THE EFFECTS OF CHIA SEED SUPPLEMENTATION ON DIETARY
DISPLACEMENT IN OVERWEIGHT/OBESE WOMEN
A Thesis
Presented to the
Faculty of
California State Polytechnic University, Pomona
In Partial Fulfillment
Of the Requirements for the Degree
Master of Science
In
Nutrition & Food Science
By
Michelle A. Chon
2018 SIGNATURE PAGE
THESIS: THE EFFECTS OF CHIA SEED SUPPLEMENTATION ON DIETARY DISPLACEMENT IN OVERWEIGHT/OBESE WOMEN
AUTHOR: Michelle A Chon
DATE SUBMITTED: Spring 2018
College of Agriculture
Bonny Burns-Whitmore, DrPH, RD Thesis Committee Chair Human Nutrition and Food Science
Edward Jo, Ph.D. Kinesiology and Health Promotion
Golandam Khayef, DrPH, RD Human Nutrition and Food Science
ii ACKNOWLEDGEMENTS
I would like to thank my advisor Dr. Bonny Burns-Whitmore, for believing in me and accepting me as a master’s student. Without her guidance and patience, I would not have been able to complete this research project. She spent hours working closely with me to provide an innovative research concept. I also want to thank Dr. Edward Jo for the countless hours he spent on this project as well. He supervised all the statistics, assisted me with the tables and figures, and provided expert feedback, which helped make this thesis what it is. I would like to thank Dr. Golandam Khayef for her advice, time, and direction. She provided an attention to detail, which helped improve this study. I am thankful for the other master’s students who worked alongside me to make this research project possible: Desiree Vera and Emily Tai. I am thankful to the participants for trusting us and for their loyalty to the chia study. I also want to take this time to thank my
“sis” Alexis Smith, for her endless support and encouragement. She has become one of my best friends and I could not have finished this thesis without her. Additionally, I want to thank Cal Poly for providing the resources for this study. I also want to thank my husband, Alex Chon for his love, support, prayers, and never-ending encouragements. He helped make my dreams come true. Most importantly, I want to thank my Lord and
Savior, Jesus Christ, for allowing me this opportunity to give Him all the glory and the praises.
iii ABSTRACT
As obesity prevalence trends continue to increase, so are the number of people acquiring diet-related diseases including cardiovascular disease, type 2 diabetes and some cancers.
Current research suggests that women are at greater risks for obesity and may develop a diet-related disease due to their higher body mass indexes (BMI), greater ability to store fat, poor diet, and exercise regimens. Most who attempt to diet complain about its rigidity and therefore, are unsuccessful. A novel approach to weight-loss may be improving diet quality through supplementation of a nutrient dense food. Various nut supplementation studies induce a positive change in diet quality, a term known as dietary displacement.
Like nuts, seeds are also nutrient dense and are known for its high fiber and omega polyunsaturated fatty acid (n-3 PUFA) content. The current study aimed to assess the effects of chia seed supplementation on dietary displacement in apparently healthy overweight/obese women. This was a randomized, 2-group, parallel experimental design with an eight-week intervention period. Healthy, free-living college women (18-45 years) with a BMI ≥ 26 kg/m2, were asked to consume their habitual diets along with chia seeds
(10% energy). Their dietary intakes were compared with a similar group of women who did not incorporate chia seeds into their habitual diets (control). A total of nine dietary intake journals per participant (n=15), were assessed. On average, chia seed supplement consumption was 41 g/day or 199 kcal. Compared with the control group (CON), the intervention group (CHIA) revealed significantly higher intakes (p < 0.05) in n-3 fatty acid, n-3 alpha linolenic acid, fiber, and magnesium. Displacement percentages for total fat, saturated fatty acid, polyunsaturated fattyacid, n-3 fatty acid, n-3 alpha linolenic acid, calcium, magnesium, and zinc ranged from 28-81%; negative displacements
iv occurred for monounsaturated fatty acid, n-6 linoleic acid, and vitamin E. On the other hand, energy, total carbohydrate, total protein, sugar, selenium, sodium, and potassium were completely displaced (>100%), indicating that the chia seed supplement more than fully displaced these variables in the diet. A daily supplement of chia seeds can induce favorable nutrient changes congruent with the dietary recommendations for prevention of chronic diseases in overweight/obese women. More research is needed to determine the effects of chia seed supplementation on overall diet and chronic disease risk in overweight/obese women.
v TABLE OF CONTENTS
Signature Page ...... ii
Acknowledgements...... iii
Abstract ...... iv
List of Tables ...... ix
List of Figures ...... x
Chapter One: Introduction ...... 1
Statement of the Problem...... 1
Purpose Statement...... 5
Significance of the Study...... 5
Specific Aim ...... 6
Hypothesis...... 6
Limitations ...... 6
Delimitations...... 6
Chapter Two: Literature Review ...... 8
Nutrient Profile of Seeds...... 8
Dietary Benefits of Seeds...... 9
Nutritive Value of Chia Seeds...... 9
Effects of Seed and Nut Supplementation on Dietary Displacement ...... 16
Further Research Implications and Conclusion ...... 22
Chapter Three: Methodology...... 23
Overview...... 23
vi Experimental Design...... 23
Participants...... 22
Inclusion Criteria ...... 26
Exclusion Criteria ...... 26
Dietary Supplementation Protocol...... 26
Dietary Analysis...... 27
Data Collection ...... 28
Anthropometric Measurements for Calculating BMI...... 28
Statistical Analysis...... 29
Chapter Four: Results ...... 30
Dietary Composition...... 30
Dietary Displacement...... 33
Chapter Five: Discussion ...... 36
Dietary Composition...... 36
Dietary Displacement...... 40
Limitations ...... 42
Practical Application and Future Research...... 43
Chapter Six: Conclusion ...... 45
References...... 46
Appendix A Institutional Review Board Approval Memorandum...... 57
Appendix B Study Flyer ...... 59
Appendix C Chia Seed Study Initial Screening Questionnaire ...... 60
Appendix D Informed Consent Form for Research Involving Human Subjects ...... 64
vii Appendix E 24-Hour Dietary Record ...... 72
Appendix F Manuscript Format for The American Journal of Clinical Nutrition...... 75
viii LIST OF TABLES
Table 1 Nutrient profile of selected seeds: chia, flax, hemp, and sesame ...... 8
Table 2 Lipid content of chia seeds (per 100 g chia) ...... 11
Table 3 Macronutrient and fiber content of chia seeds (per 100 g chia) ...... 12
Table 4 Vitamin content of chia seeds (per 100 g chia)...... 14
Table 5 Mineral content of chia seeds (per 100 g chia) ...... 15
Table 6 Literature review: nutritive value of chia seeds...... 15
Table 7 Pre-selected nutrients and their effect on chronic disease ...... 16
Table 8 Literature review: effects of nuts and seeds on dietary displacement ...... 21
Table 9 Participant’s characteristics at baseline ...... 26
Table 10 Dietary intake comparison over time and between treatment groups...... 32
Table 11 Dietary reference intakes of pre-selected nutrients and mean intakes for CON and CHIA from nine 24-hour food records...... 33
Table 12 Displacement of select nutrients after an 8-week supplementation with ~41 g chia seeds: Means of nine 24-hour food records ...... 35
ix LIST OF FIGURES
Figure 1 Methodology: experimental design...... 24
Figure 2 Summary of recruitment and enrollment ...... 25
Figure 3 Mean intake of dietary macronutrients after 8-week supplementation with ~41 g chia seeds ...... 31
Figure 4 Mean intake of dietary micronutrients after 8-week supplementation with ~41 g chia seeds ...... 31
Figure 5 Nutrient mean intakes from nine 24-hour food records in CHIA and CON diets as a percentage of goal or limit ...... 33
x CHAPTER ONE
Introduction
Statement of the Problem
The World Health Organization (WHO) labeled the obesity global epidemic as
“globesity” because over one-third of adults in the world are overweight/obese 1. From data preceding the year 2017, they estimated 32.6% of the US population were obese and that the percentage will continue to increase 1. They have defined overweight and obese as a body mass index (BMI) of ≥ 25 kg/m2 and ≥ 30 kg/m2, respectively 2. The BMI US average has steadily increased along with the unadjusted prevalence of obesity, which is
35.2% in US men and 40.5% in US women 3. This rise has resulted in an increased risk for developing diet-related health conditions. Overweight/obesity trends are increasing along with morbidity and mortality rates from diet-related complications. These include metabolic syndrome (MetS), cardiovascular disease (CVD), type 2 diabetes (T2D), respiratory problems, osteoarthritis, inflammation, and some cancers 4. Furthermore, the current leading cause of death worldwide is related to CVD 5. CVD results from plaque build-up in the walls of arteries, a process called atherosclerosis. Blocked blood vessels narrow the arteries and can lead to heart attack, chest pain, or stroke 6. Obesity is an independent risk factor for CVD. Obesity-related conditions leading to CVD include glucose intolerance, dyslipidemia, hypertension, and inflammation 7. T2D is associated with weight gain. T2D is characterized by insulin resistance and abnormal insulin levels.
There are some type 2 diabetic patients who are not overweight; however, those with a
BMI greater than 30 kg/m2 are at the greatest risk for the development of T2D 8.MetS,
CVD, and T2D can be prevented and are considered diet-related diseases 9. A high
1 quality diet has been associated with a decrease in overweight/obesity prevalence in healthy adults and thus, a decrease in diet-related diseases 10. Many overweight/obese women who attempt to improve diet quality through fad diets like the low-fat and low- carbohydrate, complain about their rigidity and restrictive nature. After a while they quit dieting and return to their previous eating habits, usually gaining more weight 10. Thus, improvements in diet quality through a change in the diet may be beneficial to those who have a BMI ≥ 25 kg/m211. Diet displacement might represent an innovative and more effective approach to achieving a high-quality diet through the supplementation of nutrient dense foods. Supplementing the diet with nutrient dense foods such as nuts or seeds has been linked with improvements in diet quality through the displacement of nutrients. Studies have shown positive dietary displacement percentages in fiber, unsaturated fat, potassium, and other minerals which are associated with a decreased risk in overweight/obesity and its related diseases. The supplementation of a nutrient dense food was attempted in several randomized, cross-over studies on healthy adults with a
BMI between 18.5 and 24.9 kg/m2. However, there are limited displacement studies conducted on an overweight/obese population and fewer on women with a BMI ≥ 25 kg/m2. Therefore, a novel approach to the obesity epidemic may be from improvements in diet quality through dietary displacement of nutrients by the supplementation of a nutrient dense food.
Dietary Displacement
The term displace means to move something in place of another 12. Therefore, diet displacement occurs when a nutrient (i) from a supplemented food has replaced nutrient i in the supplemented diet by reducing foods containing nutrient i from other sources 13.
2 Current studies have illustrated diet displacement from the supplementation of almonds
13, walnuts 14, and other nutrient dense snacks 11, specifically in healthy populations
(18.5-24.9 kg/m2). Jaceldo-Siegl defines % displacement as, “an inverse measure of the degree to which a supplemented food induced a change in the content of a particular nutrient in the supplemented diet.” 13. For example, let fat represent nutrient i and pistachios, the supplemental food: a 100% displacement of fat by the pistachios means that the fat from the pistachios has replaced an equal amount of fat in the supplemented diet (habitual diet + pistachios) by reducing fat intake from foods other than pistachios.
A 0-100% displacement qualifies a partial displacement of fat by pistachios. On the other hand, a percentage greater than one hundred means that fat from pistachios has more than replaced fat from the supplemented diet, lessening total fat intake from the habitual diet.
Thus, a negative % displacement indicates fat intake is received from foods other than pistachios, which increases total fat intake. Although diet displacement’s role in weight loss remains unclear, its positive contributions to diet quality are evident.
Supplementation of a nutrient dense food like almonds and walnuts induced a positive change in the diet (diet displacement) that related to improvements in diet quality 13,14.
The displacement of fiber, monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) were significant (p<0.05) in the almond and hazelnut studies but not in the walnut study 11,13. Therefore, the type of supplemented food is important to consider because it may be related to the percentage of nutrients displaced. There are many studies involved with the supplementation of nuts but not seeds. Seeds like chia are high in nutrients such as carbohydrates, protein, fiber, and omega-3 polyunsaturated fatty acids (n-3 PUFA).
3 Chia Seeds
Salvia hispanica L. or chia, is grown in the countries of Guatemala, Mexico, and
Colombia for its seed. Chia is nutrient dense and is consumed in the diet as an energy source for health-promoting benefits. United States Department of Agriculture (USDA) reported that 100 grams (g) of dried chia are made up of 42.1% carbohydrate, 16.5% protein, 34.4% dietary fiber, and 30.7% lipid 15. Chia is praised for its high levels (335
860 milligrams (mg)/100 g) of calcium, phosphorus, potassium, and magnesium, as well as smaller amounts of sodium, iron, zinc, niacin, and vitamin C (4.58 - 16 mg/100 g) 15.
The high fiber content in chia may be beneficial for health maintenance and disease prevention. Significant for those with T2D, consumption of high-fiber foods may assist in slowing down digestion and release of glucose. In addition, dietary fiber has been shown to increase satiety and decrease hunger 16. Therefore, chia may be favorable for weight management purposes in patients with CVD and T2D. Chia seeds are also high in unsaturated fat; more than a third of its weight comes from lipids 15. PUFA such as α linolenic (n-3 ALA) essential fatty acids are necessary in the human diet for membrane structure and anti-inflammatory properties 17. ALA is a vital precursor of omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both of which are important for brain function and development of the central nervous 17. Chia is also considered a “functional food” because of its health-promoting benefits- it can help to increase satiety, prevent CVD, inflammatory and nervous system disorders, and decrease diabetes-related complications 18. Chia seeds can potentially be incorporated into modern diets as a whole seed or seed flour, and therefore can be used as a functional food to improve dietary quality and nutritional density.
4 Justification Statement
Seeds (such as chia), are understudied. Research on chia seeds focuses on history, benefits to the diet, and therapeutic contributions 19. The two published chia supplementation studies showed elevated blood levels of omega-3 fatty acids (ALA) and
(EPA) after drinking milled chia for 7-8 weeks 19,20. Currently, there are no chia studies on dietary displacement; therefore, its effect on overweight/obese women remains unknown.
Purpose Statement
The purpose of this study was to examine the effects of chia seed supplementation on dietary displacement in apparently healthy, free-living, overweight/obese college women.
Significance of the Study
The results of the proposed study may provide a novel approach to improve dietary quality and thus, potentially decrease the overweight/obesity prevalence through chia seed supplementation. Additionally, the results of this study may provide an alternative to dieting for the overweight/obese population. Currently, there are no published dietary displacement studies that have supplemented seeds, such as chia, nor supplementation studies intentionally conducted on overweight/obese women.
In addition, two Registered Dietitian students from the Human Nutrition and Food
Science (HNFS) Department at California State Polytechnic University, Pomona (Cal
Poly Pomona) previously conducted a chia seed supplementation study on a healthy population of normal weight women and found improvements in nutrient levels and positive body composition changes (decreased body fat) 21. The proposed study was a
5 replication of their efforts on an understudied population with regard to improvements in dietary quality through displacement of nutrients.
Specific Aims
To determine the extent by which chia seed supplementation affects:
Aim: dietary displacement; participants will add 10% of their total energy intake as chia for 8 weeks and record their dietary intake at three intervals. Displacement will be determined with the Nutrition Data System for Research and the following equations:
1. Displacement nutrient (Di) = [(Habitual nutrient (Hi) + Supplemented nutrient
(Si)) – Chia nutrient (Ci)]
2. Displacement nutrient % (Di %) = Di / Si x 100
Null Hypothesis
The supplementation of chia seeds will not induce a change in the diets
(displacement) of overweight/obese women.
Hypothesis
The supplementation of chia seeds will induce a change (displacement) in the diets of overweight/obese women.
Limitations
The limitations to the proposed study included the following: (1) the sample size was small in comparison to like studies (2) all participants were females between the ages of 18 and 45 years (3) self-reported dietary intakes may lead to over-or under-reporting.
Delimitations
The measure of analysis was delimited to healthy, free-living female participants between the ages of 18 and 45 years with a BMI ≥ 26. Participation was denied if the
6 volunteer reported a medical history that would affect the interpretation of the results and/or challenge the protocol.
