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Ding D, Van Buskirk J, Partridge S, Clare P, Giovannucci E, Bauman A, Freene N, Gallagher R, Nguyen B. The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians: A longitudinal study. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:S2095-2546(24)00082-6. [PMID: 38810689 DOI: 10.1016/j.jshs.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease (CVD) prevention. However, despite their interlinked effects on metabolic health, the 2 behaviors are rarely considered jointly, particularly within the context of CVD prevention. We examined the independent, interactive, and joint associations of diet and physical activity with CVD hospitalization, CVD mortality, and all-cause mortality. METHODS CVD-free Australian participants aged 45-74 years (n = 85,545) reported physical activity, diet, and sociodemographic and lifestyle characteristics at baseline (2006-2009) and follow-up (2012-2015), and data were linked to hospitalization and death registries (03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality). Diet quality was categorized as low, medium, and high based on meeting dietary recommendations. Physical activity was operationalized as (a) total moderate-to-vigorous physical activity (MVPA) as per guidelines, and (b) the composition of MVPA as the ratio of vigorous-intensity physical activity (VPA) to total MVPA. We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates. RESULTS During a median of 10.7 years of follow-up, 6576 participants were admitted to the hospital for CVD and 6581 died from all causes (876 from CVD during 9.3 years). A high-quality diet was associated with a 17% lower risk of all-cause mortality than a low-quality diet, and the highest MVPA category (compared with the lowest) was associated with a 44% and 48% lower risk of CVD and all-cause mortality, respectively. Multiplicative interactions between diet and physical activity were non-significant. For all outcomes, the lowest risk combinations involved a high-quality diet and the highest MVPA categories. Accounting for total MVPA, some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality. CONCLUSION For CVD prevention and longevity, one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.
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Affiliation(s)
- Ding Ding
- Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Charles Perkins Centre, the University of Sydney, Camperdown, NSW 2006, Australia.
| | - Joe Van Buskirk
- Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Stephanie Partridge
- School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia
| | - Philip Clare
- Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Charles Perkins Centre, the University of Sydney, Camperdown, NSW 2006, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Adrian Bauman
- Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Charles Perkins Centre, the University of Sydney, Camperdown, NSW 2006, Australia
| | - Nicole Freene
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, the University of Sydney, Camperdown, NSW 2006, Australia; Susan Wakil School of Nursing and Midwifery, the University of Sydney, Camperdown, NSW 2050, Australia
| | - Binh Nguyen
- Sydney School of Public Health, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Charles Perkins Centre, the University of Sydney, Camperdown, NSW 2006, Australia
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Pacheco LS, Tobias DK, Li Y, Bhupathiraju SN, Willett WC, Ludwig DS, Ebbeling CB, Haslam DE, Drouin-Chartier JP, Hu FB, Guasch-Ferré M. Sugar-sweetened or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in adults: a prospective cohort study. Am J Clin Nutr 2024; 119:669-681. [PMID: 38185281 DOI: 10.1016/j.ajcnut.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Whether physical activity could mitigate the adverse impacts of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) on incident cardiovascular disease (CVD) remains uncertain. OBJECTIVES This study aimed to examine the independent and joint associations between SSB or ASB consumption and physical activity and risk of CVD, defined as fatal and nonfatal coronary artery disease and stroke, in adults from 2 United States-based prospective cohort studies. METHODS Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs between SSB or ASB intake and physical activity with incident CVD among 65,730 females in the Nurses' Health Study (1980-2016) and 39,418 males in the Health Professional's Follow-up Study (1986-2016), who were free from chronic diseases at baseline. SSBs and ASBs were assessed every 4-y and physical activity biannually. RESULTS A total of 13,269 CVD events were ascertained during 3,001,213 person-years of follow-up. Compared with those who never/rarely consumed SSBs or ASBs, the HR for CVD for participants consuming ≥2 servings/d was 1.21 (95% CI: 1.12, 1.32; P-trend < 0.001) for SSBs and 1.03 (95% CI: 0.97, 1.09; P-trend = 0.06) for those consuming ≥2 servings/d of ASBs. The HR for CVD per 1 serving increment of SSB per day was 1.18 (95% CI: 1.10, 1.26) and 1.12 (95% CI: 1.04, 1.20) for participants meeting and not meeting physical activity guidelines (≥7.5 compared with <7.5 MET h/wk), respectively. Compared with participants who met physical activity guidelines and never/rarely consumed SSBs, the HR for CVD was 1.47 (95% CI: 1.37, 1.57) for participants not meeting physical activity guidelines and consuming ≥2 servings/wk of SSBs. No significant associations were observed for ASB when stratified by physical activity. CONCLUSIONS Higher SSB intake was associated with CVD risk regardless of physical activity levels. These results support current recommendations to limit the intake of SSBs even for physically active individuals.
