE 2 can also exert anti-inflammatory effects and that arachidonic acid gives rise to anti-inflammatory mediators such as lipoxin A 4 have started to challenge the earlier view (608)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • May combine two claims.

    Premisecitation

    In Zhao et al., in the linoleic acid group, CRP and sICAM-1 concentrations decreased by 45% and 25%, respectively; sVCAM-1 and sE-selectin fell by 15% and 7% but these changes were not significant.

    “In the linoleic acid group, the concentrations of CRP and sICAM-1 decreased by 45 and 25 %, respectively; sVCAM-1 and sE-selectin also fell (by 15 and 7 %) but these changes were not significant.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [606]

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  • May combine two claims.

    Interpretationcitation

    Plasma arachidonic acid either has little impact on low-grade inflammation or is anti-inflammatory.

    “These observations suggest either that plasma arachidonic acid has little impact on low-grade inflammation (does not affect CRP or TNF-a) or that it is anti-inflammatory (lowers IL-6; increases TGF-b).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Long-chain n-3 PUFA supplementation lowers concentrations of CRP, IL-6, TNF-a, IL-18, sICAM-1, sVCAM-1 and sE-selectin in various subject/patient groups.

    “Studies have shown that longchain n-3 PUFA lower the concentrations of CRP (621,624,639) , IL-6 (621,624,639) , TNF-a (639) , IL-18 (643) , sICAM-1 (625,628,645,646) , sVCAM-1 (605,645) and sE-selectin (618) in various subject/patient groups (see Table 16).”
    Quote in the paperSubstantial claim0 of 8 sources checked
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  • May combine two claims.

    Premisecitation

    In an elderly Italian population, plasma DHA is inversely associated with IL-6 and TNF-a concentrations and positively associated with IL-10 and TGF-b concentrations.

    “Furthermore, plasma DHA was inversely associated with IL-6 and TNF-a concentrations and was also positively associated with the concentrations of IL-10 and TGF-b (578) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [578] source

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  • May combine two claims.

    Premisecitation

    Serum non-esterified EPA and DHA are inversely associated with sVCAM-1 and sICAM-1 concentrations in patients at risk of CHD; EPA is also inversely associated with sE-selectin concentration.

    “Serum non-esterified EPA and DHA were both inversely associated with concentrations of sVCAM-1 and sICAM-1 in patients at risk of CHD (585) ; EPA was also inversely associated with sE-selectin concentration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [585]

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  • May combine two claims.

    Premisecitation

    Some observations suggest that hyperglycaemia and hypertriacylglycerolaemia/elevated NEFA levels induce independent effects and, when present together, act synergistically to generate oxidative stress, inflammation, impaired endothelial function and vascular disease.

    “However, some observations have suggested that hyperglycaemia and hypertriacylglycerolaemia/elevated NEFA levels induce independent effects and, when present together, act synergistically to generate oxidative stress, inflammation, impaired endothelial function and vascular disease (651 -653) .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
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    • cites [652] source

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    • cites [653] source

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  • May combine two claims.

    Premisecitation

    Shen et al. identified that the IL-1b 6054 G>A SNP was significantly associated with CRP and adiponectin concentrations and with prevalence of metabolic syndrome among 1120 men and women with mean age 49.

    “They first identified that the IL-1b 6054 G .A SNP was significantly associated with CRP and adiponectin concentrations and with the prevalence of the metabolic syndrome among a group of 1120 men and women with a mean age of 49 years.”
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    • cites [650] source

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  • May combine two claims.

    Interpretationreasoning

    Although the overwhelming view is that EPA+DHA at sufficient doses are anti-inflammatory, evidence from measurements of low-grade inflammation markers is not entirely consistent.

    “Thus, although the overwhelming view is that EPA þ DHA given at sufficient doses are anti-inflammatory, the evidence from measurements of markers of low-grade inflammation is not entirely consistent.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    In two studies, EPA+DHA administration increased sVCAM-1 (<10%) and sE-selectin (20%) concentrations, had no effect on sP-selectin, and decreased von Willebrand factor and thrombomodulin concentrations.

    “Both studies identified an increase in sVCAM-1 (,10 %) and sE-selectin (20 %) concentrations, with no effect on sP-selectin and a decrease in von Willibrand factor and thrombomodulin concentrations.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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    • cites [642]

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  • May combine two claims.

    Premisecitation

    Restoration of NO availability normalises endothelial function and insulin sensitivity.

    “Restoration of NO availability results in normalisation of endothelial function as well as insulin sensitivity (659,660) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [659]

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    • cites [660]

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  • May combine two claims.

    Premisecitation

    Among subjects with low erythrocyte n-3 PUFA content, the 6054 G allele was associated with increased risk of metabolic syndrome (OR 3.29, 95% CI 1.49, 7.26 for GG and OR 1.95, 95% CI 0.85, 4.46 for GA) compared with AA genotype, but no significant genotype associations were found among subjects with high erythrocyte n-3 PUFA content.

    “Among subjects with low erythrocyte n-3 PUFA content (below the median), the 6054 G allele was associated with increased risk of the metabolic syndrome (OR 3•29, 95 % CI 1 •49, 7•26 for GG and OR 1•95, 95 % CI 0•85, 4•46 for GA) compared with the AA genotype, but there were no significant genotype associations among subjects with high erythrocyte n-3 PUFA content (above the median).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [650] source

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  • May combine two claims.

    Premisecitation

    Consumption of a glycaemic meal increases oxidative stress and reduces antioxidant defences, with the increase being greater with higher levels of hyperglycaemia.

    “The consumption of a glycaemic meal increases oxidative stress and reduces antioxidant defences, with the increase being significantly greater with higher levels of hyperglycaemia (169,664,665) .”
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  • May combine two claims.

    Premisecitation

    In long-term insulin-resistant, sucrose-fed rats, dietary n-3 PUFA decreased adipocyte diameter and significantly reduced several inflammation-related genes.

    “the presence of n-3 PUFA in the diet of long-term insulin-resistant, sucrosefed rats decreased adipocyte diameter (648) and significantly reduced several inflammation-related genes (unpublished results, Guerre-Millo M, Naour N, Lombardo Y, Clement K, Rizkalla S).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [648]

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  • May combine two claims.

