Prospective study of major dietary patterns and risk of coronary heart disease in men

Behavioural, attitudinal and dietary responses to the consumption of wholegrain foods

Whole grains are important dietary constituents as they provide a plethora of nutrients and protective chemicals that may have synergistic actions in promoting health. Regular consumption of wholegrain foods has been associated with a reduced risk of several chronic diseases such as CHD and certain cancers, although their exact role in disease prevention is not yet fully elucidated. Studies reporting levels of whole grain consumption reveal that those subjects who include higher levels of whole grain foods in their diets also have many other favourable dietary and lifestyle practices. While the actions of these practices and whole grains may not be mutually exclusive, these variables do not appear to explain the reduction in risk of disease observed for high-whole grain consumers. Actual whole grain consumption levels are extremely low and many practical barriers exist to consumer uptake of these foods. Effective communication of the whole grain health message is an important strategy to increase awareness of the importance of whole grains in the diet. Increasing the variety and availability of acceptable wholegrain foods is also important. Whole grain consumption at breakfast can have an important impact on total daily nutrient intakes. This simple dietary modification is potentially relatively easy to achieve and could greatly contribute to increased whole grain intake for many individuals.

Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study

BACKGROUND

Although ecological observations suggest that the Japanese diet may reduce the risk of cardiovascular disease (CVD), the impact of a Japanese dietary pattern upon mortality due to CVD is unclear.

METHODS

We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994.

RESULTS

During 7 years of follow-up, 801 participants died of CVD. Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not.

CONCLUSION

The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.

Physical activity and stomach cancer risk: The influence of intensity and timing during the lifetime

Physical inactivity is linked to risk for cancers of the colon, breast, lung and endometrium, but few data exist on this association with stomach cancer. We evaluated the association between recreational physical activity and incident stomach cancer in a case-control study. The data yielded odds ratios suggestive of approximately 20-40% reduced risk of stomach cancer when comparing more frequent (3+ times/week) to less frequent (<1/month) strenuous activities. The magnitudes of the associations for strenuous physical activities were consistent across the teens, early 30s, and early 50s. Compared to the least active quartile, the second, third, and fourth quartiles of average lifetime strenuous physical activity yielded odds ratios of 0.82, 0.69, and 0.58 (95% CI, 0.41-0.83), respectively. Odds ratios for moderate activity generally suggested a modest, but not statistically significant, inverse association. Increased strenuous physical activity, throughout the lifespan, was associated with decreased risk of incident stomach cancer.

Increased lean red meat intake does not elevate markers of oxidative stress and inflammation in humans

Red meat intake has been associated with increased risk of coronary heart disease and type 2 diabetes, but it remains uncertain whether these associations are causally related to unprocessed lean red meat. It has been proposed that iron derived from red meat may increase iron stores and initiate oxidative damage and inflammation. We aimed to determine whether an increase in unprocessed lean red meat intake, partially replacing carbohydrate-rich foods, adversely influences markers of oxidative stress and inflammation. Sixty participants completed an 8-wk parallel-designed study. They were randomized to maintain their usual diet (control) or to partially replace energy from carbohydrate-rich foods with approximately 200 g/d of lean red meat (red meat) in isoenergetic diets. Markers of oxidative stress and inflammation were measured at baseline and at the end of intervention. Results are presented as the mean between-group difference in change and [95% CI]. Red meat, relative to control, resulted in: higher protein [5.3 (3.7, 6.9) % of energy], lower carbohydrate [-5.3 (-7.9, -2.7)% of energy], and higher iron [3.2 (1.1, 5.4) mg/d] intakes; lower urinary F2-isoprostane excretion [-137 (-264, -9) pmol/mmol creatinine], lower leukocyte [-0.51 (-0.99, -0.02)x10(9)/L] counts, and a trend for lower serum C-reactive protein concentrations [-1.6 (-3.3, 0.0) mg/L, P=0.06]; and no differences in concentrations of plasma F2-isoprostanes [-12 (-122, 100) pmol/L], serum gamma-glytamyltransferase [-0.8 (-3.2, 1.5) U/L], serum amyloid A protein [-1.4 (-3.4, 0.5) mg/L], and plasma fibrinogen concentrations [-0.08 (-0.40. 0.24) g/L]. Our results suggest that partial replacement of dietary carbohydrate with protein from lean red meat does not elevate oxidative stress or inflammation.

A dietary screening questionnaire identifies dietary patterns in older adults

Dietary patterns reflect habitual exposure of foods and nutrients and are a preferred means to assess diet and disease relations. Our objective was to design a screening tool to assess diet quality and dietary patterns among older adults and to relate the patterns to markers of general health and nutrition status. We used a population-specific data-based approach to design a diet screening instrument that was tested among subjects sampled from the Geisinger Rural Aging Study cohort (n=205). All participants attended a local clinic and had biochemical, anthropometric, and other health data collected. Dietary information was obtained via 24-h recall. We used principle components analysis to derive dietary patterns, which were then compared with nutritional outcomes using Pearson partial correlations, controlling for energy, age, BMI, and supplement use. Two dietary patterns were derived; 1 represented by more healthful foods and 1 by less optimal food choices. The healthy pattern was associated with more favorable biomarkers, more nutrient-dense diets, and lower waist circumference, whereas the converse was true for the second pattern. A screening tool can be used by older adults to identify dietary patterns that may relate to nutritional risk.

Diet, nutrition and the prevention of hypertension and cardiovascular diseases

Cardiovascular diseases (CVD) are growing contributors to global disease burdens, with epidemics of CVD advancing across many regions of the world which are experiencing a rapid health transition. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases like coronary heart disease (CHD) and stroke and are also linked to other cardiovascular risk factors like diabetes, high blood pressure and obesity. The interpretation of evidence needs to involve a critical appraisal of methodological issues related to measurement of exposures, nature of outcome variables, types of research design and careful separation of cause, consequence and confounding as the basis for observed associations.

Adequate evidence is available, from studies conducted within and across populations, to link several nutrients, minerals, food groups and dietary patterns with an increased or decreased risk of CVD. Dietary fats associated with an increased risk of CHD include trans–fats and saturated fats, while polyunsaturated fats are known to be protective. Dietary sodium is associated with elevation of blood pressure, while dietary potassium lowers the risk of hypertension and stroke. Regular frequent intake of fruits and vegetables is protective against hypertension, CHD and stroke. Composite diets (such as DASH diets, Mediterranean diet, ‘prudent’ diet) have been demonstrated to reduce the risk of hypertension and CHD. Sufficient knowledge exists to recommend nutritional interventions, at both population and individual levels, to reduce cardiovascular risk. That knowledge should now be translated into policies which promote healthy diets and discourage unhealthy diets. This requires coordinated action at the level of governments, international organizations, civil society and responsible sections of the food industry.

Dietary patterns in middle-aged Irish men and women defined by cluster analysis

Objectives:

To identify and characterise dietary patterns in a middle-aged Irish population sample and study associations between these patterns, sociodemographic and anthropometric variables and major risk factors for cardiovascular disease.

Design:

A cross-sectional study.

Subjects and methods:

A group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for glucose, lipids and homocysteine. Dietary intake was assessed using a standard food-frequency questionnaire adapted for use in the Irish population. The food-frequency questionnaire was a modification of that used in the UK arm of the European Prospective Investigation into Cancer study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed primarily by K-means cluster analysis, following initial principal components analysis to identify the seeds.