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Affiliation(s)
- Lorena S Pacheco
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Deirdre K Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States
| | - David S Ludwig
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, United States
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, United States
| | - Danielle E Haslam
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jean-Philippe Drouin-Chartier
- Faculté de Pharmacie, Université Laval, Quebec City, Quebec, Canada; Centre Nutrition Santé et Societé (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnnels (INAF), Université Laval, Quebec City, Quebec, Canada
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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García-Mayor J, Moreno-Llamas A, De La Cruz Sánchez E. A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017). Nurs Health Sci 2023; 25:700-711. [PMID: 37937892 DOI: 10.1111/nhs.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Ernesto De La Cruz Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
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García-Mayor J, Moreno-Llamas A, De la Cruz-Sánchez E. How socioeconomic status affects weight status through health-related lifestyles: a latent class analysis. Eur J Cardiovasc Nurs 2023; 22:730-744. [PMID: 36316287 DOI: 10.1093/eurjcn/zvac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/12/2023]
Abstract
AIMS Obesity levels have increased worldwide with serious public health concerns. However, weight status is related to socioeconomic status (SES), which may also influence health-related lifestyles. Here, we study the association between SES and obesity mediated by diet and physical activity. METHODS AND RESULTS Using cross-sectional data from 2006, 2011, 2014, and 2017 Spanish health surveys (the final sample consisted of 61 768 adults aged between 18 and 64 years), we conducted a latent class analysis to estimate health-related lifestyle clusters (based on dietary patterns and physical activity) and mediation analyses to evaluate the association of SES and obesity through the clustering of health-related lifestyles. In both men and women, SES was inversely related to obesity (P < 0.001) and positively related to healthier lifestyle classes (P < 0.001). Obesity was inversely related to healthier lifestyle classes (P < 0.001). A small-although significant-proportion mediated by the clustering of lifestyles was found as follows: 4.9%, 95% CI (6.6%, 3.2%) in men and 2.3%, 95% CI (3.4%, 1.3%) in women for educational attainment, 5.3%, 95% CI (7.2%, 3.6%) in men and 2.0%, 95% CI (2.9%, 1.1%) in women for occupational social class, and 4.9%, 95% CI (6.5%, 3.1%) and 1.9%, 95% CI (2.9%, 1.1%) combining the above two SES indicators. CONCLUSIONS SES is related to obesity through clustering health-related lifestyles, with greater emphasis on men. However, the complex relationship between SES and weight status also suggests other indicators that contribute to the social gradient of obesity.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Ernesto De la Cruz-Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
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Garcia L, Pearce M, Abbas A, Mok A, Strain T, Ali S, Crippa A, Dempsey PC, Golubic R, Kelly P, Laird Y, McNamara E, Moore S, de Sa TH, Smith AD, Wijndaele K, Woodcock J, Brage S. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies. Br J Sports Med 2023; 57:979-989. [PMID: 36854652 PMCID: PMC10423495 DOI: 10.1136/bjsports-2022-105669] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. DESIGN Systematic review and cohort-level dose-response meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science and reference lists of published studies. ELIGIBILITY CRITERIA Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). RESULTS 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. CONCLUSIONS Inverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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Affiliation(s)
- Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sara Ali
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport, Physical Education and Health Sciences, Edinburgh, UK
| | - Yvonne Laird
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Eoin McNamara
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Economic and Social Research Institute, Dublin, Ireland
| | - Samuel Moore
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Wu Y, Wang M, Long Z, Ye J, Cao Y, Pei B, Gao Y, Yu Y, Han Z, Wang F, Zhao Y. How to Keep the Balance between Red and Processed Meat Intake and Physical Activity Regarding Mortality: A Dose-Response Meta-Analysis. Nutrients 2023; 15:3373. [PMID: 37571311 PMCID: PMC10421417 DOI: 10.3390/nu15153373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Non-communicable diseases have become a major threat to public health, with cardiovascular diseases (CVDs) and cancer being the top two causes of death each year. OBJECTIVE Our objective is to evaluate the balanced association between the effect of red and processed meat intake on the risk of death and the effect of physical activity on the risk of mortality, where the risk of death includes all causes, CVDs, and cancers. METHODS We searched electronic databases, including PubMed, ISI Web of Science, Embase, and the Cochrane Library, for prospective studies reporting risk estimates for the association between the intake of red and processed meat, walking, and muscle-strengthening activity (MSA) and the risk of mortality from all causes, CVDs, and cancer. We extracted fully adjusted effect estimates from original studies and performed a summary analysis using the fixed and random-effect models. RESULTS A conventional meta-analysis showed that red meat and processed meat were positively associated with the risk of mortality, and daily steps and MSA were negatively associated with the risk of death. Further analysis of the dose-response relationship showed that a risk reduction (20%) from 39.5 min/week of MSA or 4100 steps/d was equivalent to an increased risk of all-cause mortality from a daily intake of 103.4 g/d of red meat or 50 g/d of processed meat. The risk was further decreased as the number of steps per day increased, but the risk reversed when the MSA exceeded the threshold (39.5 min/week). CONCLUSIONS Adherence to physical activity is an effective way to reduce the risk of mortality due to meat intake. However, the total intake of red meat and processed meat should be controlled, especially the latter. Walking is recommended as the main daily physical activity of choice, while MSAs are preferred when time is limited, but it should be noted that longer MSAs do not provide additional benefits.
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Affiliation(s)
- Yi Wu
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Maoqing Wang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Rd., Nangang District, Harbin 150028, China;
| | - Zhiping Long
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Jingyu Ye
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Yukun Cao
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Bing Pei
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Yu Gao
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Yue Yu
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Zhen Han
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
- NHC Key Laboratory of Etiology and Epidemiology, Harbin 150028, China
| | - Yashuang Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin 150028, China; (Y.W.); (Z.L.); (J.Y.); (Y.C.); (B.P.); (Y.G.); (Y.Y.); (Z.H.)
