A prospective study of nutritional factors and hypertension among US men

Low levels of linoleic acid and α-linolenic acid and high levels of arachidonic acid in plasma phospholipids are associated with hypertension

Dietary fat is an important determinant in the development and progression of high blood pressure (BP), a major risk factor for cardiovascular diseases and mortality. The aim of the present study was to determine the association between plasma phospholipid fatty acids and hypertension in Japanese men. The plasma level of linoleic acid (LA) in the subjects with hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) was identified to be significantly higher than that in the healthy controls. Following adjustment for age, body mass index, physical activity, smoking status, alcohol consumption, salt intake, and serum levels of glucose and hemoglobin A1c, higher plasma levels of LA and α-linolenic acid (ALA), and lower levels of arachidonic acid (AA) were significantly associated with a lower prevalence of hypertension. The odds ratio (OR) for the highest quartile (Q4) versus the lowest quartile (Q1) of LA was 0.17 (P=0.003), the OR for Q4 versus Q1 of ALA was 0.26 (P=0.042) and the OR for Q4 versus Q1 of AA was 2.04 (P=0.047). These results indicate that elevated levels of LA and ALA, and reduced levels of AA in the plasma prevent hypertension.

Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts

BACKGROUND AND PURPOSE

The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke.

METHODS

We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis.

RESULTS

A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results.

CONCLUSIONS

In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid.

Alkaline-earth elements of scalp hair and presence of hypertension in housewives: A perspective of chronic effect

The relationship between population intakes of alkaline-earth elements (AEEs) and hypertension risk remains under discussion. Hair AEE concentrations can indicate their intake levels into human body. Thus, we aimed to investigate an association of hair AEE concentrations with hypertension risk, and the potential effect of dietary habit on this association. We recruited 398 housewives [163 subjects with hypertension (case group) and 235 subjects without hypertension (control group)] in Shanxi Province of north China. The scalp hair grown in the recent 2 years of each subject was collected and analyzed for the four concerned AEEs [i.e. calcium (Ca), magnesium (Mg), strontium (Sr), and barium (Ba)]. Our study results revealed that median concentrations (μg/g hair) of hair AEEs in the case group were systematically lower than those in control group [i.e. 701 vs. 1271 of Ca, 55.2 vs. 88.3 of Mg, 4.60 vs. 10.4 of Sr, and 1.02 vs. 1.68 of Ba]. Lower levels of the four individual AEEs of hair were associated with an increased presence of hypertension, respectively. Moreover, hair AEE concentrations were all positively correlated with the ingestion frequencies of meat, eggs, fresh vegetables, and fruits, while negatively with that of salted vegetables. A high ingestion frequency of fresh vegetables was associated with a lower prevalence of hypertension with or without adjusting confounders, while salted vegetables revealed a reverse tend. It was concluded that low hair AEEs, as markers of their long-term dietary intake, were associated with the presence of hypertension in a rural Chinese women.

Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances

Health effects of dietary fats have been extensively studied for decades. However, controversies exist on the effects of various types of fatty acids, especially saturated fatty acid (SFA), on cardiovascular disease (CVD). Current evidence supports that different types of dietary fatty acids have divergent effects on CVD risk, and the effects also depend strongly on the comparison or replacement macronutrient. A significant reduction in CVD risk can be achieved if SFAs are replaced by unsaturated fats, especially polyunsaturated fatty acids. Intake of industrially produced trans fat is consistently associated with higher CVD risk. Both n-6 and n-3 polyunsaturated fatty acids are associated with lower CVD risk, although the effects of fish oil supplementation remains inconsistent. The 2015-2020 Dietary Guidelines for Americans place greater emphasis on types of dietary fat than total amount of dietary fat and recommend replacing SFAs with unsaturated fats, especially polyunsaturated fatty acids for CVD prevention.

Dose-response relationship between dietary magnesium intake, serum magnesium concentration and risk of hypertension: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND

The findings of prospective cohort studies are inconsistent regarding the association between dietary magnesium intake and serum magnesium concentration and the risk of hypertension. We aimed to review the evidence from prospective cohort studies and perform a dose-response meta-analysis to investigate the relationship between dietary magnesium intake and serum magnesium concentrations and the risk of hypertension.

METHODS

We searched systematically PubMed, EMBASE and the Cochrane Library databases from October 1951 through June 2016. Prospective cohort studies reporting effect estimates with 95% confidence intervals (CIs) for hypertension in more than two categories of dietary magnesium intake and/or serum magnesium concentrations were included. Random-effects models were used to combine the estimated effects.

RESULTS

Nine articles (six on dietary magnesium intake, two on serum magnesium concentration and one on both) of ten cohort studies, including 20,119 cases of hypertension and 180,566 participates, were eligible for inclusion in the meta-analysis. We found an inverse association between dietary magnesium intake and the risk of hypertension [relative risk (RR) = 0.92; 95% CI: 0.86, 0.98] comparing the highest intake group with the lowest. A 100 mg/day increment in magnesium intake was associated with a 5% reduction in the risk of hypertension (RR = 0.95; 95% CI: 0.90, 1.00). The association of serum magnesium concentration with the risk of hypertension was marginally significant (RR = 0.91; 95% CI: 0.80, 1.02).

CONCLUSIONS

Current evidence supports the inverse dose-response relationship between dietary magnesium intake and the risk of hypertension. However, the evidence about the relationship between serum magnesium concentration and hypertension is limited.

Effect of magnesium supplementation on blood rheology in NOS inhibition-induced hypertension model

This study investigated the effects of magnesium on blood rheological properties and blood pressure in nitric oxide synthase (NOS) inhibition-induced hypertension model. Hypertension was induced by oral administration of the nonselective NOS inhibitor N-nitro-L-arginine methyl ester (L-NAME, 25 mg/kg/day) for 6 weeks and systolic blood pressure was measured by the tail-cuff method. The groups receiving magnesium supplementation were fed with rat chow containing 0.8% magnesium oxide during the experiment. At the end of experiment, blood samples were obtained from abdominal aorta, using ether anesthesia. Plasma and erythrocyte magnesium levels were determined by the atomic absorption spectrometer. RBC deformability and aggregation were determined by rotational ektacytometry. Plasma fibrinogen concentration was evaluated by ELISA. Whole blood and plasma viscosities were determined by viscometer and intracellular free Ca++ level was measured by using spectroflurometric method. Blood pressure was elevated in hypertensive groups and suppressed by magnesium therapy. Plasma viscosity and RBC aggregation were found to be higher in hypertensive rats than control animals and these parameters significantly decreased in magnesium supplemented hypertensive animals. Other measurements were not different between experimental groups. These results confirm that blood pressure, plasma viscosity and RBC aggregation increased in NOS inhibition-induced hypertension model and oral magnesium supplementation improved these parameters.

Dairy Food Intake Is Inversely Associated with Risk of Hypertension: The Singapore Chinese Health Study

BACKGROUND

Epidemiological evidence from Western populations suggests that dairy food intake may reduce the risk of hypertension, probably through its calcium content. However, there are no epidemiological studies among Asian populations with generally lower dairy and calcium consumption.

OBJECTIVE

The relation between dairy or calcium intake and risk of hypertension was evaluated in a Chinese population in Singapore.