Results:

Three dietary patterns were identified. These clusters corresponded to a traditional Irish diet, a prudent diet and a diet characterised by high consumption of alcoholic drinks and convenience foods. Cluster 1 (Traditional Diet) had the highest intakes of saturated fat (SFA), monounsaturated fat (MUFA) and percentage of total energy from fat, and the lowest polyunsaturated fat (PUFA) intake and ratio of polyunsaturated to saturated fat (P:S). Cluster 2 (Prudent Diet) was characterised by significantly higher intakes of fibre, PUFA, P:S ratio and antioxidant vitamins (vitamins C and E), and lower intakes of total fat, MUFA, SFA and cholesterol. Cluster 3 (Alcohol & Convenience Foods) had the highest intakes of alcohol, protein, cholesterol, vitamin B12, vitamin B6, folate, iron, phosphorus, selenium and zinc, and the lowest intakes of PUFA, vitamin A and antioxidant vitamins (vitamins C and E). There were significant differences between clusters in gender distribution, smoking status, physical activity, body mass index, waist circumference and serum homocysteine concentrations.

Conclusion:

In this general population sample, cluster analysis methods yielded two major dietary patterns: prudent and traditional. The prudent dietary pattern is associated with other health-seeking behaviours. Study of dietary patterns will help elucidate links between diet and disease and contribute to the development of healthy eating guidelines for health promotion.

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components.

Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations.

A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Trends in food intakes in Swedish adults 1986–1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study

Objective

To determine changes in reported food frequency in adults between 1986 and 1999.

Design

Four consecutive cross-sectional surveys.

Setting

Counties of Norrbotten and Västerbotten, Northern Sweden.

Subjects

The Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population, four independent cross-sectional surveys in 1986, 1990, 1994 and 1999. Randomly selected age-stratified samples of the population aged 25–64 years. Analysis is based on 2982 males and 3087 females who completed an 84-item food-frequency questionnaire.

Results

Between 1986 and 1999, average reported consumption of 3%-fat milk decreased from 42 to 7 intakes month-1 in men and from 28 to 4 intakes month-1 in women. Reported use of 1.5%-fat milk increased from 6 to 27 intakes month-1 in men and from 6 to 24 in women. Monthly intakes of potatoes and root vegetables decreased from 38 to 27 in men and from 39 to 32 in women. Consumption of pasta increased from 4 to 7 intakes month-1 in both sexes. Intakes of solid fats with 80% fat content dropped from 92 to 62 per month in men and from 78 to 52 per month in women, whereas use of 40%-fat spread increased from 12 to 22 intakes month-1 in men and from 5 to 26 in women. Monthly intakes of vegetable oil increased from 3 to 12 in men and from 3 to 15 in women. The percentage of overweight or obese individuals (body mass index >25 kg m-2) increased from 52 to 65% in men and from 41 to 52% in women (P for linear trend in all these changes, <0.001).

Conclusions

Our data indicate reduced consumption of foods with a high content of saturated fats. In spite of that, there is an unbroken trend towards increased obesity.

Dietary patterns throughout adult life are associated with body mass index, waist circumference, blood pressure, and red cell folate

Dietary patterns are important in the prevention of chronic disease; however, there are few studies that include repeat measures of dietary patterns. The objective of this study was to assess the relations between dietary patterns during adult life (at ages 36, 43, and 53 y) and risk factors for chronic disease at age 53 y. Participants of a longitudinal study of health completed a 5-d food diary at 3 occasions during adult life (n = 1265). Factor analysis was used to identify dietary patterns and a pattern score was calculated from the consumption of the food items in each dietary pattern. Means and 95% CI for dietary pattern scores were calculated for each risk factor category using random effects models adjusted for socio-demographic and health-related behaviors. In women, the fruit, vegetables, and dairy pattern was inversely associated with BMI (P < 0.004), waist circumference (P = 0.0007), blood pressure (P = 0.02), and was positively associated with red cell folate (P < 0.03). The ethnic foods and alcohol pattern was also inversely associated with blood pressure (P = 0.008), whereas the meat, potatoes and sweet foods pattern was positively associated with glycated hemoglobin (P = 0.01). In men, a mixed pattern was inversely associated with waist circumference (P = 0.02) and blood pressure (P = 0.01), whereas there were no significant associations with the ethnic foods and alcohol pattern. Specific dietary patterns throughout adult life were associated with chronic disease risk factors.

Reported food intake and distribution of body fat: a repeated cross-sectional study

Background

Body mass, as well as distribution of body fat, are predictors of both diabetes and cardiovascular disease. In Northern Sweden, despite a marked increase in average body mass, prevalence of diabetes was stagnant and myocardial infarctions decreased. A more favourable distribution of body fat is a possible contributing factor.

This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level.

Methods

Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25–64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference.

Results

Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women.

Conclusion

Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level.

Dietary patterns in the Southampton Women's Survey

OBJECTIVE

Dietary pattern analysis is receiving increasing attention as a means of summarizing the multidimensional nature of dietary data. This research aims to compare principal component analysis (PCA) and cluster analysis using dietary data collected from young women in the UK.

DESIGN

Diet was assessed using a 100-item interviewer-administered food frequency questionnaire. PCA and cluster analysis were used to examine dietary patterns.

SETTING

Southampton, UK.

SUBJECTS

A total of 6125 non-pregnant women aged 20-34 years.

RESULTS

PCA identified two important patterns: a 'prudent' diet and a 'high-energy' diet. Cluster analysis defined two clusters, a 'more healthy' and a 'less healthy' cluster. There was a strong association between the prudent diet score and the two clusters, such that the mean prudent diet score in the less healthy cluster was -0.73 standard deviations and in the more healthy cluster was +0.83 standard deviations; the difference in the high-energy diet score between the two clusters was considerably smaller.

CONCLUSIONS

Both approaches revealed a similar dietary pattern. The continuous nature of the outcome of PCA was considered to be advantageous compared with the dichotomy identified using cluster analysis.

SPONSORSHIP

The study was funded by the Dunhill Medical Trust, the University of Southampton and the Medical Research Council.

Vegetarische Ernährung: Präventives Potenzial und mögliche Risiken

INTRODUCTION

As shown in the first part of this article, consuming high amounts of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. However, the relevance of animal foods consumed within a vegetarian diet is less well-known.

MATERIALS AND METHODS

We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE-research was performed for all animal food groups relevant with a vegetarian diet (key words: "eggs", "milk", "dietary pattern" "vegetarian diet", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis", "vitamin D", "vitamin B(12)", "iron", "iodine"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence.

RESULTS

Based on the evidence criteria of the WHO/FAO, colorectal cancer risk reduction by a high intake of milk and milk products is assessed as probable, while a higher risk of prostate and ovarial carcinomas is also probable. The evidence of a risk-increasing effect of eggs relating to cardiovascular disease, colorectal cancer and breast cancer is assessed as probable. As the data of prospective cohort studies suggest, a prudent diet pattern characterized high in fruits, vegetables, whole grains and nuts is associated with a lower risk of coronary heart disease and diabetes mellitus type 2. In contrast, there is no overall association between prudent diet pattern and risk of breast cancer or colorectal cancer. The critical key nutrients for vegetarians are vitamin D and B12, iodine and iron.

CONCLUSION

For the first time evidence based dietary recommendations were provided for persons on a vegetarian diet in the D-A-CH-region.

A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus

AIMS/HYPOTHESIS

The aim of this study was to prospectively examine whether dietary patterns are related to risk of gestational diabetes mellitus (GDM).

METHODS

This prospective cohort study included 13,110 women who were free of cardiovascular disease, cancer, type 2 diabetes and history of GDM. Subjects completed a validated semi-quantitative food frequency questionnaire in 1991, and reported at least one singleton pregnancy between 1992 and 1998 in the Nurses' Health Study II. Two major dietary patterns (i.e. 'prudent' and 'Western') were identified through factor analysis. The prudent pattern was characterised by a high intake of fruit, green leafy vegetables, poultry and fish, whereas the Western pattern was characterised by high intake of red meat, processed meat, refined grain products, sweets, French fries and pizza.

RESULTS

We documented 758 incident cases of GDM. After adjustment for age, parity, pre-pregnancy BMI and other covariates, the relative risk (RR) of GDM, comparing the highest with the lowest quintile of the Western pattern scores, was 1.63 (95% CI 1.20-2.21; p (trend)=0.001), whereas the RR comparing the lowest with the highest quintile of the prudent pattern scores was 1.39 (95% CI 1.08-1.80; p (trend)=0.018). The RR for each increment of one serving/day was 1.61 (95% CI 1.25-2.07) for red meat and 1.64 (95% CI 1.13-2.38) for processed meat.

