title: An organic khorasan wheat-based replacement diet improves risk profile of patients with acute coronary syndrome: a randomized crossover trial.
abstract: Khorasan wheat is an ancient grain with previously reported health benefits in clinically healthy subjects. The aim of this study was to examine whether a replacement diet, thereby substituting all other cereal grains, with products made with organic khorasan wheat could provide additive protective effects in reducing lipid, oxidative and inflammatory risk factors, in patients with Acute Coronary Syndromes (ACS) in comparison to a similar replacement diet using products made from organic modern wheat. A randomized double-blinded crossover trial with two intervention phases was conducted on 22 ACS patients (9 F; 13 M). The patients were assigned to consume products (bread, pasta, biscuits and crackers) made either from organic semi-whole khorasan wheat or organic semi-whole control wheat for eight weeks in a random order. On average, patients ingested 62.0 g dry weight (DW) day-1 khorasan or control semolina; and 140.5 g DW day-1 khorasan or control flour, respectively. An eight-week washout period was implemented between the respective interventions. Blood analyses were performed both at the beginning and end of each intervention phase; thereby permitting a comparison of both the khorasan and control intervention phases, respectively, on circulatory risk factors for the same patient. Consumption of products made with khorasan wheat resulted in a significant amelioration in total cholesterol (-6.8%), low-density lipoprotein cholesterol (LDL-C) (-8.1%) glucose (-8%) and insulin (-24.6%) from baseline levels, independently of age, sex, traditional risk factors, medication and diet quality. Moreover, there was a significant reduction in reactive oxygen species (ROS), lipoperoxidation of circulating monocytes and lymphocytes, as well as in the levels of Tumor Necrosis Factor-alpha. No significant differences from baseline in the same patients were observed after the conventional control wheat intervention phase. The present results suggest that a replacement diet with cereal products made from organic khorasan wheat provides additional protection in patients with ACS. Circulating cardiovascular risk factors, including lipid parameters, and markers of both oxidative stress and inflammatory status, were reduced, irrespective of the number and combination of medicinal therapies with proven efficacy in secondary prevention.
authors.affiliation: Department of Agrifood Production and Environmental Sciences, University of Florence, Piazzale delle Cascine 18, 50144 Florence, Italy. anne.whittaker.anne@gmail.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Whittaker
authors.affiliation: Unit of Clinical Nutrition, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. francescosofi@gmail.com.|Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. francescosofi@gmail.com.|Don Carlo Gnocchi Foundation Florence, Via di Scandicci 269, 50143, Florence, Italy. francescosofi@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sofi
authors.affiliation: Don Carlo Gnocchi Foundation Florence, Via di Scandicci 269, 50143, Florence, Italy. mleluisi@dongnocchi.it.
authors.forename: Maria Luisa Eliana
authors.initials: ML
authors.lastname: Luisi
authors.affiliation: Don Carlo Gnocchi Foundation Florence, Via di Scandicci 269, 50143, Florence, Italy. elena.rafanelli@dongnocchi.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Rafanelli
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, Interdipartimental Center for Research on Food and Nutrition, University of Florence, Sesto Fiorentino, Florence, 50019, Italy. claudia.fiorillo@unifi.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorillo
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, Interdipartimental Center for Research on Food and Nutrition, University of Florence, Sesto Fiorentino, Florence, 50019, Italy. matteo.becatti@unifi.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Becatti
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. rosanna.bbate@unifi.it.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.affiliation: Unit of Clinical Nutrition, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. alessandro.casini@unifi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Casini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. gianfranco.gensini@unifi.it.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Department of Agrifood Production and Environmental Sciences, University of Florence, Piazzale delle Cascine 18, 50144 Florence, Italy. stefano.benedettelli@unifi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benedettelli
mesh_terms: D054058:Acute Coronary Syndrome / Q000178:diet therapy* / Q000378:metabolism / Q000473:pathology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001939:Bread; D018592:Cross-Over Studies; D004032:Diet; D004311:Double-Blind Method; D002523:Edible Grain; D005260:Female; D058870:Food, Organic; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011897:Random Allocation; D012307:Risk Factors; D013045:Species Specificity; D014908:Triticum / Q000145:classification
chemical_list: D015415:Biomarkers; D008055:Lipids
keywords: acute coronary syndrome; conventional wheat; diet; khorasan wheat; secondary prevention