7 CHAPTER TWO
Literature Review
Nutrient Profile of Seeds
According to Raven, Evert, Eichhorn, 2005, seeds are small embryonic plants with an outer coating 22. They are the product of the ripened ovule of flowering plants after the reproduction phase. The outer layer of seeds is rich in minerals including potassium (K+), magnesium (Mg2+), and calcium (Ca2+). Seeds also contain vitamins E,
K, B1 and B6 as well as bioactive phytochemicals, which protect the seed from oxidative stress. Some seeds like chia, are rich in unsaturated fatty acids such as MUFA and essential PUFAs like linoleic acid and α-linolenic acids 17. The bioactive polyphenol content in seeds counter oxygen-derived free radicals. In addition, seeds contain the highest content of phytosterols among plant food sourcesʹ͵ (Table 1).
Table 1. Nutrient profile of selected seeds: chia, flax, hemp, and sesame.
Nutrient Unit Chia Flax Hemp Sesame Per 100 g Per 100 g Per 100 g Per 100 g Water g 5.80 6.96 4.96 4.69 Energy kcal 486 534 553 573 Protein g 16.5 18.3 31.6 17.7 Total Fat g 30.7 42.2 48.8 49.7 Carbohydrate g 42.1 28.9 8.67 23.5 Total Dietary Fiber g 34.4 27.3 4.00 11.8 Total Saturated Fat g 3.33 3.66 4.60 6.96 Total MUFA g 2.31 7.53 5.40 18.8 Total PUFA g 23.7 28.7 38.1 21.8 Calcium mg 631 255 70.0 975 Iron mg 7,72 5.73 7.95 14.6 Magnesium mg 335 392 700 351 Phosphorous mg 860 642 1650 629 Potassium mg 407 813 1200 468 Sodium mg 16.0 30.0 5.00 11.0
8 Zinc mg 4.58 4.34 9.90 7.75 Vitamin C mg 1.60 0.60 0.50 0.00 Thiamin mg 0.62 1.64 1.28 0.79 Riboflavin mg 0.17 0.16 0.29 0.25 Niacin mg 8.83 3.08 9.20 4.52 Vitamin B-12 μg 0.00 0.47 0.00 0.00 Vitamin A IU 54.0 0.00 11.0 9.00 Vitamin E (alpha mg 0.50 0.31 0.80 0.25 tocopherol) U.S. Department of Agriculture (2018)
Dietary Benefits of Seeds
The consumption of seeds is highly beneficial to health and disease prevention.
Current research about seeds allude to their high energy and nutrient density 24. Some seeds are regarded for their bioactive compounds. The endosperm of certain seeds contains high-quality protein, complex carbohydrate, and fat. Large observational studies have found an association between plant protein consumption and a reduction in the incident of coronary heart disease (CHD); however, they did not observe the same effect with an animal protein diet 25. Recent evidence reported that the consumption of whole seeds may promote heart health independent of habitual diet intake 24.
Nutritive Value of Chia Seeds
Omega-3 Fatty Acids
According to the studies describing the effects of seed and nut supplementation on dietary quality and displacement, saturated fatty acid intake is associated with increased risk of CHD while unsaturated fatty acid intake may help reduce blood cholesterol levels and its associated diseases. Although there was a time when fat intake had a negative connotation, it may no longer hold that reputation. According to Howard et al., 2006, a low-fat diet did not reduce the risk for the development of CVD in women, as explained
9 in their review of the literature 26. Furthermore, the consumption of unsaturated fatty acids such as n-3 long chain PUFA have shown to improve infant development, CVD risk, hyperlipidemia, platelet aggregation, blood glucose, and inflammation 27,28,29,30,31,32.
Therefore, the consumption of higher-fat diets in MUFA and PUFA has been widely accepted in the US. N-3 fatty acids (N-3 FA) serve as precursors to eicosanoids, which have an important role in membrane structure, particularly in nerve tissue and the retina. The current adequate intake (AI) for omega-3 fatty acids is 1.6 g/day and 1.1 g/day for men and women, respectively 33. Humans cannot synthesize α-linolenic acids such as n-3 PUFAs, therefore, they must be obtained from the diet. Only then can ALA can be converted to EPA and DHA to be used by cell membranes for fluidity and function 34.
Chia seed has gained interest for their high content of n-3 FA regardless of the region they are grown. Other seeds such as flax and sesame, have also gained popularity for their fatty acid and lignin contents. Sesame seeds differ compositionally from chia and flax because of their high n-6 linoleic acid (n-6 LA) and not n-3 ALA 35 (Table 1). US adults usually consume more than the AI for n-6 LA (17 g/day for men and 12 g/day for women) but not the AI for n-3 ALA 33. Thus, by supplementing the diet with a nutrient dense food high in ALA omega-3, such as chia, US adults might be able to reach their AI for n-3 FA. Moreover, chia seed supplementation may result in the substitution of saturated fatty acids with unsaturated fatty acids, thus causing a displacement of nutrients and an improvement in dietary quality (Tables 2 and 7).
10 Table 2. Lipid content of chia seeds (per 100 g chia). Lipids Units Amount Saturated Fatty Acids g 3.33 Monounsaturated Fatty Acids g 2.31 Polyunsaturated Fatty Acids g 23.7 n-3 (ALA) g 17.8 n-6 (LA) g .584 Trans Fatty Acids g .140 Cholesterol g 0.00 U.S. Department of Agriculture (2018)
Dietary Fiber
There are two types of fiber, dietary, which is made up of nondigestible carbohydrates and lignin that are intact in plants, as well as functional, containing isolated nondigestible carbohydrates that produce valuable effects in humans 36. For this review, only dietary fiber will be discussed. There are two types of dietary fiber, insoluble and soluble (viscous, gel-forming); soluble fiber can help lower cholesterol levels by reducing postprandial glucose responses after the consumption of carbohydrates
36,37. Dietary fiber may further reduce CVD and type 2 diabetes by delaying gastric emptying, thus reducing postprandial blood glucose concentrations, which increases insulin sensitivity. It also improves changes in secretion of hormones, which may improve satiety and provide anti-inflammatory effects 38. Additionally, dietary fiber reduces plasma low-density lipoprotein (LDL) cholesterol levels by blocking the absorption of bile and cholesterol as well as increasing all LDL receptor activity 39.
Seeds, especially in their whole form, are important sources of slow-release carbohydrate and dietary fiber 24. Furthermore, most US adults do not consume enough dietary fiber daily 33. The AI for fiber is set at 38 and 25 g/day for men and women, respectively, and studies have shown that the mean intake for US adults is between 15.7
11 17.0 g/day 33. Although there are no epidemiological studies that have proven dietary fiber intake can decrease the risk of diseases such as CVD, most have found reduced
CVD rates in individuals who consume high amounts of dietary fiber 40. The Zutphen
Study was conducted to determine the relationship between CHD and all cause-mortality with long-term fiber intake. A cohort of 1373 men born from 1990-1920 were examined between 1960-2000; Of the 1130 men who died, 348 were from CHD. The study concluded that each additional 10 g of dietary fiber intake per day reduced CHD mortality rates by 17% and all-cause mortality by 9% 41. Similarly, in the Adventist
Health Study, a cohort of 34, 192 California Seventh-Day Adventists were followed for six years 42. Those who ate nuts five times a week as opposed to less than one time per week, had a reduced risk (31% reduction) of ischemic heart disease (IHD). Those who ate nuts frequently had a reduced lifetime risk of IHD (~31%). Since chia seeds contain 34.4 g (per 100g chia) dietary fiber, consuming them may help increase the US average dietary intake of fiber (Tables 3 and 7).
Table 3. Macronutrient and fiber content of chia seeds (per 100 g chia). Macronutrients and Fiber Units Amount Carbohydrate g 42.1 Protein g 16.5 Total Lipid g 30.7 Fiber, Dietary g 34.4 U.S. Department of Agriculture (2018)
Tocopherols
Nuts and seeds are rich in vitamin E, a fat-soluble antioxidant that inhibits the production of reactive oxygen species (ROS) during fat oxidation. ROS can damage cells causing them to become compromised and at risk for diseases such as cancer and CVD as well as metabolic disturbances 43. A result of food consumption is energy conversion, a
12 time when the body becomes exposed to free radicals. Therefore, antioxidants such as α tocopherol, a compound found in vitamin E, may inhibit free radicals from reacting with oxygen to form ROS, thus protecting the cells from damage 43. Furthermore, α-tocopherol
gathers where free radical production is highest- in the membranes of the mitochondria,
heart, and lungs 44. Large cohort studies have demonstrated lower CVD rates in
participants who self-selected higher intakes in vitamin E through foods and supplements
44,45. Additionally, case-control studies reported lower incidences of cancer in subjects
with higher self-selected intakes of antioxidants 47.
The dietary reference intake for vitamin E is only for α-tocopherol because it is
the form maintained in plasma. The recommended daily allowance (RDA) for vitamin E
is 15 mg/day with an upper limit (UL) of 1000 mg/day for men and women 48. Most
healthy adults consume the RDA for vitamin E; yet, studies advise consumers to eat
foods such as nuts and seeds to ensure adequate intake of the vitamin 49. However, people
who consume amounts above the UL for vitamin E may be at increased risks for adverse
effects such as hemorrhaging and interruptions in blood coagulation 50,51. Therefore,
healthy adults are advised not to take vitamin E supplements, which can easily contribute
to surpassing the recommended intake; instead, they should obtain α-tocopherol from
plant food sources like raw vegetable oil and chia seeds (Tables 4 and 7).
13 Table 4. Vitamin content of chia seeds (per 100 g chia). Vitamins Units Amount Alpha-tocopherol Mg 0.50 Ascorbic Acid Mg 1.60 Cobalamin μg 0.00 Niacin Mg 8.83 Retinoic Acid, IU IU 54.0 Riboflavin Mg 0.17 Thiamin Mg 0.62 Note. μg = microgram; IU = International unit; U.S. Department of Agriculture (2018)
Minerals
Seeds are rich sources of minerals including K+, Mg2+, and Ca2+. These three minerals are participants in intracellular processes related to glucose control as well as reactions by serving as cofactors for enzymes 52. They are known for their roles in cellular metabolism and physiological processes 53. For example, Mg2+ is an essential co factor involved in the process of glycolysis, the body’s breakdown of glucose for energy.
Thus, the dietary reference intakes (DRIs) for men and women (ages 19-50 years) for potassium, magnesium, and calcium are 4700 mg/day; 310- 320 mg/day; and 1000 mg/day, respectively 54. Observational studies identified that magnesium plays a protective role against type 2 diabetes, specifically by eliciting a 14% risk reduction for each 100 mg/day serving of Mg2+. The dietary requirement for magnesium can be easily attained through the consumption of seeds like chia and their seed products 52.
Dietary intake of calcium may also play a role against the development of stroke.
In the Nurses’ Health Study (1980), 85,764 female nurses aged 34-59 years participated in questionnaires about lifestyle patterns, dietary intake, and medical history. Every two years they were given a follow-up questionnaire for updated information, especially the
14 development of diseases. Dietary (dairy) calcium intake was inversely related to ischemic stroke (p for trend = 0.05) while potassium and magnesium had associations with like variables 55 (Table 6). Chia seeds are an easy addition to the diet as they provide adequate amounts of these minerals (Tables 5 and 7).
Table 5. Mineral content of chia seeds (per 100 g chia). Minerals Units Amount Calcium mg 631 Iron mg 7.72 Magnesium mg 335 Phosphorus mg 860 Potassium mg 407 Sodium mg 16.0 Zinc mg 4.58 U.S. Department of Agriculture (2018)
Table 6. Literature review: nutritive value of chia seeds. Author Objective Methodology Findings and Year Streppel, To study recent Cohort (n=1373) of men born Every additional 10 grams M. et al. and long-term between 1900 and 1920 studied dietary fiber intake reduced (2008) 41 intake of fiber between 1960 and 2000. Of CHD mortality by 17% (95% CI: and its relation 1130 men who died, 348 2%, 30%) and all-cause to CHD and resulted from CHD. Obtained mortality by 9% (0%, 18%). all-cause hazard ratios from time- Hazard ratio between long-term mortality dependent Cox regression dietary fiber and all-cause models. mortality decreased from age 50 (0.71; 95% CI: 0.55, 0.93) until age 80 (0.00; 0.87, 1.12). Fraser, To examine the Cohort (n= 34, 192) California Significance (p <0.001) between G. effect of diet on Seventh-Day Adventists nut consumption and (1999) 42 chronic disease followed for 6 yrs. Mailed a fatal/nonfatal IHD (RR ~ 0.5 for dietary and food-frequency those who ate nuts ≥ 5 questionnaire along with annual times/week as opposed to < 1 mailings requesting time/week, had a reduced risk hospitalization info. Used (31% reduction) of ischemic multivariate analysis to evaluate heart disease (IHD). Those who effect of dietary choices on ate nuts frequently had reduced chronic diseases. lifetime risk of IHD (~31%).
15 Iso, H. To evaluate the Nurse's Health Study Cohort Documented 690 incident cases et al. high intake from data collected in 1980. of stroke. Dietary dairy calcium (1999) 55 effects of Women (n=85,764) aged 34-59 intake (no multi-vitamin) was calcium, yrs., free of CVD, were given inversely associated with potassium, and dietary questionnaires. K+, Mg2+, ischemic stroke risk 0.68 (95% magnesium on and Ca2+ intakes were CI, 0.50 to 0.94; P for trend = risk of stroke in calculated, incidence of stroke 0.05). women. for 14 years follow-up analyzed.
Table 7. Pre-selected nutrients and their effect on chronic disease. 27,28,29,38,39,43,52,53
Nutrient Effect on Chronic Disease Monounsaturated fatty acid, MUFAUFA and PUFA maay bloodb cholesteroll. SFA intake polyunsaturated fatty acid, maay ccoronary heart d iisesease.a saturated fatty acid N-6 linoleic acid, N-3 alpha N-6N LA intake may contribute to non-alcoholic fatty linolenic acid liliver disease,isease obesity, *CVD, and inflammatory bowel disease.e. N -3 ALA may decrease CVD and inflammation.
Dietary Fiber May CVD and iinsulin sensitivity
Vitamin E Vitamin E maay CCVD rates andd cellc damage
Magnesium, calcium, potassium Minerals may protect against type 2 diabetes
Effects of Seed and Nut Supplementation on Dietary Displacement
Seeds are produced by the ripened ovule of flowering plants 22. Nuts or tree nuts are dry, edible fruits with one seed and a rough exterior shell 56. Most people consume nuts such as almonds, walnuts, hazelnuts, pistachios, cashews, pecans, and macadamia nuts 56. The array of benefits from consumption of seeds and nuts have been linked to the nutrients they contain. Seeds and nuts are nutrient dense power foods that contain fiber, protein, polyphenols, MUFA, PUFA, vitamins and minerals, which may induce changes in the diet and positively impact the consumer’s nutrient profile. To date, there are no published displacement studies involving seeds (Table 8); however, figs contain seeds. In a randomized, cross-over controlled trial, dried California mission figs were
16 supplemented in the diets of 88 healthy adults with a BMI of 18.5-35 kg/m2 (mean age of
56 years). For five weeks, participants consumed their habitual diets and then crossed over to habitual diet plus 120 g of dried figs, for five additional weeks. Participants could replace desserts with figs. There was a two-week washout period in between treatments.
Six 24-hour dietary recalls and four blood samples were collected at random. By the end of the study, displacement was found in 4% deserts, 5% vegetables, 10% dairy products,
23% grains, and 168% beverages. Dietary recalls estimated that the fig diet contained higher amounts of Ca2+, Mg 2+, and K+. However, there were no significant differences in blood mineral levels between both groups 57.
Although dietary displacement studies among seed varieties are lacking, nut supplementation studies that assessed nutrient profile and dietary displacement were searched using three databases, PubMed, Science Direct, and SpringerLink, for this review. Within the confine of the search, a total of five nut supplementation papers from the last 16 years were included. Of the five papers, two were randomized crossover trials, one performed secondary analysis from one of the two randomized crossover trials, and the remaining two were randomized controlled, parallel trials that performed secondary analyses as well. The participants varied from healthy adults (25-70 years), non-obese adults (18-65 years), men (45-75 years) at risk for prostate cancer, and the elderly (63-79 years).
One of the first published studies on nut supplementation and dietary displacement was conducted by Fraser, Bennett, Jaceldo, Sabaté, 2002, they examined the effects of regular nut consumption on diet and body weight. Their year-long randomized, cross-over design consisted of a population group of healthy adults (n=81).
17 The first six months had no intervention; however, the second six months consisted of a supplementation of almonds (~52 g/day) equivalent to 15% of their total dietary intake.