CONCLUSIONS/INTERPRETATION

These findings suggest that pre-pregnancy dietary patterns may affect women's risk of developing GDM. A diet high in red and processed meat was associated with a significantly elevated risk.

Nutritional influence on risk of high blood pressure in Bangladesh: a population-based cross-sectional study

BACKGROUND

The nutritional determinants of hypertension in Bangladesh and other low-income countries are largely unknown.

OBJECTIVE

We assessed the associations of general hypertension with nutrient intakes and diet patterns in Bangladesh.

DESIGN

This was a cross-sectional analysis of 11 116 participants enrolled in the Health Effects of Arsenic Longitudinal Study in Bangladesh. Dietary intakes were measured by use of a validated food-frequency questionnaire.

RESULTS

Three major dietary patterns were identified by using principal component analysis: 1) the "balanced" pattern, which was characterized by rice, some meat, small fish, fruit, and vegetables; 2) the "animal protein" pattern, which was more heavily weighted on meat, milk, poultry, eggs, bread, large fish, and fruit; and 3) the "gourd and root vegetable" pattern, which consisted largely of squashes and root and leafy vegetables. Adjusted prevalence odds ratios for general hypertension in increasing quintiles of balanced pattern scores were 1.00 (reference), 0.81 (95% CI: 0.79, 0.97), 0.82 (0.68, 0.97), 0.79 (0.66, 0.94), and 0.71 (0.59, 0.85) (P for trend < 0.01). Prevalence odds ratios for general hypertension in increasing quintiles of animal protein pattern scores were 1.00 (reference), 1.30 (1.01, 1.52), 1.20 (1.01, 1.47), 1.22 (1.00, 1.44), and 1.21 (1.03, 1.49) (P for trend = 0.23). Markers of high socioeconomic status were positively associated with the animal protein pattern.

CONCLUSION

Our findings suggest the importance of dietary patterns in general hypertension in a low-income population undergoing the early stage of the epidemiologic transition.

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus

OBJECTIVE

This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM).

METHODS

Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin >7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA.

RESULTS

The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m(2) (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20-35% from fat (<7% saturated), and 20% from protein.

CONCLUSION

These patients reported a low-carbohydrate, low-fiber, high-fat (especially saturated) diet, although they stated they are not following any of the popular low-carbohydrate diets. Patients with T2DM may find the current trend toward reducing weight through low-carbohydrate diets attractive for control of blood glucose, despite ADA recommendations. This dietary pattern may represent a popular trend that extends beyond our particular study and, if so, has serious cardiovascular implications in this vulnerable population of T2DM patients.

Dietary patterns and associated lifestyles in individuals with and without familial history of obesity: a cross-sectional study

Background

Familial history of obesity (FHO) and certain dietary habits are risk factors for obesity. The objectives of this cross-sectional study were 1) to derive dietary patterns using factor analysis in a population of men and women with and without FHO; 2) to compare mean factor scores for each dietary pattern between individuals with and without FHO; and 3) to examine the association between these patterns and anthropometric, lifestyle and sociodemographic variables.

Methods

A total of 197 women and 129 men with a body mass index <30 kg/m² were recruited. A positive FHO (FHO+) was defined as having at least one obese first-degree relative and a negative FHO (FHO-) as no obese first-degree relative. Dietary data were collected from a food frequency questionnaire. Factor analysis was performed to derive dietary patterns. Mean factor scores were compared using general linear model among men and women according to FHO. Regression analyses were performed to study the relationship between anthropometric, lifestyle and sociodemographic variables, and each dietary pattern.

Results

Two dietary patterns were identified in both men and women : the Western pattern characterized by a higher consumption of red meats, poultry, processed meats, refined grains as well as desserts, and the Prudent pattern characterized by greater intakes of vegetables, fruits, non-hydrogenated fat, and fish and seafood. Similar Western and Prudent factor scores were observed in individual with and without FHO. In men with FHO+, the Western pattern is negatively associated with age and positively associated with physical activity, smoking, and personal income. In women with FHO-, the Prudent pattern is negatively associated with BMI and smoking and these pattern is positively associated with age and physical activity.

Conclusion

Two dietary patterns have been identified among men and women with and without FHO. Although that FHO does not seem to influence the adherence to dietary patterns, results of this study suggest that anthropometric, lifestyle and sociodemographic variables associated with dietary patterns differ according to FHO and gender.

Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies

The consumption of fruit and vegetables is associated with a reduced rate of coronary heart disease (CHD) in observational cohorts. The purpose of this study was to assess the strength of this association in a meta-analysis. Cohort studies were selected if they reported relative risks (RRs) and 95% CI for coronary heart disease or mortality and if they presented a quantitative assessment of fruit and vegetable intake. The pooled RRs were calculated for each additional portion of fruit and/or vegetables consumed per day, and the linearity of the associations were examined. Nine studies were eligible for inclusion in the meta-analysis that consisted of 91,379 men, 129,701 women, and 5,007 CHD events. The risk of CHD was decreased by 4% [RR (95% CI): 0.96 (0.93-0.99), P = 0.0027] for each additional portion per day of fruit and vegetable intake and by 7% [0.93 (0.89-0.96), P < 0.0001] for fruit intake. The association between vegetable intake and CHD risk was heterogeneous (P = 0.0043), more marked for cardiovascular mortality [0.74 (0.75-0.84), P < 0.0001] than for fatal and nonfatal myocardial infarction [0.95 (0.92-0.99), P = 0.0058]. Visual inspection of the funnel plot suggested a publication bias, although not statistically significant. Therefore, the reported RRs are probably overestimated. This meta-analysis of cohort studies shows that fruit and vegetable consumption is inversely associated with the risk of CHD. The causal mechanism of this association, however, remains to be demonstrated.

Low adherence of a clinically healthy Italian population to nutritional recommendations for primary prevention of chronic diseases

BACKGROUND AND AIM

Several data demonstrated that dietary habits significantly affect the health state of the population. During recent years all the major scientific associations have provided nutritional recommendations for primary prevention of chronic diseases but few data are available about prevalence of adherence to these recommendations in an otherwise healthy population. The aims of this study were to evaluate dietary habits, and to assess the adherence of the general population to the recommendations for correct nutritional behaviour.

METHODS AND RESULTS

Dietary habits, anthropometric and biochemical parameters were evaluated in a population of 932 (367 M; 565 F) clinically healthy subjects living in Florence, enrolled in an epidemiologic study conducted between 2002 and 2004. By comparing the dietary pattern with the nutritional guidelines, the study population reported a hyperproteic and hyperlipidic nutritional pattern, with a considerably low contribution from polyunsaturated fats (PUFA). A low fibre intake is shown in both genders. In addition, food consumption pattern showed an increased consumption of some foods such as meat, both fresh and processed, and a low intake of some "healthy" foods like fruit and vegetables.

CONCLUSIONS

We found several nutritional flaws in the dietary habits of a clinically healthy Italian population. In particular, we reported a high intake of animal protein and total fats with a very low contribution from PUFA.

Effects of tomato extract on platelet function: a double-blinded crossover study in healthy humans

BACKGROUND

Aqueous extracts from tomatoes display a range of antiplatelet activities in vitro. We previously showed that the active components also alter ex vivo platelet function in persons with a high response to ADP agonist.

OBJECTIVE

The objective was to evaluate the suitability of a tomato extract for use as a dietary supplement to prevent platelet activation.

DESIGN

A randomized, double-blinded, placebo-controlled crossover study was conducted in 90 healthy human subjects selected for normal platelet function. Changes from baseline hemostatic function were measured 3 h after consumption of extract-enriched or control supplements.