- NHC Key Laboratory of Etiology and Epidemiology, Harbin 150028, China
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7
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Talavera-Rodriguez I, Fernandez-Lazaro CI, Hernández-Ruiz Á, Hershey MS, Galarregui C, Sotos-Prieto M, de la Fuente-Arrillaga C, Martínez-González MÁ, Ruiz-Canela M. Association between an oxidative balance score and mortality: a prospective analysis in the SUN cohort. Eur J Nutr 2023; 62:1667-1680. [PMID: 36781422 DOI: 10.1007/s00394-023-03099-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE We aimed to prospectively investigate the association of an overall oxidative balance score (OBS) with all-cause death and cause-specific mortality among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of Spanish graduates. METHODS Using baseline information on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures-vitamins C and E, β-carotenes, selenium, zinc, heme iron, polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity-we constructed an equally weighted OBS categorized into quartiles, with higher scores representing greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality. RESULTS A total of 18,561 participants (mean [SD] age, 38.5 [12.4] years; 40.8% males) were included in the analysis. During a median follow-up of 12.2 years (interquartile range 8.3-14.9), 421 deaths were identified, including 80 deaths from cardiovascular disease (CVD), 215 from cancer, and 126 from other causes. After adjustment for potential confounders, the hazard ratios and 95% confidence interval (CIs) between the highest quartile (predominance of antioxidants) vs. the lowest quartile (reference category) were 0.35 (95% CI 0.22-0.54, P-trend < 0.001) for all-cause mortality, 0.18 (95% CI 0.06-0.51, P-trend = 0.001) for CVD mortality, 0.35 (95% CI 0.19-0.65, P-trend = 0.002) for cancer mortality, and 0.45 (95% CI 0.20-1.02, P-trend = 0.054) for other-cause mortality. CONCLUSION Our findings suggest a strong inverse association between the OBS and all-cause, CVD, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk. STUDY REGISTRY NUMBER Dynamic Mediterranean Prospective Cohort: the SUN Project; NCT02669602. https://clinicaltrials.gov/ct2/show/NCT02669602 . https://proyectosun.es.
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Affiliation(s)
- Irene Talavera-Rodriguez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain
| | - Cesar I Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
| | | | - Maria S Hershey
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Cristina Galarregui
- Department of Nutrition, Food Sciences and Physiology and Centre for Nutrition Research, Faculty of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029, Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,IMDEA-Food Institute. CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029, Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029, Madrid, Spain.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea, 31008, Pamplona, Spain. .,IdisNA, Navarra Institute for Health Research, 31008, Pamplona, Spain. .,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029, Madrid, Spain.
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8
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Predictors of total mortality and their differential association on premature or late mortality in the SUN cohort. Exp Gerontol 2023; 172:112048. [PMID: 36521566 DOI: 10.1016/j.exger.2022.112048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Several studies have tried to analyse the association between all-cause mortality and different risk factors, (especially those which are modifiable, such as smoking, diet or exercise), to develop public health preventive strategies. However, a specific analysis of predictors of premature and late mortality is needed to give more precise recommendations. Considering that there are risk factors which exert an influence on some diseases and not on others, we expect that, similarly, they may have a different impact depending on the timing of mortality, separating premature (≤65 years) from late mortality (>65 years). Thus, we prospectively followed-up during a median of 12 years a cohort of 20,272 university graduates comprising an ample range of ages at inception. Time-dependent, covariate-adjusted Cox models were used to estimate adjusted hazard ratios (HR) and their 95 % confidence intervals (CI) for each predictor. The strongest independent predictor of mortality at any age was physical activity which was associated with reduced risk of total, premature and late mortality (range of HRs when comparing the highest vs. the lowest level: 0.24 to 0.48). Specific strong predictors for premature mortality were smoking, HR: 4.22 (95 % CI: 2.42-7.38), and the concurrence of ≥2 metabolic conditions at baseline, HR: 1.97 (1.10-3.51). The habit of sleeping a long nap (≥30 min/d), with HR: 2.53 (1.30-4.91), and poor adherence to the Mediterranean Diet (≤3 points in a 0 to 8 score vs. ≥6 points), with HR: 2.27 (1.08-4.76), were the strongest specific predictors for late mortality. Smoking, diet quality or lifestyles, probably should be differentially assessed as specific predictors for early and late mortality. In the era of precision medicine, this approach will allow tailored recommendations appropriate to each person's age and baseline condition.