No dietary advice was provided. Seven 24-hour recalls and two one-day diet diaries, height, fasting weight, and hip circumference were analyzed. Although the almonds supplied 57, 500 additional calories per participant during the feeding period, no significant weight gain took place (p= 0.05). According to dietary recalls and diaries, the displacement of energy totaled 54% and 78%, respectively. The extra energy from the almonds was estimated to have substituted energy from other foods. Additionally, there were 40-50% increases in unsaturated/saturated fatty acid ratios during the almond supplementation. Their findings paved the way for more research using nut and seed supplementation as well as dietary displacement 58.
Jaceldo-Siegl et al., 2004, performed secondary analysis on the almond study to determine the effects of almond supplementation on nutrient profile and dietary displacement. Displacement for each nutrient was calculated with the following equations: Displacement nutrient= (Habitutal nutrient + Supplemented nutrient) – Actual nutrient (Di = (Hi + Si) – Ai) and % Displacement nutrient = Displacement nutrient /
Supplemented nutrient x 100 (%D = Di / Si) x 100. There were significant increases (p<
0.05) in MUFA, PUFA, fiber, vegetable protein, α-tocopherol, Cu2+, and Mg2+ and decreases (p< 0.05) in trans fatty acids, animal protein, sodium, cholesterol, and sugars when participants switched to the almond supplemented diet 13.
Kranz et al., 2014, aimed to determine the effect of walnut supplementation on nutrient displacement in men at risk for prostate cancer (n=21). Using a four-month crossover design, participants received two treatments in no particular order- usual diet or
18 usual diet + walnuts. There was a two-week washout period in between treatments. The
usual diet + walnuts supplemented 75 g of walnuts daily. Participants were given dietary
advice on ways to incorporate the nuts into their diets. Five 3-day food records were
taken at baseline and weeks 4 and 8 per treatment and analyzed using Nutrition Data
System for Research (NDSR) software and statistical analysis was performed using SAS
version 9.1.3. There were significant effects in energy (E) (p= 0.003), total fat (FAT) (p<
0.001), PUFA (p= 0.006), n-3 FA (p< 0.001) and total fiber (p= 0.014). Using the same
equations as Jaceldo-Siegl et al., 2004, they determined that there was 25% and 39%
displacements of energy and fiber, respectively, by the calculated walnut diet as well as
displacements of 14% unsaturated fat and 15% saturated fat 14.
In a secondary analysis, Pearson et al., 2017, analyzed data from a 12-week
randomized controlled, parallel study conducted on non-obese patients (n=102) to
determine dietary quality, displacement, and CVD risk on nut consumption. Each
participant was placed in one of four groups, hazelnut (42 g), chocolate (50 g), potato
crisps (50 g), or no snack. Pre-and post-study diet records, body composition, and
physical activity were measured. Displacement outcome differences were calculated
using Kruskal-Wallis one-way analysis of variance test. By the end of the study, fiber
was almost completely displaced (p= 0.034) and partial displacements occurred for E,
protein (PRO), FAT, MUFA (p= < 0.001), PUFA (p= 0.012), and vitamin E (p< 0.001) in
the hazelnut group. No significant differences in nutrients were observed in the other
interventional groups; however, overcompensation of carbohydrate (CHO) and sugar
occurred in the nut group, indicating their mean intakes in these categories were lower than expected on the nut supplementation. The high displacement for carbohydrate is
19 consistent with Jaceldo-Siegl et al., 2004, where carbohydrate intake decreased when almonds were added to the habitual diet 11,13.
A secondary analysis from a 2-year trial was performed by Bitok et al., 2017.
Data from a randomized, controlled parallel study (n=356) where participants between
the ages of 63 and 79 years, were assessed for nutritional quality and displacement.
Subjects, of which 65% were women, were randomly assigned to one of two groups,
walnut (experimental) or control. Estimated energy intake was provided to all participants
and calculated using the WHO formula for adults >60 years and the Harris Benedict
equation. Those in the walnut group were supplemented 15% of their total energy intake
in walnuts. For example, if the participant required 2000 kcals/day, they were given 300
kcals of walnuts and consumed a total of 2300 kcals/day. No dietary advice or recipes
were provided to the participants; however, they were asked to make up a missed day by
doubling their walnut intake the following day. A total of 1490 random telephone dietary
recalls were gathered and entered into the NDSR software for analysis. Arithmetic mean
values were calculated for energy and key nutrients for each participant. Furthermore,
displacement was calculated with the following equations: estimated Walnut Diet =
Control Diet + Walnut (eWD = CD + W); Displacement = estimated Walnut Diet– actual
Walnut Diet (D = eWD – aWD) or D = (CD + W) – aWD; % Displacement = D/W x 100.
The results of their study were as follows: 19% E, 24.2% PRO, 25% FAT, 21% MUFA,
16% PUFA, 17% n-6 PUFA, 12-8% n-3 PUFA, and 9% insoluble fiber were displaced by
the walnuts; negative displacements were seen in CHO, total fiber, and soluble fiber;
>100% displacement occurred for niacin, sodium and selenium. Thus, their study
provided evidence that walnut supplementation can improve nutrient intake and
20 cardiovascular health in the elderly 59. Ultimately, these studies have provided evidence that a nutrient dense food may induce a positive change in the diet, thus improving nutrient profile.
Table 8. Literature review: effects of seed and nut supplementation on dietary displacement
Author Objective Methodology Findings and Year Alshaeri, To determine the Randomized, crossover, controlled Displacement may have H. et al. effect of California trial; adults (n=88) assigned to eat occurred by elimination of 4% (2015) 57 mission fig habitual diets or habitual diets plus deserts, 5% vegetables, 10% supplementation on California mission figs (120g/day) for dairy products, 23% grains, mineral and five weeks. Each group crossed over and 168% beverages. 24 h nutrient levels and for another five weeks. Six dietary recalls estimated higher Ca self-selected recalls and four blood samples and K in fig diets (p< 0.05). habitual diet on collected at random and analyzed. No significant differences in dietary patterns mineral levels seen. Fraser, G. To examine the Randomized, cross-over design; adults Additional 57, 500 kcal from et al. effect of regular (n=81) studied for 1 year. No almonds did not induce weight (2002) 58 nut consumption intervention the first six months; gain (p=0.05). Energy was on diet and body second six months 15% of diets were displaced at 54% (recalls) and weight supplemented with almonds. Seven 24 78% (diaries). 40- 50% h recalls, two one-day diet diaries, increases in height, fasting weight (Scale-Tronix unsaturated/saturated fatty electronic scales), and hip acids during the almond circumference obtained. supplementation. Jaceldo- To evaluate the Randomized, cross-over design, adults Significant increase (p <0.05) Siegl, K. effects of almond (n=81) were followed for 1 year. in MUFA, PUFA, fiber, et al. supplementation on Participants consumed regular diets vegetable protein, α (2004) 13 nutrient profile and for the first six months and ~52 g of tocopherol, Cu, and Mg and displacement in almonds were added to their diets the decrease (p <0.05) in trans healthy adults second six months. Secondary fatty acids, animal protein, Na, analysis performed from previously cholesterol, and sugars when collected seven 24 h recalls and two participants switched to the food diaries from each participant. almond supplemented diet. Displacement per nutrient calculated using: Di = (Hi + Si) -Ai.
Kranz, S. To determine the Cross-over intervention study, men Significance in E (p= 0.003), et al. effect of walnut (n=21) at risk for prostate cancer FAT (p< 0.001), PUFA (2014) 14 supplementation on supplemented 75 g/day English (p=0.006), n-3 FA (p< 0.001) nutrient walnuts. Interventions: 8 weeks with and total fiber (p= 0.014). displacement in walnuts, 8 weeks without walnuts, and 25% displacement of E by the men 2-week washout period. Five 3-day calculated walnut diet along food records taken at baseline and with 14%, 15%, 39% of total weeks 4 and 8 per treatment. fat and saturated fat, and fiber Displacement per nutrient calculated respectively. using: Di = (Hi + Si) - Ai.
21 Pearson, To determine if Secondary analysis from a 12-week Fiber almost completely K. et al. regular nut randomized controlled, parallel study displaced (p=0.034); partial (2017) 11 consumption will (n=102). Non-obese participants displacements for E, PRO, improve diet placed in 1/4 groups: hazelnut (42 g), FAT, MUFA (p=<0.001), quality, induce chocolate (50 g), potato crisps (50 g), PUFA (P=0.012), and vitamin dietary or no snack. Pre- and post-study diet E (p=<0.001) for the hazelnut displacement, and records, body composition, and group. Overcompensation of reduce CVD risk physical activity were measured. CHO and sugar occurred in Displacement outcome differences the nut group. measured using Kruskal-Wallis. Bitok, E. To assess Secondary analysis (SPSS v 23) from 19% E, 24.2% PRO, 25% et al. nutritional quality a 2-yr trial; randomized controlled, FAT, 21% MUFA, 16% (2017) 59 and displacement parallel study (n=356, 65% women, PUFA, 17% n-6 PUFA, 12 in the elderly 63-79 years). Participants placed in 8% n-3 PUFA, 9% insoluble through walnut walnut (experimental) or control fiber displaced by walnuts. supplementation group without dietary advice. Negative displacements for Experimental group consumed 15% of CHO, total fiber, and soluble E in walnuts. 1490 random telephone fiber. >100% displacement for recalls collected and analyzed using niacin, Na and Se. NDSR. Displacement calculated: %D = D/W x 100
Future Research Implications and Conclusion
There is substantial evidence which supports the contributory effects of nut supplementation on dietary displacement for the improvement of overall diet quality.
Seed supplementation has been linked to health benefits and to reducing the risks of
CVD; however, evidence is lacking as to whether seed supplementation can induce the same positive change in the diet through the displacement of nutrients. To date, there are no published studies assessing the effects of chia seed supplementation on dietary displacement. Additionally, there are limited studies that can be generalized to the overweight/obese population and even fewer studies conducted on female participants.
Therefore, future studies should analyze the effects of chia seed supplementation on dietary displacement in overweight/obese women.
22 CHAPTER THREE
Methodology
Overview
This research protocol and all forms generated for recruitment and screening was approved by the Institutional Review Board (IRB) at California State Polytechnic
University, Pomona (Protocol 16-188) (Appendix A). This research implemented a 2 group parallel experimental design consisting of an eight-week treatment period during which, one of the following conditions were applied: 1) habitual diet with added chia seeds (CHIA) or 2) habitual diet without chia seeds (CON). This research aimed to evaluate if chia seed supplementation would induce a positive change in the diets of free- living college women with a BMI ≥ 26 kg/m2.
Experimental Design
A randomized 2-group, parallel experimental design was conducted for the proposed study. Participants visited the HNFS Laboratory at Cal Poly Pomona (2-115) on three separate occasions. This was a year-long study conducted in five quarters, with new participants each time (Winter ’17-Winter ‘18). The treatment period lasted eight weeks of which, one of the following conditions were established: 1) habitual diet with added chia seeds (CHIA) or 2) habitual diet without chia seeds (CON). Data were collected during weeks zero, four, and nine (Figure 1). Dietary intake journals were collected at week zero and nine and three times at random throughout the treatment period.
23 Recruitment Period
Winter 2017- Winter 2018
Informed Consent
Randomization
Habitual Diet Habitual Diet + 10% Chia Seeds (CON) (CHIA)
Data Collection
Week 0 Week 4 Week 9 Baseline Midpoint Post
Figure 1. Experimental design.
Participants
Forty female students were recruited from Cal Poly Pomona and thirty took part in the study (Figure 2). By the end of the year-long investigation, fifteen were included in the statistical analysis. The mean age was 21.7 ± 1.7 years and 24.3 ± 4.5 and BMI was
28.6 ± 1.6 kg/m2 30.9 ± 3.5 for CHIA and CON, respectively (Table 9). Our research sample of college females from CPP, was a convenience sample. Recruitment methods consisted of posted flyers, e-mails to every college in the university and their specific departments, as well as professor and peer recruitment (Appendix B). Interested participants were asked to contact one of the principle investigators via phone or email.
After the initial contact and prior to participation, volunteers were required to complete a
24 Figure 2. Summary of recruitment and enrollment. health questionnaire (Appendix C) and provide written informed consent (Appendix D), which described the overview, procedures, inclusion and exclusion criteria, potential risks and benefits, and confidentiality of the study. When both forms were completed, the primary investigators determined inclusion and exclusion from responses to the health questionnaire and by calculating BMI. Participants were notified if they were a qualified candidate for the study. Thus, interested participants were scheduled for their first data collection appointment. The entire study consisted of five recruitment periods: Winter
’17, Spring ’17, Summer ’17, Fall ’18 and Winter ’18. CPP is on a quarter system consisting of 10 weeks of lectures and 1 week of finals, so recruitment was timed in accordance with this schedule to increase retention.
25 Table 9. Participant’s characteristics at baseline.
CHIA (n=8) CON (n=7)
Measure Mean ± SD Mean ± SD Age 21.7 ± 1.7 24.3 ± 4.5 Height (cm) 163.5 ± 6.9 161.4 ± 7.3 Weight (kg) 76.7 ± 9.8 80.7 ± 12.1 BMI (kg/m2) 28.6 ± 1.6 30.9 ± 3.6 The data is expressed as mean ± SD (standard deviation)
Inclusion Criteria
In order to be eligible for this study, participants had to be a student/staff and/or faculty member at Cal Poly Pomona, biologically female, between the ages of 18 and 45 years, healthy with no known chronic disease, and willing to avoid eating high n-3 containing fish and fish oil supplements, nuts including walnut, flaxseed or flaxseed oil for the duration of the study.
Exclusion Criteria
Those who were not included in the study were not a student/staff/faculty member at Cal Poly Pomona, biologically female, overweight/obese (BMI less than 18.5 or greater than 24.9 kg/m2), pregnant, free from a chronic disease or condition requiring treatment that would affect normal dietary intake.
Dietary Supplementation Protocol
A Registered Dietitian calculated the daily caloric intake of each participant prior to the baseline data collection using the Harris-Benedict equation. Activity level was accounted for (1.2, 1.375, or 1.55) and multiplied to the daily caloric intake calculated, depending on each participant’s activity listed on their Initial Health Screening Form.
Participants in both the CHIA and the CON groups were encouraged to maintain the exercise routine reported in the Initial Health Screening Form, keep their habitual diets,
26 and avoid n-3 supplementation and foods high in ALA and/or fiber. Ten percent of the participant’s daily caloric intake was supplemented with chia seeds supplied by Salba
Smart Natural Products, LLC (Colorado, USA). The Salba brand was used to ensure consistency in seed size, color, shape, and nutrient content. According to the nutrient information listed on Salba Smart Natural Products, LLC, 15 g of Salba chia seeds contain 70 kcal, 5 g fat, 5 g dietary fiber, and 3.4 g ALA omega-3. The amount of chia seeds was pre-measured and pre-packaged according to the needs of each participant and distributed at the beginning of each week. The empty bag from the previous week was collected to ensure compliance. Bags were labelled with each participant’s study identification number for confidentiality purposes. Participants were given instructions to take chia seeds with 10 ounces of water, 30-45 minutes before each meal. No amount of chia was specified per meal so long as participants consumed one pre-measured bagful per day. Additionally, no nutrition education or instructions were administered throughout the study to maintain a true free-living status.
Dietary Analysis
Participants were asked to complete nine 3-day food records throughout the study
(Appendix E). These included baseline and post-study food records as well as three individual records requested at random via email or phone text/call (participants were given 24-hour notice). Instructions for filling out food records and measuring portion sizes were administered verbally and written on the food record handout. After excluding seven participants’ food records because of incomplete data and noncompliance, 15
(n=15) 3-day food records per data collection period (135 total) were entered into the
University of Minnesota Nutrition Data System for Research (NDSR) version 2017
27 (Minneapolis, MN) and the nutrient content of the diets were further estimated using
NDSR. Diet displacement was determined using the equations:
Di =(Hi +Si) – Ci
Di %= Di / Si x 100
As explained by Jaceldo-Siegl & et al., 2004, if i represents a nutrient, then Hi is the intake of a nutrient during the habitual diet; Si is the amount of the same nutrient found in the chia supplement; Ci is the intake of that nutrient throughout the chia-supplementation period. Since the chia supplement was added to the habitual diet, the expected intake of that nutrient in the supplemented diet is Hi + Si. Displacement of the same nutrient (Di) was further estimated by subtracting the intake of that nutrient in the supplemented diet
(Ci), from the expected intake of that nutrient. Thus, Di = (Hi + Si)-Ci. Percentage displacement was calculated by Di/Si x 100. These equations have been accepted and utilized by other displacement studies 11, 13,14,57.