    Premisecitation

    In overweight women with type 2 diabetes, 8 weeks of 1.8 g/d EPA+DHA decreases adiposity and reduces expression of inflammation-related genes in subcutaneous adipose tissue.

    “In a group of overweight women with type 2 diabetes, 8 weeks of a moderate dose of long-chain n-3 PUFA (1•8 g/d of EPA þ DHA) decreased adiposity and reduced expression of a number of inflammation-related genes in the subcutaneous adipose tissue (630) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • May combine two claims.

    Premisecitation

    After meals, LDL oxidation increases and this phenomenon correlates with the degree of hyperglycaemia.

    “Ceriello et al. (652) observed that after meals LDL oxidation increases and that this phenomenon is correlated with the degree of hyperglycaemia.”
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    Premisecitation

    Oxidative stress induces damage to cell membranes, internal cell structures and DNA and induces inflammatory responses.

    “Oxidative stress is known to induce damage to cell membranes, internal cell structures and DNA as well as to induce inflammatory responses (Fig. 8) (654) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [654]

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  • May combine two claims.

    Interpretationreasoning

    The decrease in endothelium-dependent vasodilation can be prevented by antioxidants such as vitamin C, vitamin E and alpha-lipoic acid or by L-arginine, suggesting that increased NO oxidation and related NO drain affect vasculature cells.

    “The fact that such a decrease can be prevented by supplying various antioxidants such as vitamin C, vitamin E and a-lipoic acid (659 -662) or L-arginine (656,663) , the precursor of NO, suggests that increased NO oxidation and the related NO drain have an impact on cells of the vasculature.”
    Quote in the paperSubstantial claim0 of 6 sources checked
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    • cites [660]

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    • The authors state this as an assumption: Nitric oxide plays a key role in linking hyperglycaemia-induced free radical production to metabolic events.
  • May combine two claims.

    Interpretationcitation

    IL-1b genetic variants are associated with measures of chronic low-grade inflammation and risk of metabolic syndrome, and genetic influences are more evident among subjects with low erythrocyte n-3 PUFA status.

    “The results suggest that IL-1b genetic variants are associated with measures of chronic low-grade inflammation and the risk of the metabolic syndrome, and that genetic influences were more evident among subjects with low erythrocyte n-3 PUFA status and so, most probably low n-3 PUFA intake.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Elevated NEFA can cause oxidative stress due to increased mitochondrial uncoupling and beta-oxidation, leading to increased ROS production and activation of stress-sensitive signalling pathways, which impair insulin secretion and action.

    “They also pointed out that elevated NEFA can cause oxidative stress due to increased mitochondrial uncoupling and b-oxidation, the latter leading to an increased production of ROS and to an activation of stress-sensitive signalling pathways, which in turn impair insulin secretion and action.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • May combine two claims.

    Premisecitation

    Higher iron intake, especially haem iron, and higher iron status are associated with increased risk of type 2 diabetes, atherosclerosis and coronary heart disease, although the literature is not fully consistent.

    “There is some epidemiological evidence that higher Fe intake, particularly that of haem Fe, and higher Fe status are associated with increased risk of type 2 diabetes, atherosclerosis and CHD (702 -714) , although not all of the literature is consistent.”
    Quote in the paperSubstantial claim0 of 10 sources checked
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    • cites [708] source

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    • cites [709] source

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    • cites [710] source

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    • cites [711] source

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  • May combine two claims.

    Premisecitation

    In an intervention with lean normotensive and obese hypertensive adults, both DASH diet (30 g fibre/d) and fibre-supplemented usual diet (30 g psyllium/d) caused a reduction in CRP concentration (14% and 18%, respectively), significant only in lean normotensive subjects.

    “Both diets caused a reduction in CRP concentration (14 and 18 %, respectively), although this was significant only in lean normotensive subjects in either intervention arm.”
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    • cites [682]

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  • May combine two claims.

    Premisecitation

    Because Fe is a redox-active transition metal, it may contribute to production of ROS, oxidative stress and inflammation, and thus Fe excess can augment risk for diabetes and CVD.

    “On the other hand, because Fe is a redox-active transition metal, it may contribute to the production of ROS, oxidative stress and inflammation (698,699) , and thus Fe excess can augment the risk for diabetes and CVD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • May combine two claims.

    Premisecitation

    Fe deficiency is associated with alterations in the immune response and increased risk of infections.

    “Fe deficiency is associated with alterations in the immune response and increased risk of infections (695 -697) .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [695]

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      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Evidence from large observational studies is highly suggestive of a positive association between GI/GL and low-grade inflammation, but intervention trials do not support this convincingly, perhaps because of small size.

    “Thus, evidence from large observational studies is highly suggestive that there is a positive association between GI/GL and low-grade inflammation, but intervention trials do not support this convincingly, perhaps because of the small size of most of the latter trials.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    ROS are produced by free, not bound, Fe, and the body has evolved a metabolic system that minimises availability of free Fe.

    “It is important to indicate that ROS are produced by free, and not bound, Fe (700) and the body has evolved a metabolic system that minimises the availability of free Fe (698) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [700]

      Not checked in the free run.

    • cites [698]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fe deficiency and excess can both have deleterious effects.

    “Fe has been called a double-edged sword, as both Fe deficiency and excess can have deleterious effects (695) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [695]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary GI and GL are both positively associated with plasma CRP concentration in 18,137 healthy women aged >45 years without diagnosed diabetes.

    “Dietary glycaemic index (GI) and glycaemic load (GL) were both positively associated with plasma CRP concentration in 18 137 healthy women aged .45 years without diagnosed diabetes (672) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [672]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Most Fe in the body is not free and is bound to proteins such as ferritin, transferrin and Hb; thus serum ferritin, transferrin, transferrin saturation and Hb measurements do not reflect availability of free or labile Fe implicated in ROS production.

    “Most Fe in the body is not free, and is bound to proteins such as ferritin, transferrin and Hb; thus, serum ferritin, transferrin, transferrin saturation and Hb measurements do not reflect the availability of 'free' or 'labile' Fe that is implicated in the production of ROS.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Whey protein-derived peptides lower CRP concentration after 6 weeks in one study in hypertensive subjects, but not in another.