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9
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Gregory S, Pullen H, Ritchie CW, Shannon OM, Stevenson EJ, Muniz-Terrera G. Mediterranean diet and structural neuroimaging biomarkers of Alzheimer's and cerebrovascular disease: A systematic review. Exp Gerontol 2023; 172:112065. [PMID: 36529364 DOI: 10.1016/j.exger.2022.112065] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Previous studies have demonstrated an association between adherence to the Mediterranean diet (MedDiet) and better cognitive performance, lower incidence of dementia and lower Alzheimer's disease biomarker burden. The aim of this systematic review was to evaluate the evidence base for MedDiet associations with hippocampal volume and white matter hyperintensity volume (WMHV). We searched systematically for studies reporting on MedDiet and hippocampal volume or WMHV in MedLine, EMBASE, CINAHL and PsycInfo. Searches were initially carried out on 21st July 2021 with final searches run on 23rd November 2022. Risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of an initial 112 papers identified, seven papers were eligible for inclusion in the review reporting on 21,933 participants. Four studies reported on hippocampal volume, with inconclusive or no associations seen with MedDiet adherence. Two studies found a significant association between higher MedDiet adherence and lower WMHV, while two other studies found no significant associations. Overall these results highlight a gap in our knowledge about the associations between the MedDiet and AD and cerebrovascular related structural neuroimaging findings.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Hannah Pullen
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Brain Health Scotland, UK.
| | - Oliver M Shannon
- Faculty of Medical Sciences, Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
| | - Emma J Stevenson
- Faculty of Medical Sciences, Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Social Medicine, Ohio University, OH, USA.
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10
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DHULI KRISTJANA, NAUREEN ZAKIRA, MEDORI MARIACHIARA, FIORETTI FRANCESCO, CARUSO PAOLA, PERRONE MARCOALFONSO, NODARI SAVINA, MANGANOTTI PAOLO, XHUFI SUELA, BUSHATI MARSIDA, BOZO DHURATA, CONNELLY STEPHENTHADDEUS, HERBST KARENL, BERTELLI MATTEO. Physical activity for health. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E150-E159. [PMID: 36479484 PMCID: PMC9710390 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Physical activity plays a substantial role in maintaining people's good health and mental wellbeing, but that is not all: not only it positively affects the individuals' mental and physical health, but a lack of physical exercise exerts a negative impact also on the overall economy of a nation. In addition, physical inactivity not only increases the risk of non-communicable diseases (NCD), but also contributes significantly to the increased morbidity and mortality in patients suffering from these diseases. On the contrary, physical activity reduces the risk of NCDs - such as cardiovascular diseases, type 2 diabetes, and cancer - in a dose-dependent manner; regular exercise is also associated with many health benefits and delayed mortality. However, understanding the role of physical activity in modern society and creating an awareness in the general population is one of the most important tasks of health and recreation promoters. Correspondingly, there is a dire need to enhance our knowledge, perception, and awareness of physical activity and its impacts on an individual's health, ultimately contributing to developing a healthy society. The current review will focus on the health benefits of the two most widely studied modifiable lifestyle risk factors, physical activity and diet, focusing particularly on the Mediterranean diet.
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Affiliation(s)
- KRISTJANA DHULI
- MAGI’S LAB, Rovereto (TN), Italy
- Correspondence: Kristjana Dhuli, MAGI’S LAB, Rovereto (TN), 38068, Italy. E-mail:
| | | | | | - FRANCESCO FIORETTI
- Department of Cardiology, University of Brescia and ASST “Spedali Civili” Hospital, Brescia, Italy
| | - PAOLA CARUSO
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | | | - SAVINA NODARI
- Department of Cardiology, University of Brescia and ASST “Spedali Civili” Hospital, Brescia, Italy
| | - PAOLO MANGANOTTI
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | | | | | | | - STEPHEN THADDEUS CONNELLY
- San Francisco Veterans Affairs Health Care System, Department of Oral & Maxillofacial Surgery, University of California, San Francisco, CA, USA7
| | - KAREN L. HERBST
- Total Lipedema Care, Beverly Hills California and Tucson Arizona, USA
| | - MATTEO BERTELLI
- MAGI’S LAB, Rovereto (TN), Italy
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Peachtree Corners (GA), USA
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11
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Zhang X, Molsberry SA, Schwarzschild MA, Ascherio A, Gao X. Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease. JAMA Netw Open 2022; 5:e2227738. [PMID: 35984656 PMCID: PMC9391952 DOI: 10.1001/jamanetworkopen.2022.27738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Greater diet quality and physical activity level are associated with a lower risk of developing Parkinson disease (PD). However, information regarding the association between lifestyle behaviors and survival after PD diagnosis remains limited. OBJECTIVE To examine the association of prediagnosis and postdiagnosis overall diet quality and physical activity with all-cause mortality among individuals with PD. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study analyzed male participants in the Health Professionals Follow-up Study from 1986 to 2012 and female participants in the Nurses' Health Study from 1984 to 2012. Participants who were diagnosed with PD and had complete baseline dietary assessment data were included. Data were analyzed from January 2021 to February 2022. EXPOSURES Prediagnosis diet quality, assessed by the Alternative Healthy Eating Index (AHEI), and physical activity, assessed by metabolic equivalent task (MET) hours per week reported on questionnaires, were the primary exposures of interest to minimize reverse causation. MAIN OUTCOMES AND MEASURES Mortality, which was followed up until 2018, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of diet and physical activity with mortality individually and jointly, and the models were adjusted for age, total energy intake, caffeine intake, and other lifestyle risk factors. RESULTS The sample comprised 1251 individuals with PD, which included 652 men (52.1%) with a median (IQR) age at diagnosis of 73.4 (67.5-78.7) years. During the 32 to 34 years of follow-up, 942 participants died. The adjusted hazard ratio (HR) comparing the highest vs the lowest AHEI quartile was 0.69 (95% CI, 0.56- 0.85) for prediagnosis analyses and 0.57 (95% CI, 0.42-0.78) for postdiagnosis analyses. Similar results were obtained for cumulative mean MET hours per week in the prediagnosis analyses (HR, 0.71; 95% CI, 0.57-0.87) and postdiagnosis analyses (HR, 0.47; 95% CI, 0.35-0.63). The inverse association persisted for PD-specific mortality (postdiagnosis AHEI: HR, 0.52 [95% CI, 0.33-0.80]; postdiagnosis physical activity: HR, 0.37 [95% CI, 0.25-0.55]). In the joint analyses of diet quality and physical activity before the PD diagnosis, the adjusted HR was 0.51 (95% CI, 0.36-0.73) for individuals in the highest vs lowest tertiles for both variables. The HR for diet quality and physical activity after the diagnosis was 0.35 (95% CI, 0.23-0.52). CONCLUSIONS AND RELEVANCE Results of this study showed that a healthy dietary pattern and an active lifestyle were associated with a lower rate of all-cause mortality among individuals with PD. Consuming a healthy diet and engaging in physical activity or exercise could be targeted to improve PD outcomes.