Data Collection
Anthropometric Measurements for Calculating BMI
Height was measured during week 0 using a stadiometer and recorded to the nearest 0.1 centimeter (cm). Bodyweight measurements were taken with a Tanita Body
Impedance Analyzer (BIA) TBF-300A (Arlington Heights, IL) during weeks 0, 4, and 9.
To assure accuracy, the researcher entered information about the participant in the Tanita scale including gender, age, clothing, body type, and height. Female gender was entered for every participant because all were biologically female for the study. Only the initial age of the participant was used throughout the study to ensure standardization. Clothing was entered as 0.2 and participants were asked to remove any heavy outerwear before
28 stepping barefoot onto the scale. Standard female, non-athletic was used for body type and height was entered in centimeters.
Statistical Analysis
A 2 (condition) x 3 (time) Analysis of Variance (ANOVA) was used to analyze mean differences for each dependent variable. In the event of a significant main effect or interaction, a follow-up test was conducted for pairwise comparisons. Statistical significance was set at p< 0.05. Analysis was performed using SPSS Statistics 22.
29 CHAPTER FOUR
Results
Dietary Composition
Of the 30 females who took part in the study, 15 were included in the statistical analysis. Three participants never began the study due to scheduling conflicts, four dropped out because of the intervention, two became unresponsive, one had gastrointestinal issues unrelated to the intervention, and five were eliminated due to non compliance with completing nine 24-hour food records (Figure 2).
Analysis of 135 total 24-hour dietary records revealed no significant difference in energy (E), total fat (FAT), total carbohydrate (CHO), total protein (PRO), cholesterol
(CHOL), saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), conjugated linoleic acid (CLA), n-6 linoleic acid (n-6 LA), sugar, vitamin E (VIT E), calcium (Ca2+), zinc (Zn), selenium (Se), sodium (Na+), and potassium (K+) intake among baseline
(PRE), midpoint (MID), and post study (POST) for CHIA and CON (Table 10).
For the dependent variables omega-3 fatty acid (n-3 FA) and n-3 alpha-linolenic acid (n-3 ALA), there was a significant group x time interaction (p< 0.0001). Pairwise comparisons revealed CHIA to have greater n-3 FA and n-3 ALA at MID (p< 0.0001) and post-study (POST) (p< 0.0001) compared to CON (Figure 3). There was a significant group x time interaction for fiber (p< 0.0008). Pairwise comparisons revealed
CHIA to have greater fiber at MID (p< 0.001) and POST (p< 0.01). For the dependent variable Mg2+, there was a significant group x time interaction (p< 0.004) (Figure 4).
Pairwise comparisons revealed CHIA to have greater Mg2+ at MID (p< 0.004) and POST
(p< 0.04) (Table 10).
30 Total CHO (g) Total Dietary Fiber (g) ȗ ȗȗ Total FAT (g) SFA(g) MUFA (g) ȗ ȗȗ PUFA (g) N-3 FA (g) ȗȗȗ CLA (g) N-3 ALA(g) N-6 LA (g) Total PRO (g)
0.0 25.0 50.0 75.0 100.0 125.0 150.0 175.0 200.0 225.0 250.0 275.0 CHIA MEANS Dietary Intake of Macronutrients CON MEANS Figure 3. Mean±SD intake of dietary macronutrients after 8-week supplementation with ~41g chia seeds. Values represent mean intake of nine 24-h food records. *Significantly different from baseline p< 0.05 **Significantly different than chia diet p< 0.05.
Vitamin E (mg)
Calcium (mg)
Magnesium (mg) ȗ ȗȗ Zinc (mg)
Selenium (mg)
Sodium (mg)
Potassium (mg)
0.0 500.0 1000.0 1500.0 2000.0 2500.0 3000.0 3500.0 4000.0 CHIA MEANS Dietary Intake of Micronutrients CON MEANS Figure 4. Mean±SD intake of dietary micronutrients after 8-week supplementation with ~41g chia seeds. Values represent mean intake of nine 24-h food records. *Significantly different from baseline p< 0.05 **Significantly different than chia diet p< 0.05.
31 Table 10. Dietary intake comparison over time and between treatment groups. *significantly different from PRE (p<0.05) **significantly different than CHIA (p<0.05)
CHIA (n=8) CONTROL (n=7) PRE MID POST PRE MID POST E 1643.1± 1817.9± 1636.3± 1642.0± 1600.2± 1938.4± (kcal) 519.8 363.3 474.5 449.0 405.8 706.1 FAT 76.4± 91.4± 73.6± 62.9± 66.5± 88.2± (g) 36.9 26.3 29.3 23.3 27.1 32.4 CHO 184.0± 192.7± 188.1± 201.6± 168.7± 210.0± (g) 44.8 30.1 42.0 52.8 66.7 84.8 PRO 59.4± 66.7± 63.2± 71.0± 63.3± 81.5± (g) 16.0 21.5 26.4 19.3 14.2 31.0 CHOL 242.1± 270.4± 207.3± 235.6± 246.7± 386.0± (mg) 149.0 189.1 190.1 149.0 121.0 147.9 SFA 23.6± 26.3± 22.2± 19.0± 22.3± 30.2± (g) 14.3 13.1 11.4 6.3 10.4 12.8 MUFA 26.3± 28.0± 23.2± 22.6± 22.3± 28.8± (g) 13.6 9.9 11.1 11.1 10.4 9.4 PUFA 20.2± 29.4± 22.9± 15.9± 16.2± 21.5± (g) 10.0 7.3 6.0 6.3 6.8 8.4 n-3 FA 2.0± 9.4± 8.7± 1.8± 2.0± 2.2± (g) 1.0 0.8* 0.7* 0.9 1.3** 0.9** CLA 0.1± 3.6± 0.1± 0.1± 0.1± 0.1± (g) 0.1 9.8 0.1 0.0 0.1 0.1 n-3 1.9± 9.3± 8.6± 1.6± 1.1± 2.1± ALA (g) 1.0 0.8* 0.7* 0.8 0.7** 0.9** n-6 17.9± 19.8± 13.7± 12.7± 12.3± 18.9± LA (g) 8.9 6.6 5.6 7.0 2.9 7.5 Sugar 57.3± 52.1± 52.3± 66.5± 60.2± 58.3± (g) 22.1 19.4 18.6 36.9 25.4 22.3 Fiber 15.8± 32.1± 29.6± 13.9± 15.2± 17.4± (g) 7.5 8.7* 7.9* 4.1 6.9** 8.1** Vit E 8.4± 9.0± 8.1± 8.0± 7.6± 9.1± (mg) 3.6 3.0 8.0 3.1 3.8 3.8 Ca2+ 588.5± 866.6± 840.5± 646.9± 700.1± 722.6± (mg) 180.5 307.3 255.6 199.1 147.4 254.4 Mg2+ 207.0± 374.1± 366.4± 204.4± 213.6± 254.9± (mg) 81.4 86.0* 86.5* 57.1 89.2** 98.5** Zn 7.1± 9.7± 9.5± 8.3± 6.6± 8.4± (mg) 2.1 3.4 3.7 2.8 1.0 3.0 Se 99.4± 113.6± 108.6± 103.8± 90.0± 132.4± (mg) 23.0 28.7 38.8 34.2 18.0 57.4 Na+ 2928.5± 2983.4± 2613.3± 2862.3± 2645.0± 3201.4± (mg) 1039.2 731.2 1009.0 853.8 768.7 1210.4 K+ 1944.8± 2023.1± 1684.9± 1880.3± 1756.1± 2121.0± (mg) 905.0 907.1 704.8 648.4 728.3 560.5
32 Table 11. Dietary reference intakes of pre-selected nutrients and mean intakes for CON and CHIA from nine 24-hr food records. *Mean recommended dietary allowance (RDA) or adequate intake (AI) per nutrient. 33, 48, 54 *Mean RDA/AI Nutrient (Females 19-50 yrs.) Control (n=7) Chia (n=8) Total Carbohydrate (g) 130 193.5 188.3 N-3 ALA (g) 1.1 1.6 6.6 N-6 LA (g) 12 14.6 17.1 Dietary Fiber (g) 25 15.5 25.8 Vitamin E (mg) 15 8.2 8.5 Calcium (mg) 1000 689.9 765.2 Magnesium (mg) 315 224.3 315.8 Zinc (mg) 8 7.8 8.8 Selenium (mg) 55 108.7 107.2 Sodium (mg) 1500 2902.9 2841.7 Potassium (mg) 4700 1919.1 1884.3
Goal or limit
Total CHO (g) N-3 ALA(g) N-6 LA Fiber (g) VIT E (mg) Ca (mg) Mg (mg) Zn (mg) Se (mg) CHIA Na (mg) CON K (mg) RDA/AI
0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 Percentage of Goal or Limit
Figure 5. Nutrient mean intakes from nine 24-hour food records in CHIA and CON diets as a percentage of goal or limit. Values based on recommended dietary allowance (RDA) or adequate intake (AI). 33, 48, 54
Dietary Displacement
33 Table 12 represents estimates of percentage displacement of 20 selected nutrients after 8-weeks supplementation with chia seeds. The third column presents the composition of the chia supplement, based on mean values of the average amount (~41.3 g) consumed by CHIA.
Percentages greater than 100 indicate total displacement of the nutrient; “nutrient
(i) from chia seeds has more than replaced i from the supplemented diet, lessening total i intake in the habitual diet” 13. Total energy, CHO, and PRO were completely displaced with approximate percentages of 114, 130, and 229, respectively (Table 12). FAT on the other hand, was 1/3 displaced. Sugar was also completely displaced with a displacement percentage of ~2131%. Nutrients with partial displacements (0-100%) include SFA,
PUFA, n-3 FA, n-3 ALA and fiber. However, MUFA and n-6 LA were negatively displaced, (-26% and -4%, respectively) indicating that non-chia seed foods in CHIA supplied more of these nutrients compared with CON, see figure 3.
Displacement percentage calculations further revealed complete displacement of micronutrients such as Se (107%), Na+ (974%), and K+ (121%). Others, including Mg2+,
Ca2+, and Zn experienced partial displacements ranging from 43-71%. On the other hand, a negative computed displacement occurred for VIT E, see table 12.
34 Table 12. Displacement of select nutrients after an 8-week supplementation with ~41 g chia seeds: Means of nine 24-hour food records.
Nutrient Habitual Habitual Chia Absolute % Displacement (CON) + Chia Supplement (D) (CHIA)
H C S S+H-C D/S*100 SEM Macronutrients And Energy Energy (kcal) 1727.9 1699.1 201.0 228.8 113.8 105.3 Total FAT (g) 72.5 80.5 12.7 4.7 37.0 6.20 Total CHO (g) 193.5 188.3 17.4 22.6 129.9 11.8 Total PRO (g) 71.9 63.1 6.80 15.6 228.7 4.40 Lipids SFA(g) 23.8 24.1 1.60 1.30 80.8 2.400 MUFA (g) 24.6 25.8 1.00 -0.20 -25.7 2.3 PUFA (g) 17.9 24.2 9.80 3.50 35.6 1.80 N-3 FA (g) 2.00 6.70 7.40 2.70 36.2 0.70 CLA (g) 0.10 1.30 0.00 -1.20 0.00 0.60 N-3 ALA(g) 1.6 6.6 7.4 2.4 32.2 0.70 N-6 LA (g) 14.6 17.1 2.40 -0.10 -3.6 1.4 Carbohydrate Sugar (g) 61.7 53.9 0.40 8.20 2131 4.60 Fiber Total Dietary Fiber 15.5 25.8 14.2 3.90 27.6 2.20 (g) Vitamin Vitamin E (mg) 8.20 8.50 0.20 -0.10 -44.9 0.70 Minerals Calcium (mg) 690 765 261 186 71.1 43.9 Magnesium (mg) 224 316 161 69.5 43.2 21.6 Zinc (mg) 7.80 8.80 1.90 0.90 47.2 0.50 Selenium (mg) 109 107 22.8 24.3 107 7.20 Sodium (mg) 2903 2842 7.00 68.2 974 182 Potassium (mg) 1919 1884 168 203 121 161
35 CHAPTER FIVE
Discussion
The aim of the present study was to determine the effect of chia seed supplementation on dietary displacement in healthy, overweight and obese, free-living college-aged females. Although insignificant values in dietary composition existed in most nutrients except for n-3 FA, n-3 ALA, total dietary fiber, and Mg2+, each analysis discussed was compared to literature with regard to disease prevention to explore potential for future studies with a larger sample size. Despite the insignificance of the results, values for dietary displacement and its associations with improving dietary quality were found to be congruent with existing literature.
Dietary Composition
Results from 24-hour food records indicate that supplementing the diet with a daily intake of chia seeds can lead to improved dietary quality. Compared with CON, participants consuming their habitual diet + chia seeds (CHIA) reported significantly higher intakes of total dietary fiber, n-3 FA, n-3 ALA, and Mg2+.
Studies suggest that increases in PUFA and MUFA may help reduce blood cholesterol levels and its associated diseases 27,28,29,30,31,32 (Table 7). However, these studies also support a decreased intake in SFA to promote decreased disease risk such as coronary heart disease (CHD). In the present study, compared with CON, CHIA showed significant increases in unsaturated fatty acid intake but non-significant decreases in saturated fatty acid (SFA) and cholesterol intake. Most of the literature supporting higher intakes of PUFA and MUFA in prevention of chronic disease included a large sample size, middle-aged adults, and a longer intervention period 11,58,59. This experiment was
36 specified for an understudied population of healthy, overweight and obese, college females, which may explain the lack of decrease in SFA and cholesterol intake. Our sample size (n =15) was small and intervention period (8 weeks) short, in comparison to like studies with an average sample size of ~130 and intervention period of ~39.2 weeks
11, 13, 14, 57, 58, 59. Another explanation may be related to the fact that college students experience bouts of high stress during midterms and finals week, thus contributing to unstructured eating patterns and consumption of convenience foods, which are high in
SFA.
US adults most often do not consume the adequate intake (AI) for n-3 ALA (1.1 g/day for women) but exceed that for n-6 LA (12 g/day for women) 33. The past few decades have demonstrated continuous increases n-6 PUFA and n-3 PUFA ratios (~15:1) along with a rise in chronic inflammatory 60. Optimal n-6:n-3 ratios range from 1-4:1 60.
However, research has identified the opposite effect with high n-3 PUFA to n-6 PUFA ratios because of anti-inflammatory effects from n-3 PUFAs 60. Thus, high intakes of n-3
PUFA are promoted while n-6 LA are discouraged due to its proinflammatory effects, which may contribute to non-alcoholic fatty liver disease, obesity, CVD, and inflammatory bowel disease 60 (Table 7). Our study determined that before the intervention period, both CON and CHIA consumed ~15.3 g/day of n-6 LA and ~1.75 g/day of n-3 ALA a ratio of approximately 7.5:1. Post study, CHIA consumed ~14 g/day n-6 LA and ~9 g/day n-3 ALA (1.5:1) while CON consumed ~19 g/day n-6 LA and ~2 g/day n-3 ALA (9.5:1) (Table 11). Unlike the US average population, both CON and
CHIA exceeded the AI for n-3 ALA before and after the intervention (Table 10).
Although insignificant, CHIA exhibited decreases in n-6 LA intakes while CON
37 displayed increases, post study (Figure 5). Evidence shows that chia seed supplementation assists in reaching an optimal n-6:n-3 ratio, congruent with decreases in chronic inflammatory disease rates.
Studies have determined that increased intakes of dietary fiber may reduce CVD rates and increase insulin sensitivity 36,37,40. Literature reveals that most US adults fail to meet the dietary reference intake (DRI) for fiber (25 g/day for women) 33. Post study,
CHIA exceeded the AI for fiber (~29.6 g/day) while CON fell short (~17.4 g/day) (Table
10). The present study provides evidence that daily supplementation of ~41 g chia seeds increases total dietary fiber intake in support of the AI for fiber (Table 11 and Figure 5).
