Sodium also increases the expression of the COX2 enzyme, which synthesizes oxylipins. In NP1, sodium may play a role in shifting the oxylipin profile towards LA-related oxylipins, leading to the protective association of NP1. NP1 was characteristic of a diet high in LA , and also explained more variation in oxylipin PC1 compared to oxylipin PC2. Oxylipin PC1 represented LAand ALA-related oxylipins and was associated with a decreased risk of T1D, which may explain the higher loading value for LA. In The Environmental Determinants of Diabetes in the Young study, higher levels of LA in the erythrocyte membranes was associated with a reduced risk of IA in non-breastfed infants, suggesting a role of LA in the pathogenesis of T1D. LA has been linked to other inflammatory conditions. Mendelian randomization studies demonstrate that LA may reduce inflammation in asthma and reduce the risk of autoimmune disorders. Although LA and ARA are n6 FAs, which are generally associated with promoting inflammation, LA also plays a role in resolving inflammation. LA reduces the mitochondrial damage inflicted through streptozotocin. The difference between an LA- and ARA-related oxylipin profile may be related to resiliency to stressors through the promotion and resolution of inflammation, which has been proposed as a model for health. Oxylipins have been used as markers of this resiliency to stress. LA-related oxylipins exhibit both pro-inflammatory and pro-resolving effects . The protective effect of LA-related oxylipins may represent a child’s ability to respond to a stressor through the promotion and subsequent resolution of inflammation. ARA-related oxylipins, in contrast,blueberry grow bag size do not demonstrate the same pro-resolution properties as LA-related oxylipins. NP1 explained 9.5% of the variation in genetically adjusted PC1 and 0.01% of the variation of genetically adjusted PC2, so this nutrient pattern may be measuring a diet that promotes a state of resiliency to stress.

This is a similar percent explained in other RRRs with biomarkers as response variables and similar factor loadings to other RRR-derived dietary patterns. The protective association of NP1 on the T1D risk did not replicate in the full DAISY cohort. One explanation may be limited power. There was a smaller proportion of cases of T1D to people without T1D in the cohort. NP1 may have a small impact on the oxylipin profile and, thus, on the risk of T1D. A larger sample size may be needed to capture this small difference in risk. Additionally, genetic factors and environmental triggers may have larger and more lasting impacts on the oxylipin profile, and these environmental triggers instigating inflammation may be a more potent target for reducing T1D risk. The nested case-control study may not be representative of the full cohort. There were T1D cases that were included in the analysis in the DAISY cohort, but were not included in the case-control, because these participants did not have measured oxylipins. The background characteristics of these T1D cases may be different than those in the nested case-control study. The average age of the T1D onset of the cases that were in the cohort analysis was 13.96 ± 7.25 compared to an average age of the T1D onset of 9.67 ± 4.49 in the nested case-control study. The pathophysiology of the development of T1D, as well as the serum vitamin D levels and genetic risk factors has been shown to be different in early-onset compared to late-onset T1D. Additionally, when developing the nutrient patterns in the case-control studies, we used the intercept as a summary measure, which did not incorporate the standard error of the summary measure, and a joint Cox PH model was used to test the nutrient pattern, which did incorporate the standard error. Incorporating this uncertainty when using the joint Cox PH model may have led to the inability to replicate the findings. Inflammation is also a dynamic process, as is the synthesis of oxylipins. Using the summary measures may not adequately capture these fluctuations in oxylipin synthesis in response to an inflammatory stimulus.

We utilized all the dietary measures and did not restrict them by age, but there may also be a critical time window during which an oxylipin-related diet might be effective. The strengths of this study include multiple measures of diets throughout childhood, as well as multiple measures of numerous oxylipins. An additional strength was the ability to adjust for the genetic influences on oxylipins and the oxylipin profile. The limitations include the small sample size in the nested case-control studies and a lack of the generalizability, given that DAISY is a cohort of children at an elevated risk of T1D compared to the general population, owing to a selection based on a genetic risk factor and family history of T1D. Lifestyle choices such as diet and physical activity can create risk factors for several chronic diseases including cardiovascular disease , diabetes, and certain cancers. Worldwide, chronic diseases are projected to cause USD 17.3 trillion of cumulative economic loss between 2011 and 2030 due to increased healthcare expenditures, reduced productivity, and lost capital. Prevention and risk-reduction strategies, including dietary recommendations, are crucial to stem this burden. In addition to guidelines on items to avoid, emphasis on health-promoting foods that complement current dietary strategies is key to the prevention and treatment of numerous chronic diseases. Current dietary guidelines advocate beneficial patterns that share several key characteristics, including abundant intakes of fruits, vegetables, nuts and seeds, legumes, and whole grains, as well as seafood, yogurt, and vegetable oils, while minimizing the intake of red and processed meats, refined grains, starches, and added sugars. Fruits and vegetables are rich in many essential nutrients and other bio-active compounds that can provide protection against many chronic diseases. Dietary recommendations promote the consumption of at least five to nine servings of a variety of fruits and vegetables per day in a 2000 kcal diet, which provide abundant amounts of vitamins , minerals ,fibers, and a diversity of bio-active phytochemicals such as polyphenols and carotenoids. An increased intake of polyphenols, particularly flavonoids, has been associated with a decreased risk for CVD through improved endothelial function, and a reduction in platelet reactivity, low-density lipoprotein [LDL], and blood pressure.