METHODS

The analysis included 37,124 Chinese men and women aged 45-74 y who participated in the Singapore Chinese Health Study in 1993-1998. The subjects included in the present study had no history of cancer, hypertension, or cardiovascular disease at baseline and completed ≥1 follow-up interview. Diet at baseline was assessed by using a validated 165-item semiquantitative food-frequency questionnaire. The occurrence of new, physician-diagnosed hypertension was ascertained through follow-up interviews during 1999-2004 and 2006-2010. The Cox proportional hazard regression method was used to compute HRs and 95% CIs with adjustment for potential confounders.

RESULTS

Dairy food intake was inversely associated with the risk of hypertension in a dose-dependent manner: HRs across quartiles were 1.00 (lowest quartile, reference), 0.97 (95% CI: 0.92, 1.02), 0.98 (95% CI: 0.92, 1.03), and 0.93 (95% CI: 0.88, 0.98) (P-trend = 0.01). Milk accounted for ∼80% of all dairy products consumed in this population. Daily milk drinkers had a lower risk of hypertension (HR: 0.94; 95% CI: 0.89, 0.99) than did nondrinkers. Nondairy calcium intake contributed 80% of total calcium intake. Although dairy calcium intake was associated with a lower risk of hypertension (HR comparing extreme quartiles: 0.88; 95% CI: 0.83, 0.94; P-trend < 0.001), there was no association for nondairy calcium intake (HR: 1.02; 95% CI: 0.94, 1.10; P-trend = 0.58).

CONCLUSIONS

Baseline dairy food intake, and specifically that of milk, may reduce the risk of developing hypertension in Chinese adults, and this may not be associated with the calcium component.

Assessing Sex Differences in the Risk of Cardiovascular Disease and Mortality per Increment in Systolic Blood Pressure: A Systematic Review and Meta-Analysis of Follow-Up Studies in the United States

In the United States (US), cardiovascular (CV) disease accounts for nearly 20% of national health care expenses. Since costs are expected to increase with the aging population, informative research is necessary to address the growing burden of CV disease and sex-related differences in diagnosis, treatment, and outcomes. Hypertension is a major risk factor for CV disease and mortality. To evaluate whether there are sex-related differences in the effect of systolic blood pressure (SBP) on the risk of CV disease and mortality, we performed a systematic review and meta-analysis. We conducted a comprehensive search using PubMed and Google Scholar to identify US-based studies published prior to 31 December, 2015. We identified eight publications for CV disease risk, which provided 9 female and 8 male effect size (ES) observations. We also identified twelve publications for CV mortality, which provided 10 female and 18 male ES estimates. Our meta-analysis estimated that the pooled ES for increased risk of CV disease per 10 mmHg increment in SBP was 25% for women (95% Confidence Interval (CI): 1.18, 1.32) and 15% for men (95% CI: 1.11, 1.19). The pooled increase in CV mortality per 10 mm Hg SBP increment was similar for both women and men (Women: 1.16; 95% CI: 1.10, 1.23; Men: 1.17; 95% CI: 1.12, 1.22). After adjusting for age and baseline SBP, the results demonstrated that the risk of CV disease per 10 mm Hg SBP increment for women was 1.1-fold higher than men (P<0.01; 95% CI: 1.04, 1.17). Heterogeneity was moderate but significant. There was no significant sex difference in CV mortality.

A feasibility study on smartphone accelerometer-based recognition of household activities and influence of smartphone position

BACKGROUND

Obesity and physical inactivity are the most important risk factors for chronic diseases. The present study aimed at (i) developing and testing a method for classifying household activities based on a smartphone accelerometer; (ii) evaluating the influence of smartphone position; and (iii) evaluating the acceptability of wearing a smartphone for activity recognition.

METHODS

An Android application was developed to record accelerometer data and calculate descriptive features on 5-second time blocks, then classified with nine algorithms. Household activities were: sitting, working at the computer, walking, ironing, sweeping the floor, going down stairs with a shopping bag, walking while carrying a large box, and climbing stairs with a shopping bag. Ten volunteers carried out the activities for three times, each one with a smartphone in a different position (pocket, arm, and wrist). Users were then asked to answer a questionnaire.

RESULTS

1440 time blocks were collected. Three algorithms demonstrated an accuracy greater than 80% for all smartphone positions. While for some subjects the smartphone was uncomfortable, it seems that it did not really affect activity.

CONCLUSIONS

Smartphones can be used to recognize household activities. A further development is to measure metabolic equivalent tasks starting from accelerometer data only.

Changes in Overall Diet Quality and Subsequent Type 2 Diabetes Risk: Three U.S. Prospective Cohorts

OBJECTIVE

Recent public health recommendations emphasize adopting a healthful dietary pattern, but evidence is scarce on whether incremental diet quality changes have an impact on long-term diabetes prevention. We aim to evaluate diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes incidence.

RESEARCH DESIGN AND METHODS

Participants of prospective cohorts, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, who were free of diabetes at baseline (n = 124,607), were observed for ≥20 years. Diet quality, reflected by the Alternate Healthy Eating Index (AHEI) score, was assessed every 4 years to calculate changes.

RESULTS

We documented 9,361 cases of type 2 diabetes during 2,093,416 person-years of follow-up. A >10% decrease in AHEI score over 4 years was associated with a higher subsequent diabetes risk (pooled hazard ratio 1.34 [95% CI 1.23-1.46]) with multiple adjustment, whereas a >10% increase in AHEI score was associated with a lower risk (0.84 [0.78-0.90]). Greater improvement in diet quality was associated with lower diabetes risk across baseline diet quality status (P for trend ≤ 0.001 for low, medium, or high initial diet quality) and baseline BMI (P for trend ≤ 0.01 for BMI <25, 25-29, or 30 kg/m²). Changes in body weight explained 32% (95% CI 24-41) of the association between AHEI changes (per 10% increase) and diabetes risk.

CONCLUSIONS

Improvement in overall diet quality is associated with a lower risk of type 2 diabetes, whereas deterioration in diet quality is associated with a higher risk. The association between diet quality changes and diabetes risk is only partly explained by body weight changes.

Parathyroid hormone and the risk of incident hypertension: the Atherosclerosis Risk in Communities study

BACKGROUND

Recent evidence suggests that parathyroid hormone (PTH) has effects on vascular smooth muscle cells, the rennin-angiotensin system and kidney function, but less is known about its role in the development of hypertension. The distribution of serum PTH also varies by race.

METHODS AND RESULTS

Therefore, we examined the relation between PTH and incident hypertension and tested for interaction by race among 7504 Atherosclerosis Risk in Communities participants (1264 black, 6240 white, median age 56 years) without initial hypertension in 1990-1992. During a median follow-up of 6 years, 1487 white and 509 black participants developed hypertension. In the overall study population, PTH was not associated with incident hypertension after adjustment for demographics and behavioral risk factors [hazard ratio highest vs. lowest quintiles, 95% confidence interval: 1.11 (0.96-1.28); P for linear trend 0.02]. Although the interaction was not statistically significant (P = 0.60), there was some evidence that the PTH-hypertension association differed by race. Among blacks, PTH was positively associated with incident hypertension, independent of demographics, and behavioral risk factors (P for linear trend 0.003). Among whites, PTH was not associated with hypertension risk. Results were similar when comparing participants with elevated versus nonelevated PTH (≥65 vs. <65 pg/ml): hazard ratio in blacks: 1.24 (1.02-1.54); hazard ratio in whites: 0.95 (0.78-1.16).