Vitamin E is a fat-soluble antioxidant known to inhibit cell damage and promote
CVD health as well as other diseases such as cancer 45,46,47. The RDA for VIT E is 15 mg/day, which most healthy adults achieve from consuming their habitual diets 48 (Table
11). Baseline data from the current study revealed that participants consume approximately 8.2 mg/day of alpha-tocopherol (α-tocopherol), the most abundant compound found in VIT E (Table 10). Post study, CHIA consumed an average of ~8.1 mg/day and CON consumed ~9.1 mg/day of the vitamin, amounts below the RDA for α tocopherol. Overall, the decrease in consumption of α-tocopherol for CHIA and increase for CON was insignificant. In a study conducted by Jaceldo-Siegl et al., 2004, results from their almond supplementation study revealed a significant increase (p<0.05) in α tocopherol when participants switched from the habitual diet to the almond supplemented diet (habitual diet + 52 g of almonds). It must be noted that their study was a crossover design with a 6-month intervention period 13. Pearson et al., 2017, conducted a shorter
(12-week) randomized controlled, parallel study which identifies better with the present
38 one. However, they too found a significantly higher intake (p<0.05) of VIT E between the control (habitual diet) and intervention (habitual diet + 42 g hazelnut supplement) groups 11. There are a few possible explanations for the lack of significance seen in our study. First, the substantial differences in milligram (mg) amounts of α-tocopherol in chia seeds (.207 mg per ~ 41 g chia) compared with almonds (13.5 mg per 52 g almonds) and hazelnuts (7.31 mg per 42 g hazelnuts) 15. Second, a small sample size (n=15) for the chia study compared with n=81 and n=102 for the almond and hazelnut studies, respectively
11, 13. Third, the sample specificity for the present study was limited to overweight/obese college females aged 18-45 years in comparison with the almond and hazelnut studies, adults aged 25-70 years and non-obese adults aged 18-65 years, respectively 11,13.
Chia seeds are rich in minerals including potassium (K+), magnesium (Mg2+), and calcium (Ca2+). The DRIs for K+, Mg2+, and Ca2+ for women ages 19-30 years are 4700 mg/day; 310-320 mg/day; and 1000 mg/day, respectively 54. Minerals may play protective roles against type 2 diabetes and other diet-related diseases (Table 7) 52.
Jaceldo-Siegl et al., 2004, reported a significant increase in copper (Cu) and magnesium
(Mg2+) in a secondary analysis of adults (n=81) who consumed their habitual diets for six months and then added ~52 g/day of almonds for another six months 13. Similarly, results of the current study revealed a significant increase in Mg2+ (Cu was not pre-selected in the analysis due to miniscule amounts contained in chia). Post study, CHIA met the RDA for Mg2+ (~366.4 mg/day) while CON did not (~254.9 mg/day), see figure 5. Alshaeri et al., 2015, also reported significantly higher intakes of Mg2+ as well as Ca2+ and K+ in the intervention group (n=88) receiving 120 g/day of California mission figs for five weeks.
Chia seeds are higher in Mg2+and Ca2+ but lower in K+ than California mission figs 57.
39 Therefore, it would be appropriate to assume a similar result from chia seed supplementation. However, unlike Alshaeri et al.’s study, ours was not a cross-over design and only half of our participants experienced the intervention (n=8), thus contributing to a difference in statistical analysis. In addition, Alshaeri et al. posed no limitations on how the figs were to be consumed, while our participants were asked to take the chia seeds in water 57.
Dietary Displacement
Results of the present study revealed that chia seed supplementation promotes displacement of nutrients congruent with dietary recommendations for the prevention of
CVD and chronic diseases 48. According to our calculations, all variables displayed a positive displacement percentage except for MUFA, n-6 LA, and VIT E. Many, on the other hand, were completely displaced (>100%), including total energy (114%), CHO
(130%), PRO (229%), sugar (2131%), Zn (107%), Na+ (974%), and K+ (121%).
Our calculations of displacement percentages revealed similar results with like studies 11, 13, 57, 58, 59 which found positive displacement percentages for total energy, macronutrients, and micronutrients. Most nut supplementation studies report partial displacements ranging from 50 and 70% for total energy 11. This means that nuts in the supplemented diet (habitual + nut supplement) induced a favorable change that lessened total energy intake from the habitual diet, being replaced instead by the nut supplement.
We found complete displacement for total energy; thus, energy from chia seeds has more than replaced energy from the supplemented diet, lessening total energy intake in the habitual diet. The same observation can be applied to CHO, PRO, sugar, Se, Na+, and K+.
Additionally, we calculated negative displacement percentages for total MUFA
40 (-.26%), n-6 LA (-4%), and VIT E (-45%). Therefore, non-chia seed foods in the supplemented diet contributed more MUFA, n-6 LA, and VIT E than the actual chia seed supplement. Similar studies have reported partial or complete displacements for these nutrients 11, 13, 57, 58, 59. There a few explanations for the lack of similarity in ours. First, chia seed supplementation may have induced an increase in consumption of foods containing high amounts of MUFA, n-6 LA, and VIT E. Second, compared with other nut supplementation studies, there are nearly insignificant amounts of MUFA (.95 g), n-6 LA
(.24 mg), and VIT E (.21 mg) contained in 41 g chia seeds 15. For example, in the almond study, 52 g almonds contained approximately 15 g MUFA, 6 g n-6 LA, and 13.5 mg VIT
E 13. These values far outweigh amounts per nutrient contained in chia seeds. Third, perhaps the way in which overweight/obese individuals displace nutrients differs from those with a normal BMI. More studies should be conducted to determine the differences in displacement of nutrients between individuals with a normal BMI (18.5-24.9 kg/m2) and a BMI greater than 25 kg/m2.
In the current study, the variables with partial displacement percentages include
FAT (37%), SFA (81%), PUFA (36%) n-3 FA (36%), n-3 ALA (32%), fiber (28%), Ca2+
(71%), Mg2+ (43%), and Zn (47%). Therefore, the chia seed supplement is responsible for the displacement of these nutrients in the habitual diet. Based on the evidence of this study, chia seed supplementation may promote CVD health by reducing intake of foods high in SFA as well as increasing intakes of dietary fiber and PUFA (n-3 FA and n-3
ALA) 42,55. Additionally, displacements in micronutrients is congruent with existing literature; thus, meets the dietary recommendations to prevent CVD and chronic disease
48.
41 Limitations
Several limitations exist in the present study. The published displacement studies reviewed here have an average sample size of ~130 participants and intervention period of ~39.2 weeks. With our sample population being limited to healthy, overweight/obese college females from Cal Poly Pomona, we were only able to recruit a total of 40 females, of which 30 qualified. Additionally, there were many variables that kept qualified participants from completing the 10-week study. Many reported disliking the taste and texture of chia seeds. Initially, participants were asked to consume 20% of their calculated total energy intake in chia seeds; however, four participants complained about gastrointestinal discomfort and dropped out of the study. Therefore, the quantity of the chia seed supplement was reduced to 10%. With this new amount, dropout rates decreased from 80% to 10%. In addition, participants had a difficult time completing the study because of scheduling conflicts. Our quarters last 11 weeks and if participants joined during the 2nd and 3rd week, there was a higher dropout rate.
The “gold standard” to any clinical experiment is a randomized, placebo- controlled, clinical trial. Another limitation to our study was the absence of a placebo group. During the planning stages of this study, all researchers were in favor of a placebo group; however, published chia seed studies determined alterations in absorption of the supplement upon milling the seeds 19,20. Since we were examining the effects of chia seed supplementation on dietary quality and displacement, we chose to keep the seed in its whole form.
42 Furthermore, college students are known to have unstructured eating patterns related to the high demands of multiple classes, stressful life events, and lack of time/resources to prepare meals 61.
Other limitations exist in the gathering of 24-hour dietary records from participants. Similar displacement studies use a different method, 24-hour dietary recalls.
Although this is more time-consuming than asking for self-reported diet records; it is accurate and eliminates over/under-reporting of food.
Lastly, this study involved other researchers who shared responsibility in collecting the 24-hour dietary records. Participants were not given a single method for submitting their records; therefore, they submitted records to any researcher via email, text, or in person. This opened opportunities for misplacing documents and delaying data entry. One researcher should have been given sole responsibility for collecting the dietary records or a drop box should have been established for uploading said documents.
Practical Application and Future Research
Since this was an exploratory pilot study, additional research is necessary. To correct for the identified limitations of the present study, further chia seed supplementation studies using healthy, overweight/obese, college-aged males and females need to be conducted with a larger sample size and longer intervention period, at least 12-weeks. Chia seeds should be grounded and a placebo group such as ground barley, should be utilized to reduce results left to chance. There are 10 g of dietary fiber and 0.8 g of PUFA per 100 g ground barley, placing barley as a potential contender of chia 62. Similar studies must continue recruiting from all majors to obtain an accurate representation of the college-aged population. Recruitment should be conducted at least
43 six weeks prior to the beginning of a new quarter to establish commitment and increase retention.
Future studies should also collect 24-hour dietary recalls instead of self-reported dietary records. This can be accomplished by calling participants for a previous day’s food record at random times during the study. Should future studies have multiple researchers collecting data such as food records, a digital drop box may need to be created to avoid misplacing data or delaying data entry. A suggestion would be to design a thread on Blackboard, a universal tool which allows college students to easily upload documents and communicate with one another.
Finally, expanding the nutrient analysis of chia seeds will help determine if supplementation induces a favorable change in the diet in support of cardiovascular health. An example would be polyphenols, powerful antioxidants known for being a key player in the prevention of cancer, CVD, and other degenerative diseases caused by oxidative stress 63. Many polyphenol molecules are found in edible plants like chia and are consumed for protection from ultraviolet radiation and pathogens. Additionally, they assist in enzymatic activity within cells, which are important for metabolic processes 64.
44 CHAPTER SIX
Conclusion
The present study identified that daily supplementation of chia seeds (10% of total energy intake) in apparently healthy, overweight/obese women (18-45 years) can induce positive nutrient changes to the habitual diet. Specifically, post study results revealed that participants in the intervention group (CHIA) better met the dietary reference intakes in support of chronic disease prevention than the control group (CON). Arithmetic means of
135 24-hour food records showed that CHIA had significantly higher intakes (p < 0.05) in n-3 fatty acid, n-3 alpha linolenic acid, fiber, and magnesium, compared with CON.
Results further indicate dietary displacement of nutrients congruent with existing literature, i.e. all macronutrients as well as total dietary fiber, calcium, magnesium, zinc, selenium, sodium, and potassium. Displacement of these nutrients are known for their role in reducing the risk of diet-related diseases such as cardiovascular disease, type 2 diabetes, and some cancers. Additional research is necessary to affirm the results of this study and to further examine the effects of chia seed supplementation on overall diet in relation to chronic disease risk in overweight/obese women.
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revision 2006: a scientific statement from the american heart association
nutrition committee. Circulation, 114, 82–96. Retrieved from:
https://doi.org/10.1161/circulationaha.106.176158
51. Sesso, H. D., Buring, J. E., Christen, W. G., Kurth, T., Belanger, C., MacFadyen,
J.,…Gaziano, M. J. (2008). Vitamins E and C in the prevention of
cardiovascular disease in men: the physicians’ health study ii randomized
controlled trial. JAMA, 300, 18, 2123-2133.doi:10.1001/jama.2008.600
52. Dong, J., Xun, P., He, K., Qin, L. (2011). Magnesium intake and risk of type 2
diabetes: meta-analysis of prospective cohort studies. Diabetes Care, 34,
9, 2116–2122. Retrieved from: https://doi.org/10.2337/dc11-0518
53. Karppanen, H., Karppanen, P., Mervaala, E. (2005). Why and how to implement
sodium, potassium, calcium, and magnesium changes in food items and
diets? Journal of Human Hypertension, 19, 3, S10–S19.
doi:10.1038/sj.jhh.1001955
54. Institute of Medicine. Panel on Dietary Reference Intakes for Electrolytes Water.
54 (2004). DRI, dietary reference intakes for water, potassium, sodium,
chloride, and sulfate. Washington, D.C.: National Academies Press.
55. Iso, H., Stampfer, M. J., Manson, J. E., Rexrode, K., Hennekens, C. H, Colditz, G.
A.,…Willett, W. C. (1999). Prospective study of calcium, potassium, and
magnesium intake and risk of stroke in women. Stroke, 30, 9, 1772- 1779.
Retrieved from: https://doi.org/10.1161/01.STR.30.9.1772
56. Ros, E. (2010). Health Benefits of Nut Consumption. Nutrients, 2, 7, 652-682.
doi10.1007/s11883-010-0132-5
57. Alshaeri, H. K., Natto, Z. S., Tonstad, S., Haddad, E., & Jaceldo-Siegl, K. (2015).
Effect of dried California mission figs on mineral status and food
replacement. Public Health Nutrition, 18, 6, 1135-1140.
doi:10.1017/S1368980014001566
58. Fraser, G. E., Bennett, H. W., Jaceldo, K. B., Sabaté, J. (2002). Effect on body
weight of a free 76 kilojoule (320 calorie) daily supplement of almonds for
six months. Journal of the American College of Nutrition, 21, 3, 275-283.
Retrieved from: https://doi.org/10.1080/07315724.2002.10719221
59. Bitok, E., Jaceldo-Siegl, K., Rajaram, S., Serra-Mir, M., Roth, I., Feitas-Simoes,
T.,…Sabaté, J. (2017). Favourable nutrient intake and displacement with
long-term walnut supplementation among elderly: results of a randomised
trial. British Journal of Nutrition, 118, 201-209.
doi:10.1017/S0007114517001957
60. Patterson, E., Wall, R., Fitzgerald, G.F., Ross, R.P., Stanton, C. (2011). Health
55 implications of high dietary omega-6 polyunsaturated fatty acids. Journal
of Nutrition and Metabolism, 2012, 1-16. doi:10.1155/2012/539426
61. Deshpanda, S., Basil, M. D., Basil, D. Z. (2009). Factors influencing healthy
eating habits among college students: An application of the health belief
model. Health Marketing Quarterly, 25, 2, 145-164.
doi:10.1080/07359680802619834
62. Nutrition Value. (2018). Barley flour or meal. Retrieved from
https://www.nutritionvalue.org/Barley_flour_or_meal_nutritional_value.ht
ml
63. Manach, C., Scalbert, A., Morand, C., Remesy, C., Jimenez, L. (2004).
Polyphenols: food sources and bioavailability. American Journal of
Clinical Nutrition, 79, 5, 727. Retrieved from:
https://doi.org/10.1093/ajcn/79.5.727
64. Middleton, E., Kandaswami, C., Theoharides, T. C. (2000). The effects of plant
flavonoids on mammalian cells: implications for inflammation, heart
disease, and cancer. Pharmacological Reviews, 52, 4, 673–751.
56 APPENDIX A
Institutional Review Board Approval Memorandum
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58 APPENDIX B
Study Flyer
59 APPENDIX C
Chia Seed Study Initial Screening Questionnaire California State Polytechnic University, Pomona IRB #16-188
CHIA SEEDS STUDY INITIAL SCREENING QUESTIONNAIRE
California State Polytechnic University, Pomona IRB # 16-188
Date: ______Study ID #: ______
Thank you for taking the time to fill out this questionnaire. Please be sure to read each question carefully, and then check the appropriate box. All information you provide on this form will be kept confidential.
Preferred method of contact: ☐Telephone ☐E-Mail
1. What is your age? ____ years.
2. What is your weight? ____ pounds or ____ kilograms.
3. Have you experienced any weight changes in the last year?
☐No ☐Yes: ____ pounds gained or ____ pounds lost over a period of ____ months.
4. Do you currently have an exercise plan? If you answer “No”, please skip to question 6.
☐No
☐Yes, I exercise ____ day(s)/ week and ______hour(s)/ day using the following activities:
______.
5. How long have you been following this exercise plan?
____ Days ____ Months ____ Years
6. What is your height? ____ inches or ____ centimeters.
7. Do you have any current medical problems (ex. diabetes, high blood pressure)?
60 ☐No ☐Yes, I have the following: ______.
8. Do you have any gastrointestinal problems (ex. IBS, ulcerative colitis)?
☐No ☐Yes, I have the following: ______.
9. Are you currently taking any medications (prescription or over the counter)?
☐No ☐Yes, I am taking: ______.
10. How often do you take the following medications?
Types of Medication Never Daily Weekly Monthly Yearly
Aspirin ☐ ☐ ☐ ☐ ☐
Tylenol (Acetominophen) ☐ ☐ ☐ ☐ ☐
☐ Advil (Ibuprofen) ☐ ☐ ☐ ☐
Naprosin/Naproxin/Aleve ☐ ☐ ☐ ☐ ☐
☐ Steroids/Steroidal drugs ☐ ☐ ☐ ☐
Hormone supplements ☐ ☐ ☐ ☐ ☐
☐ Fiber supplements ☐ ☐ ☐ ☐
Statins ☐ ☐ ☐ ☐ ☐
11. Are you currently taking any supplements (ex. vitamins, plant sterols, fish oil, fiber)?
61 ☐No ☐Yes, I am taking: ______.
