ARTICLE | NUTRACEUTICALS | However, the findings in women were driven by the
results of a single study, and the possible gender differences for aspirin effectiveness still remain unclear3
. Furthermore, Dale et al4 showed that statins
reduce the risk of stroke, but only in men. A causal role of depression in the development and
course of cardiovascular diseases has been repeatedly established5
. This gender difference
emerges during adolescence and persists later in life and into old age5, 9, 10
. It is well recognised that
inflammation contributes to the development of depression11
. In fact, patients with major depression have
been found to have activated inflammatory pathways, including the elevation of pro-inflammatory cytokines and acute phase proteins, such as interleukin 6 (IL-6), IL-1β, tumour necrosis factor-α (TNF-α), and C-reactive protein12
. The European study RISTOMED (www.
ristomed.eu), providing a new e-service for a dietary approach to older patients, is a multi-centre Ôopen-labelÕ randomised study (CORDIS FP7), using a personalised approach to provide e-health/telemedicine services13
. Epidemiological data demonstrated that
depression and/or anxiety are approximately twice as common in women as in men6–8
Materials and methods
Recruitment, diet and supplementation The RISTOMED study enrolled 125 healthy
individuals from three different countries (Italy, France, Germany). They all received an Ôoptimal diet for the elderlyÕ either supplemented or not with a range of nutraceutical compounds for a period of 56 days. The diet was developed on the basis of the current recommendations for elderly people and personalised individual dietary requirements, with particular attention given to food compounds that can affect inflammation, oxidative stress and gut microbiota, such as polyunsaturated fatty acids (PUFAs), antioxidant vitamins, polyphenols, flavonoids, and fibres. The diet was adapted to the dietary habits for each country. In this report, the authors compared the group receiving the diet without
. The study focuses on the effect of
a specific dietary programme alone, or associated nutraceutical interventions on inflammatory status, oxidative stress and gut microbiota in a healthy elderly population, including women and men in equal distribution. In this article, the authors relate the observed differences between women and men according to baseline inflammatory status for their response to the diet alone, and that associated with the supplementation of an orange peel extract (OPE) containing d-Limonene. OPE has known anti-inflammatory properties active on inflammatory markers, depression and anxiety14–20
.
30 20 10 0
-10 -20 -30
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Diet Low inflammation 32 ❚ Diet High inflammation Diet + OPE Low inflammation July/August 2012 |
prime-journal.com Diet + OPE High inflammation
supplementation (14 males, mean age 69.6 ± 4.1 years; 17 females, 71.3 ± 3.8 years) to that which received diet supplemented with daily soft gel capsules containing OPE (14 males, mean age 70.6 ± 4.4 years; 16 females, 69.6 ± 3.3 years). OPE containing 95% d-Limonene purchased from Golgemma (Esp• raza, France) was added to sunflower oil (Olvea) and were packaged in soft gel capsules for oral administration to patients.
Laboratory measurements and questionnaires
Patients with major depression have been
found to have activated inflammatory pathways, including the elevation of pro-inflammatory
cytokines and acute phase proteins such as IL-6, IL-1β, TNF-α, and C-reactive protein.
Figure 1 Inflammation sub-groups and IL-6 variation in diet versus diet plus OPE
Erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (CRP), white blood cell count (WBC) and fibrinogen were measured using standard haematology methods. Plasma levels of IL-6 and TNF-α were determined using multiplex sandwich-ELISA (SearchLight, Aushon Biosystem, Billerica, MA) according to the manufacturerÕs instructions. An inflammation score was
calculated at baseline using the values of ESR, CRP, WBC, fibrinogen, IL-6 and TNF-α. This enabled the separation of the patients into two groups of respectively low and high inflammation, so that inflammatory status could be evaluated according to the scores of
these markers. The SF-36v2 Health Survey was used to evaluate
what each subject felt about his/her health using 36 items covering functional status, wellbeing, and an overall evaluation of health, that together are referred to as quality of life (QoL). Two summary scores ® physical component summary (PCS) and mental component summary (MCS) ® were calculated to distinguish an eventual physical dysfunction and bodily pain from psychological distress and emotional problems. The State-Trait Anxiety Inventory-X (STAI-X) questionnaire was used to assess the anxiety state and trait, and to describe each subjectÕs feelings at a particular point. The Center for Epidemiologic Studies Depression
IL-6 difference
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