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Affiliation(s)
- Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Samantha A. Molsberry
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Social & Scientific Systems Inc, Durham, North Carolina
| | | | - Alberto Ascherio
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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12
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Ding D, Van Buskirk J, Nguyen B, Stamatakis E, Elbarbary M, Veronese N, Clare PJ, Lee IM, Ekelund U, Fontana L. Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. Br J Sports Med 2022; 56:bjsports-2021-105195. [PMID: 35811091 DOI: 10.1136/bjsports-2021-105195] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine independent and interactive associations of physical activity and diet with all-cause, cardiovascular disease (CVD) and physical activity, diet and adiposity-related (PDAR) cancer mortality. METHODS This population-based prospective cohort study (n=346 627) is based on the UK Biobank data with linkage to the National Health Service death records to 30 April 2020. A left-truncated Cox proportional hazards model was fitted to examine the associations between exposures (self-reported total moderate-to-vigorous intensity physical activity (MVPA), vigorous-intensity physical activity (VPA) and a diet quality index (score ranged 0-3)) and outcomes (all-cause, CVD and PDAR cancer mortality). RESULTS During a median follow-up of 11.2 years, 13 869 participants died from all causes, 2650 from CVD and 4522 from PDAR cancers. Compared with quartile 1 (Q1, 0-210 min/week), Q2-Q4 of MVPA were associated with lower risks of all-cause (HR ranged from 0.87 (95% CI: 0.83 to 0.91) to 0.91 (95% CI: 0.87 to 0.96)), CVD (HR ranged from 0.85 (95% CI: 0.76 to 0.95) to 0.90 (95% CI: 0.81 to 1.00)) and PDAR cancer mortality (HR ranged from 0.86 (95% CI: 0.79 to 0.93) to 0.94 (95% CI: 0.86 to 1.02)). Compared with no VPA, any VPA was associated with lower risk for all-cause and CVD mortality (HR ranged from 0.85 (95% CI: 0.80 to 0.89) to 0.88 (95% CI: 0.84 to 0.93) and from 0.75 (95% CI: 0.68 to 0.83) to 0.90 (95% CI: 0.80 to 1.02), respectively). Although not reaching statistical significance for all-cause and CVD mortality, being in the best dietary category (diet quality index=2-3) was associated with a reduction in PDAR cancer mortality (HR=0.86, 95% CI: 0.78 to 0.93). No additive or multiplicative interactions between physical activity categories and dietary quality was found. When comparing across physical activity and diet combinations, the lowest risk combinations consistently included the higher levels of physical activity and the highest diet quality score. CONCLUSIONS Adhering to both quality diet and sufficient physical activity is important for optimally reducing the risk of mortality from all causes, CVD and PDAR cancers.
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Affiliation(s)
- Ding Ding
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Joe Van Buskirk
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Binh Nguyen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Mona Elbarbary
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Philip J Clare
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - I-Min Lee
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ulf Ekelund
- Norwegian School of Sports Sciences, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Luigi Fontana
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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13
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Alcohol and early mortality (before 65 years) in the 'Seguimiento Universidad de Navarra' (SUN) cohort: does any level reduce mortality? Br J Nutr 2022; 127:1415-1425. [PMID: 34176531 DOI: 10.1017/s0007114521002397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study was to assess the association between alcohol intake and premature mortality (younger than 65 years) and to explore the effect of potential alcohol underreporting by heavy drinkers. We followed-up 20 272 university graduates. Four categories of alcohol intake were considered (abstainer, light, moderate and heavy consumption). Repeated measurements of alcohol intake and updated information on confounders were used in time-dependent Cox models. Potential underreporting of alcohol intake by some heavy drinkers (likely misclassified as light or moderate drinkers) was explicitly addressed in an attempt to correct potential underreporting by using indirect information. During 12·3 years of median follow-up (interquartile range: 6·8-15·0), 226 participants died before their 65th birthday. A higher risk of early mortality was found for the highest category of alcohol intake (≥50 g/d) in comparison with abstention (multivariable-adjusted hazard ratio (HR) = 2·82, 95 % CI 1·38, 5·79). In analyses of alcohol as a continuous variable, the multivariable-adjusted HR was 1·17 (95 % CI 1·08, 1·26), for each 10 g/d of alcohol. This harmful linear association was present both in uncorrected models and in models corrected for potential underreporting. No significant inverse association between light or moderate alcohol intake and premature mortality was observed, even after correcting for potential misclassification. Alcohol intake exhibited a harmful linear dose-response association with premature mortality (<65 years) in this young and highly educated Mediterranean cohort. Our attempts to correct for potential misclassification did not substantially change these results.