12. Do you have high cholesterol?
☐No ☐Yes, my total blood cholesterol is ____ mg/dL. ☐I’m not sure, but I think so. ☐I don’t know.
13. Do you have high blood sugar?
☐No ☐Yes, my fasting blood sugar is ____ mg/dL. ☐I’m not sure, but I think so. ☐I don’t know.
14. Are you a(n):
☐Omnivore
☐Vegetarian ☐Vegan/Strict Vegetarian
15. How long have you followed that diet?
____ Days ____ Months ____ Years
16. Do you have any food allergies (ex. peanuts, seeds, shellfish, dairy)?
☐No ☐Yes, I have the following allergies: ______.
17. Are you allergic to nuts or seeds?
☐No ☐Yes
18. How often do you eat Chia seeds?
☐Never ☐Daily ☐Weekly ☐Monthly ☐Yearly
19. Do you like Chia seeds?
☐Yes ☐No ☐I am indifferent. ☐I don't know what it is.
20. How often do you eat any kinds of nuts or seeds?
☐Never ☐Daily ☐Weekly ☐Monthly ☐Yearly
21. Are you willing to come to campus once a week to pick up your chia seeds?
☐Yes ☐No
62 22. Would you be willing not to eat any other nuts or seeds during this study?
☐Yes ☐No
23. Do you have any pins or metal objects in your body (other than piercing that can be removed?
☐Yes ☐No
24. Where did you find out about this study?
☐E-Mail ☐Flyer ☐Friend or coworker ☐Professor
25. Have you ever been diagnosed with any eating disorders?
☐Yes ☐No
63 APPENDIX D
California State Polytechnic University, Pomona Informed Consent Form for Research Involving Human Subjects Informed Consent Form
You are being invited to participate in a research study, which the Cal Poly Pomona Institutional Review Board (IRB) has reviewed and approved for conduct by the investigators named here. This form is designed to provide you - as a human subject/participant - with information about this study. The investigator or his/her representative will describe this study to you and answer any of your questions. You are entitled to an Experimental Research Subject’s Bill of Rights and a copy of this form. If you have any questions about your rights as a subject or participant, complaints about the informed consent process of this research study, or experience an adverse event (something goes wrong), please contact the Research Compliance Office within Cal Poly Pomona’s Office of Research at 909.592-7823. More information is available at the IRB website, http://www.cpp.edu/~research/irb/index.shtml
Chia Feeding Study Primary Investigator: Desiree Vera Faculty Advisor: Dr. Bonny Burns-Whitmore, R.D. CPP IRB protocol # 16-188
VOLUNTARY STATUS: You have met the requirements for enrollment as a volunteer in a research study conducted by the researchers listed above. You are now being invited to participate in this study. Before you can make your decision, you will need to know what the study is about, the possible risks and benefits of being in this study, and what you will have to do in this study. The research team will discuss with you the details, and they will provide you this consent form to read. You may also decide to discuss it with your family and/or friends. Some of the language may be difficult to understand and if this is the case, please ask the researcher and/or the research team for an explanation. If you decide to participate, you will be asked to sign this form. Your participation is voluntary. You may withdraw any time without penalty and there will be no loss of any benefits to which you are entitled.
PURPOSE: The purpose of this study is to examine the effects of chia seed consumption on body composition, fasting blood glucose and dietary profile on females with a BMI greater than 26.
PROCEDURES: This study will be an 8-week chia seed intervention study with two groups (chia seed added-20% of kcals and a no-chia control diet). In the beginning of the study, you will be assigned to one of two groups, either consuming chia seeds for eight weeks or not consuming chia seeds for eight weeks. After weeks 4 and 8, you will be asked to return to the laboratory to conduct the same data collection procedures as in the beginning of the study.
64 Week Data Collection Treatment Location 0 (baseline data Tanita scale for body No treatment 2-110 collection) composition analysis; fasting finger prick for glucose, 3-day diet journal, electronic questionnaires, urine sample 1-8 Satiety Chia Seed or 2-110 questionnaires will Control be administered randomly to assess satiety in both the control and treatment groups. Distribution of chia seeds to the treatment group will occur each week. Week 4 Midpoint data 2-110 collection: Tanita scale for body composition analysis; fasting finger prick for glucose, 3-day diet journal, electronic questionnaires, urine sample 9 Tanita scale for body 2-110 composition analysis; fasting finger prick for glucose, 3-day diet journal, electronic questionnaires, urine sample
The following is a detailed description of each method of data collection.
1. After signing the consent form, you will be asked to fill out a brief health- screening and qualification questionnaire. i. Examples of questions will be: Are you currently suffering from or have you ever been diagnosed with a chronic disease (heart attack, cancer, diabetes, renal failure, asthma)? Do you eat chia seeds on a regular basis? How much chia seeds do you add to your food? ii. For important safety reasons, you will be asked to answer each and every question on the health-screening questionnaire prior to
65 qualification for the study; especially the seeds-allergy and medication log. 2. You will be educated / instructed about the background diet and exercise plan that you must maintain for the duration of the study, by a registered dietitian. The background diet / habitual diet is your normal diet, but free from any food that has high level of omega-3 fatty acid like walnuts, pistachios, chia seeds, flax seeds, omega-3 enriched eggs, fish oil, or any omega-3 fatty acid, or fiber supplements. This instruction will require you to meet with the study personnel a total of 10 study visits. 3. This study is composed of two distinct experimental treatments (eight weeks total): i. The chia seed-free diet, in which you must maintain just the background diet. ii. The chia seed-added diet, in which you must consume 20% of your calories of chia seeds per day in addition to the background diet. iii. We will ask that you meet with the study personnel every week during the chia seed treatment to pick up your weekly allotment of seeds. You will also may be randomly asked to complete a Satiety questionnaires to assess satiety. 4. Before you begin the 8-week experimental phase, you will complete a one-week “lead-in” period in which the background diet will be consumed and we will ask you to complete a 3-day food record. 5. Your body composition will be measured at the beginning and end of each distinct treatment using a Tanita brand bio-impedance analyzer. The body composition measurements will require you to remove your shoes and socks, and stand on a platform while the machine analyzes body composition. The analysis will take approximately 5-10 minutes. This measurement will be taken twice during each treatment.
6. Your blood pressure will be measured at these same intervals using an Omicron blood pressure cuff. You will be asked to sit down for 15 minutes before we can measure your blood pressure. The blood pressure measurement will require you to allow us to measure your blood pressure with a wrist cuff that will expand and then deflate, revealing your blood pressure and heart rate. You will be asked to sit down and have your blood pressure measured using a blood pressure cuff around your left wrist. This process will take about 15-20 minutes. This measurement will be taken twice during each treatment.
7. At three random points during each of the diet period you will be asked to fill out a 3-day food record. You do not need to be on-site to complete this task.
8. You will be asked to rate your hunger using a validated rating scale (1-10) and questionnaire next to each snack or meal on your three required 3-day food records. You can turn in 3 day food record and questionnaire at the next nutrition lab visit.
9. Your waist circumference will be measured using a flexible measuring tape between the middle of the bottom rib (close to your belly button) and iliac crest (top of the hip bone) and recorded to the nearest 0.1 cm. Hip circumference will be measured using a flexible
66 measuring tape around the largest part of the hips (i.e. buttocks) and recorded to the nearest 0.1 cm. It will take no longer than 5 minutes to do both measurements. This measurement will be taken twice during each treatment. 10. Your height will be measured using a stadiometer and recorded to the nearest 0.1 cm. This will take no longer than 5 minutes and will only be done once at the beginning of the study 11. Body Serotonin Levels: You will be asked to provide a urine sample at 0, 4, and 8 weeks of the chia study. The urine sample will only be used to analyze body serotonin levels. Collection starts at baseline on the day of the fingerpick test. The sample is a single void sample, collected into a sample cup provided on site. 12. You will be asked to complete an electronic survey that contains multiple questionnaires that include questions pertaining to: pain, mood, sleep quality, and physical activity. These questionnaires will be distributed weeks 0, 4, and 8.
Please review the following Inclusion Criteria:
INCLUSION CRITERIA You are qualified to participate in this study if you: - are a female. - are between the ages of 18 and 45. - are not averse to consuming chia seeds on a regular basis (at least six weeks). - have not taken any medication for any chronic disease (heart, diabetes, cancer) for twelve weeks. - have not taken any steroid or hormone medication in the last eight weeks. - are free of any other chronic diseases. - do not consume excess amounts of nuts and seeds. - do not consume alcohol on a regular basis. - are not currently on a diet plan. - are not pregnant or plan to become pregnant.
Do you meet all the criteria listed above? YES ______NO ______
Please review the following Exclusion Criteria:
EXCLUSION CRITERIA You are NOT qualified to participate in this study if you: - are a child, teenager, woman, or male younger than 18 or older than 45. - eat large quantities of chia seeds on a regular basis. - are taking any steroid or hormone medication (other than birth control pills). - are taking laxatives or fiber containing supplements on a regular basis. - are pregnant or become pregnant. - are diagnosed with any chronic diseases. - are currently on a diet plan. - have a known allergy to seeds.
67 - consume excess amounts of seeds or nuts. - consume alcohol on a regular basis. - have a pacemaker or metal pins or plates in the body - have a compromised immune system -have any blood disorders
Do you meet any of the criteria listed above? YES ______NO ______
This study will be conducted from the Cal Poly Pomona campus. You will be required to come to campus each week (place to be determined as per your schedule) to pick up your allotment of chia seeds.
COMMITMENT AND COMPENSATION: Your total participation in the study will take 10 weeks with three 1 hour sessions. You will not receive financial compensation for participation in the study, however, you will receive your results to review with your primary physician at the completion of the research study.
POSSIBLE RISKS: You may experience mild gastrointestinal discomfort such as bloatedness or flatulence, when consuming the amount of dietary fiber from chia seeds that account for 20% of your daily calories for a period of six weeks. You may not know whether you have allergic reaction to consuming chia seeds prior to the study. Some possible symptoms of an allergic reaction or intolerance include: scratchy throat, difficulty breathing and/or swallowing, skin rash, blurred vision, persistent diarrhea, vomiting, and excessive gastrointestinal discomfort. There may be a potential risk for personal identification, as you will provide demographic information such as age, height and weight. We will ensure maintaining confidentiality during the study by assigning you an study identification number. You may feel inconvenience during the course of the study, as you will have to check in with PIs once every week during the treatment periods. Feel free to discuss potential schedule conflicts or concerns with PIs. You may experience some discomfort during the finger prick process and may have slight bruising at the area of the finger prick. The research team will try to minimize any of these discomforts.
If you experience any of the above mentioned symptoms, intolerances, stress or discomfort in connection with this study, please do not hesitate to get in touch with the Principal Investigators Desiree Vera at (909) 762- 4075, Dr. Burns-Whitmore, R.D. at (909) 869-3793, or your physician to discuss options.
If more severe and or intolerable symptoms are experienced, please contact your physician, and/or the emergency room at the nearest hospital, or 911. Afterwards, please contact the study personnel (Desiree Vera or Dr. Burns-Whitmore) to report an adverse effect. All cost and time associated with a reaction to the chia or blood draws, or any necessary medical tests, transportation, expenses, etc. are the sole responsibility of the study participant and the participant should strongly consider having insurance to pay for such care. If your blood values are found to be not within the normal range, we will ask
68 you to have the values re-checked with your physician.
It is possible that you might experience a weight gain, however, a number of published scientific studies show that adding 20% of your required calories in the form of seeds will not cause significant weight gain.
POSSIBLE BENEFITS: You will receive chia seeds for six weeks (whether you are on the chia seeds group or not). You will be able to understand and apply current Dietary Guideline for Americans for healthier food choices and lifestyle. You will not receive any type of monetary compensation. You will also have access to the results of your blood test, body composition as well as other measurements once the entire study has been completed.
PARTICIPATION IN THE STUDY: Your participation in this study is voluntary, and declining to participate will involve no penalty or loss of benefits to which you are otherwise entitled, and you may discontinue participation at any time without penalty.
COMPENSATION FOR INJURY: There will be no compensation for lost wages, lost time, allergic reactions, adverse reactions, or pain. Payment for care resulting from adverse reactions is the sole responsibility of the participant and they should consider having medical insurance to pay for such care. If your test results are abnormal, you may need follow-up medical evaluation and treatment. Payment for care resulting from abnormal test results is the sole responsibility of the participant and you should consider having medical insurance to pay for such care.
CONFIDENTIALITY: The investigator and staff involved with the study will not reveal the personal information which they collect about you. Any information that is obtained in connection with this study -- and that can be identified with you -- will remain private and will be disclosed only with your permission or as required by law. Your identity will be kept strictly confidential by removing your name and all identifiers. Do be aware, that the results, in either an anonymous or a summarized format, will likely be published or presented at conferences.
STATEMENT OF CONSENT: I claim that I am 18 years or older and I consent to participate in the study. I understand that my participation in this study is entirely voluntary and that I may refuse to participate or withdraw from the study at any time without penalty. I have received a copy of this consent form for my records.
______Printed name of participant Signature Date
______Signature of primary investigator Date:
69 IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please feel free to contact the following individuals:
Desiree L. Vera, (909) 762-4075, [email protected] Dr. Bonny Burns-Whitmore, R.D., Ph.D., (909) 869-3793, [email protected]
EXPERIMENTAL SUBJECT’S BILL OF RIGHTS – MEDICAL RESEARCH
California Assembly Bill 1752: Human Experimentation, which became effective January 1, 1979, provides that all investigators doing a "medical experiment" must offer their subjects a copy of the "Experimental Subject's Bill of Rights” as included below. A "medical experiment" is defined in the bill as: "The severance or penetration or damaging of tissues of a human subject, or the use of a drug or device as defined in section 26009 or 26010 (of the Health and Safety Code), electromagnetic radiation, heat or cold, or a biological substance or organism, in or upon a human subject in the practice or research of medicine in a manner not reasonably related to maintaining or improving the health of such subject or otherwise directly benefiting such subject."
Any person who is requested to consent to participate as a subject in a research study involving a medical experiment, or who is requested to consent on behalf of another, has the right to: x Be informed of the nature and purpose of the experiment. x Be given an explanation of the procedures to be followed in the medical experiment, and any drug or device to be used. x Be given a description of any attendant discomforts and risks reasonably to be expected from the experiment, if applicable. x Be given an explanation of any benefits to the subject reasonably to be expected from the experiment, if applicable. x Be given a disclosure of any appropriate alternative procedures, drugs, or devices that might be advantageous to the subject, and their relative risks and benefits. x Be informed of the avenues of medical treatment, if any, available to the subject after the experiment if complications should arise. x Be given an opportunity to ask any questions concerning the experiment or other procedures involved. x Be instructed that consent to participate in the medical experiment may be withdrawn at any time, and the subject may discontinue participation in the medical experiment without prejudice. x Be given a copy of a signed and dated written consent form when one is required. x Be given the opportunity to decide to consent or not to consent to a medical
70 experiment without the intervention of any element of force, fraud, deceit, duress, coercion, or undue influence on the subject’s decision.
71 APPENDIX E
24-Hour Dietary Record
The Cal Poly Chia Study
Diet Record Instructions
Directions: Record what you eat and drink on the sheets provided. As you record each food, make careful note of the amount and how it was prepared (fried, baked etc.). Estimate the amount to the nearest weight or fluid ounce, quarter cup, tablespoon, or other common measure. It is suggested to bring a measuring cup with you to meals.
In guessing at the sizes of meat portions, it helps to know that a piece of meat the size of the palm of your hand weighs about 3 or 4 ounces. It also helps to know that a slice of cheese (such as sliced American cheese) or a 1 1/2-inch cube of cheese weighs about 1 ounce. If you are unable to estimate serving sizes, measure out servings the size of a cup, tablespoon, and teaspoon onto a plate or into a bowl to see how they look. You will have to break down mixed dishes to their ingredients (for example: burrito = 10 inch whole wheat tortilla, ¼ cup black beans drained, ¼ cup Spanish rice, 1oz. Monterey jack cheese, 2 tbs. chopped tomatoes, 1 tbs. chopped onion, 1/8 medium avocado sliced).