CONCLUSIONS

In this large community-based cohort, PTH levels, overall, were not independently associated with the risk of hypertension. However, we found some evidence that PTH may be associated with hypertension in blacks. Future research should continue to explore potential race differences in the PTH-hypertension association.

Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women

BACKGROUND

Markers of systemic inflammation (high-sensitivity C-reactive protein [hsCRP], soluble intercellular adhesion molecule 1 [sICAM-1], and fibrinogen) have been associated with a greater risk of total and ischemic stroke, in addition to elevated blood pressure. However, the role of these inflammatory markers on stroke pathophysiology by hypertension status is uncertain.

METHODS

Blood samples were collected and assayed for hsCRP, sICAM-1, and fibrinogen among 27,330 initially healthy women from the Women's Health Study, and women were followed up from 1992 to 2013. Prior to randomization, the baseline questionnaire collected self-reported hypertension status, cardiovascular risk factors, and lifestyle factors. New cases of total, ischemic, and hemorrhagic stroke were updated annually through questionnaires and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models estimated overall associations between each inflammatory marker and stroke and separately stratified by hypertension status.

RESULTS

We observed 629 incident total strokes over 477,278 person-years. In adjusted analyses, extreme quartiles of hsCRP and sICAM-1 were each associated with a significantly greater risk of total stroke (hsCRP: hazard ratios [HR] = 1.77, 95% confidence interval [CI]: 1.39-2.26; sICAM-1: HR = 1.28, 95% CI: 1.00-1.63). Fibrinogen was not associated with a significantly greater stroke risk. In analyses stratified by hypertension status, elevated hsCRP was associated with a nonstatistically significant greater risk of total stroke among prehypertensive and hypertensive women.

CONCLUSIONS

These data indicate that hsCRP and sICAM-1 are associated with hypertension status and stroke risk among women. Further work should examine the role of inflammatory markers on ischemic stroke subtypes and clarify mechanisms.

Multivitamin use and the risk of hypertension in a prospective cohort study of women

OBJECTIVE

Despite the widespread use of multivitamin supplements, little is known regarding their effects on blood pressure (BP) and the development of hypertension. We, therefore, sought to prospectively investigate how multivitamin use was associated with incident hypertension among middle-aged and older women.

METHODS

We studied 28 157 women from the Women's Health Study aged at least 45 years and free of cardiovascular disease, cancer, and hypertension at baseline. Women reported information on a wide range of lifestyle, clinical, and dietary factors, including multivitamin and other supplement use at baseline. Hypertension was identified on baseline and annual follow-up questionnaires. Incident hypertension was defined as either a new diagnosis of hypertension by a physician, initiation of antihypertensive medication, newly reported SBP at least 140 mmHg, or DBP at least 90 mmHg during follow-up.

RESULTS

During a mean follow-up of 11.5 years, we identified 16 316 cases of incident hypertension. We found that neither baseline (hazard ratio = 1.03, 95% confidence interval: 1.00, 1.07) nor time-varying multivitamin use (hazard ratio = 0.97, 95% confidence interval: 0.94-1.00) were associated with the risk of incident hypertension in multivariable-adjusted models. When we investigated the duration of multivitamin use reported at baseline, we also observed no association with the risk of hypertension.

CONCLUSION

The results from this prospective study of middle-aged and older women suggest that neither baseline multivitamin use nor time-varying multivitamin use is associated with the risk of developing hypertension.

Long-term intake of animal flesh and risk of developing hypertension in three prospective cohort studies

OBJECTIVE

Prospective data are scarce on the relation of red meat, seafood, and poultry consumption with hypertension risk. Although red and processed meats are generally considered to have adverse cardiovascular consequences, seafood is believed to be protective and poultry's effect is controversial.

METHODS

We prospectively examined the independent association of long-term intake of animal flesh with incident hypertension in three longitudinal cohort studies of nonhypertensive individuals: Nurses' Health Study (NHS, n = 62 273 women), Nurses' Health Study II (NHS II, n = 88 831 women), and Health Professionals Follow-Up Study (HPFS, n = 37 414 men). We used multivariable Cox proportional hazards regression to study the associations of different types of animal flesh with the risk of developing hypertension while controlling for other hypertension risk factors. We then used fixed-effects meta-analysis to derive pooled estimates of effect.

RESULTS

Compared with participants whose consumption was less than 1 serving/month, the pooled hazard ratios among those whose intake was at least 1 serving/day were 1.30 (95% confidence interval 1.23-1.39) for total meat (a combination of processed and unprocessed red meat), 1.22 (1.12-1.34) for poultry, and 1.05 (0.98-1.13) for seafood. Seafood was associated with an increased risk of hypertension in HPFS and NHS II, but not NHS. Consumption of any animal flesh at least 1 serving/day was associated with an increased hypertension risk [pooled hazard ratio = 1.30 (1.16-1.47)].

CONCLUSION

Long-term intake of meat and poultry were associated with increased risk of hypertension. In contrast to our hypothesis, we found a weak but significant trend toward an increased risk of hypertension with increasing seafood consumption.

Potato intake and incidence of hypertension: results from three prospective US cohort studies

OBJECTIVE

To determine whether higher intake of baked or boiled potatoes, French fries, or potato chips is associated with incidence of hypertension.

DESIGN

Prospective longitudinal cohort studies.

SETTING

Healthcare providers in the United States.

PARTICIPANTS

62 175 women in Nurses' Health Study, 88 475 women in Nurses' Health Study II, and 36 803 men in Health Professionals Follow-up Study who were non-hypertensive at baseline.

MAIN OUTCOME MEASURE

Incident cases of hypertension (self reported diagnosis by healthcare provider).

RESULTS

Compared with consumption of less than one serving a month, the random effects pooled hazard ratios for four or more servings a week were 1.11 (95% confidence interval 0.96 to 1.28; P for trend=0.05) for baked, boiled, or mashed potatoes, 1.17 (1.07 to 1.27; P for trend=0.001) for French fries, and 0.97 (0.87 to 1.08; P for trend=0.98) for potato chips. In substitution analyses, replacing one serving a day of baked, boiled, or mashed potatoes with one serving a day of non-starchy vegetables was associated with decreased risk of hypertension (hazard ratio 0.93, 0.89 to 0.96).

CONCLUSION

Higher intake of baked, boiled, or mashed potatoes and French fries was independently and prospectively associated with an increased risk of developing hypertension in three large cohorts of adult men and women.

Potato intake and incidence of hypertension: results from three prospective US cohort studies

OBJECTIVE

To determine whether higher intake of baked or boiled potatoes, French fries, or potato chips is associated with incidence of hypertension.

DESIGN

Prospective longitudinal cohort studies.

SETTING

Healthcare providers in the United States.

PARTICIPANTS

62 175 women in Nurses' Health Study, 88 475 women in Nurses' Health Study II, and 36 803 men in Health Professionals Follow-up Study who were non-hypertensive at baseline.

MAIN OUTCOME MEASURE

Incident cases of hypertension (self reported diagnosis by healthcare provider).