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14
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Wolosowicz M, Prokopiuk S, Kaminski TW. Recent Advances in the Treatment of Insulin Resistance Targeting Molecular and Metabolic Pathways: Fighting a Losing Battle? Medicina (B Aires) 2022; 58:medicina58040472. [PMID: 35454311 PMCID: PMC9029454 DOI: 10.3390/medicina58040472] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022] Open
Abstract
Diabetes Mellitus (DM) is amongst the most notable causes of years of life lost worldwide and its prevalence increases perpetually. The disease is characterized as multisystemic dysfunctions attributed to hyperglycemia resulting directly from insulin resistance (IR), inadequate insulin secretion, or enormous glucagon secretion. Insulin is a highly anabolic peptide hormone that regulates blood glucose levels by hastening cellular glucose uptake as well as controlling carbohydrate, protein, and lipid metabolism. In the course of Type 2 Diabetes Mellitus (T2DM), which accounts for nearly 90% of all cases of diabetes, the insulin response is inadequate, and this condition is defined as Insulin Resistance. IR sequela include, but are not limited to, hyperglycemia, cardiovascular system impairment, chronic inflammation, disbalance in oxidative stress status, and metabolic syndrome occurrence. Despite the substantial progress in understanding the molecular and metabolic pathways accounting for injurious effects of IR towards multiple body organs, IR still is recognized as a ferocious enigma. The number of widely available therapeutic approaches is growing, however, the demand for precise, safe, and effective therapy is also increasing. A literature search was carried out using the MEDLINE/PubMed, Google Scholar, SCOPUS and Clinical Trials Registry databases with a combination of keywords and MeSH terms, and papers published from February 2021 to March 2022 were selected as recently published papers. This review paper aims to provide critical, concise, but comprehensive insights into the advances in the treatment of IR that were achieved in the last months.
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Affiliation(s)
- Marta Wolosowicz
- Department of Physiology, Medical University of Bialystok, 15-222 Bialystok, Poland;
| | - Slawomir Prokopiuk
- Faculty of Health Sciences, Lomza State University of Applied Sciences, 18-400 Lomza, Poland;
| | - Tomasz W. Kaminski
- Department of Medicine, Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Correspondence:
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15
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The Rise and Fall of the Mediterranean Diet and Related Nutrients in Preventing Diabetes. Nutrients 2022; 14:nu14020379. [PMID: 35057560 PMCID: PMC8779477 DOI: 10.3390/nu14020379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/12/2022] [Indexed: 01/23/2023] Open
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16
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Strahler J, Wurst R, Fuchs R, Wunsch K. Joint associations of regular exercise and healthy diet with psychobiological stress reactivity in a healthy male sample. Stress 2021; 24:696-709. [PMID: 33605191 DOI: 10.1080/10253890.2021.1878496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objectives: Engaging in physical activity and exercise have long been shown to have beneficial effects on (psychosocial) stress reactivity. Initial studies could reveal that these positive effects on stress reactivity also exist for a healthy diet. Aim of this study was to examine whether combining a healthy diet and regular exercise can provide additional benefits on psychobiological stress levels. Methods: Forty-two men self-identifying as non-exercisers or regular exercisers between 18 and 30 years were exposed to the Trier Social Stress Test for Groups. Salivary cortisol (sCort) and alpha-amylase (sAA) as biological stress markers, and self-reported momentary stress were repeatedly examined. Questionnaires on regular exercise and dietary intake were completed once. Results: Two-stage hierarchical multiple regressions predicting participants' stress reactivity, i.e. response and recovery, from diet quality, exercise as well as their interaction appeared inconsistent. sCort response was significantly predicted by regular exercise whereas greater sCort recovery was predicted by higher diet quality. In contrast, higher sAA reactivity was predicted by higher diet quality while participants eating less healthy and exercising more showed the most pronounced sAA recovery. None of the other outcome variables was predicted by the interaction. Subjective stress was unrelated to either health behavior. Conclusions: The present examination among an all-male sample emphasized the stress-buffering capabilities of regular exercise and provided initial evidence for a distinct link to healthy diet. Assumed synergistic benefits could, however, not be confirmed. Advances are needed to better understand how individuals profit the most from which behaviors as well as their interactive effects.