    “Whey protein-derived peptides lowered CRP concentration (after 6 weeks) in one study in hypertensive subjects (685) , but not in another (686) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [685]

      Not checked in the free run.

    • cites [686]

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  • May combine two claims.

    Premisecitation

    In NHANES 1999-2000, dietary fibre intake is inversely associated with serum CRP concentrations in diabetic women (n 3920) and in subjects with diabetes, hypertension and obesity (n 7891).

    “In NHANES 1999-2000 in the USA, dietary fibre intake was inversely associated with serum CRP concentrations (OR 0•49 for 32 g/d v. 5•1 g/d) in diabetic women (n 3920) (677) , as well as in subjects with diabetes, hypertension and obesity (n 7891) (678) .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [677]

      Not checked in the free run.

    • cites [678]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vitamin D analogues selectively inhibit inducible cyclo-oxygenase-2, which could be viewed as an anti-inflammatory action.

    “Vitamin D analogues selectively inhibit the inducible cyclo-oxygenase-2 (738) , which could be viewed as an anti-inflammatory action.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [738] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Within any tertile of vitamin D status, telomere length was longer in those with lower CRP concentrations, suggesting inflammation plays a role in telomere shortening.

    “Within any tertile of vitamin D status, telomere length was longer in those with lower CRP concentrations, suggesting that inflammation plays a role in those processes associated with telomere shortening.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [740]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Serum vitamin D concentration was associated with leucocyte telomere length in 2160 women aged 18-79 years and was inversely associated with CRP concentration.

    “Serum vitamin D concentration was associated with leucocyte telomere length in 2160 women aged 18 -79 years (mean age 49 years) and was inversely associated with CRP concentration (740) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [740]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Jablonski et al. found that endothelial cell expression of NF-κB and IL-6 was higher in vitamin D-deficient subjects, and IL-6 expression was inversely related to 25(OH)D3 concentration.

    “Jablonski et al. (746) examined the inflammatory phenotype of endothelial cells collected from the antecubital vein of middle-aged and older subjects: endothelial cell expression of NF-kB and of IL-6 were both higher in vitamin D-deficient subjects, and IL-6 expression was inversely related to 25(OH)D 3 concentration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [746]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among forty-four morbidly obese subjects, 25(OH)D3 did not correlate with leptin, resistin, adiponectin or IL-18.

    “Among forty-four morbidly obese subjects, 25(OH)D 3 did not correlate with leptin, resistin, adiponectin or IL-18.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [745]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vitamin D primes monocytes to respond less effectively to bacterial cell wall components, most probably through suppression of TLR.

    “Indeed, vitamin D primes monocytes to respond less effectively to bacterial cell wall components, most probably due to the aforementioned suppression of TLR (735) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [735] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pittas et al. provided 700 IU vitamin D3 plus 500 mg calcium citrate daily to adult non-diabetics for three years in a double-blind randomised controlled trial and found no effect on plasma CRP or IL-6.

    “Pittas et al. (749) provided 700 IU (17•5 mg) vitamin D 3 plus 500 mg calcium citrate daily to adult non-diabetics for 3 years in a double-blind, randomised, controlled trial and found no effect on plasma CRP or IL-6.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [749]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Jorde et al. provided 40 000 or 20 000 IU vitamin D3 per week or placebo to overweight subjects for one year; there was no difference between groups in changes in CRP, sICAM-1, MCP-1, IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13 or IL-17.

    “Jorde et al. (743) provided 40 000 or 20 000 IU (1000 or 500 mg) vitamin D 3 per week or placebo to overweight subjects for 1 year; there was no difference between groups in the changes in concentrations of CRP, sICAM-1, MCP-1, IFN-g, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13 or IL-17 over the course of the study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [743]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After bariatric surgery in morbidly obese women, transferrin saturation improved and CRP and orosomucoid concentrations decreased.

    “A concomitant improvement in Fe status (as measured by transferrin saturation) and decrease in inflammation (CRP and orosomucoid concentrations) has been observed after bariatric surgery intervention in morbidly obese women (722) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [722]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among 261 healthy men and women, plasma 25(OH)D3 was not correlated with resistin, adiponectin or IL-18, but was inversely correlated with leptin.

    “Among 261 healthy men and women, plasma 25(OH)D 3 was not correlated with resistin, adiponectin or IL-18 concentrations but was inversely correlated with leptin concentration (745) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [745]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Vitamin D dose, the nature of the supplementation regimen, the health status of the individuals studied, and starting vitamin D status may all be important factors in determining the effect of supplemental vitamin D.

    “This finding suggests that vitamin D dose, the nature of the supplementation regimen and the health status of the individuals under study, as well as starting vitamin D status, may all be important factors in determining the effect of supplemental vitamin D.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Vitamin D affects ICAM-1 expression on mononuclear and endothelial cells, suggesting it suppresses leucocyte recruitment to sites of inflammation.

    “In addition, vitamin D affects the expression of ICAM-1 on mononuclear cells and on endothelial cells, suggesting that it suppresses the recruitment of leucocytes to sites of inflammation (732) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [732] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Guatemalan children aged 8-11 years, twice the recommended daily iron for eight weeks versus placebo produced no differences in CRP or orosomucoid, but increased α-1 antichymotrypsin.

    “In a small study in 8-11-year-old Guatemalan children who received twice the recommended daily amounts of Fe for 8 weeks (n 20) or placebo (n 20), no differences in CRP or orosomucoid concentrations were noted, although a-1 antichymotrypsin levels were increased with the Fe supplement (724) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [724]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vitamin D blunts the pro-inflammatory effects of advanced glycation end products on endothelial cells, suggesting it acts as an endogenous vascular protector against their deleterious effects.

    “It blunts the pro-inflammatory effects of AGE on endothelial cells, suggesting that it acts as an endogenous vascular protector counteracting the possible deleterious effects of AGE (731) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [731] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Devaraj et al. found significant inverse relationships between serum 25(OH)D3 and CRP concentration, monocyte NF-κB activation and TLR4 expression in pooled healthy subjects, type 1 diabetics and type 1 diabetics with microvascular complications.