Date palm fruit , a species of the family Arecaceae that is rich in many essential nutrients and polyphenols, is one of the most commonly consumed fruits in the Middle East and North Africa. Date palm fruit, which is termed simply as dates in this review, is cultivated throughout the Middle East and to an increasing degree in other regions of the world including parts of Central and South America, Europe, India, and the United States. Consumer demand for dates continues to increase. The top countries produced about 3.5 million metric tons in 1990, around 6.5 million metric tons by 2000, and in excess of 7.5 million metric tons by 2014. Several biological activities, proposed mainly based on in vitro and animal models, have been described with respect to potential health effects of dates. These include support of oxidant defense, anti-inflammatory and gastroprotective effects , and anticancer activity. With the high incidence of CVD and diabetes worldwide, a comprehensive review of dates and their potential value in promoting vascular health is timely. Here, we focus on the roles of dates to affect markers of cardiovascular function, with particular attention to their beneficial actions in humans. Future research directions concerning dates are also suggested. Date trees are among the oldest in the world, and are an important fruit crop in Middle Eastern countries. Dates have significant religious importance for Muslims, where the fruit is mentioned in many sections of the Holy Quran for its nutritional and medicinal values. This fruit has been used traditionally to break the fast during the holy month of Ramadan in Arabic and Islamic countries. The earliest examples of the use of dates in the Middle East come from two sites, Sabiyah in Kuwait and the island of Dalma in the United Arab Emirates,blueberry box as evidenced by carbonized date seeds and stones. Dates have a special social status among Middle Eastern countries and with Arabs in general, as dates and date-based foods are served during most auspicious occasions and events, such as weddings, births, family gatherings, and religious holidays. Although dates are admired for their nutritional and health-promoting properties by the natives of the Middle East and northern Africa, the fruit is less recognized in other regions of the world due in part to limited scientific documentation derived from Islamic prophetic traditions. Iraqi dates also varied, ranging from 331 to 475 mg GAE/100 g, which are concentrations higher than other fruits such as apple, blueberry, orange, pomegranate, papaya, banana, and red grape. In contrast, others have reported that the polyphenol content in the earlier stages of date ripening to be similar to that in apples, but lower than that in an extract of various citrus fruits. Delineating the composition, variety, and ripening stage of dates and their bio-active fractions is important when designing and interpreting research studies. For consistent compositional reporting, standardization of extraction and analytical methods is needed. Dates are relatively rich in kilocalories and contain a substantial percentage of carbohydrates , which are predominately glucose , fructose, and sucrose. The fruit also contains a significant amount of dietary fibers including pectin, hemicellulose, lignin, resistant starch, and soluble fiber. Around 100 g of dates, equivalent to seven to nine fruits, provide 25–30 g of dietary fiber, which is 100% of the current US recommendations.

A variety of micro-nutrients are found in dates, including vitamins A, B-complex and C, and minerals such as calcium, magnesium, copper, sodium, phosphorus, zinc, selenium, fluorine, potassium, and iron. Variability in the polyphenol content of dates exists, as well as in the macro- and micro-nutrient levels, depending on the cultivar and degree of ripeness, along with geographic location and environmental conditions. Worldwide, CVD is the leading cause of death, taking an estimated 17.8 million lives in 2017, and is expected to account for more than 22.2 million deaths in 2030. An estimated 54% of deaths from noncommunicable disease in the eastern Mediterranean region are due to CVD and by 2030, an estimated 44% of the US population is projected to suffer from some form of CVD. Age-standardized prevalence rates of CVD per 100,000 for both sexes are particularly high in North Africa and the Middle East, Central Asia and North America, ranging between about 7066 to greater than 9266. A number of risk factors are associated with the development and progression of CVD. While constitutional risk factors such as family history, age and sex cannot be controlled, lifestyle factors related to hypercholesterolemia, hypertension, hyperglycemia, obesity, physical inactivity, and smoking can be modified and can significantly impact cardiovascular health. The presence of cardiac risk factors can be associated with vascular changes, and ultimately, the development of atherosclerosis, the underlying pathological process of CVD. Atherosclerotic CVD is a chronic inflammatory disease and disorder of lipid metabolism, initiated by endothelial dysfunction and damage promoted by immune-related mechanisms that interact with platelets, leukocytes and low-density lipoprotein cholesterol to initiate and propagate formation of lesions. Vascular homeostasis is maintained, in part, by the vasodilators nitric oxide , prostacyclin, endothelial derived hyperpolarizing factors, and vasoconstrictors such as thromboxane and endothelin-1. These mediators also help regulate smooth muscle cell proliferation, inflammation and platelet activation. In general, endothelial dysfunction occurs due to a disruption of the balance and regulatory function between vascular smooth muscle relaxing and contracting factors, growth promoting and inhibiting factors, and pro- and anti-atherogenic factors, characterized as a state of endothelial activation. Diet and physical activity are essential components of a healthy lifestyle, which play important roles in the primary and secondary prevention of chronic diseases such as CVD. Several bio-active dietary components are present in heart-healthy dietary patterns abundant in fruits, vegetables, nuts/seeds, and whole grains, including mono- and polyunsaturated fats, essential vitamins and minerals, phytochemicals such as polyphenols, and a variety of non-digestible carbohydrates that either aloneor through their interactive effects are thought to promote cardiovascular health. Understanding how specific plant foods may be beneficial can provide further insight for future refinements of dietary and public health recommendations, especially since fruits and vegetables vary greatly in their profile of bio-active compounds.Most studies on the vascular-related effects of dates have focused on cholesterol and lipid regulation, and oxidant defense and inflammatory responses .