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Paleolithic Diet, Abdominal Adiposity, and Systemic Low-grade Chronic Inflammation. Associations in Observational Studies and a Randomized Controlled Trial

Carrera Bastos, Pedro LU (2025) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background: Systemic low-grade chronic inflammation (SLGCI), commonly assessed by biomarkers such as total leukocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), is associated with cardiometabolic disease, and both are associated with diet and abdominal adiposity. The Paleolithic diet may reduce SLGCI by reducing abdominal adiposity and through direct effects on the immune system.
Aims: This thesis explores the relationship between SLGCI, abdominal adiposity, and the Paleolithic diet using both observational and interventional designs.
Methods: Papers I and II compared CRP and total adiponectin (an adipokine often inversely associated with SLGCI, abdominal adiposity, and cardiometabolic disease)... (More)
Background: Systemic low-grade chronic inflammation (SLGCI), commonly assessed by biomarkers such as total leukocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), is associated with cardiometabolic disease, and both are associated with diet and abdominal adiposity. The Paleolithic diet may reduce SLGCI by reducing abdominal adiposity and through direct effects on the immune system.
Aims: This thesis explores the relationship between SLGCI, abdominal adiposity, and the Paleolithic diet using both observational and interventional designs.
Methods: Papers I and II compared CRP and total adiponectin (an adipokine often inversely associated with SLGCI, abdominal adiposity, and cardiometabolic disease) between Kitavans, a lean Melanesian population with a Paleolithic-type diet and an apparent absence of cardiometabolic disease, and Swedish controls. Paper III was a 2-year RCT comparing a healthy diet without cereal grains, a main characteristic of the Paleolithic diet, versus one emphasizing whole grains, each with and without long-term exercise, on waist circumference, a proxy for abdominal adiposity. Paper IV analyzed associations between the Paleolithic Diet Fraction (PDF), a dietary pattern measure defined as the proportion of food intake consistent with a Paleolithic diet, and inflammatory biomarkers (total leukocyte count, NLR, and CRP) in 23,250 participants from the Malmö Diet and Cancer Study.
Results: In Papers I and II, Kitavans had lower CRP and lower total adiponectin than Swedish controls. In Paper III, the no-grain group without exercise showed the largest, albeit non-significant, reduction in waist circumference. In Paper IV, PDF was inversely associated with all inflammatory biomarkers, independent of adiposity and lifestyle factors.
Conclusion: A relatively higher intake of Paleolithic foods is associated with lower levels of SLGCI, potentially through both reduced abdominal adiposity and direct effects on the immune system. The low adiponectin levels among Kitavans raise questions about its presumed inverse association with SLGCI, abdominal adiposity, and cardiometabolic disease. (Less)
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author
supervisor
opponent
  • Professor Risérus, Ulf, Uppsala University, Department of Public Health and Caring Sciences, Uppsala, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Systemic Low-grade Chronic Inflammation, Paleolithic Diet, C-Reactive Protein, Adiponectin, Waist Circumference
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2025:118
pages
116 pages
publisher
Lund University, Faculty of Medicine
defense location
Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/61912349679
defense date
2025-11-07 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-771-2
language
English
LU publication?
yes
id
398b029c-d3d5-4a01-91af-1cd0e8dc5420
date added to LUP
2025-09-29 21:30:48
date last changed
2025-10-12 16:28:49
@phdthesis{398b029c-d3d5-4a01-91af-1cd0e8dc5420,
  abstract     = {{Background: Systemic low-grade chronic inflammation (SLGCI), commonly assessed by biomarkers such as total leukocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), is associated with cardiometabolic disease, and both are associated with diet and abdominal adiposity. The Paleolithic diet may reduce SLGCI by reducing abdominal adiposity and through direct effects on the immune system. <br/>Aims: This thesis explores the relationship between SLGCI, abdominal adiposity, and the Paleolithic diet using both observational and interventional designs. <br/>Methods: Papers I and II compared CRP and total adiponectin (an adipokine often inversely associated with SLGCI, abdominal adiposity, and cardiometabolic disease) between Kitavans, a lean Melanesian population with a Paleolithic-type diet and an apparent absence of cardiometabolic disease, and Swedish controls. Paper III was a 2-year RCT comparing a healthy diet without cereal grains, a main characteristic of the Paleolithic diet, versus one emphasizing whole grains, each with and without long-term exercise, on waist circumference, a proxy for abdominal adiposity. Paper IV analyzed associations between the Paleolithic Diet Fraction (PDF), a dietary pattern measure defined as the proportion of food intake consistent with a Paleolithic diet, and inflammatory biomarkers (total leukocyte count, NLR, and CRP) in 23,250 participants from the Malmö Diet and Cancer Study. <br/>Results: In Papers I and II, Kitavans had lower CRP and lower total adiponectin than Swedish controls. In Paper III, the no-grain group without exercise showed the largest, albeit non-significant, reduction in waist circumference. In Paper IV, PDF was inversely associated with all inflammatory biomarkers, independent of adiposity and lifestyle factors. <br/>Conclusion: A relatively higher intake of Paleolithic foods is associated with lower levels of SLGCI, potentially through both reduced abdominal adiposity and direct effects on the immune system. The low adiponectin levels among Kitavans raise questions about its presumed inverse association with SLGCI, abdominal adiposity, and cardiometabolic disease.}},
  author       = {{Carrera Bastos, Pedro}},
  isbn         = {{978-91-8021-771-2}},
  issn         = {{1652-8220}},
  keywords     = {{Systemic Low-grade Chronic Inflammation; Paleolithic Diet; C-Reactive Protein; Adiponectin; Waist Circumference}},
  language     = {{eng}},
  number       = {{2025:118}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Paleolithic Diet, Abdominal Adiposity, and Systemic Low-grade Chronic Inflammation. Associations in Observational Studies and a Randomized Controlled Trial}},
  url          = {{https://lup.lub.lu.se/search/files/228683539/2025-11-07_Carrera-Bastos.pdf}},
  year         = {{2025}},
}