RESULTS

Significant reductions in ex vivo platelet aggregation induced by ADP and collagen were observed 3 h after supplementation with doses of tomato extract equivalent to 6 (6TE) and 2 (2TE) tomatoes [3 micromol ADP/L: 6TE (high dose), -21.3%; 2TE (low dose), -12.7%; P < 0.001; 7.5 micromol ADP/L: 6TE, -7.8%, 2TE, -7.6%; P < 0.001; 3 mg collagen/L: 6TE, -17.5%; 2TE, -14.6%; P = 0.007]. No significant effects were observed for control supplements. A dose response to tomato extract was found at low levels of platelet stimulation. Inhibition of platelet function was greatest in a subgroup with the highest plasma homocysteine (P < 0.05) and C-reactive protein concentrations (P < 0.001).

CONCLUSION

As a functional food or dietary supplement, tomato extract may have a role in primary prevention of cardiovascular disease by reducing platelet activation, which could contribute to a reduction in thrombotic events.

Effects of antiplatelet components of tomato extract on platelet function in vitro and ex vivo: a time-course cannulation study in healthy humans

BACKGROUND

Natural antithrombotic agents that influence platelet function are of potential interest for primary prevention of cardiovascular disease. Previous reports showed that tomato extracts inhibit platelet aggregation in vitro, but little is known of the active components, their mode of action, or their efficacy in vivo.

OBJECTIVE

The objectives of the study were to examine the antiplatelet activity of specific tomato components by in vitro experimentation and to establish their ex vivo efficacy in healthy humans.

DESIGN

The mechanisms of action of antiplatelet components isolated from tomato extracts were examined in vitro. A 7-h time-course study was carried out in cannulated human subjects (n = 23) to determine the ex vivo efficacy of a supplement drink containing tomato extract and the onset and duration of antiplatelet effects.

RESULTS

The inhibition of ADP-, collagen-, thrombin-, and arachidonate-mediated platelet aggregation by tomato extract components appears to be linked to the inhibition of glycoprotein IIb/IIIa and platelet secretory mechanisms. We found a significant inhibition of baseline platelet function, from 2.9 +/- 1.4% (optimal ADP concentrations; P = 0.03) to 20.0 +/- 4.9% (suboptimal ADP concentrations; P < 0.001), 3 h after supplementation with a dose of tomato extract equivalent to 6 tomatoes. The observed effects persisted for >12 h. Coagulation variables were not affected.

CONCLUSIONS

The ingestion of tomato components with in vitro antiplatelet activity significantly affects ex vivo platelet function. The reported cardioprotective effects of tomatoes are potentially linked to a modulation of platelet function.

Motivating 18- to 24-Year-Olds to Increase Their Fruit and Vegetable Consumption

OBJECTIVE

This study assessed the effectiveness of a 4-month intervention using stage-based newsletters, computer-based communication, and motivational interviewing to increase fruit and vegetable consumption by college students aged 18 to 24 years.

DESIGN

Participants were stratified by stage of change for fruit and vegetable consumption and randomized to an intervention or control group. Participants completed the staging algorithm for fruit and vegetable intake, which included a one-item food frequency question, a 26-item food frequency questionnaire (FFQ), an 18-item decisional balance questionnaire, and a five-item self-efficacy questionnaire at baseline and completion of study.

SUBJECTS

A convenience sample of 437 college students enrolled in a rural, land grant university was enrolled in the study. Only nondietetics majors between ages 18 to 24 years were included in the study. A total of 314 students finished the study for a completion rate of 72%.

INTERVENTION

After baseline staging and randomization, the intervention group participants received four stage-based newsletters, one motivational interview, and an individually tailored e-mail follow-up over a 4-month period. Control group participants only received assessment at baseline and at completion.

MAIN OUTCOME MEASURES

Two fruit and vegetable instruments, a one-item food frequency question, and a 26-item FFQ measured daily consumption of fruits and vegetables at baseline and postintervention.

STATISTICAL ANALYSES PERFORMED

The SAS system for Windows, version 8 (1999, SAS Institute, Inc, Cary, NC), was used for analysis, including the following tests: PROC GLM, PROC FREQ, and PROC NPAR1WAY, Kruskal-Wallis, Fisher, Wilcoxon rank sum, and chi(2).

RESULTS

Fruit and vegetable consumption increased significantly more for the intervention group than the control group. Consumption increased in the intervention group by one serving a day for both instruments compared with 0.4 servings a day in the control group for a one-item instrument and no change in the control group for a 26-item FFQ.

CONCLUSIONS

This intervention is an effective way to increase fruit and vegetable consumption by young adults.

Comparative strategies for using cluster analysis to assess dietary patterns

OBJECTIVES

To characterize dietary patterns using two different cluster analysis strategies.

DESIGN

In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit.

SUBJECTS

One hundred seventy-nine community-dwelling adults, aged 66 to 87 years, in rural Pennsylvania.

STATISTICAL ANALYSIS

Cluster analysis was performed.

RESULTS

The methods differed in the food subgroups that clustered together. Both methods produced clusters that had significant differences in overall diet quality as assessed by Healthy Eating Index (HEI) scores. The clusters with higher HEI scores contained significantly higher amounts of most micronutrients. Both methods consistently clustered subgroups with high energy contribution (eg, fats and oils and dairy desserts) with a lower HEI score. Clusters resulting from the percent energy method were less likely to differentiate fruit and vegetable subgroups. The higher diet quality dietary pattern derived from the number of servings method resulted in more favorable weight status.

CONCLUSIONS

Cluster analysis of food subgroups using two different methods on the same data yielded similarities and dissimilarities in dietary patterns. Dietary patterns characterized by the number of servings method of analysis provided stronger association with weight status and was more sensitive to fruit and vegetable intake with regard to a more healthful dietary pattern within this sample. Public health recommendations should evaluate the methodology used to derive dietary patterns.

The Dietary Quality Score: validation and association with cardiovascular risk factors: the Inter99 study

OBJECTIVE

To develop and assess the validity of the Dietary Quality Score (DQS) and investigate the association with cardiovascular risk factors.

DESIGN

Cross-sectional population-based study.

SETTING

Copenhagen County, Glostrup, Denmark.

SUBJECTS

A random sample of 12,934 men and women aged 30-60 years were invited to a health examination. A total of 6542 participants were included in the statistical analysis.

METHODS

The DQS was developed using eight questions from a 48-item food frequency questionnaire (FFQ) and validated using a 198-item FFQ. Associations between the DQS and fasting serum lipids, homocysteine, blood pressure and the absolute risk of ischaemic heart disease (IHD) were explored.

RESULTS

A higher DQS was shown to be associated with higher dietary quality in general, including a low intake of fat, especially saturated fat; a high intake of fibre; various vitamins and minerals; and fruit, fish, vegetables and whole-grain products. A higher score according to the DQS was significantly negatively associated with total cholesterol (P=0.0031), triglyceride (P=0.0406), low-density lipoprotein-cholesterol (P=0.0071), homocysteine (P<0.0001) and the absolute risk of IHD (P<0.0001), adjusted for sex, age, smoking habits and physical activity level.

CONCLUSIONS

The DQS is a simple, valid and quick tool to make a rough classification of individuals into groups with high, average and low dietary quality. The DQS is negatively associated with serum lipids, homocysteine and the absolute risk of IHD.

SPONSORSHIP

The Inter99 study is supported economically by The Danish Medical Research Council, The Danish Centre for Evaluation and Health Technology Assessment, Novo Nordisk, Copenhagen County, The Danish Heart Foundation, The Danish Pharmaceutical Association, Augustinus Foundation, Ib Henriksen Foundation and Becket Foundation, Copenhagen County.

Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum

OBJECTIVE

To identify dietary patterns in women who are planning immediate pregnancy in preconception, weeks 6, 10, 26 and 38 of pregnancy, and 6 months postpartum, and to describe how particular lifestyles, the body mass index (BMI) and sociodemographic factors are associated to these patterns.