The closer your approximations, the closer your actual intake will be reflected. Some common errors include using weight ounces instead of fluid ounces. Record the liquids as fluid ounces and the solids as weight oz. It is also very helpful to read the labels of the foods you consume. If you eat name brand foods, please also include the name brand of the food or the restaurant chain name if applicable. Be sure to list the actual amounts of foods eaten (ie. don’t include milk left in your bowl after eating cereal. Only count what you’ve consumed).
Please record any nutrient supplements you take.
Some Common Portion Sizes: http://www.win.niddk.nih.gov/publications/just_enough.htm
Serving Sizes Everyday Objects
1 cup of cereal = a fist
72 1/2 cup of cooked rice, pasta, or potato = 1/2 baseball
1 baked potato = a fist
1 medium fruit = a baseball
1/2 cup of fresh fruit = 1/2 baseball
1 1/2 ounces of low-fat or fat-free cheese = 4 stacked dice
1/2 cup of ice cream = 1/2 baseball
2 tablespoons of peanut butter = a ping-pong ball
73 Food Record #______Date:______ID #:______
Meal (B, L, D) Food/Beverage (Brand) Cooking Method Amount or snack (S)
Supplements Taken Today Brand Amount Taken
74 APPENDIX F
Manuscript Format for The American Journal of Clinical Nutrition
The Effects of Chia Seed Supplementation on Dietary Displacement in
Overweight/Obese Women
Michelle Chon, Desiree Vera, Bonny Burns-Whitmore, DrPH, Edward Jo, PhD,
Golandam Khayef, DrPH
California State Polytechnic, University, Pomona, CA
Corresponding Author:
Name: Michelle Chon
Mailing Address: 2561 E Temple Ave Apt B
West Covina, CA 91792
Telephone: (904) 563-0382
Email: [email protected]
75 ABSTRACT
Purpose: Obesity prevalence trends are continuing to increase as are the number of people acquiring diet-related diseases including cardiovascular disease, type 2 diabetes, and some cancers. A novel approach to weight loss may be improving dietary quality through displacement of nutrientsǤThe current study aimed to assess the effects of chia seed supplementation on dietary displacement in apparently healthy, overweight/obese women. Methods: Following informed consent, participants (n=40; 18-45 years) with a
BMI ≥ 26 kg/m2, were asked to consume their habitual diets along with chia seeds (10% energy) for eight weeks. Their dietary intakes were compared with a similar group of women who did not incorporate chia seeds into their habitual diets (control). A total of nine 24-hour food records per participant (n=15), were assessed. Results: On average, chia seed supplement consumption was 41 g/day or 199 kcal. Compared with the control
(CON), the intervention (CHIA) revealed significantly higher intakes (p < 0.05) in n-3 fatty acid (n-3 FA), n-3 alpha-linolenic acid (n-3 ALA), fiber, and magnesium.
Displacement percentages for total fat, saturated fatty acid, polyunsaturated fatty acid, n
3 FA, n-3 ALA, calcium, magnesium, and zinc ranged from 28-81%; negative displacements occurred for monounsaturated fatty acid, n-6 linoleic acid, and vitamin E.
On the other hand, energy, total carbohydrate, total protein, sugar, selenium, sodium, and potassium were completely displaced (>100%), indicating that the chia seed supplement more than fully displaced these variables in the diet. Conclusion: A daily supplement of chia seeds can induce favorable nutrient changes congruent with the dietary recommendations for prevention of chronic diseases in overweight/obese women.
76 KEY WORDS: CHIA SEED, CHIA SEED SUPPLEMENTATION, OVERWEIGHT,
OBESE, WOMEN, DIET DISPLACEMENT, CHRONIC DISEASE
INTRODUCTION
The World Health Organization (WHO) labeled the obesity global epidemic as
“globesity” because over one-third of adults in the world are overweight/obese 1. They define overweight and obese as a body mass index (BMI) of ≥ 25 kg/m2 and ≥ 30 kg/m2, respectively 2. The BMI US average has steadily increased along with the unadjusted prevalence of obesity, which is 35.2% in US men and 40.5% in US women 3.
Overweight/obesity trends are increasing along with morbidity and mortality rates from diet-related complications. These include metabolic syndrome (MetS), cardiovascular disease (CVD), type 2 diabetes (T2D), respiratory problems, osteoarthritis, inflammation, and some cancers 4. The current leading cause of death worldwide is related to CVD 5.
Obesity is an independent risk factor for CVD and obesity-related conditions leading to
CVD include glucose intolerance, dyslipidemia, hypertension, and inflammation 6.
A high-quality diet has been associated with a decrease in overweight/obesity prevalence in healthy adults and thus, a decrease in diet-related diseases 7. Many overweight/obese women who attempt to improve diet quality through fad diets like the low-fat and low-carbohydrate, complain about their rigidity and restrictive nature. Thus, diet displacement might represent an innovative and more effective approach to achieving a high-quality diet through the supplementation of nutrient dense foods.
Supplementing the diet with nutrient dense foods such as nuts or seeds has been linked with improvements in diet quality through the displacement of nutrients. Current studies have illustrated diet displacement from the supplementation of almonds 8, walnuts
77 9,10, and hazelnuts 11, specifically in healthy populations (BMI 18.5-24.9 kg/m2). Jaceldo-
Siegl defines % displacement as, “an inverse measure of the degree to which a supplemented food induced a change in the content of a particular nutrient in the supplemented diet.” 8. Supplementation of a nutrient dense food like almonds and walnuts induces a positive change in the diet (diet displacement) that relates to improvements in diet quality 8,9. There are studies involved with the supplementation of nuts but not seeds. Seeds like chia are also high in nutrients such as carbohydrates, protein, fiber, and omega-3 polyunsaturated fatty acids (n-3 PUFA).
Salvia hispanica L. or chia, is nutrient dense and is consumed in the diet as an energy source for health-promoting benefits. United States Department of Agriculture
(USDA) reported that 100 grams (g) of dried chia are made up of 42.1% carbohydrate,
16.5% protein, 34.4% dietary fiber, and 30.7% lipid 12.
Studies have shown positive dietary displacement percentages in fiber, unsaturated fat, potassium, and other minerals associated with a decreased risk in overweight/obesity and its related diseases. There are limited displacement studies on an overweight/obese population and fewer on women. Therefore, a novel approach to the obesity epidemic may be from improvements in diet quality through dietary displacement of nutrients by the supplementation of a nutrient dense food such as chia seeds.
The objective of this pilot study is to identify the effects of chia seed supplementation on dietary displacement in healthy, free-living, overweight/obese, college-aged females (18-45 years) during an eight-week intervention period.
METHODS
Experimental Design
78 This was a randomized 2-group, parallel experimental design. The study was conducted in five quarters, with new participants each time (Winter ’17-Winter ‘18). The treatment period lasted eight weeks of which, one of the following conditions were established: 1) habitual diet with added chia seeds (CHIA) or 2) habitual diet without chia seeds (CON). Data were collected during weeks zero, four, and nine. 24-hour dietary records were collected at weeks zero and nine as well as three times at random throughout the treatment period (Figure 1).
Figure 1. Experimental design.
Participants
Forty female students were recruited from Cal Poly Pomona and thirty took part in the study. By the end of the year-long investigation, fifteen were included in the statistical analysis (Figure 2). The mean age was 21.7±1.7 years and 24.3±4.5 and BMI
79 was 28.6±1.6 kg/m2 and 30.9±3.5 for CHIA and CON, respectively (Table 1). Our research sample of college females from CPP, was a convenience sample. Recruitment methods consisted of posted flyers and e-mails to every college in the university as well as professor and peer recruitment. Interested participants were asked to contact one of the principle investigators via phone or email. After the initial contact and prior to participation, volunteers were required to complete a health questionnaire (questions regarding medical and diet history as well as physical activity level). Then, volunteers were asked to provide written informed consent, which described the overview, procedures, inclusion and exclusion criteria, potential risks and benefits, and confidentiality of the study. The primary investigators determined inclusion and exclusion from responses to the health questionnaire and by calculating BMI. Participants were notified if they were a qualified candidate for the study and interested participants were scheduled for their first data collection appointment. CPP is on a quarter system consisting of 10 weeks of lectures and 1 week of finals, so recruitment was timed in accordance with this schedule to increase retention.
Figure 2. Summary of recruitment and enrollment
80 Table 1. Participant’s characteristics at baseline
CHIA (n=8) CON (n=7)
Measure Mean ± SD Mean ± SD Age 21.7 ± 1.7 24.3 ± 4.5 Height (cm) 163.5 ± 6.9 161.4 ± 7.3 Weight (kg) 76.7 ± 9.8 80.7 ± 12.1 BMI (kg/m2) 28.6 ± 1.6 30.9 ± 3.6 The data is expressed as mean ± SD (standard deviation)
Dietary Supplementation Protocol
A Registered Dietitian calculated the daily caloric intake of each participant prior to the baseline data collection using the Harris-Benedict equation. Activity level was accounted for (1.2, 1.375, or 1.55) and multiplied to the daily caloric intake calculated, depending on each participant’s activity listed on their Initial Health Screening Form.
Participants in the CHIA and the CON groups were encouraged to maintain the exercise routine reported initially, keep their habitual diets, and avoid n-3 supplementation/foods high in ALA and/or fiber. Ten percent of the participant’s daily caloric intake was supplemented with chia seeds supplied by Salba Smart Natural Products, LLC (Colorado,
USA). The Salba brand was used to ensure consistency in seed size, color, shape, and nutrient content. According to the nutrient information listed on Salba Smart Natural
Products, LLC, 15 g of Salba chia seeds contain 70 kcals, 5 g fat, 5 g dietary fiber, and
3.4 g n-3 ALA. The amount of chia seeds was pre-measured and pre-packaged according to the needs of each participant and distributed at the beginning of each week. The empty bag from the previous week was collected to ensure compliance. Bags were labelled with each participant’s study identification number for confidentiality purposes. Participants were given instructions to take chia seeds with 10 ounces of water, 30-45 minutes before each meal. No amount of chia was specified per meal so long as participants consumed
81 one pre-measured bagful per day. Additionally, no nutrition education or instructions were administered throughout the study to maintain a true free-living status.
Dietary Analysis
Participants were asked to complete nine 3-day food records throughout the study.
These included baseline, post-study food records, and three individual records requested at random via email or phone text/call (participants were given 24-hour notice).
Instructions for filling out food records and measuring portion sizes were administered verbally and written on the food record handout. After excluding seven participants’ food records because of incomplete data and noncompliance, 15 (n=15) 3-day food records (135 total) were entered into the University of Minnesota Nutrition Data System for Research (NDSR) version 2017 (Minneapolis, MN) and the nutrient content of the diets were further estimated using NDSR. Diet displacement was calculated using the equations:
1. Displacement nutrient (Di) = [(Habitual nutrient (Hi) + Supplemented nutrient
(Si)) – Chia nutrient (Ci)]
2. Displacement nutrient % (Di %) = Di / Si x 100
As explained by Jaceldo-Siegl et al., 2004, if i represents a nutrient, then Hi is the intake of a nutrient during the habitual diet; Si is the amount of the same nutrient found in the chia supplement; Ci is the intake of that nutrient throughout the chia-supplementation period. Since the chia supplement was added to the habitual diet, the expected intake of that nutrient in the supplemented diet is Hi + Si. Displacement of the same nutrient (Di) was further estimated by subtracting the intake of that nutrient in the supplemented diet
(Ci), from the expected intake of that nutrient. Thus, Di = (Hi + Si)-Ci. Percentage
82 displacement was calculated by Di/Si x 100. These equations have been accepted and utilized by other displacement studies 8,9.
Anthropometric Measurements for Calculating BMI
Height was measured during week 0 using a stadiometer and recorded to the nearest 0.1 centimeter (cm). Bodyweight measurements were taken with a Tanita Body
Impedance Analyzer (BIA) TBF-300A (Arlington Heights, IL) during weeks 0, 4, and 9.
To assure accuracy, the researcher entered information about the participant in the Tanita scale including gender, age, clothing, body type, and height. Female gender was entered for every participant because all were biologically female for the study. Only the initial age of the participant was used throughout the study to ensure standardization. Clothing was entered as 0.2 and participants were asked to remove any heavy outerwear before stepping barefoot onto the scale. Standard female, non-athletic was used for body type and height was entered in centimeters.
Statistical Analysis
A 2 (condition) x 3 (time) Analysis of Variance (ANOVA) was used to analyze mean differences for each dependent variable. In the event of a significant main effect or interaction, a follow-up test was conducted for pairwise comparisons. Statistical significance was set at p < 0.05. Analysis was performed using SPSS Statistics 22.
RESULTS
Dietary Composition
Of the 30 females who took part in the study, 15 were included in the statistical analysis. Three participants never began the study due to scheduling conflicts, four dropped out because of the intervention, two became unresponsive, one had
83 gastrointestinal issues unrelated to the intervention, and five were eliminated due to non compliance with completing nine 24-hour food records (Figure 2).
Analysis of 135 24-hour food records revealed no significant difference in energy
(E), total fat (FAT), total carbohydrate (CHO), total protein (PRO), cholesterol (CHOL), saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), conjugated linoleic acid
(CLA), n-6 linoleic acid (n-6 LA), sugar, vitamin E (VIT E), calcium (Ca2+), zinc (Zn), selenium (Se), sodium (Na+), and potassium (K+) intake between CHIA and CON.
Table 2. Dietary composition based on means of nine 24-hour food records. *Statistical significance at p-value <0.05 CHIA (n=8) CON (n=7) p-value E (kcal) 1699 ± 520 1727 ± 464 0.120 FAT (g) 81 ± 26 73 ± 23 0.056 CHO (g) 188 ± 30 194 ± 61 0.170 PRO (g) 63 ± 17 72 ± 16 0.247 CHOL (mg) 242 ± 149 236 ± 149 0.057 SFA (g) 24 ± 11 24 ± 7.6 0.097 MUFA (g) 26 ± 9.7 25 ± 8.4 0.138 PUFA (g) 24 ± 6.2 18 ± 6.4 0.130 n-3 FA (g) 7.0 ± 0.7 2.0 ± 0.9 <0.000* CLA (g) 1.0 ± 3.3 0.1 ± 0.0 0.108 n-3 ALA (g) 7.0 ± 0.6 2.0 ± 0.6 <0.000* n-6 LA (g) 17 ± 5.5 15 ± 5.0 0.452 Sugar (g) 57 ± 22 67 ± 37 0.939 Fiber (g) 26 ± 7.2 16 ± 6.0 <0.000* Vit E (mg) 9.0 ± 2.0 8.0 ± 3.1 0.451 2+ Ca (mg) 765 ± 198 690 ± 136 0.258 2+ Mg (mg) 316 ± 67 224 ± 77 0.004* Zn (mg) 9.0 ± 2.1 8.3 ± 2.0 0.168 Se (mg) 107 ± 27 109 ± 31 0.079 + Na (mg) 2842 ± 654 2903 ± 812 0.238 K+ (mg) 1884 ± 710 1919 ± 567 0.156
84 Total CHO (g) Total Dietary Fiber… ȗ ȗȗ Total FAT (g) SFA(g) MUFA (g) PUFA (g) N-3 FA (g) ȗȗȗ CLA (g) N-3 ALA(g) ȗ ȗȗ N-6 LA (g) Total PRO (g)
0.0 25.0 50.0 75.0 100.0 125.0 150.0 175.0 200.0 225.0 250.0 275.0 CHIA MEANS Dietary Intake of Macronutrients CON MEANS Figure 3. Mean±SD intake of dietary macronutrients after 8-week supplementation with ~41g chia seeds. Values represent mean intake of nine 24-h food records. *Significantly different from baseline p < 0.05 **Significantly different than chia diet p< 0.05.
Vitamin E (mg)
Calcium (mg)
Magnesium (mg) ȗ ȗȗ Zinc (mg)
Selenium (mg)
Sodium (mg)
Potassium (mg)
0.0 500.0 1000.0 1500.0 2000.0 2500.0 3000.0 3500.0 4000.0 CHIA MEANS Dietary Intake of Micronutrients CON MEANS Figure 4. Mean±SD intake of dietary micronutrients after 8-week supplementation with ~41g chia seeds. Values represent mean intake of nine 24-h food records. *Significantly different from baseline p < 0.05 **Significantly different than chia diet p< 0.05.