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Affiliation(s)
- Jana Strahler
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Giessen, Germany
| | - Ramona Wurst
- Department of Sport Psychology, University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport Psychology, University of Freiburg, Freiburg, Germany
| | - Kathrin Wunsch
- Department of Sport Psychology, University of Freiburg, Freiburg, Germany
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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17
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The Mediterranean diet and physical activity: better together than apart for the prevention of premature mortality. Br J Nutr 2021; 128:1413-1424. [PMID: 34462020 PMCID: PMC9530916 DOI: 10.1017/s0007114521002877] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diet and physical activity (PA) have been studied extensively in epidemiology as single or combined lifestyle factors; however, their interaction has not been studied thoroughly. Studying potential synergisms between lifestyle components with a comprehensive interaction analysis, including additive measures of interaction, provides key insights into the nature of their joint effect and helps target interventions more effectively. First, a comprehensive review was conducted to assess the potential research gap regarding reported interaction analyses conducted in studies assessing the Mediterranean diet (MedDiet) in combination with PA on all-cause mortality. Thereafter, we prospectively assessed the joint association of the MedDiet with PA on all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort, followed by both multiplicative and additive interaction analyses. The conjoint effect of low adherence to the MedDiet and low PA observed an increased risk greater than the individual risk factors, suggesting a potential additive interaction or synergism between both exposures, with relative risk due to interaction (RERI) and (95 % confidence interval (95 % CI)) = 0·46 (–0·83 to 1·75) and attributable proportion (95 % CI) due to interaction of 36 % (–0·62, 1·34). No multiplicative interaction was detected. Studying interactions between lifestyle factors, such as the MedDiet and PA, is particularly relevant given the current research gaps in studying the complexities of combined aspects of lifestyle in comparison with isolated behaviours. Our findings underline the important public health message of adhering to both the MedDiet and PA for the prevention of premature mortality.
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18
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Martínez-González MA, Trichopoulou A. Observational Epidemiology, Lifestyle, and Health: The Paradigm of the Mediterranean Diet. Am J Health Promot 2021; 34:948-950. [PMID: 33076689 DOI: 10.1177/0890117120960580c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain and CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
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19
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Sanchez-Bayona R, Gardeazabal I, Romanos-Nanclares A, Fernandez-Lazaro CI, Alvarez-Alvarez I, Ruiz-Canela M, Gea A, Martinez-Gonzalez MA, Santisteban M, Toledo E. Leisure-time physical activity, sedentary behavior, and risk of breast cancer: Results from the SUN ('Seguimiento Universidad De Navarra') project. Prev Med 2021; 148:106535. [PMID: 33798533 DOI: 10.1016/j.ypmed.2021.106535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/01/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022]
Abstract
Evidence is still limited on the influence of sedentary lifestyles on breast cancer (BC) risk. Also, prospective information on the combined effects of both sedentariness and leisure-time physical activity (LTPA) is scarce. We aimed to assess the association of higher sedentary behavior and LTPA (separately and in combination) with the risk of BC in a middle-aged cohort of university graduates. The SUN Project is a follow-up study initiated in 1999 with recruitment permanently open. Baseline assessments included a validated questionnaire on LTPA and sedentary habits. Subsequently, participants completed biennial follow-up questionnaires. Multivariable adjusted Cox models were used to estimate the hazard ratios (HR) for incident BC according to LTPA, TV-watching, the joint classification of both, and a combined 8-item multidimensional active lifestyle score. We included 10,812 women, with 11.8 years of median follow-up of. Among 115,802 women-years of follow-up, we confirmed 101 incident cases of BC. Women in the highest category of LTPA (>16.5 MET-h/week) showed a significantly lower risk of BC (HR = 0.55; 95% CI: 0.34-0.90) compared to women in the lowest category (≤6 MET/h-week). Women watching >2 h/d of TV sh owed a higher risk (HR = 1.67; 95% CI:1.03-2.72) than those who watched TV <1 h/d. Women in the highest category (6-8 points) of the multidimensional combined 8-item score showed a lower BC risk (HR = 0.35; 95% CI: 0.15-0.79) than those in the lowest category (<2 points) group. There was no significant supra-multiplicative interaction between TV-watching and LTPA. Both low LTPA and TV-watching >2 h/d may substantially increase BC risk, independently of each other.
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Affiliation(s)
- R Sanchez-Bayona
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; Department of Clinical Oncology, Breast Cancer Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Clinical Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - I Gardeazabal
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; Department of Clinical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Romanos-Nanclares
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - C I Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - I Alvarez-Alvarez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Ruiz-Canela
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain
| | - A Gea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain
| | - M A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
| | - M Santisteban
- Department of Clinical Oncology, Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - E Toledo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain.
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Dominguez LJ, Di Bella G, Veronese N, Barbagallo M. Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity. Nutrients 2021. [PMID: 34204683 DOI: 10.3390/nu130620208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.
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Affiliation(s)
- Ligia J Dominguez
- Geriatric Unit, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Giovanna Di Bella
- Geriatric Unit, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, 90127 Palermo, Italy
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21
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Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity. Nutrients 2021; 13:nu13062028. [PMID: 34204683 PMCID: PMC8231595 DOI: 10.3390/nu13062028] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.