RESULTS

Compared with consumption of less than one serving a month, the random effects pooled hazard ratios for four or more servings a week were 1.11 (95% confidence interval 0.96 to 1.28; P for trend=0.05) for baked, boiled, or mashed potatoes, 1.17 (1.07 to 1.27; P for trend=0.001) for French fries, and 0.97 (0.87 to 1.08; P for trend=0.98) for potato chips. In substitution analyses, replacing one serving a day of baked, boiled, or mashed potatoes with one serving a day of non-starchy vegetables was associated with decreased risk of hypertension (hazard ratio 0.93, 0.89 to 0.96).

CONCLUSION

Higher intake of baked, boiled, or mashed potatoes and French fries was independently and prospectively associated with an increased risk of developing hypertension in three large cohorts of adult men and women.

Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes

AIMS

Observational studies report inconsistent associations between moderate alcohol intake and blood pressure (BP). In a sub-study of a larger randomized controlled trial, we assessed the effect of initiating moderate red wine consumption on 24-h BP recordings and the effect of a common genetic variant of alcohol dehydrogenases (ADH) among patients with type 2 diabetes.

METHODS

Fifty-four type 2 diabetes, alcohol abstainers were randomized to consume 150 ml/dinner dry red wine or mineral water. Both groups were guided to adhere to a Mediterranean diet, without caloric restriction. We measured 24-h ambulatory BP monitoring (ABPM) at baseline and after 6 months.

RESULTS

Participants (age = 57 years; 85% men; mean 24-h BP = 129/77 mm Hg) had 92% 6-month retention. After 6 months of intervention, the average 24-h BP did not differ between the wine and water groups. A transient decrease in BP was observed in the red wine group at midnight (3-4 hours after wine intake: systolic BP: red wine = -10.6mm Hg vs. mineral water = +2.3 mm Hg; P = 0.031) and the following morning at 7-9 am (red wine: -6.2mm Hg vs. mineral water: +5.6mm Hg; P = 0.014). In a second post hoc sub-analysis among the red wine consumers, individuals who were homozygous for the gene encoding ADH1B*2 variant (Arg48His; rs1229984, TT, fast ethanol metabolizers), exhibited a reduction in mean 24-h systolic BP (-8.0mm Hg vs. +3.7 mm Hg; P = 0.002) and pulse pressure (-3.8 mm Hg vs. +1.2 mm Hg; P = 0.032) compared to heterozygotes and those homozygous for the ADH1B*1 variant (CC, slow metabolizers).

CONCLUSIONS

Initiating moderate red wine consumption at dinner among type 2 diabetes patients does not have a discernable effect on mean 24-h BP. Yet, a modest temporal BP reduction could be documented, and a more pronounced BP-lowering effect is suggested among fast ethanol metabolizers.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT00784433.

Fruit and Vegetable Consumption and the Incidence of Hypertension in Three Prospective Cohort Studies

Increased fruit and vegetable intake lowers blood pressure in short-term interventional studies. However, data on the association of long-term intake of fruits and vegetables with hypertension risk are scarce. We prospectively examined the independent association of whole fruit (excluding juices) and vegetable intake, as well as the change in consumption of whole fruits and vegetables, with incident hypertension in 3 large longitudinal cohort studies: Nurses' Health Study (n=62 175), Nurses' Health Study II (n=88 475), and Health Professionals Follow-up Study (n=36 803). We calculated hazard ratios and 95% confidence intervals for fruit and vegetable consumption while controlling for hypertension risk factors. Compared with participants whose consumption was ≤4 servings/week, the pooled hazard ratios among those whose intake was ≥4 servings/day were 0.92(0.87-0.97) for total whole fruit intake and 0.95(0.86-1.04) for total vegetable intake. Similarly, compared with participants who did not increase their fruit or vegetable consumption, the pooled hazard ratios for those whose intake increased by ≥7 servings/week were 0.94(0.90-0.97) for total whole fruit intake and 0.98(0.94-1.01) for total vegetable. Analyses of individual fruits and vegetables yielded different results. Consumption levels of ≥4 servings/week (as opposed to <1 serving/month) of broccoli, carrots, tofu or soybeans, raisins, and apples was associated with lower hypertension risk. In conclusion, our results suggest that greater long-term intake and increased consumption of whole fruits may reduce the risk of developing hypertension.

Triterpenoic Acids from Apple Pomace Enhance the Activity of the Endothelial Nitric Oxide Synthase (eNOS)

Pomace is an easy-accessible raw material for the isolation of fruit-derived compounds. Fruit consumption is associated with health-promoting effects, such as the prevention of cardiovascular disease. Increased vascular nitric oxide (NO) bioavailability, for example, due to an enhanced endothelial nitric oxide synthase (eNOS) activity, could be one molecular mechanism mediating this effect. To identify compounds from apple (Malus domestica Borkh.) pomace that have the potential to amplify NO bioavailability via eNOS activation, a bioassay-guided fractionation of the methanol/water (70:30) extract has been performed using the (14)C-L-arginine to (14)C-L-citrulline conversion assay (ACCA) in the human endothelium-derived cell line EA.hy926. Phytochemical characterization of the active fractions was performed using the spectrophotometric assessment of the total phenolic content, as well as TLC, HPLC-DAD-ELSD, and HPLC-MS analyses. Eleven triterpenoic acids, of which one is a newly discovered compound, were identified as the main constituents in the most active fraction, accompanied by only minor contents of phenolic compounds. When tested individually, none of the tested compounds exhibited significant eNOS activation. Nevertheless, cell stimulation with the reconstituted compound mixture restored eNOS activation, validating the potential of apple pomace as a source of bioactive components.

Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals

PURPOSE

Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals.

MATERIALS AND METHODS

The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases.

RESULTS

No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34).

CONCLUSIONS

In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic prostatitis/chronic pelvic pain syndrome remains unknown, additional prospective studies are needed to elucidate modifiable risk factors for this common condition.

Evidence-Based Guideline of the German Nutrition Society: Fat Intake and Prevention of Selected Nutrition-Related Diseases

As nutrition-related chronic diseases have become more and more frequent, the importance of dietary prevention has also increased. Dietary fat plays a major role in human nutrition, and modification of fat and/or fatty acid intake could have a preventive potential. The aim of the guideline of the German Nutrition Society (DGE) was to systematically evaluate the evidence for the prevention of the widespread diseases obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease (CHD), stroke, and cancer through the intake of fat or fatty acids. The main results can be summarized as follows: it was concluded with convincing evidence that a reduced intake of total and saturated fat as well as a larger intake of polyunsaturated fatty acids (PUFA) at the expense of saturated fatty acids (SFA) reduces the concentration of total and low-density lipoprotein cholesterol in plasma. Furthermore, there is convincing evidence that a high intake of trans fatty acids increases risk of dyslipoproteinaemia and that a high intake of long-chain polyunsaturated n-3 fatty acids reduces the triglyceride concentration in plasma. A high fat intake increases the risk of obesity with probable evidence when total energy intake is not controlled for (ad libitum diet). When energy intake is controlled for, there is probable evidence for no association between fat intake and risk of obesity. A larger intake of PUFA at the expense of SFA reduces risk of CHD with probable evidence. Furthermore, there is probable evidence that a high intake of long-chain polyunsaturated n-3 fatty acids reduces risk of hypertension and CHD. With probable evidence, a high trans fatty acid intake increases risk of CHD. The practical consequences for current dietary recommendations are described at the end of this article.