    “Using data pooled from thirty-six healthy subjects, twenty-four type 1 diabetics and twenty-six type 1 diabetics with microvascular complications, Devaraj et al. (747) found significant inverse relationships between serum 25(OH)D 3 and CRP concentration, monocyte NF-kB activation and TLR4 expression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [747] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with metabolic syndrome or diabetes showed decreased vitamin C status and increased lipid peroxidation.

    “Patients with the metabolic syndrome or diabetes showed decreased vitamin C status and increased lipid peroxidation (753 -756) .”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [753]

      Not checked in the free run.

    • cites [754]

      Not checked in the free run.

    • cites [755]

      Not checked in the free run.

    • cites [756]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Various immune cells can convert inactive vitamin D3 to its active form and can respond to active vitamin D via the vitamin D receptor they express.

    “Various immune cells including monocytes/macrophages, dendritic cells, T-cells and B-cells can convert inactive vitamin D 3 to its active form (1,25(OH) 2 D 3 ), and these cells can also respond to the active vitamin D via its receptor which they express (727) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [727]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vitamin D inhibits lymphocyte proliferation and induces lymphocyte apoptosis.

    “Vitamin D inhibits the proliferation of lymphocytes and induces their apoptosis (732) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [732] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obese subjects have lower plasma vitamin C concentrations than non-obese subjects, and obesity was associated with moderately elevated CRP concentrations.

    “Obese subjects have lower plasma vitamin C concentrations than non-obese, and obesity was associated with moderately elevated CRP concentrations (757) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [757]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Supplementation with α-tocopherol decreases γ-tocopherol concentrations because the α-tocopherol transfer protein in the liver prefers α-tocopherol.

    “Supplementation with a-tocopherol decreases g-tocopherol concentrations (764,765) due to a preference of the a-tocopherol transfer protein in the liver for a-tocopherol.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [764]

      Not checked in the free run.

    • cites [765]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 379 Dutch adults, serum lutein and lycopene concentrations were inversely associated with sICAM-1, serum β-carotene with total blood leucocyte numbers and CRP, serum vitamin C with CRP, while plasma α-tocopherol was positively associated with CRP.

    “In 379 Dutch adults, serum lutein and lycopene concentrations were inversely associated with sICAM-1 concentrations, serum b-carotene with total blood leucocyte numbers and CRP concentrations, serum vitamin C with CRP concentrations, while plasma atocopherol concentrations were positively associated with CRP concentrations (773) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [773]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among 3258 healthy men, dietary vitamin C intake and plasma vitamin C concentrations were both inversely associated with CRP concentrations.

    “Among 3258 healthy men (age 68 (SD 5) years; BMI 26•7 (SD 3•6) kg/m 2 ), dietary vitamin C intake and plasma vitamin C concentrations were both inversely associated with CRP concentrations (329) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [329]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Flaxseed-derived lignans at 360 mg per day lowered CRP concentrations in type 2 diabetic women but not men over twelve weeks compared with placebo, with no effect on IL-6 concentrations.

    “In a recent study, flaxseed-derived lignans (360 mg/d) lowered CRP concentrations in type 2 diabetic women but not in men over 12 weeks compared with placebo, with no effect on IL-6 concentrations (818) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [818]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a second prospective study, a high intake of carotenoids in elderly subjects was associated with lower plasma IL-6 concentrations, while α-tocopherol did not correlate significantly.

    “In a second prospective study, a high intake of carotenoids in elderly subjects (BMI 28•8 (SD 6•8) kg/m 2 ) was associated with lower plasma IL-6 concentrations, while a-tocopherol did not correlate significantly (779) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [779]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Growing evidence indicates that γ-tocopherol, unlike α-tocopherol, exerts anti-inflammatory properties explained by an unsubstituted chromanol ring that allows trapping of reactive nitrogen species and formation of 5-nitro-γ-tocopherol.

    “There is growing evidence that g-tocopherol, in contrast to a-tocopherol, exerts anti-inflammatory properties which can be explained by an unsubstituted position on the chromanol ring providing g-tocopherol with the ability to trap reactive N species and subsequent formation of 5-nitro-g-tocopherol (762,763) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [762]

      Not checked in the free run.

    • cites [763]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In normal-weight, overweight and obese Swiss children aged 6-14 years, dietary intakes of vitamin C, vitamin E and β-carotene did not predict CRP, IL-6 or TNF-α concentrations, but were significant predictors of leptin concentrations.

    “In another study, dietary intakes of vitamin C, vitamin E and b-carotene did not predict the concentrations of CRP, IL-6 or TNF-a in normal-weight, overweight and obese Swiss children aged 6 -14 years, but they were significant predictors of leptin concentrations (772) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [772]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    It is possible that a greater or lesser anti-inflammatory effect of antioxidant vitamins will be observed in people with different genotypes related to inflammatory processes.

    “Thus, it is possible that a greater or lesser anti-inflammatory effect of antioxidant vitamins will be observed in people with different genotypes related to inflammatory processes.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    A lignan complex at 500 mg per day isolated from flax given to healthy postmenopausal women significantly reduced plasma CRP concentration during a six-week placebo-controlled intervention, with no significant differences for IL-6, TNF-α, sICAM-1, sVCAM-1 or MCP-1 concentrations.

    “In contrast, a lignan complex (500 mg/d) isolated from flax given to healthy postmenopausal women significantly reduced plasma CRP concentration during the 6-week placebo-controlled intervention.No significant differences were found for IL-6, TNF-a, sICAM-1, sVCAM-1 or MCP-1 concentrations (817) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [817]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a randomised placebo-controlled double-blind trial in metabolic syndrome subjects, CRP decreased only in the combined α- and γ-tocopherol supplementation group, while TNF-α decreased with α-tocopherol alone or in combination with γ-tocopherol.

    “In a randomised, placebo-controlled, double-blind trial, subjects with the metabolic syndrome received 800 mg/d a-tocopherol, 800 mg/d g-tocopherol, a combination of both (800 mg/d each) or placebo; there was a decrease in CRP concentrations only in the combined aand g-tocopherol supplementation group, while TNF-a decreased with a-tocopherol alone or in combination with g-tocopherol (790) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [790]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of black tea increased plasma catechin concentrations, but these were not associated with changes in plasma CRP concentrations in healthy overweight and obese adults.