DESIGN

Longitudinal study throughout the reproductive cycle of food consumption carried out in a Spanish Mediterranean city.

SETTING

Faculty of Medicine and Health Sciences, Rovira i Virgili University.

SUBJECTS

In total, 80 healthy female volunteers who were planning immediate pregnancy.

INTERVENTIONS

A seven-consecutive-day dietary record was used to evaluate the dietary intake. Exploratory factor analysis was used to identify the main dietary patterns in each of the periods. Fitted multiple linear regression models were used to study the associations between the lifestyle and sociodemographic variables, and each dietary pattern.

RESULTS

The 'sweetened beverages and sugars' pattern was identified from preconception to 6 months postpartum and the 'vegetables and meat' pattern to the end of pregnancy. The 'sweetened beverages and sugars' pattern is positively associated with smoking and negatively associated with physical activity before conception and in the first trimester of pregnancy. The 'vegetables and meat' pattern is negatively associated with the BMI during the preconception period and positively associated with age in weeks 10 and 38 of pregnancy. It is shown that the patterns do not change significantly throughout the period studied.

CONCLUSIONS

We have identified two stable dietary patterns from preconception to postpartum. The 'sweetened beverages and sugars' pattern is associated with habits of risk for the health of the pregnant woman and her offspring.

SPONSORSHIP

'Comisión Interministerial de Ciencia y Tecnología' (CICYT: ALI89-0388) and 'Instituto de Salud Carlos III', RCMN (C03/08), Madrid, Spain'.

Methodological approaches to study dietary patterns in relation to risk of coronary heart disease and stroke

Dietary pattern analysis, which reflects the complexity of dietary intake, has received considerable attention by nutritional epidemiology. For a long time, two general approaches have been used to define these summary variables in observational studies. The exploratory approach is based only on the data of the study, whereas the hypothesis-oriented approach constructs pattern variables based on scientific evidence available before the study. Recently, a new statistical method, reduced rank regression, was applied to nutritional epidemiology that is exploratory by nature, but can use scientific evidence by focusing on disease-related dietary components or biomarkers. Several studies, both observational and clinical, suggest that dietary patterns may predict the risk of CHD and stroke. In the present review, we describe the results of these studies and the available evidence regarding the relationships between dietary patterns and risk of CVD and we discuss limitations and strengths of the statistical methods used to extract dietary patterns.

Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Dietary patterns may influence cardiovascular disease risk through effects on inflammation and endothelial activation.

OBJECTIVE

We examined relations between dietary patterns and markers of inflammation and endothelial activation.

DESIGN

At baseline, diet (food-frequency questionnaire) and concentrations of C-reactive protein (CRP), interleukin 6 (IL-6), homocysteine, soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin were assessed in 5089 nondiabetic participants in the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Four dietary patterns were derived by using factor analysis. The fats and processed meats pattern (fats, oils, processed meats, fried potatoes, salty snacks, and desserts) was positively associated with CRP (P for trend < 0.001), IL-6 (P for trend < 0.001), and homocysteine (P for trend = 0.002). The beans, tomatoes, and refined grains pattern (beans, tomatoes, refined grains, and high-fat dairy products) was positively related to sICAM-1 (P for trend = 0.007). In contrast, the whole grains and fruit pattern (whole grains, fruit, nuts, and green leafy vegetables) was inversely associated with CRP, IL-6, homocysteine (P for trend < or = 0.001), and sICAM-1 (P for trend = 0.034), and the vegetables and fish pattern (fish and dark-yellow, cruciferous, and other vegetables) was inversely related to IL-6 (P for trend = 0.009). CRP, IL-6, and homocysteine relations across the fats and processed meats and whole grains and fruit patterns were independent of demographics and lifestyle factors and were not modified by race-ethnicity. CRP and homocysteine relations were independent of waist circumference.

CONCLUSIONS

These results corroborate previous findings that empirically derived dietary patterns are associated with inflammation and show that these relations in an ethnically diverse population with unique dietary habits are similar to findings in more homogeneous populations.

Comparison of Two Nutrition Education Approaches to Reduce Dietary Fat Intake and Serum Lipids Reveals Registered Dietitians Are Effective at Disseminating Information Regardless of the Educational Approach

OBJECTIVE

The purpose of this study was to compare an educational approach based on the Stages of Change Model with usual care education in reducing dietary fat intake and serum lipids in individuals with hyperlipidemia.

DESIGN

A 40-week randomized control study was conducted. Four education sessions were provided on an outpatient basis during a 1-month period with follow-up every 6 weeks.

PARTICIPANTS

The sample consisted of 141 men and women with hyperlipidemia (mean age 50+/-11 years and a mean body mass index of 30+/-6) randomly assigned to one of two education interventions.

INTERVENTION

The stages of change group was provided with tailored dietary activities based on their readiness to change to reduce dietary fat intake. Dietary information and activities for the usual care program were developed for those individuals ready to make a change in their diets.

MAIN OUTCOME MEASURES

Serum lipids, anthropometric measures, readiness to change, dietary intake, and exercise data were assessed at baseline, 4, 16, 28, and 40 weeks.

STATISTICAL ANALYSES

A repeated measures analysis of variance was used to compare differences between groups across time.

RESULTS

Total cholesterol, low-density lipoprotein cholesterol, and body weight decreased significantly at 4 weeks (P<0.05) for both groups and were sustained over time, with no differences between the groups.

CONCLUSIONS

The stages of change education approach was not more effective than the usual care education approach in decreasing dietary fat intake and serum lipids in a classroom setting.

Changes in the stability of dietary patterns in a study of middle-aged Swedish women

Dietary patterns reflecting food habits may be associated with chronic diseases, yet little is known about the stability of these patterns. The objective of this study was to observe over time the stability of dietary patterns measured with exploratory and confirmatory factor analysis. Four random subsamples of 1000 women between 49 and 70 y old were chosen from >60,000 women included in the Swedish Mammography Cohort. Subjects in these subsamples were administered a FFQ 4, 5, 6, or 7 y after the baseline questionnaire; 3607 of the women responded (90% response rate). The stability of dietary patterns was evaluated with Spearman correlation coefficients between pattern scores at baseline and follow-ups and by a test of internal stability, which evaluated the significance of changes within patterns between baseline and follow-up. We found 3 major dietary patterns: a healthy pattern, a Western pattern, and an alcohol pattern. Correlations between explored dietary pattern scores at baseline and at follow-up decreased from 0.59 (P < 0.01) after 4 y to 0.50 (P < 0.01) after 7 y for the healthy pattern, from 0.47 (P < 0.01) to 0.39 (P < 0.01) for the Western pattern and from 0.54 (P < 0.01) to 0.46 (P < 0.01) for the alcohol pattern. After 4 and 5 y, there was no evidence for internal instability in any of the 3 patterns. The Western pattern became internally unstable after 6 and 7 y and the alcohol pattern was unstable after 7 y. Our findings for this specific population suggest that in longitudinal studies, dietary exposures should be updated after at least 7 y.

Faut-il conseiller à nos patients de boire du vin?

No study has shown that moderate wine consumption has any adverse effect on cardiovascular risk. Binge drinking induces a risk of thrombosis. The continuation of moderate wine consumption is reasonable and probably beneficial as secondary prevention. Polyphenols are antioxidants, antiaggregants, and NO donors; they increase HDL cholesterol levels. Moderate wine consumption appears to protect cognitive function in the elderly.

Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature

A number of reviewers have examined studies investigating the relationship between coronary heart disease and stroke prior to 2000. Since then, several key studies have been published. Five studies have examined the relationship between wholegrain consumption, coronary heart disease (CHD) and cardiovascular (CVD) disease and found protection for either or both diseases. The researchers concluded that a relationship between wholegrain intake and CHD is seen with at least a 20% and perhaps a 40% reduction in risk for those who eat wholegrain food habitually vs those who eat them rarely. Notwithstanding the fact that fibre is an important component of wholegrains, many studies have not shown an independent effect of fibre alone on CHD events. Thus in terms of CHD prevention, fibre is best obtained from wholegrain sources. Wholegrain products have strong antioxidant activity and contain phytoestrogens, but there is insufficient evidence to determine whether this is beneficial in CHD prevention. Soluble fibre clearly lowers cholesterol to a small but significant degree and one would expect that this would reduce CHD events. There have been a small number of epidemiological studies showing soy consumption is associated with lower rates of heart disease. Countering the positive evidence for wholegrain and legume intake has been the Nurses Health Study in 2000 that showed women who were overweight or obese consuming a high glycaemic load (GL) diet doubled their relative risk of CHD compared with those consuming a low GL diet. Although the literature relating GL with CHD events is somewhat mixed, the relationship with risk factors such as HDL cholesterol, triglyceride and C reactive protein is relatively clear. Thus, carbohydrate-rich foods should be wholegrain and, if they are not, then the lowest glycaemic index (GI) product should be used. Promotion of carbohydrate foods should be focused on wholegrain cereals because these have proven to be associated with health benefits. There is insufficient evidence about whether the addition of other components of wholegrains such as polyphenolics or minerals (such as magnesium or zinc) would improve the health benefits of refined grain foods and this needs investigation. Whether adding bran to refined carbohydrate foods can improve the situation is also not clear, and it was found that added bran lowered heart disease risk in men by 30%. This persisted after full adjustment (including GL) suggesting, at least in men, that fibre may be more important than GI. Thus there are two messages: The intake of wholegrain foods clearly protects against heart disease and stroke but the exact mechanism is not clear. Fibre, magnesium, folate and vitamins B6 and vitamin E may be important. The intake of high GI carbohydrates (from both grain and non-grain sources) in large amounts is associated with an increased risk of heart disease in overweight and obese women even when fibre intake is high but this requires further confirmation in normal-weight women.

RECOMMENDATION

Carbohydrate-rich foods should be wholegrain and if they are not, then the lowest GI product available should be consumed. Glycemic index is largely irrelevant for foods that contain small amounts of carbohydrate per serve (such as most vegetables).

Dietary patterns and survival in older Dutch women

BACKGROUND

The need to gain insight into prevailing eating patterns and their health effects is evident.

OBJECTIVE

This study aimed to identify dietary patterns and their relation to total mortality in older Dutch women.

DESIGN

A principal component analysis of 22 food groups was used to identify dietary patterns in 5427 women aged 60-69 y who were included in the Dutch European Prospective Investigation into Cancer and Nutrition-Elderly cohort (follow-up: approximately 8.2 y). Mortality ratios for 3 major principal components were assessed by using Cox proportional hazard analysis.

RESULTS

The most relevant principal components were a Mediterranean-like dietary pattern (high intakes of vegetable oils, pasta and rice, sauces, fish, and wine), a Traditional Dutch dinner dietary pattern (high intakes of meat, potatoes, vegetables, and alcoholic beverages), and a Healthy Traditional Dutch dietary pattern (healthy variant of the Traditional Dutch dinner dietary pattern; high intakes of vegetables, fruit, nonalcoholic drinks, dairy products, and potatoes). Differences in mean intakes between the highest and lowest tertiles of the 3 patterns were greatest for fruit, dairy products, potatoes, and alcoholic beverages. Consumption of Mediterranean foods, such as fish and oils, was relatively low overall. Two hundred seventy-seven deaths occurred in 44,667 person-years. Independent of age, education, and other lifestyle factors, only the Healthy Traditional dietary pattern score was associated with a lower mortality rate. Women in the highest tertile of this pattern experienced a 30% reduction in mortality risk.

CONCLUSION

A Healthy Traditional Dutch diet, rather than a Mediterranean diet, appears beneficial for longevity and feasible for health promotion in older Dutch women. This diet is comparable with other reported healthy or prudent diets that have been shown to be protective against morbidity or mortality.

Partial substitution of carbohydrate intake with protein intake from lean red meat lowers blood pressure in hypertensive persons

BACKGROUND

Compared with carbohydrate intake, dietary intake of plant protein can lower blood pressure in humans, but the effects of animal protein intake on blood pressure have yet to be investigated.

OBJECTIVE

We aimed to determine whether partial substitution of carbohydrate intake with animal protein intake from lean red meat changes blood pressure and other markers of cardiovascular disease risk in hypertensive persons.

DESIGN

Hypertensive persons (n = 60) were recruited to an 8-wk parallel-design study. The participants were randomly assigned either to maintain their usual diet (control group) or to partially replace energy intake from carbohydrate-rich foods with protein from lean red meat (protein group). Measurements were performed at baseline and at the end of the intervention.

RESULTS

Compared with the control group, the protein group had a significantly higher protein intake [x (95% CI) percent of energy: 5.3% (3.7%, 6.9%), P < 0.001] and a corresponding lower carbohydrate intake [-5.3% of energy (-7.9%, -2.7%), P < 0.001]. Body weight and intakes of fat, alcohol, and fiber were not significantly different between the groups. Compared with the control group, the clinic, 24-h, awake, and asleep systolic blood pressures were lower [-5.2 (-10.3, -0.1), -4.0 (-7.4, -0.6), -4.7 (-8.9, -0.5), and -4.7 (-10.3, -0.1) mm Hg, respectively, P < 0.05] and fasting plasma glucose concentrations were higher [0.33 mmol/L (0.09, 0.58 mmol/L), P = 0.008] in the protein group. These differences were independent of age, sex, and changes in weight, alcohol intake, or urinary sodium and potassium excretion. Diastolic blood pressure and heart rate, arterial compliance, blood lipids, and serum insulin were not significantly different between the groups.

CONCLUSION

Within the context of other studies, these results suggest that modest substitution of carbohydrate-rich foods with protein-rich foods may lower blood pressure in hypertensive persons.

Reducing hypertensive cardiovascular disease risk of African Americans with diet: focus on the facts

Hypertension is more common and more severe in African Americans than in other population groups in the United States, placing them at increased risk of cardiovascular disease, stroke, and end-stage renal disease. Whereas past efforts to reduce blood pressure (BP) via the diet centered on manipulating isolated nutrients, there are now conclusive data demonstrating that it is not single dietary components but the overall dietary pattern that has the greatest influence on BP. A nutritionally complete diet rich in fruits, vegetables, and low-fat dairy foods has been clearly proven to significantly lower BP in all population groups. This diet, commonly referred to as the Dietary Approaches to Stop Hypertension (DASH) diet, has been tested in randomized, controlled trials emphasizing African American populations and documented the greatest beneficial effects in hypertensive African Americans. Improving diet quality has been shown to be simply implemented without adverse effects such as symptoms of lactose maldigestion. It is also known to beneficially affect other cardiovascular risk factors and is in keeping with dietary recommendations for prevention of some cancers and osteoporosis. This paper reviews the current data relating dietary patterns to BP control, and advocates dietary recommendations that can accomplish their intended objective of enhancing the health of Americans by promoting safe, feasible, and proven-effective means of doing so. In the case of hypertension prevention and treatment, and thus the reduction of cardiovascular disease risk, overall diet quality should be the primary focus of nutritional recommendations.

Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort

INTRODUCTION

Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases. We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly (> or =60 years) Italians participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

METHODS AND RESULTS

Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food questionnaires. Individual participants were assigned factor scores, indicating the extent to which their diet conformed to each of the four dietary patterns identified: prudent (cooked vegetables, pulses, cabbage, seed oil and fish); pasta & meat (pasta, tomato sauce, red meat, processed meat, bread and wine); olive oil & salad (raw vegetables, olive oil, soup and chicken); and sweet & dairy (sugar, cakes, ice cream, coffee and dairy). Highly educated people had high scores on prudent and low scores on pasta & meat. The pasta & meat and prudent patterns were strongly positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) in men and women. Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids. The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year, suggesting awareness of the health consequences of these patterns.