Association Between High-Sensitivity C-Reactive Protein and Total Stroke by Hypertensive Status Among Men

BACKGROUND

High-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, may promote atherosclerosis, particularly among adults with elevated blood pressure; however, data are sparse. We examined the association between hsCRP concentrations and risk of total stroke by hypertension status (normotension, prehypertension, and hypertension) among men in the Physicians' Health Study (PHS).

METHODS AND RESULTS

Blood samples were collected (1996-1997) and assayed for hsCRP among 10 456 initially healthy men from PHS I and PHS II and followed from 1997 to 2012. Self-reported hypertension status, cardiovascular risk factors, lifestyle, and alcohol consumption were obtained from the baseline questionnaire prior to randomization in PHS II. Strokes were updated approximately annually and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models were used. We observed 395 incident total strokes over 115 791 person-years. In analyses adjusted for potential confounders and stroke risk factors, clinically elevated hsCRP (>3 mg/L) was associated with a 40% significantly greater hazard of total stroke compared with hsCRP <1 mg/L (hazard ratio 1.40, 95% CI 1.06 to 1.87; Ptrend=0.01). Additional adjustment for blood pressure and biomarkers associated with cardiovascular risk marginally attenuated the estimates. Results were similar by hypertension status, although not statistically significant among normotensive and prehypertensive participants due to limited events.

CONCLUSIONS

Elevated hsCRP levels were associated with a greater risk of total stroke, even after adjustment for potential confounders and cardiovascular risk factors. Risk of total stroke was significantly higher among hypertensive men with elevated hsCRP compared with normotensive men with low hsCRP.

Plasma Inflammatory Markers and the Risk of Developing Hypertension in Men

Background

Several cross-sectional, but few prospective, studies suggest that inflammation may be involved in the development of hypertension. We examined markers of inflammation—high-sensitivity C-reactive protein, interleukin-6, and soluble intercellular adhesion molecule-1—and a marker of fibrinolysis, D-dimer, for their associations with incident hypertension in the Physicians’ Health Study.

Methods and Results

Baseline blood values and information on hypertension-related risk factors were collected in 1982. Incident hypertension was defined as self-reported initiation of antihypertensive treatment, systolic blood pressure ≥140 mm Hg, or diastolic blood pressure ≥90 mm Hg during follow-up. With use of a nested case-control design, 396 cases of incident hypertension and controls free of hypertension were matched 1:1 on age (mean 47.4 years) and follow-up time. In crude matched-pair analyses, the conditional relative risks of hypertension in the second through fourth versus the lowest quartiles for plasma high-sensitivity C-reactive protein were 1.27, 1.73, and 1.81 (P_trend=0.01); for interleukin-6, 1.22, 1.02, and 1.51 (P_trend=0.06); for soluble intercellular adhesion molecule-1, 1.00, 0.80, and 1.26 (P_trend=0.37); and for D-dimer, 1.61, 1.81, and 1.52 (P_trend=0.46). Multivariable adjustment attenuated the estimates. The multivariable relative risks of hypertension in the second through fourth compared to the lowest quartiles of high-sensitivity C-reactive protein were 1.24, 1.60, and 1.47 (P_trend=0.20); for interleukin-6, 1.08, 0.92, and 1.36 (P_trend=0.16); for soluble intercellular adhesion molecule-1, 0.89, 0.79, and 1.18 (P_trend=0.55); and for D-dimer, 1.48, 1.68, and 1.38 (P_trend=0.63).

Conclusions

Elevated plasma inflammatory markers and D-dimer were nonsignificantly associated with a higher risk of hypertension among initially healthy men.

Total, insoluble and soluble dietary fibre intake in relation to blood pressure: the INTERMAP Study

Prospective cohort studies have shown inverse associations between fibre intake and CVD, possibly mediated by blood pressure (BP). However, little is known about the impact of types of fibre on BP. We examined cross-sectional associations with BP of total, insoluble and soluble fibre intakes. Data were used from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) study, including 2195 men and women aged between 40 and 59 years from the USA. During four visits, eight BP, four 24 h dietary recalls and two 24 h urine samples were collected. Linear regression models adjusted for lifestyle and dietary confounders to estimate BP differences per 2 sd higher intakes of total and individual types of fibre were calculated. After multivariable adjustment, total fibre intake higher by 6·8 g/4184 kJ (6·8 g/1000 kcal) was associated with a 1·69 mmHg lower systolic blood pressure (SBP; 95% CI -2·97, -0·41) and attenuated to -1·01 mmHg (95% CI -2·35, 0·34) after adjustment for urinary K. Insoluble fibre intake higher by 4·6 g/4184 kJ (4·6 g/1000 kcal) was associated with a 1·81 mmHg lower SBP (95% CI -3·65, 0·04), additionally adjusted for soluble fibre and urinary K excretion, whereas soluble fibre was not associated with BP. Raw fruit was the main source of total and insoluble fibre, followed by whole grains and vegetables. In conclusion, higher intakes of fibre, especially insoluble, may contribute to lower BP, independent of nutrients associated with higher intakes of fibre-rich foods.

Magnesium in disease

Although the following text will focus on magnesium in disease, its role in healthy subjects during physical exercise when used as a supplement to enhance performance is also noteworthy. Low serum magnesium levels are associated with metabolic syndrome, Type 2 diabetes mellitus (T2DM) and hypertension; consequently, some individuals benefit from magnesium supplementation: increasing magnesium consumption appears to prevent high blood pressure, and higher serum magnesium levels are associated with a lower risk of developing a metabolic syndrome. There are, however, conflicting study results regarding magnesium administration with myocardial infarction with and without reperfusion therapy. There was a long controversy as to whether or not magnesium should be given as a first-line medication. As the most recent trials have not shown any difference in outcome, intravenous magnesium cannot be recommended in patients with myocardial infarction today. However, magnesium has its indication in patients with torsade de pointes and has been given successfully to patients with digoxin-induced arrhythmia or life-threatening ventricular arrhythmias. Magnesium sulphate as an intravenous infusion also has an important established therapeutic role in pregnant women with pre-eclampsia as it decreases the risk of eclamptic seizures by half compared with placebo.

Intakes of magnesium, potassium, and calcium and the risk of stroke among men

BACKGROUND

Intakes of magnesium, potassium, and calcium have been inversely associated with the incidence of hypertension, a known risk factor for stroke. However, only a few studies have examined intakes of these cations in relation to risk of stroke.

AIM

The aim of this study was to investigate whether high intake of magnesium, potassium, and calcium is associated with reduced stroke risk among men.

METHODS

We prospectively examined the associations between intakes of magnesium, potassium, and calcium from diet and supplements, and the risk of incident stroke among 42 669 men in the Health Professionals Follow-up Study, aged 40 to 75 years and free of diagnosed cardiovascular disease and cancer at baseline in 1986. We calculated the hazard ratio of total, ischemic, and haemorrhagic strokes by quintiles of each cation intake, and of a combined dietary score of all three cations, using multivariate Cox proportional hazard models.