    “In contrast, although the consumption of black tea resulted in increased plasma catechin concentrations, these were not associated with changes in plasma CRP concentrations in healthy overweight and obese adults (389) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [389]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In subjects who had survived myocardial infarction and received statin therapy for at least six months, supplementation with a chokeberry flavonoid extract for six weeks significantly decreased CRP and MCP-1 concentrations, while adiponectin was significantly increased.

    “In subjects who had survived myocardial infarction and had received statin therapy for at least 6 months, supplementation with a chokeberry flavonoid extract for 6 weeks significantly decreased CRP and MCP-1 concentrations, while adiponectin was significantly increased (803) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [803]

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    High-glucose and high-fat meals cause postprandial inflammation; this is increased by high AGE content and reduced in part by certain antioxidants or antioxidant-rich foods.

    “Both high-glucose and high-fat meals induce postprandial inflammation, and it is exaggerated by a high meal content of AGE and partly ablated by the inclusion of certain antioxidants or antioxidant-containing foods within the meal.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisereasoning

    SFA and trans-MUFA are pro-inflammatory, and one conjugated linoleic acid isomer may also be.

    “Available data indicate that SFA and trans-MUFA are pro-inflammatory, and that one isomer of conjugated linoleic acid may also be.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Premisecitation

    Prebiotics escape digestion in the upper gastrointestinal tract and reach the large intestine virtually intact, where they are fermented by the microbiota and express their prebiotic activity.

    “Prebiotics escape digestion in the upper gastrointestinal tract and reach the large intestine virtually intact, where they are fermented by the microbiota and express their prebiotic activity (834) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [834]

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In overweight subjects, plasma phospholipid total saturated fatty acid levels are positively associated with IL-6.

    “Total SFA:”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [579]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Dietary fatty acids affect low-grade inflammation, and PUFA are the best studied.

    “Dietary fatty acids also influence low-grade inflammation; best studied are PUFA.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisecitation

    In overweight subjects, the ratio of PUFA to SFA in plasma cholesteryl esters is not associated with CRP.

    “Ratio of PUFA to SFA: ¼ CRP; # IL-6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [579]

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Weight loss from diet or surgery lowers blood concentrations of inflammatory markers, most likely because adipose tissue mass falls.

    “Blood concentrations of inflammatory markers are lowered following weight loss, whether this is induced by diet or surgery, which most probably reflects the decrease in adipose tissue mass.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Milk peptides, vitamin D, probiotics, and prebiotics are understudied dietary factors for low-grade inflammation.

    “Underexplored dietary factors include milk peptides, vitamin D, probiotics and prebiotics.”
    • Also stated in: § Summary, conclusions and research gaps · hedged
      “There may also be a role for milk peptides, but these have not been sufficiently evaluated.”
    • Also stated in: § Summary, conclusions and research gaps · plain
      “The effect of prebiotics on chronic low-grade inflammation is not clear and is underexplored.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
    • Rests on an assumption: The reviewed studies' findings can be combined despite differences in inflammatory outcomes and time points.
  • May combine two claims.

    Premisecitation

    Institutionalised elderly individuals supplemented with oligofructose at 8 g per day for three weeks showed increased faecal bifidobacteria counts and decreased expression of IL-6 mRNA in blood monocytes.

    “Institutionalised elderly individuals (mean age 85 years) supplemented with oligofructose (8 g/d for 3 weeks) showed increased faecal bifidobacteria counts and decreased expression of IL-6 mRNA in blood monocytes (837) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [837]

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Whole grains, vegetables, fruits, and fish are each associated with lower inflammation.

    “Among the components of healthy diets, whole grains, vegetables and fruits, and fish are all seen to be associated with lower inflammation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Interpretationreasoning

    Many plant-derived substances probably affect low-grade inflammation and may contribute to a healthy anti-inflammatory diet.

    “There are likely to be many plant-derived substances that influence low-grade inflammation and which may have a role as part of a healthy 'anti-inflammatory diet'.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Premisenone given

    The inflammatory response after a meal is larger in obese individuals and those with type 2 diabetes.

    “This postprandial inflammatory response is greater in obese subjects and type 2 diabetics.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cell volume regulatory mechanisms participate in the signalling of hormones and mediators.

    “Cell volume regulatory mechanisms, therefore, participate in the signalling of those hormones and mediators (840) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [840]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a Japanese general population aged over 70 years, dietary alpha-linolenic acid intake is not associated with CRP.

    “aLNA: ¼ CRP”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [581]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisecitation

    In overweight subjects, the ratio of PUFA to SFA in plasma phospholipids is not associated with CRP.

    “Ratio of PUFA to SFA: ¼ CRP; # IL-6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [579]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In overweight subjects, plasma cholesteryl ester linoleic acid and DHA are not associated with CRP or IL-6.

    “Linoleic acid, DHA: ¼ CRP, IL-6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [579]

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Chronic low-grade inflammation is thought to raise the risk of insulin resistance, type 2 diabetes, and cardiovascular disease.

    “Chronic low-grade inflammation is believed to increase the risk of insulin resistance, type 2 diabetes and CVD.”
    • Also stated in: § Summary, conclusions and research gaps · hedged
      “Obese people have higher circulating concentrations of many inflammatory markers (measured in the 'resting' state, i.e. in fasted blood), and these are believed to play a role in causing insulin resistance and in other metabolic disturbances of the metabolic syndrome and type 2 diabetes.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationnone given

    The effect of prebiotics on chronic low-grade inflammation is unclear and under-researched.

    “The effect of prebiotics on chronic low-grade inflammation is not clear and is underexplored.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Interpretationcitation

    Although probiotics have the potential to lower markers of chronic low-grade inflammation, intervention studies in human volunteers rarely demonstrate this effect.

    “Thus, although there is the potential for probiotics to lower markers of chronic low-grade inflammation, intervention studies performed to date in human volunteers rarely demonstrate this effect.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many metabolic pathways are sensitive to cell volume as a result of activation, inhibition or altered expression of enzymes.