85 Table 3. Dietary Reference Intakes of preselected nutrients and mean intakes for CON and CHIA from nine 24-hr food records. *Mean recommended dietary allowance (RDA) or adequate intake (AI) per nutrient 13,14,15. *Mean RDA/AI Nutrient (Females 19-50 yrs.) Control (n=7) Chia (n=8) Total Carbohydrate (g) 130 193.5 188.3 N-3 ALA (g) 1.1 1.6 6.6 N-6 LA (g) 12 14.6 17.1 Dietary Fiber (g) 25 15.5 25.8 Vitamin E (mg) 15 8.2 8.5 Calcium (mg) 1000 689.9 765.2 Magnesium (mg) 315 224.3 315.8 Zinc (mg) 8 7.8 8.8 Selenium (mg) 55 108.7 107.2 Sodium (mg) 1500 2902.9 2841.7 Potassium (mg) 4700 1919.1 1884.3
Goal or Limit
Total CHO (g) N-3 ALA(g) N-6 LA Fiber (g) VIT E (mg) Ca (mg) Mg (mg) Zn (mg) Se (mg) CHIA Na (mg) CON K (mg) RDA/AI
0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 Percentage of Goal or Limit
Figure 5. Nutrient mean intakes from nine 24-hour food records in CHIA and CON diets as a percentage of goal or limit. Values based on recommended dietary allowance (RDA) or adequate intake (AI) 13,14,15.
(Table 2). For the dependent variables omega-3 fatty acid (n-3 FA) and n-3 alpha linolenic acid (n-3 ALA), there was a significant group x time interaction (p < 0.0001).
86 Pairwise comparisons revealed CHIA to have greater (p< 0.000-004) n-3 FA, n-3 ALA, fiber, and Mg2+ compared with CON (Figures 3 and 4).
Dietary Displacement
The following table represents estimates of percentage displacement of 20 selected nutrients after 8-weeks supplementation with chia seeds. The third column presents the composition of the chia supplement, based on mean values of the average amount (~41.3 g) consumed by the intervention group (CHIA).
Percentages greater than 100 indicate total displacement of the nutrient; “nutrient
(i) from chia seeds has more than replaced i from the supplemented diet, lessening total i intake in the habitual diet” 8. Total energy, CHO, and PRO were completely displaced with approximate percentages of 114, 130, and 229, respectively. FAT on the other hand, was 1/3 displaced. Sugar was also completely displaced with a displacement percentage of ~2131%. Nutrients with partial displacements (0-100%) include SFA, PUFA, n-3 FA, n-3 ALA and fiber. However, MUFA and n-6 LA were negatively displaced, (-26% and
4%, respectively) indicating that non-chia seed foods in CHIA supplied more of these nutrients compared with CON (Table 4).
Displacement percentage calculations further revealed complete displacement of micronutrients including Se (107%), Na+ (974%), and K+(120%). Others, including Mg2+,
Ca, and Zn experienced partial displacements ranging from 43-71%. On the other hand, a negative computed displacement occurred for VIT E (Table 4).
87 Table 4. Displacement of select nutrients after an 8-week supplementation with ~41 g chia seeds: Means of nine 24-hour food records.
Nutrient Habitual Habitual Chia Absolute % Displacement (CON) + Chia Supplement (D) (CHIA)
H C S S+H-C D/S*100 SEM Macronutrients And Energy Energy (kcal) 1727.9 1699.1 201.0 228.8 113.8 105.3 Total FAT (g) 72.5 80.5 12.7 4.7 37.0 6.20 Total CHO (g) 193.5 188.3 17.4 22.6 129.9 11.8 Total PRO (g) 71.9 63.1 6.80 15.6 228.7 4.40 Lipids SFA(g) 23.8 24.1 1.60 1.30 80.8 2.400 MUFA (g) 24.6 25.8 1.00 -0.20 -25.7 2.3 PUFA (g) 17.9 24.2 9.80 3.50 35.6 1.80 N-3 FA (g) 2.00 6.70 7.40 2.70 36.2 0.70 CLA (g) 0.10 1.30 0.00 -1.20 0.00 0.60 N-3 ALA(g) 1.6 6.6 7.4 2.4 32.2 0.70 N-6 LA (g) 14.6 17.1 2.40 -0.10 -3.6 1.4 Carbohydrate Sugar (g) 61.7 53.9 0.40 8.20 2131 4.60 Fiber Total Dietary Fiber 15.5 25.8 14.2 3.90 27.6 2.20 (g) Vitamin Vitamin E (mg) 8.20 8.50 0.20 -0.10 -44.9 0.70 Minerals Calcium (mg) 690 765 261 186 71.1 43.9 Magnesium (mg) 224 316 161 69.5 43.2 21.6 Zinc (mg) 7.80 8.80 1.90 0.90 47.2 0.50 Selenium (mg) 109 107 22.8 24.3 107 7.20 Sodium (mg) 2903 2842 7.00 68.2 974 182 Potassium (mg) 1919 1884 168 203 121 161
DISCUSSION
The aim of the present study was to determine the effect of chia seed supplementation on dietary displacement in healthy, overweight and obese women.
Although insignificant values in displacement percentages existed for most nutrient components except for n-3 FA, n-3 ALA, total dietary fiber, and Mg2+, each analysis
88 discussed was compared to literature with regard to disease prevention to explore potential for future studies with a larger sample size. Despite the insignificance of the results, values for dietary displacement and its associations with improving dietary quality were found to be congruent with existing literature.
Dietary Composition
Results from 24-hour food records indicate that supplementing the diet with a daily intake of chia seeds can lead to improved dietary quality (Table 2). Compared with
CON, participants consuming their habitual diet + chia seeds (CHIA) reported significantly higher intakes of total dietary fiber, n-3 FA, n-3 ALA, and Mg2+.
Studies suggest that increases in PUFA and MUFA may help reduce blood cholesterol levels and its associated diseases 16,17,18,19,20,21. However, these studies also support a decreased intake in SFA to promote decreased disease risk such as coronary heart disease (CHD). In the present study, compared with CON, CHIA showed significant increases in unsaturated fatty acid intake but non-significant decreases in saturated fatty acid (SFA) and cholesterol intake. Most of the literature supporting higher intakes of PUFA and MUFA in prevention of chronic disease included a large sample size, middle-aged adults, and a longer intervention period 10,11,22. The reason for the lack of decrease in SFA may be related to the specifications of the study (overweight and obese college females), our sample size (n =15) and intervention period (8 weeks). Like studies consist of an average sample size of ~130 participants and intervention period of
~39.2 weeks 8,9,10,11,22. Another explanation may be related to college students experiencing bouts of high stress during midterms and finals week, thus contributing to
89 unstructured eating patterns and consumption of convenience foods, which are high in
SFA.
US adults most often do not consume the adequate intake (AI) for n-3 ALA (1.1 g/day for women) but exceed that for n-6 LA (12 g/day for women) 15. The past few decades have demonstrated continuous increases n-6 PUFA and n-3 PUFA ratios (~15:1) along with a rise in chronic inflammatory diseases 23. Optimal n-6:n-3 ratios range from
1-4:1. Thus, high intakes of n-3 PUFA are promoted due to its anti-inflammatory effects while n-6 LA are discouraged due to its proinflammatory effects, which may contribute to non-alcoholic fatty liver disease, obesity, CVD, and inflammatory bowel disease 23.
Means from nine 24-hour food records revealed that CHIA consumed ~17 g/day n-6 LA and ~7 g/day n-3 ALA (2.4:1) while CON consumed ~15 g/day n-6 LA and ~2 g/day n-3
ALA (7.5:1) (Tables 2 and 3). Although insignificant, CHIA exhibited decreases in n-6
LA intakes while CON displayed increases, post study (Figures 3 and 5).
Studies have determined that increased intakes of dietary fiber may reduce CVD rates and increase insulin sensitivity 24,25,26. Literature reveals that most US adults fail to meet the dietary reference intake (DRI) for fiber (25 g/day for women15. Post study,
CHIA exceeded the AI for fiber (~29.6 g/day) while CON fell short (~17.4 g/day)
(Tables 2 and 3).
Vitamin E is a fat-soluble antioxidant known to inhibit cell damage and promote
CVD health as well as other diseases such as cancer 27,28,29. The RDA for VIT E is 15 mg/day, which most healthy adults achieve from consuming their habitual diets 13 (Table
3). Post study, CHIA consumed an average of ~8.1 mg/day and CON consumed ~9.1 mg/day of the vitamin, amounts below the RDA for α-tocopherol. Overall, the decrease
90 in consumption of α-tocopherol for CHIA and increase for CON was insignificant. In a study conducted by Jaceldo-Siegl et al. (2004), results from their almond supplementation study revealed a significant increase (p<0.05) in α-tocopherol when participants switched from their habitual diet to the almond supplemented diet (habitual diet + 52 g of almonds). Their study was a crossover design with a 6-month intervention period 8. Pearson & et al. (2017) conducted a shorter (12-week), randomized controlled, parallel study which identifies better with the present one. However, they too found a significantly higher intake (p<0.05) of VIT E between the control (habitual diet) and intervention (habitual diet + 42 g hazelnut supplement) groups 11. There are a few possible explanations for the lack of significance seen in our study. First, the substantial differences in milligram (mg) amounts of α-tocopherol in chia seeds (.207 mg per ~ 41 g chia) compared with almonds (13.5 mg per 52 g almonds) and hazelnuts (7.31 mg per 42 g hazelnuts) 8,11. Second, a small sample size (n=15) for the chia study compared with n=81 and n=102 for the almond and hazelnut studies, respectively. Third, the sample specificity for the present study was limited to overweight/obese college females aged
18-45 years in comparison with the almond and hazelnut studies, adults aged 25-70 years and non-obese adults aged 18-65 years, respectively 8,11.
Chia seeds are rich in minerals including potassium (K+), magnesium (Mg2+), and calcium (Ca2+). The DRIs for K+, Mg2+, and Ca2+ for women ages 19-30 years are 4700 mg/day; 310-320 mg/day; and 1000 mg/day, respectively 14. Minerals may play protective roles against type 2 diabetes and other diet-related diseases 30 (Table 3).
Jaceldo-Siegl et al. (2004) reported a significant increase in copper (Cu) and magnesium
(Mg2+) in a secondary analysis of adults (n=81) who consumed their habitual diets for six
91 months and then added ~52 g/day of almonds for another six months 8. Similarly, results of the current study revealed a significant increase in Mg2+. Post study, CHIA met the
RDA for Mg2+ (~366.4 mg/day) while CON did not (~254.9 mg/day), see figure 5.
Alshaeri et al., 2015, also reported significantly higher intakes of Mg2+ as well as Ca2+ and K+ in the intervention group (n=88) receiving 120 g/day of California mission figs for five weeks. Chia seeds are higher in Mg2+and Ca2+ but lower in K+ than California mission figs. Therefore, it would be appropriate to assume a similar result from chia seed supplementation. However, unlike Alshaeri et al.’s study, ours was not a cross-over design and only half of our participants experienced the intervention (n=8), thus contributing to a difference in statistical analysis. In addition, Alshaeri et al. posed no limitations on how the figs were to be consumed, while our participants were asked to take the chia seeds in water 31.
Dietary Displacement
Results from the present study revealed that chia seed supplementation promotes displacement of nutrients congruent with dietary recommendations for the prevention of
CVD and chronic diseases 13. According to our calculations, all variables displayed a positive displacement percentage except for MUFA, n-6 LA, and VIT E. Many, on the other hand, were completely displaced (>100%), including total energy (114%), CHO
(130%), PRO (229%), sugar (2131%), Zn (107%), Na+ (974%), and K+ (121%).
Our calculations of displacement percentages revealed similar results with like studies 8,9,10,11,22,31 who found positive displacement percentages for total energy, macronutrients, and micronutrients. Most nut supplementation studies report partial displacements ranging from 50 and 70% for total energy 11. We found complete
92 displacement for total energy, thus energy from chia seeds has more than replaced energy from the supplemented diet, lessening total energy intake in the habitual diet. The same observation can be applied to CHO, PRO, sugar, Se, Na+, and K+.
Additionally, we calculated negative displacement percentages for total MUFA
(-26%), n-6 LA (-4%), and VIT E (-45%). Thus, non-chia seed foods in the supplemented diet contributed more MUFA, n-6 LA, and VIT E than the actual chia seed supplement.
Similar studies have reported partial or complete displacements for these nutrients
8,9,10,11,22. There a few explanations for the lack of similarity in ours. First, chia seed supplementation may have induced an increase in consumption of foods containing high amounts of MUFA, n-6 LA, and VIT E. Second, compared with other nut supplementation studies, there are nearly insignificant amounts of MUFA (.95 g), n-6 LA
(.24 mg), and VIT E (.21 mg) contained in 41 g chia seeds 12. In the almond study, 52 g almonds contained approximately 15 g MUFA, 6 g n-6 LA, and 13.5 mg VIT E 8. These values far outweigh amounts per nutrient contained in chia seeds. Third, perhaps the way in which overweight/obese individuals displace nutrients differs from those with a normal
BMI.
In the current study, the variables with partial displacement percentages include
FAT (37%), SFA (81%), PUFA (36%) n-3 FA (36%), n-3 ALA (32%), fiber (28%), Ca2+
(71%), Mg2+ (43%), and Zn (47%). Therefore, the chia seed supplement is responsible for the displacement of these nutrients in the habitual diet. Based on the evidence of this study, chia seed supplementation may promote CVD health by reducing intake of foods high in SFA and increasing unsaturated fatty acid. Additionally, displacements in
93 micronutrients is congruent with existing literature; thus, meets the dietary recommendations to prevent CVD and chronic disease 13,14,15.
Limitations
Several limitations exist in the present study. Most published displacement studies have an average sample size of ~130 participants and intervention period of ~39.2 weeks.
With our sample population being limited to healthy, overweight/obese college females from CPP, we were only able to recruit a total of 40 females, of which 30 qualified.
Additionally, there were many variables that kept qualified participants from completing the 10-week study. Many reported disliking the taste and texture of chia seeds. Also, participants had a difficult time completing the study because of scheduling conflicts.
Furthermore, college students are known to have unstructured eating patterns related to the high demands of multiple classes, stressful life events, and lack of time/resources to prepare meals 33.
The “gold standard” to any clinical experiment is a randomized, placebo- controlled, clinical trial. It may have been valuable to add a placebo group, such as ground barley.
A final limitation existed in gathering of 24-hour food records from participants.
Similar displacement studies use a different method, dietary recalls. Although more time- consuming, it may reduce over/under-reporting of food.
Practical Application and Future Research
Since this was an exploratory pilot study, additional research is necessary. To correct for the identified limitations of the present study, further chia seed supplementation studies using healthy, overweight/obese, college-aged males and
94 females need to be conducted with a larger sample size and longer intervention period, of at least 12-weeks. Chia seeds should be grounded and a placebo group, such as ground barley, should be utilized to reduce results left to chance. There are 10 g of dietary fiber and 0.8 g of polyunsaturated fatty acid per 100 g ground barley, placing barley as a potential contender of chia 34. Similar studies must continue recruiting from all majors to obtain an accurate representation of the college-aged population. Recruitment should be conducted at least six weeks prior to the beginning of a new quarter to establish commitment and increase retention. Future studies should also collect 24-hour dietary recalls instead of self-reported dietary records.
Finally, expanding the nutrient analysis of chia seeds will help determine if supplementation induces a favorable change in the diet in support of cardiovascular health. An example would be polyphenols, powerful antioxidants known for being a key player in the prevention of cancer, CVD, and other degenerative diseases caused by oxidative stress 35. Many polyphenol molecules are found in edible plants like chia and are consumed for protection from ultraviolet radiation and pathogens.
CONCLUSION
The present study identified that daily supplementation of chia seeds (10% of total energy intake) in apparently healthy, overweight/obese women (18-45 years) can induce positive nutrient changes to the habitual diet. Specifically, post study results revealed
CHIA better met the dietary reference intakes in support of chronic disease prevention than CON. Arithmetic means of 135 24-hour food records showed that CHIA had significantly higher intakes (p< 0.05) in n-3 fatty acid, n-3 alpha linolenic acid, fiber, and magnesium, compared with CON.
95 Results further indicate dietary displacement of nutrients congruent with existing literature, i.e. all macronutrients as well as total dietary fiber, calcium, magnesium, zinc, selenium, sodium, and potassium. Displacement of these nutrients are known for their role in reducing the risk of diet-related diseases such as CVD, type 2 diabetes, and some cancers. Additional research is necessary to affirm the results of this study and to further examine the effects of chia seed supplementation on overall diet in relation to chronic disease risk in overweight/obese women.
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