RESULTS

During 24 years of follow-up, 1547 total stroke events were documented. In multivariate analyses, the relative risks and 95% confidence intervals of total stroke for men in the highest vs. lowest quintile were 0·87 (95% confidence interval, 0·74-1·02; P, trend = 0·04) for dietary magnesium, 0·89 (95% confidence interval, 0·76-1·05; P, trend = 0·10) for dietary potassium, and 0·89 (95% confidence interval, 0·75-1·04; P, trend = 0·25) for dietary calcium intake. The relative risk of total stroke for men in the highest vs. lowest quintile was 0·74 (95% confidence interval, 0·59-0·93; P, trend = 0·003) for supplemental magnesium, 0·66 (95% confidence interval, 0·50-0·86; P, trend = 0·002) for supplemental potassium, and 1·01 (95% confidence interval, 0·84-1·20; P, trend = 0·83) for supplemental calcium intake. For total intake (dietary and supplemental), the relative risk of total stroke for men in the highest vs. lowest quintile was 0·83 (95% confidence interval, 0·70-0·99; P, trend = 0·04) for magnesium, 0·88 (95% confidence interval, 0·75-4; P, trend = 6) for potassium, and 3 (95% confidence interval, 79-09; P, trend = 84) for calcium. Men in the highest quintile for a combined dietary score of all three cations had a multivariate relative risk of 0·79 (95% confidence interval, 0·67-0·92; P, trend = 0·008) for total stroke, compared with those in the lowest.

CONCLUSIONS

A diet rich in magnesium, potassium, and calcium may contribute to reduced risk of stroke among men. Because of significant collinearity, the independent contribution of each cation is difficult to define.

Magnesium in CKD: more than a calcification inhibitor?

Magnesium fulfils important roles in multiple physiological processes. Accordingly, a tight regulation of magnesium homeostasis is essential. Dysregulated magnesium serum levels, in particular hypomagnesaemia, are common in patients with chronic kidney disease (CKD) and have been associated with poor clinical outcomes. In cell culture studies as well as in clinical situations magnesium levels were associated with vascular calcification, cardiovascular disease and altered bone-mineral metabolism. Magnesium has also been linked to diseases such as metabolic syndrome, diabetes, hypertension, fatigue and depression, all of which are common in CKD. The present review summarizes and discusses the latest clinical data on the impact of magnesium and possible effects of higher levels on the health status of patients with CKD, including an outlook on the use of magnesium-based phosphate-binding agents in this context.

Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses

BACKGROUND

Prospective data on the relation of magnesium, potassium, and calcium intakes with stroke risk are inconsistent, and to our knowledge, the effect of a combined mineral diet score has not been examined.

OBJECTIVE

We examined associations between intakes of magnesium, potassium, and calcium and risk of incident stroke in 86,149 women in the Nurses' Health Study (NHS) I and 94,715 women in the NHS II.

DESIGN

In this prospective cohort study, we calculated HRs of stroke by quintiles of intake for each mineral and for a combined diet score of all 3 minerals by using multivariate Cox proportional hazard models. In addition, we updated meta-analyses on dietary intakes of these minerals and risk of stroke.

RESULTS

During follow-up (30 y in the NHS I; 22 y in the NHS II) a total of 3780 incident stroke cases were documented. Pooled multivariate RRs of total stroke for women in the highest compared with the lowest quintiles were 0.87 (95% CI: 0.78, 0.97) for total magnesium, 0.89 (95% CI: 0.80, 0.99) for total potassium, and 0.97 (95% CI: 0.87, 1.09) for total calcium intake. Pooled RRs for women in the highest compared with the lowest quintiles of a combined mineral diet score were 0.72 (95% CI: 0.65, 0.81) for total stroke, 0.78 (95% CI: 0.66, 0.92) for ischemic stroke, and 0.80 (95% CI: 0.61, 1.04) for hemorrhagic stroke. In the updated meta-analyses of all prospective studies to date, the combined RR of total stroke was 0.87 (95% CI: 0.83, 0.92) for a 100-mg/d increase in magnesium intake, 0.91 (95% CI: 0.88, 0.94) for a 1000-mg/d increase in potassium intake, and 0.98 (95% CI: 0.94, 1.02) for a 300-mg/d increase in calcium intake.

CONCLUSIONS

A combined mineral diet score was inversely associated with risk of stroke. High intakes of magnesium and potassium but not calcium were also significantly associated with reduced risk of stroke in women.

Association between Macronutrients Intake, Visceral Obesity and Blood Pressure in a Sample of Obese Egyptian Women

AIM

Study the association between the total caloric intake, protein, lipid, and some classes of fatty acids of the diet, and their effects on blood pressure in a sample of Egyptian obese women with and without visceral obesity.

METHODS

Five hundred forty-nine obese women were included in the study with mean age of 38.1 ± 11.56 years and mean Body mass index [BMI] of 36.17 ± 7.23. They enrolled in a program for losing weight. Visceral fat was determined using ultrasound. Blood pressure was measured 3 times and the mean was recorded. Twenty four hours dietary recall was reported.

RESULTS

Thirty point four percentages of samples has visceral obesity ≥ 7cm; they were the older, showed higher values of BMI, visceral obesity and blood pressure. Significant difference was found between groups regarding mean value of BMI, visceral obesity, both systolic blood pressure SBP and diastolic blood pressure DBP and most of the daily macronutrients intake. In groups (2&3) positive significant correlation was recorded between (SBP) & (DBP) and total daily intake of total calories, carbohydrate, total fat, saturated fatty acids and cholesterol, and negative significant correlation with total daily intake of total protein, animal and vegetable protein, linolenic and linoleic fatty acids, while oleic fatty acid showed negative correlation with SBP&DBP in all groups.

CONCLUSION

This study emphasizes the hypothesis that the macronutrients composition of diet influences blood pressure in different ways, in obese patients with visceral obesity.

Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project

BACKGROUND

Healthy dietary patterns have been linked positively with health and longevity. However, prospective studies in diverse populations in the United States addressing dietary patterns and mortality are limited.

OBJECTIVE

We assessed the ability of the following 4 diet-quality indexes [the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH)] to predict the reduction in risk of mortality from all causes, cardiovascular disease (CVD), and cancer.

DESIGN

White, African American, Native Hawaiian, Japanese American, and Latino adults (n = 215,782) from the Multiethnic Cohort completed a quantitative food-frequency questionnaire. Scores for each dietary index were computed and divided into quintiles for men and women. Mortality was documented over 13-18 y of follow-up. HRs and 95% CIs were computed by using adjusted Cox models.

RESULTS

High HEI-2010, AHEI-2010, aMED, and DASH scores were all inversely associated with risk of mortality from all causes, CVD, and cancer in both men and women (P-trend < 0.0001 for all models). For men, the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes (HR: 0.75; 95% CI: 0.71, 0.79), CVD (HR: 0.74; 95% CI: 0.69, 0.81), and cancer (HR: 0.76; 95% CI: 0.70, 0.83) when lowest and highest quintiles were compared. In women, the AHEI and aMED showed large reductions for all-cause mortality (HR: 0.78; 95% CI: 0.74, 0.82), the AHEI showed large reductions for CVD (HR: 0.76; 95% CI: 0.69, 0.83), and the aMED showed large reductions for cancer (HR: 0.84; 95% CI: 0.76, 0. 92).

CONCLUSION

These results, in a US multiethnic population, suggest that consuming a dietary pattern that achieves a high diet-quality index score is associated with lower risk of mortality from all causes, CVD, and cancer in adult men and women.