    “Many metabolic pathways are sensitive to cell volume (841) , as a result of activation, inhibition or altered expression of enzymes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [841]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In high-fat-fed mice, oligofructose restored gut bifidobacteria and normalised systemic endotoxin levels and the inflammatory state.

    “In high-fat-fed mice, oligofructose restored gut bifidobacteria, and normalised systemic endotoxin levels and the inflammatory state (836) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [836]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Hyperglycaemia causes both postprandial and chronic low-grade inflammation, partly via oxidative stress.

    “Hyperglycaemia induces both postprandial and chronic low-grade inflammation, acting in part through oxidative stress.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Interpretationreasoning

    Hyperglycaemia or a high-fat meal promotes inflammation after eating.

    “Hyperglycaemia or a high-fat meal promote postprandial inflammation.”
    • Also stated in: § Summary, conclusions and research gaps · plain
      “Both high-glucose and high-fat meals induce postprandial inflammation, and it is exaggerated by a high meal content of AGE and partly ablated by the inclusion of certain antioxidants or antioxidant-containing foods within the meal.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationnone given

    Oxidised lipids, saturated fatty acids, and trans-fatty acids are dietary factors that increase inflammation.

    “Dietary factors that promote inflammation are oxidised lipids, SFA and trans-fatty acids.”
    • Also stated in: § Summary, conclusions and research gaps · hedged
      “Available data indicate that SFA and trans-MUFA are pro-inflammatory, and that one isomer of conjugated linoleic acid may also be.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • The quote only partly states this claim.

    Premisecitation

    In overweight subjects, plasma cholesteryl ester total saturated fatty acid levels are positively associated with IL-6.

    “Total SFA:”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [579]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A meal produces a temporary inflammatory state that is connected with oxidative stress.

    “Following consumption of a meal, there is a transient state of inflammation that is linked with oxidative stress.”
    • Also stated in: § Summary, conclusions and research gaps · plain
      “These latter observations link postprandial inflammation to oxidative stress.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    AGE and ALE are also formed in the body and through non-food exposures, so the overall contribution of foods to AGE/ALE burden is currently unclear, and measurement is technically difficult.

    “However, AGE and ALE are also generated in vivo and also as a result of other, non-food-related, environmental exposures (e.g.smoking), and so the overall impact of foods on the burden of AGE and ALE is not currently clear; this is compounded by technical difficulties in measuring these complex chemical entities in foods and in body fluids.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Mice raised under germ-free conditions fail to develop experimental colitis, suggesting an important modulating role of intestinal microbiota on local inflammatory processes.

    “Mice raised under germ-free conditions fail to develop experimental colitis, suggesting an important modulating role of intestinal microbiota on local inflammatory processes (826) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [826] source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In healthy subjects, L. rhamnosus GG compared with Bifidobacterium animalis and Propionibacterium freudenreichii for three weeks had no effect on serum TNF-α, IL-6, IL-10 or IFN-γ concentrations, but serum CRP concentration decreased in the L. rhamnosus group.

    “There was no effect of serum TNF-a, IL-6, IL-10 or IFN-g concentrations, but serum CRP concentration decreased in the L. rhamnosus group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [832]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Milk peptides may play a role in low-grade inflammation, but they have not been adequately evaluated.

    “There may also be a role for milk peptides, but these have not been sufficiently evaluated.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Premisereasoning

    Vitamin D may reduce low-grade inflammation, with plausible mechanisms demonstrated in model systems.

    “Vitamin D has the potential to reduce low-grade inflammation, with plausible mechanistic actions demonstrated in model systems.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Interpretationcitation

    There is some evidence of beneficial effects of prebiotics in inflammatory conditions, but results are inconsistent.

    “There is some evidence of beneficial effects but results are inconsistent.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [839]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A chronic low-grade inflammatory state exists and is more pronounced in obese and type 2 diabetic individuals.

    “A state of chronic low-grade inflammation exists and this is exaggerated in obese and type 2 diabetic individuals.”
    • Also stated in: § Summary, conclusions and research gaps · hedged
      “It is now recognised that a lower level of inflammation, here termed chronic low-grade inflammation, can also persist and may be a cause of, or result from, the obese state.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisereasoning

    Heated meals high in AGE and ALE increase oxidative stress and inflammation; low-AGE meals reduce inflammatory markers.

    “Heated meals high in AGE and ALE enhance oxidative stress and inflammation; intervention studies with low-and high-AGE meals either acutely or chronically have associated AGE with increased inflammatory marker concentrations and show that these are decreased by meals low in AGE.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
  • May combine two claims.

    Premisenone given

    Exercise causes short-lived local inflammation, for example in muscle, which may be important for producing a protective anti-inflammatory response.

    “Exercise itself is associated with transient and local inflammation (e.g. in muscle) that may, in fact, be important in inducing a protective and ultimately healthy anti-inflammatory response.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Protective dietary factors for low-grade inflammation include whole grains, fibre, vegetables, fruits, fish, PUFA (particularly marine n-3), vitamin C, vitamin E, and carotenoids.

    “Important protective factors in the diet are whole grains, fibre, vegetables, fruits, fish, PUFA, especially marine n-3 PUFA, vitamin C, vitamin E and carotenoids.”
    • Also stated in: § Summary, conclusions and research gaps · plain
      “Among the components of healthy diets, whole grains, vegetables and fruits, and fish are all seen to be associated with lower inflammation.”
    • Also stated in: § Summary, conclusions and research gaps · boosted
      “There is good evidence from both model systems and from human observational and intervention studies that vitamin C, vitamin E and carotenoids decrease the concentrations of inflammatory markers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.
    • Rests on an assumption: The reviewed studies' findings can be combined despite differences in inflammatory outcomes and time points.
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Cellular volume has the potential to affect inflammation directly or indirectly, but the effect of hydration status on low-grade inflammation is not well documented.

    “Cellular volume has the potential to have an impact directly or indirectly on inflammation, but the effect of hydration status on low-grade inflammation is not well documented.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisecitation

    In healthy young and older men, supplementation with EPA and DHA at 1.35, 2.7, or 4.05 g/d for 12 weeks did not affect sICAM-1 or sVCAM-1.

    “¼ sICAM-1, sVCAM-1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [622]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). The quote only partly states this claim.

