Fat Quality Index and Risk of Cardiovascular Disease in the Sun Project

Associations between dietary macronutrient quality and asthenozoospermia risk: a hospital-based case-control study

Background & aims: Macronutrients are the main part of the human diet and can affect multiple health outcomes. Nevertheless, associations between dietary macronutrient quality and asthenozoospermia risk have not been reported to date. Thus, this study aimed to be the first to explore the associations between macronutrient quality and asthenozoospermia risk using the novel multidimensional macronutrient quality index (MQI). Methods: A case-control study was conducted at infertility clinics of Shengjing Hospital of China Medical University during June and December 2020, including 552 asthenozoospermia cases and 585 normozoospermia controls. Data on diet were collected using a validated food frequency questionnaire. MQI was estimated according to the carbohydrate quality index (CQI), fat quality index (FQI), and protein quality index (PQI). Binary logistic regression models were performed to calculate the odds ratio (OR) with a 95% confidence interval (CI). Subgroup and interaction analyses were performed based on age, body mass index, physical activity, smoking, drinking, and education level. Dose-response relationships were evaluated by restricted cubic splines. Sensitivity analyses were performed in two ways. First, participants with a dietary change were excluded to lower potential reverse causation. Then, we used the healthy plate protein source quality index instead of PQI to redefine MQI. Results: No statistically significant association was observed between dietary MQI and asthenozoospermia risk (OR = 1.24, 95% CI: 0.88-1.73). The sub-indices of MQI, CQI, FQI, and PQI, failed to be identified as having a statistically significant association with asthenozoospermia risk (OR = 1.35, 95% CI: 0.92-1.97 for CQI; OR = 1.13, 95% CI: 0.84-1.53 for FQI; OR = 1.28, 95% CI: 0.92-1.78 for PQI). However, CQI showed a positive association with the risk of asthenozoospermia among non-drinkers (Ptrend < 0.05) and highly educated participants (OR = 1.82, 95% CI: 1.13-2.94; Ptrend < 0.05). Additionally, there was a multiplicative interaction between CQI and education level for asthenozoospermia risk (P < 0.05). Conclusions: Our findings demonstrated no association of MQI and its sub-indices with asthenozoospermia risk except for CQI. Although our findings are mostly non-significant, they contribute novel knowledge to this research field and lay the foundation for future studies.

Dietary carbohydrate quality index and cardio-metabolic risk factors

Introduction: Improving the quality of diet is known as one of the practical ways to reduce cardio-metabolic risk factors (CMRFs). The carbohydrate quality index (CQI) is a relatively new index to evaluate diet quality. It is calculated based on the ratio of solid carbohydrates to total carbohydrates, dietary fibre intake, glycemic index and the ratio of whole grains to total grains. This systematic review and meta-analysis was designed to investigate the association between dietary CQI and CMRFs. Methods: In this systematic review, some international databases, including Scopus, PubMed, EMBASE, Web of Science, and Google Scholar up to July 2022, were searched according to appropriate keywords. All observational studies with an English full text assessing the association between the dietary CQI and CMRFs were included. Two researchers independently extracted the data and assessed the quality of the articles with the Newcastle-Ottawa Scale. Random/fixed-effect meta-analysis was used to pool standardized mean difference (SMD) as an effect size. Results: 11 studies with a total of 63962 subjects were found to be eligible and included in the qualitative synthesis; only BMI, WC and metabolic syndrome reached the threshold of 3 reports with the same effect size and thus only 5 were included in the meta-analysis. The main finding of the included studies was that there were inverse associations between CQI and CMRFs, mainly obesity, glucose metabolism indices, and blood pressure. In the five studies included in the random effect meta-analysis, the association between CQI and body mass index (SMD: 0.45, 95%CI: -0.12, 1.01), waist circumference (SMD: -0.09, 95%CI: -0.34, 0.15) and metabolic syndrome (SMD: 0.63, 95%CI: -0.01, 1.28) was not statistically significant. Conclusion: Although the qualitative findings support the positive association of CQI with CMRFs, the evidence is insufficient to conclude robust findings. Further observational and interventional studies are needed to clearly elucidate this association.

The association of macronutrient quality and its interactions with energy intake with survival among patients with ovarian cancer: results from a prospective cohort study

BACKGROUND

Emerging evidence supports shifting the focus from the quantity of macronutrients to quality to obtain greater benefits for the prognosis of ovarian cancer (OC). Additionally, despite the high relevance between macronutrient quality and quantity, the interaction of these parameters on OC survival remains unknown.

OBJECTIVE

A multidimensional macronutrient quality index (MQI) was applied to investigate the association between overall macronutrient quality and the survival of patients with OC.

METHODS

A prospective cohort study was conducted with 701 females diagnosed with OC who were enrolled from 2015 to 2020. Dietary intake information was obtained from a validated food frequency questionnaire. The MQI was calculated based on 3 quality indices: carbohydrate quality index (CQI), fat quality index (FQI), and protein quality index (PQI). Cox proportional hazards regression was conducted to calculate HRs and 95% CIs. Furthermore, we evaluated whether energy intake status (total energy intake and energy balance) modified the association between MQI and OC survival.