Consumption of fruit and vegetable and risk of coronary heart disease: a meta-analysis of prospective cohort studies

BACKGROUND

Observational studies suggest that an association between fruit and vegetable consumption and coronary heart disease (CHD). However, the results are inconsistent. We conducted a meta-analysis to evaluate the relationship of fruit and vegetable consumption with CHD risk and quality the dose-response relationship between them.

METHODS

Relevant prospective studies were identified by a search of PubMed, Embase and Web of Science databases to July 2014. A random-effects model was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CI).

RESULTS

Twenty-three studies involving 937,665 participants and 18,047 patients with CHD were included. Compared with the lowest consumption levels of total fruit and vegetable, fruit and vegetable, the RR of CHD was 0.84 (95% CI, 0.79-0.90), 0.86 (95% CI, 0.82-0.91), 0.87 (95% CI, 0.81-0.93), respectively. The dose-response analysis indicated that, the RR of CHD was 0.88 (95% CI: 0.85-0.91) per 477 g/day of total fruit and vegetable consumption, 0.84 (95% CI: 0.75-0.93) per 300 g/day of fruit intake and 0.82 (95% CI: 0.73-0.92) per 400 g/day of vegetable consumption. A nonlinear association of CHD risk with fruit or vegetable consumption separately was found (P for nonlinearity <0.001). In the subgroup analysis of location, a significant inverse association was observed in Western populations, but not in Asian populations.

CONCLUSIONS

This meta-analysis indicates that total fruit and vegetable, fruit and vegetable consumption, are significantly associated with a lower risk of CHD. The significant inverse association was found in Western populations, but not in Asian populations, which warrants further research.

Calcium and phosphorus regulatory hormones and risk of incident symptomatic kidney stones

BACKGROUND AND OBJECTIVES

Calcium and phosphorus regulatory hormones may contribute to the pathogenesis of calcium nephrolithiasis. However, there has been no prospective study to date of plasma hormone levels and risk of kidney stones. This study aimed to examine independent associations between plasma levels of 1,25-dihydroxyvitamin D (1,25[OH]2D), 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, fibroblast growth factor 23 (FGF23), parathyroid hormone, calcium, phosphate, and creatinine and the subsequent risk of incident kidney stones.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This study was a prospective, nested case-control study of men in the Health Professionals Follow-Up Study who were free of diagnosed nephrolithiasis at blood draw. During 12 years of follow-up, 356 men developed an incident symptomatic kidney stone. Using risk set sampling, controls were selected in a 2:1 ratio (n=712 controls) and matched for age, race, and year, month, and time of day of blood collection.

RESULTS

Baseline plasma levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, parathyroid hormone, calcium, phosphate, and creatinine were similar in cases and controls. Mean 1,25(OH)2D and median FGF23 levels were higher in cases than controls but differences were small and statistically nonsignificant (45.7 versus 44.2 pg/ml, P=0.07 for 1,25[OH]2D; 47.6 versus 45.1 pg/ml, P=0.08 for FGF23). However, after adjusting for body mass index, diet, plasma factors, and other covariates, the odds ratios of incident symptomatic kidney stones in the highest compared with lowest quartiles were 1.73 (95% confidence interval, 1.11 to 2.71; P for trend 0.01) for 1,25(OH)2D and 1.45 (95% confidence interval, 0.96 to 2.19; P for trend 0.03) for FGF23. There were no significant associations between other plasma factors and kidney stone risk.

CONCLUSIONS

Higher plasma 1,25(OH)2D, even in ranges considered normal, is independently associated with higher risk of symptomatic kidney stones. Although of borderline statistical significance, these findings also suggest that higher FGF23 may be associated with risk.

Role of magnesium in cardiovascular diseases

Magnesium, the fourth most abundant cation in the human body, is involved in several essential physiological, biochemical, and cellular processes regulating cardiovascular function. It plays a critical role in modulating vascular smooth muscle tone, endothelial cell function, and myocardial excitability and is thus central to the pathogenesis of several cardiovascular disorders such as hypertension, atherosclerosis, coronary artery disease, congestive heart failure, and cardiac arrhythmias. This review discusses the vasodilatory, anti-inflammatory, anti-ischemic, and antiarrhythmic properties of magnesium and its current role in the prevention and treatment of cardiovascular disorders.

Mediterranean diet and telomere length in Nurses' Health Study: population based cohort study

OBJECTIVE

To examine whether adherence to the Mediterranean diet was associated with longer telomere length, a biomarker of aging.

DESIGN

Population based cohort study.

SETTING

Nurses' Health Study, an ongoing prospective cohort study of 121,700 nurses enrolled in 1976; in 1989-90 a subset of 32,825 women provided blood samples.

PARTICIPANTS

4676 disease-free women from nested case-control studies within the Nurses' Health Study with telomere length measured who also completed food frequency questionnaires.

MAIN OUTCOME MEASURE

Association between relative telomere lengths in peripheral blood leukocytes measured by quantitative real time polymerase chain reaction and Alternate Mediterranean Diet score calculated from self reported dietary data.

RESULTS

Greater adherence to the Mediterranean diet was associated with longer telomeres after adjustment for potential confounders. Least squares mean telomere length z scores were -0.038 (SE 0.035) for the lowest Mediterranean diet score groups and 0.072 (0.030) for the highest group (P for trend = 0.004).

CONCLUSION

In this large study, greater adherence to the Mediterranean diet was associated with longer telomeres. These results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.

Circulating biomarkers of dairy fat and risk of incident stroke in U.S. men and women in 2 large prospective cohorts

BACKGROUND

Previous observational studies of self-reported dairy product consumption and stroke risk have reported mixed findings. Few studies have used circulating biomarkers that provide objective measures of dairy fat intake.

OBJECTIVES

We tested the hypothesis that the circulating biomarkers of dairy fat, pentadecanoic acid (15:0), heptadecanoic acid (17:0), and trans palmitoleate (trans 16:1n-7), were associated with lower incidence of stroke, especially ischemic stroke. Secondarily, we evaluated 14:0, which is obtained from dairy products and beef, and also endogenously synthesized.

DESIGN

In participants from 2 large US cohorts (the Health Professionals Follow-Up Study: 51,529 men; the Nurses' Health Study: 121,700 women) with stored blood samples in 1993-1994 (n = 18,225) and 1989-1990 (n = 32,826), respectively, we prospectively identified 594 incident stroke cases (median follow-up: 8.3 y) and matched them 1:1 to risk-set-sampled control subjects by age, sex, race, and smoking. Total plasma and red blood cell (RBC) fatty acids were measured by using gas-liquid chromatography. Covariates were assessed by using validated questionnaires. Stroke events and subtypes were adjudicated by using medical records or other supporting documentation. We used conditional logistic regression to estimate associations of fatty acids with incident stroke, and cohort-specific findings were combined by inverse-variance weights.

RESULTS

After adjustment for demographic characteristics, lifestyle, cardiovascular disease risk factors, diet, and other circulating fatty acids, no significant associations with total stroke were seen for plasma 15:0 (pooled HR for highest compared with lowest quartiles: 0.85; 95% CI: 0.54, 1.33), 17:0 (0.99; 0.67, 1.49), trans 16:1 n-7 (0.89; 0.55, 1.45), or 14:0 (1.05; 0.62, 1.78). Results were similar for ischemic and hemorrhagic stroke subtypes, for RBC fatty acids, and in several different sensitivity analyses.