    Premisecitation

    In elderly men at risk of coronary heart disease, supplementation with 2.4 g/d EPA and DHA for 18 months inversely affected von Willebrand factor and thrombomodulin.

    “# von Willibrand factor, thrombomodulin”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [619]

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In healthy women on hormone replacement therapy, supplementation with EPA and DHA at 1.09 or 2.18 g/d for 5 weeks inversely affected CRP and IL-6.

    “# CRP, IL-6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [624]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisecitation

    In myocardial infarction survivors, supplementation with 3.5 g/d EPA and DHA for 12 months did not affect sICAM-1, sVCAM-1, or sE-selectin.

    “¼ sICAM-1, sVCAM-1, sE-selectin”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [627] source

      Not checked in the free run.

235 of 235
  • The paper relies on this without support.

    Chronic low-grade inflammation is characterized by raised concentrations of inflammatory markers in the systemic circulation.

    “Chronic low-grade inflammation is characterised by raised concentrations of inflammatory markers in the systemic circulation.”
  • The paper relies on this without support.

    In low-grade inflammation, systemic inflammatory indicators rise modestly, usually less than twofold above controls.

    “The up-regulation of systemic indicators of inflammation such as leucocyte count, and serum and plasma concentrations of acute-phase proteins, pro-inflammatory cytokines, chemokines, soluble adhesion molecules and prothrombotic mediators is modest, usually less than 2-fold above what is observed in controls.”
  • The paper relies on this without support.

    Diagnostic criteria for low-grade inflammation are not precisely defined, but the phenotype is not disputed.

    “Diagnostic criteria for low-grade inflammation have not been precisely defined, but the phenotype per se is not disputed.”
  • The paper relies on this without support.

    The vast majority of macrophage infiltration in adipose tissue in obesity originates from the circulation.

    “It should be noted, however, that the vast majority of the macrophage infiltration in adipose tissue in obesity originates most probably from the circulation.”
  • The paper relies on this without support.

    In obesity and metabolic syndrome, key organs with increased insulin resistance are liver, skeletal muscle, adipose tissue and endothelium.

    “In obesity and the metabolic syndrome, key organs displaying increased insulin resistance are the liver, skeletal muscle, adipose tissue and the endothelium (Fig. 6).”
  • The paper relies on this without support.

    The postprandial inflammatory response lasts 4-8 hours and recurs several times daily.

    “The postprandial inflammatory response lasts for only few (4 -8) h but it recurs several times a day following eating.”
  • The paper relies on this without support.

    Meals or food components may contain LPS that directly triggers systemic inflammation.

    “Meals or food components may contain LPS which directly triggers systemic inflammation.”
  • The paper relies on this without support.

    Hyperglycaemia induces free radicals that initiate an inflammatory reaction.

    “Hyperglycaemia induces the production of free radicals which themselves initiate an inflammatory reaction.”
  • The paper relies on this without support.

    Self-reported physical activity data are subject to recall and reporting biases.

    “Self-reported data of physical activity are easy and feasible to ask in a questionnaire or interview in large populations but are a measurement subject to recall and reporting biases.”
  • The paper relies on this without support.

    IL-6 stimulates lipolysis and fat oxidation.

    “Moreover, IL-6 stimulates lipolysis as well as fat oxidation.”
  • The paper relies on this without support.

    The increase in IL-6 at the end of exercise causes the increased CRP levels during late recovery.

    “The increase in IL-6 at the end of exercise is responsible for the increased CRP levels during late recovery.”
  • The paper relies on this without support.

    Regular physical activity decreases basal and post-exercise plasma IL-6 concentrations.

    “In response to regular physical activity, basal as well as post-exercise plasma concentrations of IL-6 will decrease by mechanisms that might include increased glycogen content, improved antioxidant capacity and improved insulin sensitivity.”
  • The paper relies on this without support.

    Lower circulating IL-6 results in lower CRP levels.

    “The lower concentrations of IL-6 in the circulation will subsequently result in lower CRP levels.”
  • The paper relies on this without support.

    Physical activity and obesity are often inversely related.

    “Given that physical activity and obesity are often inversely related, it is not clear as to whether the antiinflammatory health benefits of a physically active lifestyle are due to exercise per se or result from favourable changes in body composition.”
  • The paper relies on this without support.

    A strong background of low-grade inflammatory status determines any possible inverse association.

    “These determinants do most probably involve a strong background of low-grade inflammatory status, which consistently is shown to determine any possible inverse association.”
  • The paper relies on this without support.

    Energy restriction itself may play an anti-inflammatory role via sirtuin and FoxO proteins.

    “However, energy restriction itself may also play an anti-inflammatory role, with key mediators of the effect being proteins of the sirtuin and Forkhead box, sub-group O (FoxO) families which are induced/activated during states of limited energy supply.”
  • The paper relies on this without support.

    IL-6 is a more sensitive marker of chronic low-grade inflammation than CRP, and CRP reflects a downstream effect associated with IL-6.

    “It is likely that IL-6 is a more sensitive marker of chronic low-grade inflammation and that CRP reflects a more downstream effect associated with IL-6.”
  • The authors state this as an assumption.

    Nitric oxide plays a key role in linking hyperglycaemia-induced free radical production to metabolic events.

    “NO, a potent vasodilator, is assumed to play a key role in this respect.”
  • The paper relies on this without support.

    Hyperglycaemia, elevated TAG/NEFA and hyperinsulinaemia are mutually inherent to the initial development of a diabetic state.

    “Hyperglycaemia, elevated TAG/NEFA and hyperinsulinaemia are events that are mutually inherent to the initial development of a diabetic state.”
  • The paper relies on this without support.

    Incorporation of EPA and DHA into human inflammatory cells occurs partly at the expense of arachidonic acid, reducing substrate for synthesis of classic inflammatory eicosanoids such as PGE2.

    “The incorporation of EPA and DHA into human inflammatory cells is partly at the expense of arachidonic acid, resulting in less substrate available for the synthesis of the classic inflammatory eicosanoids such as PGE 2 .”
  • The paper relies on this without support.

    The inflammatory markers measured in the reviewed studies adequately represent chronic low-grade inflammation.