RESULTS

During a median follow-up period of 38 (interquartile: 35-40) mo, 130 deaths occurred. The prediagnosis high MQI scores were associated with substantially improved survival among females with OC (HR_{tertile 3 vs. tertile 1} = 0.50, 95% CI: 0.33, 0.77). For sub-indices of the MQI, higher CQI (HR = 0.60, 95% CI: 0.36, 0.99), higher FQI (HR = 0.55, 95% CI: 0.34, 0.87), and higher PQI (HR = 0.58, 95% CI: 0.35, 0.94) scores were all associated with better survival. Notably, significant interactions were observed for the MQI score with total energy intake and energy balance as well as the quantity and quality of carbohydrates on survival.

CONCLUSIONS

Intake of high-quality macronutrients before diagnosis was associated with improved survival among females with OC, especially for those with energy imbalance. Am J Clin Nutr 2023;xxx:xx-xx.

Association between a new dietary protein quality index and micronutrient intake adequacy: a cross-sectional study in a young adult Spanish Mediterranean cohort

PURPOSE

There is no evidence of a dietary index that measures not only the quantity but also the quality of protein. The aim is to investigate the association between a new dietary protein quality index (PQI) and micronutrient intake adequacy in a Mediterranean cohort.

DESIGN

We assessed 17,535 participants' diet at baseline using a semi-quantitative FFQ. The PQI was calculated according to the ratio of protein (g/d) sources: [fish, seafood, lean meat, pulses, eggs, nuts, low-fat dairy, and whole grains]/[red and ultra-processed meats, whole-fat or semi-skimmed dairy, potatoes and refined grains]. Participants were classified into quintiles of PQI. We evaluated the intakes of Fe, Cr, I, K, Mg, Ca, P, Na, Se, Zn and vitamins A, B1, B2, B3, B6, B12, C, E and folic acid. Micronutrient adequacy was evaluated using DRIs. Logistic regression analysis was used to assess the micronutrient adequacy according to quintiles of PQI.

RESULTS

In this cross-sectional analysis, a total of 24.2% and 4.3% participants did not to meet DRIs in ≥ 4 and ≥ 8 micronutrients, respectively. The odds of failing to meet ≥ 4 and ≥ 8 DRI were lower in participants in the highest quintile of protein quality (OR = 0.22; IC 95% = 0.18, 0.26; P-trend < 0.001; and OR = 0.08; IC 95% = 0.05, 0.14; P-trend < 0.001, respectively) as compared to participants in the lowest quintile.

CONCLUSION

Higher PQI was found to be strongly associated with better micronutrient intake adequacy in this Mediterranean cohort. The promotion of high-quality protein intake may be helpful for a more adequate intake of micronutrients. The odds of failing to meet certain numbers of DRIs were lower rather than saying lower risk.

Dietary fatty acid patterns and risk of oesophageal squamous cell carcinoma

Background

To characterize and examine the associations between dietary fatty acid intake patterns and the risk of oesophageal squamous cell carcinoma (ESCC).

Methods

A total of 422 patients and 423 controls were recruited. Dietary fatty acids were entered into a factor analysis. Multivariable logistic regression and restricted cubic spline were used to evaluate the risk of ESCC specific for different dietary fatty acid patterns (FAPs). A forest plot was applied to show the association between FAPs and ESCC risk after stratification by lifestyle exposure factors (tobacco smoking, alcohol drinking, pickled food, fried food, hot food, hard food).

Results

The factor analysis generated four major fatty acid patterns: a medium- and long-chain SFA (MLC-SFA) pattern; an even-chain unsaturated fatty acid (EC-UFA) pattern, a saturated fatty acid (SFA) pattern and an n-3 long-chain polyunsaturated fatty acid (n-3 LC-PUFA) pattern. In the multivariate-adjusted model, the odds ratios (ORs) with 95% confidence intervals (CIs) of ESCC were 2.07 (1.31, 3.26) and 0.53 (0.34, 0.81) for the highest versus the lowest tertiles of the EC-UFA pattern and n-3 LC-PUFA pattern, respectively. The MLC-SFA and SFA patterns were not associated with ESCC. An association between FAPs and ESCC risk after stratification by lifestyle exposure factors was also observed.

Conclusions

Our study indicates that the EC-UFA pattern and n-3 LC-PUFA pattern intake are associated with ESCC, providing a potential dietary intervention for ESCC prevention.

Macronutrient quality index and cardiovascular disease risk in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

To assess the association between a multi-dimensional Macronutrient Quality Index (MQI) and the risk of cardiovascular disease (CVD) in a Mediterranean cohort.