CONCLUSION

In 2 large prospective cohorts, circulating biomarkers of dairy fat were not significantly associated with stroke.

β2-microglobulin, cystatin C, and creatinine and risk of symptomatic peripheral artery disease

BACKGROUND

β2-Microglobulin and cystatin C may have advantages over creatinine in assessing risk associated with kidney function. We therefore investigated whether emerging filtration markers, β2-microglobulin and cystatin C, are prospectively associated with risk of the development of peripheral artery disease (PAD).

METHODS AND RESULTS

We conducted nested case-control studies among women within the Nurses' Health Study (1990-2010) and among men within the Health Professionals Follow-up Study (1994-2008) with the use of archived blood samples collected before PAD diagnosis. During follow-up, symptomatic PAD was confirmed in 144 women and 143 men. Controls were matched 3:1 based on age, race, smoking status, fasting status, and date of blood sampling. Conditional logistic regression models were used to estimate relative risks (RRs) and were adjusted for plasma creatinine and cardiovascular risk factors. In women, the RRs (95% CI) per 1-SD) increment were 1.16 (0.85 to 1.58) for β2-microglobulin and 0.94 (0.69 to 1.28) for cystatin C. Corresponding RRs in men were 1.50 (1.08 to 2.09) for β2-microglobulin and 1.54 (1.07 to 2.22) for cystatin C. There was no association between creatinine and PAD risk in women, whereas the association in men (RR 1.41, 95% CI 1.10 to 1.81) disappeared after adjustment for either β2-microglobulin or cystatin C. In pooled analyses of men and women, only β2-microglobulin was associated with PAD risk (RR 1.31, 95% CI 1.04 to 1.64).

CONCLUSIONS

In pooled analyses, β2-microglobulin was associated with an increased risk of symptomatic PAD; a similar association with cystatin C was observed only in men. The findings suggest that β2-microglobulin may capture the atherosclerosis-promoting or atherosclerosis-related elements of kidney dysfunction better than creatinine.

Potassium-rich diet and risk of stroke: updated meta-analysis

Recently a few prospective population studies provided additional and heterogeneous information concerning the reported statistical associations between potassium (K) intake and stroke risk. Therefore, we updated our previous meta-analysis of K intake and risk of cerebrovascular events. Three studies were added to the previous analysis, and the results of the comparison between the event rate in the two extreme categories of K intake were used. Pooled analysis of 14 cohorts (overall 333,250 participants and 10,659 events) showed an inverse and significant association between K intake and risk of stroke (Relative Risk: 0.80; 95% CI: 0.72-0.90). Our results indicated a favorable effect of higher K intake on risk of stroke. These results confirm the appropriateness of worldwide recommendations for a population increased consumption of potassium-rich foods to prevent cardiovascular disease.

Association between usual sodium and potassium intake and blood pressure and hypertension among U.S. adults: NHANES 2005-2010

OBJECTIVES

Studies indicate high sodium and low potassium intake can increase blood pressure suggesting the ratio of sodium-to-potassium may be informative. Yet, limited studies examine the association of the sodium-to-potassium ratio with blood pressure and hypertension.

METHODS

We analyzed data on 10,563 participants aged ≥20 years in the 2005-2010 National Health and Nutrition Examination Survey who were neither taking anti-hypertensive medication nor on a low sodium diet. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their associations with blood pressure, and logistic regression to assess their associations with hypertension.

RESULTS

The average usual intakes of sodium, potassium and sodium-to-potassium ratio were 3,569 mg/d, 2,745 mg/d, and 1.41, respectively. All three measures were significantly associated with systolic blood pressure, with an increase of 1.04 mmHg (95% CI, 0.27-1.82) and a decrease of 1.24 mmHg (95% CI, 0.31-2.70) per 1,000 mg/d increase in sodium or potassium intake, respectively, and an increase of 1.05 mmHg (95% CI, 0.12-1.98) per 0.5 unit increase in sodium-to-potassium ratio. The adjusted odds ratios for hypertension were 1.40 (95% CI, 1.07-1.83), 0.72 (95% CI, 0.53-0.97) and 1.30 (95% CI, 1.05-1.61), respectively, comparing the highest and lowest quartiles of usual intake of sodium, potassium or sodium-to-potassium ratio.

CONCLUSIONS

Our results provide population-based evidence that concurrent higher sodium and lower potassium consumption are associated with hypertension.

Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals

BACKGROUND

Among adults, skipping meals is associated with excess body weight, hypertension, insulin resistance, and elevated fasting lipid concentrations. However, it remains unknown whether specific eating habits regardless of dietary composition influence coronary heart disease (CHD) risk. The objective of this study was to prospectively examine eating habits and risk of CHD.

METHODS AND RESULTS

Eating habits, including breakfast eating, were assessed in 1992 in 26 902 American men 45 to 82 years of age from the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer. During 16 years of follow-up, 1527 incident CHD cases were diagnosed. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for CHD, adjusted for demographic, diet, lifestyle, and other CHD risk factors. Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not (relative risk, 1.27; 95% confidence interval, 1.06-1.53). Compared with men who did not eat late at night, those who ate late at night had a 55% higher CHD risk (relative risk, 1.55; 95% confidence interval, 1.05-2.29). These associations were mediated by body mass index, hypertension, hypercholesterolemia, and diabetes mellitus. No association was observed between eating frequency (times per day) and risk of CHD.

CONCLUSIONS

Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals.

Health care and lost productivity costs of overweight and obesity in New Zealand

OBJECTIVE

To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006.

METHODS

A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA).

RESULTS

Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA.

CONCLUSION

The cost burden of overweight and obesity in NZ is considerable.

IMPLICATIONS

Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs.

A diet pattern with more dairy and nuts, but less meat is related to lower risk of developing hypertension in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) study

Dietary intake among other lifestyle factors influence blood pressure. We examined the associations of an “a priori” diet score with incident high normal blood pressure (HNBP; systolic blood pressure (SBP) 120–139 mmHg, or diastolic blood pressure (DBP) 80–89 mmHg and no antihypertensive medications) and hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or taking antihypertensive medication). We used proportional hazards regression to evaluate this score in quintiles (Q) and each food group making up the score relative to incident HNBP or hypertension over nine years in the Atherosclerosis Risk of Communities (ARIC) study of 9913 African-American and Caucasian adults aged 45–64 years and free of HNBP or hypertension at baseline. Incidence of HNBP varied from 42.5% in white women to 44.1% in black women; and incident hypertension from 26.1% in white women to 40.8% in black women. Adjusting for demographics and CVD risk factors, the “a priori” food score was inversely associated with incident hypertension; but not HNBP. Compared to Q1, the relative hazards of hypertension for the food score Q2–Q5 were 0.97 (0.87–1.09), 0.91 (0.81–1.02), 0.91 (0.80–1.03), and 0.86 (0.75–0.98); p_trend = 0.01. This inverse relation was largely attributable to greater intake of dairy products and nuts, and less meat. These findings support the 2010 Dietary Guidelines to consume more dairy products and nuts, but suggest a reduction in meat intake.