    “Perhaps the most important is that there is no consensus regarding the inflammatory mediators which best represent chronic low-grade inflammation.”
    “Most studies have measured CRP, perhaps because it is long established, is linked to the risk of CVD and is routinely measured in clinical laboratories.”
  • The paper relies on this without support.

    The reviewed studies' findings can be combined despite differences in inflammatory outcomes and time points.

    “Further, even where dietary components have been fairly well explored through intervention studies, many of the studies have been small in size and they have reported on different inflammatory outcomes at different time points.”
  • The paper relies on this without support.

    In overweight and obese women, supplementation with 4.2 g/d EPA and DHA for 12 weeks does not affect sialic acid, fibrinogen, or PAI-1 activity.

    “¼ Sialic acid, fibrinogen, PAI-1 activity”
  • The paper relies on this without support.

    In overweight and obese women, supplementation with 4.2 g/d EPA and DHA for 12 weeks inversely affects CRP and IL-6.

    “# CRP, IL-6”
24 of 24

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a recent randomized clinical trial, individuals randomized to a Mediterranean diet supplemented with extra-virgin olive oil had a significant reduction in circulating oxidized LDL and inflammatory markers.

    “In a recent randomized clinical trial, individuals randomized to a Mediterranean diet supplemented with extra-virgin olive oil had a significant reduction in circulating oxidized LDL and inflammatory markers (48,49).”
  • Data from several epidemiological studies suggest that people consuming higher quality diets have lower inflammation, independently from the classical cardiometabolic risk factors.

    “In support of this hypothesis, data from several epidemiological studies suggest that people consuming higher quality diets have lower inflammation, independently from the classical cardiometabolic risk factors (49,50).”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Soya-protein CRP result conflicts with Table 7

    Major

    The prose says the study found a CRP reduction with soya nuts but not soya protein. Table 7 reports a CRP reduction for soya protein as well.

  • A cited cellular vitamin D study measured no cellular marker

    Minor

    The review identifies studies 747 and 748 as the two reporting cellular anti-inflammatory findings. Its description of study 748 instead reports only an absence of association with serum CRP; the cellular study described immediately before it is study 746.

  • A purported negative alcohol trial reports increased adiponectin

    Minor

    The prose groups study 433 among the negative longer-term alcohol trials. Table 11 reports increased adiponectin in that study, which the paper identifies as anti-inflammatory.

3 of 3

Cites

3 retracted

Flagged first, then by citations

39 of the 903 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Kennedy, 1994, The Healthy Eating Index Final Report
  2. Schalkwijk, 2006, Is reduction of AGEs in food a potential medical nutrition therapy: are AGEs the real culprits?, IMARS Highlights, 1, 8
  3. 258 Wärnberg, J (2006) Inflammatory status in adolescents; the impact of health determinants such as overweight and and fitness. PhD Thesis, Karolinska Institutet.
  4. Hoffmeister, 2003, Moderate alcohol consumption and plasma concentration of sensitive markers of inflammation. Comment on an atheroprotective relationship, Dtsch Med Wochenschr, 128, 2237
  5. Bierhaus, 2005, The immune response to food and its impact on atherogenesis, Diabetes Stoffwechsel, 14
  6. Erbersdobler, 2001, Metabolic transit of Amadori products, Nahrung, 45, 177, 10.1002/1521-3803(20010601)45:3 · DOI
  7. McCord, 1998, Iron, free radicals, and oxidative injury, Semin Hematol, 35, 5
  8. Collins, 2002, A randomized controlled trial of a probiotic Lactobacillus strain in healthy adults: assessment of its delivery, transit and influence on microbial flora and enteric immunity, Micro Ecol Health Dis, 81
  9. Dalgard, 2009, Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease, Br J Nutr, 101, 263, 10.1017/s0007114508995660 · DOI · Paper page

Cited by

Sorted by citations

Authors
Calder, P. C., Ahluwalia, N., Brouns, F., Buetler, T., Clement, K., Cunningham, K., Esposito, K., Jönsson, L. S., Kolb, H., Lansink, M., Marcos, A., Margioris, A., Matusheski, N., Nordmann, H., O'Brien, J., Pugliese, G., Rizkalla, S., Schalkwijk, C., Tuomilehto, J., Wärnberg, J., Watzl, B., & Winklhofer-Roob, B. M.
Affiliations
  • University of Southampton (GB)
  • Inserm (FR)
  • Maastricht University Medical Centre (NL)
  • University of Zurich (CH)
  • University of Naples Federico II (IT)
  • Heinrich Heine University Düsseldorf (DE)
  • Danone (Netherlands) (NL)
  • University of Crete (GR)
  • Nestlé (Switzerland) (CH)
  • Sapienza University of Rome (IT)
  • Maastricht University (NL)
  • University of Helsinki (FI)
  • Max Rubner Institut (DE)
Venue
British Journal of Nutrition
Published
2011-12
Volume
106
Issue
S3
Pages
S1-S78
ISSN
  • 0007-1145 (ISSN-L)
  • 1475-2662
OpenAlex
W2127855202
Cited by
1,098
References
903
Citations by year
2026: 45 · 2025: 55 · 2024: 67 · 2023: 93 · 2022: 109 · 2021: 117 · 2020: 86 · 2019: 80 · 2018: 70 · 2017: 61 · 2016: 55 · 2015: 76 · 2014: 81 · 2013: 74 · 2012: 27
FWCI
6.94
Type
journal article
Language
en
Open access
Locations
  • British Journal Of Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • reroDoc Digital Library (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • OpenAgrar (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • Danone
  • Vifor Pharma
Topics
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
low-grade inflammation, obesity, overweight, dietary factors, postprandial inflammation, advanced glycation end products, oxidative stress, adipose tissue macrophages, insulin resistance, type 2 diabetes, omega-3 fatty acids, dietary antioxidants, hyperglycemia, dietary fat, whole grains, fruits and vegetables, fish, vitamin C, vitamin E, carotenoids, weight loss
MeSH terms
Aging, Animals, Diet, Food Handling, Humans, Insulin Resistance, Motor Activity, Obesity, Peroxides, Lipid Peroxidation, Glycation End Products, Advanced, Overweight

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

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