METHODS

Prospective analyses among 18,418 participants (mean age 36 years, 60.8% women) of the Seguimiento Universidad de Navarra (SUN) cohort. Dietary intake information was obtained through a validated semi-quantitative food-frequency questionnaire (FFQ). The MQI (expressing high-quality macronutrient intake) was calculated based on three previously reported quality indices: the Carbohydrate Quality Index (CQI), the Fat Quality Index (FQI), and the Healthy Plate Protein source Quality Index (HPPQI). Adherence to the Mediterranean diet (MedDiet) and Provegetarian Diet was evaluated using the Trichopoulou index and the score proposed by Martínez-González, respectively. CVD was defined as new-onset stroke, myocardial infarction, or CVD death.

RESULTS

After a median follow-up time of 14 years (211,744 person-years), 171 cases of CVD were identified. A significant inverse association was found between the MQI and CVD risk with multivariable-adjusted HR for the highest vs. the lowest quartile of 0.60 (95% IC, 0.38-0.96; P_trend = 0.024).

CONCLUSION

In this Mediterranean cohort, we found a significant inverse relationship between a multidimensional MQI (expressing high-quality macronutrient intake) and a lower risk of CVD.

Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period

BACKGROUND

Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood.

OBJECTIVE

To evaluate within-participant longitudinal changes in scores for nine a priori-defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the "Seguimiento Universidad de Navarra" (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up.

DESIGN

In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ).

PARTICIPANTS/SETTING

Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7).

MAIN OUTCOME MEASURES

Main outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010.

STATISTICAL ANALYSES PERFORMED

Adjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up.

RESULTS

The comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices.

CONCLUSIONS

In this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.

Macronutrient Quality and All-Cause Mortality in the SUN Cohort

No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3-14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59-1.06; Ptrend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45-0.90; Ptrend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.

Association of Dietary Fatty Acid Consumption Patterns with Risk of Hyper-LDL Cholesterolemiain Korean Adults

This study aimed to identify the association between the risk of hyper-LDL cholesterolemia (hyper-LDLC) and fatty acid consumption patterns (FACPs) using the data from the Korean Genome and Epidemiology Study (KoGES) prospective cohort. A total of 6542 middle-aged Korean adults were included in the analysis. Four FACPs were identified through principal component analysis of the reported intakes of 34 fatty acids (FAs): "long-chain FA pattern"; "short & medium-chain saturated fatty acid (SFA) pattern"; "n-3 polyunsaturated fatty acid (PUFA) pattern"; and "long-chain SFA pattern". The "long-chain SFA pattern" lowered the risk of hyper-LDLC (relative risk (RR), 0.82; 95% confidence interval (CI), 0.72-0.94; p for trend, 0.004) and the "short & medium-chain SFA pattern" increased the risk of hyper-LDLC (RR, 1.17; 95% CI, 1.03-1.32; p for trend = 0.004). In sex-stratified analyses, the associations of the "long-chain SFA pattern" (RR, 0.73; 95% CI, 0.58-0.93; p for trend = 0.007) and the "short & medium-chain SFA pattern" (RR, 1.34; 95% CI, 1.07-1.69; p for trend = 0.003) with the hyper-LDLC risk were observed only in men, but not in women. These results suggest that FACPs with a high intake of long-chain SFA or a low intake of short and medium-chain SFA may protect Korean adults from hyper-LDLC.

Association between diet quality indexes and the risk of short telomeres in an elderly population of the SUN project

BACKGROUND

Shorter telomeres are associated with several age-related diseases, and lifestyle factors could influence this relationship. The aim of this study was to examine associations between salivary telomere length (TL) and diet quality using 5 evidence-based dietary indexes in an elderly (>55 years old) Spanish population of the SUN project (n = 886).

METHOD

TL was measured using the quantitative real-time polymerase chain reaction. Age-adjusted TL variable through residuals methods was used for all analysis. Diet quality was assessed by the Prime Diet Quality Score (PDQS), Fat Quality Index (FQI), Mediterranean Diet Adherence Screener (MEDAS), Dietary Approaches to Stop Hypertension (DASH) index and the Alternative Healthy Eating Index (AHEI-2010).

RESULTS

TL did differ according to sex, smoking status, and dyslipidemia in elderly subjects of the SUN study. In addition, subjects with dyslipidemia (compared to absence of dyslipidemia) had a significantly higher risk (27% vs. 18%, p = 0.015) of short telomeres (<percentile 20th). Interestingly, a lower risk of having short telomeres was observed among participants in the top tertiles of the following diet quality score PDQS, MEDAS and DASH compared to the bottom tertiles in crude and adjusted models. Moreover, FQI and AHEI-2010 scores showed an inverse association with the risk of having short telomeres after adjustment for potential confounders (model adjusted for dyslipidemia interaction, p for trend = 0.025 and 0.021, respectively; and model additionally adjusted for sex and smoking status, p for trend = 0.033 and 0.029, respectively).

CONCLUSION

Adherence to high quality diet is associated to longer salivary TL in our elderly Spanish population of the SUN study.