CONCLUSIONS

Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people, and can be used to provide tangible dietary advice to elderly people.

Olive oil consumption and weight change: The SUN prospective cohort study

The aim of this dynamic prospective follow-up study was to assess the association between olive oil consumption and the likelihood of weight gain or the incidence of overweight or obesity in a large Mediterranean cohort of 7,368 male and female Spanish university graduates (the SUN Project) who were followed for a median period of 28.5 mon. A validated Food Frequency Questionnaire was administered at baseline, and respondents also completed a follow-up questionnaire after 28.5 mon. Changes in participants' consumption of olive oil and their weight were assessed during follow-up. A higher baseline consumption of olive oil was associated with a lower likelihood of weight gain, although the differences were not statistically significant. The adjusted difference in weight gain (kg) was -0.16 [95% confidence interval (CI): -0.42 to +0.11] for participants in the upper quintile of olive oil consumption (median: 46 g/d) compared with those in the lowest quintile (median: 6 g/d). For participants with a high baseline consumption of olive oil whose olive oil consumption also increased during follow-up, we found a slightly increased but nonsignificant risk of incidence of overweight or obesity (adjusted odds ratio = 1.19, 95% CI: 0.73 to 1.95). Our study, carried out in a sample of free-living people, shows that a high amount of olive oil consumption is not associated with higher weight gain or a significantly higher risk of developing overweight or obesity in the context of the Mediterranean food pattern.

Long-term stability of food patterns identified by use of factor analysis among Swedish women

Limited data exist on the reproducibility of food patterns measured by factor analysis as well as on the use of stability of patterns over time. Our primary objective was to explore the long-term stability of food patterns derived by confirmatory factor analysis among 33,840 women participating in the Swedish Mammography Cohort. Our secondary objective was to compare factor solutions from confirmatory factor analysis with those derived by use of exploratory factor analysis. Diet was assessed by a food frequency questionnaire in 1987 and 1997, and food patterns were derived by the use of exploratory and confirmatory factor analysis. We observed four major food patterns (Healthy, Western/Swedish, Alcohol, and Sweets) at both time points. Correlations between confirmed food patterns in 1987 and 1997 were 0.37 for the Healthy pattern, 0.27 for the Western/Swedish pattern, 0.54 for the Alcohol pattern, and 0.44 for the Sweets pattern (P < 0.0001 for all associations). Patterns derived by the use of exploratory factor analysis were strongly associated with those derived by the use of confirmatory factor analysis (r >/= 0.90, P < 0.0001, for all associations). The patterns derived in this study were similar to those derived in other studies, indicating reproducibility of food patterns across populations. Our study suggests that food patterns measured by the use of confirmatory factor analysis are reproducible over time, and weaker correlations observed may reflect natural changes in eating behavior, the food supply, and/or perceptions of what is considered healthy. Testing whether patterns measured over a long time period can be used in analytic studies is the next step in assessing the validity of this method.

Cardiovascular disease: optimal approaches to risk factor modification of diet and lifestyle

Cardiovascular disease (CVD) accounts for almost 50% of all deaths in industrialized nations. As much as 70% of CVD can be prevented or delayed with dietary choices and lifestyle modifications. Western-style diets, sedentary lifestyles, and cigarette smoking are key modifiable CVD risk factors. Although CVD mortality was trending downward for almost 50 years, a resurgence, both nationally and globally, has occurred. A growing epidemic of obesity ("globesity"), decreasing physical activity, and persistent cigarette smoking are major behavioral factors underlying this change. Diet and lifestyle increase CVD risk both directly and indirectly. Direct effects include biological, molecular, and physiologic alterations, including inflammatory stimuli and oxidative stresses. Indirect effects include diabetes, dyslipidemias, and hypertension. However, trials studying links between diet and CVD remain notoriously difficult to execute and interpret. Diet interventions are typically confounded by other aspects of an overall diet as well as by lifestyle. Furthermore, benefits derived from a specific dietary or lifestyle intervention may not be proportional to the degree of risk posed by the unhealthy diet or lifestyle. Nonetheless, therapeutic rationale for diet and lifestyle are supported by basic and clinical research. Key components of a healthy aggregate diet include 1) reduced caloric intake; 2) reduced total fat, saturated fat, trans fat, and cholesterol with proportional increases in monosaturated, n-3 (omega-3), and n-6 fatty acids; 3) increased dietary fiber, fruit, and vegetables; 4) increased micronutrients (eg, folate, B6, B12); 5) increased plant protein in lieu of animal protein; 6) reduced portions of highly processed foods; and 7) adopting a more Mediterranean or "prudent" dietary pattern over the prevailing "western" dietary pattern. Key lifestyle interventions include increased physical activity and smoking cessation. Translation of the benefits of healthy diet and lifestyle to the wider population requires both individual and public health strategies targeting at-risk groups.

Association of fiber intake and fruit/vegetable consumption with weight gain in a Mediterranean population

OBJECTIVE

We assessed the association between fiber intake and fruit/vegetable consumption with the likelihood of weight gain in the previous 5 y in a Mediterranean population.

METHODS

We conducted a cross-sectional analysis of participants (5094 men and 6613 women) in a multipurpose prospective cohort (Seguimiento Universidad de Navarra Study). Diet was measured by using a semiquantitative food-frequency questionnaire that was previously validated in Spain. We calculated the odds ratios of weight gain in the previous 5 y according to quintiles of energy-adjusted fiber intake and quintiles of energy-adjusted of fruit/vegetable consumption. We also considered the joint exposure to fiber intake and fruit/vegetable consumption.

RESULTS

Multivariate-adjusted odds ratios for weight gain across quintiles 1 to 5 of fiber intake were 1.00 (reference), 0.86, 0.86, 0.70, and 0.52 (P for trend < 0.001) among men and 1.00 (reference), 0.99, 1.08, 1.05, and 0.72 (P for trend = 0.005) among women. We also observed a significant inverse association between total fruit/vegetable consumption and weight gain, but only among men (adjusted odds ratios, 0.78, 0.89, 0.70, and 0.54 for quintiles 2 to 5, P for trend < 0.001). The inverse association between fruit/vegetable consumption and weight gain in the previous 5 y was more evident among those with a high intake of total fiber, and the benefit of total fiber was more evident among those with a high consumption of fruits and vegetables.

CONCLUSIONS

This study provides additional support to the inverse association between fiber or fruit/vegetable consumption and weight gain, thus emphasizing the importance of replacing some dietary compounds by such foods and fiber-rich products, which may help to avoid weight gain.

Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults

OBJECTIVE

To investigate the association between dietary patterns and risk of a first nonfatal acute myocardial infarction (MI) in Costa Rican adults.

DESIGN

Population-based case-control study.

SUBJECTS

A total of 496 incident MI cases and 518 population-based randomly selected controls matched to the cases by age (+/-5 years), gender, and county of residence. Subjects were interviewed with a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using multivariate conditional logistic regression adjusted for several recognized risk factors for MI.

RESULTS

Two diet patterns were identified, 'vegetable' characterized by increased intake of vegetables and fruits, and 'staple', characterized by an increased use of palm oil for cooking, and intake of refined grains (mostly white rice and white bread), legumes, coffee, added sugar, and red meat. Compared to the lowest quintile of the staple diet pattern, the highest quintile was associated with an increased risk of MI (OR: 3.70, 95% CI: 2.30-5.97). Adjusting for potential confounders did not change the results (OR: 3.53, 95% CI: 1.98-6.31). Consistently, an increasing staple pattern score was associated with lower HDL cholesterol (P for trend <0.02) and alpha-linolenic acid in adipose tissue (P for trend <0.0001). The vegetable pattern was not associated with MI.

CONCLUSIONS

The staple dietary pattern of Costa Rican adults is associated with low plasma HDL cholesterol, low alpha-linolenic acid in adipose tissue, and increased risk of MI.

Dietary patterns and risk of prostate cancer in U.S. men

We prospectively investigated the associations between dietary patterns and risk of prostate cancer in the Health Professionals Follow-up Study. Between 1986 and 2000, 3,002 incident prostate cancer cases were identified in our cohort. Using factor analysis, two major dietary patterns were identified, a prudent and a western dietary pattern. Dietary patterns were not appreciably associated with risk of total prostate cancer. For the highest versus the lowest quintiles, the multivariable relative risk (RR) for the prudent pattern was 0.94 [95% confidence interval (CI), 0.83-1.06], and for the western pattern, the multivariable RR was 1.03 (95% CI, 0.92-1.17). Neither were these associated with risk of advanced prostate cancer [highest versus lowest quintile, prudent pattern (RR, 1.01; 95% CI, 0.68-1.49); western pattern (RR, 1.13; 95% CI, 0.77-1.67)]. Higher western pattern scores were suggestively associated with a greater risk of advanced prostate cancer among older men [highest versus lowest quintile (RR, 1.35; 95% CI, 0.97-1.90)], but not after adding processed meat to the model [highest versus lowest quintile (RR, 1.11; 95% CI, 0.75-1.65)]. We did not find any evidence for a protective association between prudent pattern and risk of prostate cancer. The lack of association between a western dietary pattern as identified by factor analysis in our cohort and prostate cancer risk suggests that dietary risk factors for prostate cancer are likely to differ from those for other conditions, such as cardiovascular disease and type 2 diabetes, that have been associated with a western dietary pattern in this cohort.

Dietary fiber intake and risk factors for cardiovascular disease in French adults

BACKGROUND

Increased consumption of dietary fiber is widely recommended to maintain or improve health, but knowledge of the relation between dietary fiber sources and cardiovascular disease risk factors is limited.

OBJECTIVE

We examined the relation between the source or type of dietary fiber intake and cardiovascular disease risk factors in a cohort of adult men and women.

DESIGN

In a cross-sectional study, quintiles of fiber intake were determined from dietary records, separately for 2532 men and 3429 women. Age- and multivariate-controlled logistic models investigated the odds ratios of abnormal markers for quintiles 2-5 of fiber intake compared with the lowest quintile.

RESULTS

The highest total dietary fiber and nonsoluble dietary fiber intakes were associated with a significantly (P < 0.05) lower risk of overweight and elevated waist-to-hip ratio, blood pressure, plasma apolipoprotein (apo) B, apo B:apo A-I, cholesterol, triacylglycerols, and homocysteine. Soluble dietary fiber was less effective. Fiber from cereals was associated with a lower body mass index, blood pressure, and homocysteine concentration; fiber from vegetables with a lower blood pressure and homocysteine concentration; and fiber from fruit with a lower waist-to-hip ratio and blood pressure. Fiber from dried fruit or nuts and seeds was associated with a lower body mass index, waist-to-hip ratio, and fasting apo B and glucose concentrations. Fiber from pulses had no specific effect.

CONCLUSION

Dietary fiber intake is inversely correlated with several cardiovascular disease risk factors in both sexes, which supports its protective role against cardiovascular disease and recommendations for its increased consumption.

Diet, alcohol, and gout: how do we advise patients given recent developments?

The disease burden of gout remains substantial and may be increasing as a result of trends in demographics and lifestyles. Recent scientific data serve to illuminate the links between dietary and other factors and risk for gout. These lifestyle factors affect not only the risk for gout, but also are risk factors for other chronic diseases of public health importance. Accordingly, dietary and lifestyle recommendations related to gout should consider their effect on many diseases beyond gout. These recommendations should reinforce established recommendations where the influence on gout parallels the influence on other diseases, and consider modifying the recommendations where they are divergent.

Dietary Patterns and the Risk of Breast Cancer

PURPOSE

Ecologic, migrant, and secular trend studies suggest an association between the Western diet and the risk of breast cancer. We examined data from the Nurses Health Study II to evaluate the association between major dietary patterns and the risk of breast cancer among pre-menopausal women.

METHODS

We derived "Western" and "prudent" dietary patterns from the responses of 90,638 premenopausal women, aged 26 to 46 years at baseline in 1991, who completed validated food frequency questionnaires in 1991 and 1995. These patterns were then evaluated for their associations with risk of breast cancer.

RESULTS

During 8 years of follow-up, we documented 710 cases of invasive breast cancer. The multivariate RR (95% CI) comparing highest to lowest quintiles of cumulative average score were 0.90 (0.68-1.18, p-value, test for trend = 0.54) for the prudent dietary pattern and 0.97 (0.71-1.33, p-value, test for trend = 0.97) for the Western dietary pattern.

CONCLUSIONS

Our findings suggest that there is no overall association between dietary patterns and risk of breast cancer. However, we found an inverse association between the prudent dietary pattern and breast cancer risk among ever smokers, but the test for interaction was not significant. We suggest that this finding merits further evaluation.

Prospective study of dietary patterns and persistent cough with phlegm among Chinese Singaporeans

RATIONALE

Using principal components analysis to examine dietary patterns complements the evaluation of individual food and nutrient intake in relation to health outcomes, but has not yet been applied to nonmalignant respiratory disease or symptoms.

OBJECTIVE

To examine the relation between patterns of dietary intake at baseline and new onset of persistent cough with phlegm in a population-based cohort of Singapore Chinese.

METHODS

A 165-item validated food frequency questionnaire was administered in-person at baseline in 1993. We identified 623 cases of incident cough with phlegm among 52,325 subjects by telephone interview from 1999 through 2004. We identified two distinct food patterns: a "meat-dim sum" pattern characterized by pork and chicken dim sum foods and noodle dishes, and a "vegetable-fruit-soy" pattern characterized by vegetables, fruit, and soyfood items.

MAIN RESULTS

The meat-dim sum pattern was positively associated with new-onset cough with phlegm (odds ratio, 1.43; 95% confidence interval, 1.08, 1.89; comparing fourth to first quartile, p for trend = 0.02), after adjustment for age, sex, total energy intake, smoking, education, and nonstarch polysaccharide intake, a protective factor for cough with phlegm in this cohort. Weaker associations were seen for more chronic symptoms and for incident asthma. A weak inverse association for the vegetable-fruit-soy pattern disappeared after adjustment for nonstarch polysaccharide intake.

CONCLUSION

A diet rich in meats, sodium, and refined carbohydrates may increase risk of developing cough with phlegm, independently of the apparent beneficial effects of a diet high in fiber in this Singapore Chinese cohort.

Dietary patterns among older Europeans: the EPIC-Elderly study

Overall dietary patterns have been associated with health and longevity. We used principal component (PC) and cluster analyses to identify the prevailing dietary patterns of 99 744 participants, aged 60 years or older, living in nine European countries and participating in the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort) and to examine their socio-demographic and lifestyle correlates. Two PC were identified: PC1 reflects a 'vegetable-based' diet with an emphasis on foods of plant origin, rice, pasta and other grain rather than on margarine, potatoes and non-alcoholic beverages. PC2 indicates a 'sweet- and fat-dominated' diet with a preference for sweets, added fat and dairy products but not meat, alcohol, bread and eggs. PC1 was associated with a younger age, a higher level of education, physical activity, a higher BMI, a lower waist:hip ratio and never and past smoking. PC2 was associated with older age, less education, never having smoked, a lower BMI and waist:hip ratio and lower levels of physical activity. Elderly individuals in southern Europe scored positively on PC1 and about zero on PC2, whereas the elderly in northern Europe scored negatively on PC1 and variably on PC2. The results of cluster analysis were compatible with the indicated dietary patterns. 'Vegetable-based' and a 'sweet- and fat-dominated' diets are prevalent among the elderly across Europe, and there is a north-south gradient regarding their dietary choices. Our study contributes to the identification of groups of elderly who are likely to have different prospects for long-term disease occurrence and survival.