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Moreno-Montañés J, Gutierrez-Ruiz I, Gándara E, Moreno-Galarraga L, Santiago S, Ruiz-Canela M, Martínez-González J, Martínez-González MÁ, Fernandez-Montero A. Carbohydrate intake and risk of glaucoma in the sun cohort. Eur J Ophthalmol 2021; 32:11206721211012862. [PMID: 33896221 DOI: 10.1177/11206721211012862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the association between carbohydrates (CH) intake and glaucoma incidence. METHODS 18,247 volunteer participants (183,067 person-years at risk) with 10-year of median follow-up were included in this prospective dynamic cohort. Baseline total CH intake (g/d) was categorised in quartiles and classified in nine different CH food sources. Self-reported diagnosis of glaucoma was collected at baseline and on biennial follow-up questionnaires. CH intake and glaucoma diagnosis were validated in a subsample of participants. We studied potential confounders and effect modificators, including diabetes. The relationship between CH intake and glaucoma incidence was analysed using multivariable Cox proportional hazards ratio (HR) models to adjust for potential confounding factors. RESULTS During 10 years of median follow-up, a total of 242 new cases of glaucoma were identified. Participants in the highest quartile of baseline CH intake had a significantly higher risk of glaucoma as compared to participants in the lowest quartile [HR 1.50 (95% Confidence interval (CI): 1.01-2.25), p for trend = 0.042]. None of the nine CH food groups was individually related to glaucoma. In stratified analyses, after excluding all cases of diabetes, the HR comparing extreme quartiles of CH intake was 1.77 (95% CI: 1.15-2.74). CONCLUSIONS Our results suggest that a higher intake of total carbohydrates is associated with a higher risk of incident glaucoma. The total amount of CH, rather than the specific food sources of CH, seems to play a major role, and this association does not seem to be confounded or modified by diabetic status.
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Affiliation(s)
- Javier Moreno-Montañés
- Department of Ophthalmology, University of Navarra, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Itziar Gutierrez-Ruiz
- Department of Ophthalmology, University of Navarra, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Elsa Gándara
- Department of Ophthalmology, University of Navarra, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Laura Moreno-Galarraga
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, School of Medicine, Pamplona, Navarra, Spain
- Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona, Navarra, Spain
| | - Susana Santiago
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Department of Nutrition, Food Science and Physiology, University of Navarra, School of Pharmacy and Nutrition, Pamplona, Navarra, Spain
| | - Miguel Ruiz-Canela
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, School of Medicine, Pamplona, Navarra, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Miguel Ángel Martínez-González
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, School of Medicine, Pamplona, Navarra, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - Alejandro Fernandez-Montero
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, School of Medicine, Pamplona, Navarra, Spain
- Department of Occupational Medicine, University of Navarra, Pamplona, Navarra, Spain
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23
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Oakey-Frost N, Trachik B, Ganulin ML, LoPresti ML, Dretsch MN, Tucker RP. Indirect effects of soldier healthy eating and physical activity on suicidal ideation through psychological health symptoms in active-duty military. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1902180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicolas Oakey-Frost
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
| | - Benjamin Trachik
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michelle L. Ganulin
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Mathew L. LoPresti
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Michael N. Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Washington
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
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24
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Llavero-Valero M, Escalada-San Martín J, Martínez-González MA, Basterra-Gortari FJ, de la Fuente-Arrillaga C, Bes-Rastrollo M. Ultra-processed foods and type-2 diabetes risk in the SUN project: A prospective cohort study. Clin Nutr 2021; 40:2817-2824. [PMID: 33933748 DOI: 10.1016/j.clnu.2021.03.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIM The association between ultra-processed foods (UPF) consumption and the risk of type 2 diabetes (T2D) has not been much explored. We aimed to evaluate the association between consumption of UPF and the incidence of T2D. METHODS We assessed 20,060 participants (61.5% women) from the SUN project (Seguimiento Universidad de Navarra) followed-up every two years (median follow-up 12 years). Food and drink consumption were evaluated through a validated 136-item food frequency questionnaire and grouped according to their degree of processing by the NOVA classification. Participants were categorized into tertiles of UPF consumption adjusted for total energy intake. We fitted Cox proportional hazard models with repeated dietary measurements at baseline and updating information on food consumption after 10 years of follow-up to minimise the potential effect of diet variation. RESULTS During 215,149 person-years of follow-up, 175 new-onset T2D cases were confirmed. Participants in the highest baseline tertile (high consumption) of UPF consumption had a higher risk of T2D as compared to those in the lowest tertile (multivariable adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.06 to 2.22) with a significant dose-response relationship (p for linear trend = 0.024). The multivariable adjusted HR using repeated measurements of UPF intake was 1.65 (95% CI 1.14-2.38) when comparing extreme tertiles. CONCLUSIONS In a highly-educated Mediterranean cohort with a low absolute risk, a higher intake of UPF was independently associated with a higher risk for T2D. These results provide more evidence to encourage the limitation of UPF consumption to reduce the population burden of T2D.
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Affiliation(s)
- María Llavero-Valero
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; University of Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain
| | - Javier Escalada-San Martín
- University of Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain
| | - Miguel A Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Francisco Javier Basterra-Gortari
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain; Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carmen de la Fuente-Arrillaga
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain
| | - Maira Bes-Rastrollo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain.
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25
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Population-level Interventions Based on Walking and Cycling as a Means to Increase Physical Activity. PHYSICAL ACTIVITY AND HEALTH 2021. [DOI: 10.5334/paah.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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García-Mayor J, Moreno-Llamas A, la Cruz-Sánchez ED. High educational attainment redresses the effect of occupational social class on health-related lifestyle: findings from four Spanish national health surveys. Ann Epidemiol 2021; 58:29-37. [PMID: 33640485 DOI: 10.1016/j.annepidem.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Social determinants as occupational social class or educational attainment might influence health outcomes. This phenomenon is known as the social gradient of health and is related to a skewed distribution of health behaviours that might explain differences in morbidity and mortality between social groups. But social class and educational attainment differ in their nature and might have distinct effects on health. Here we study the combined effect of educational attainment and occupational social class on health-related lifestyle. METHODS We retrieved data from four large-scale, national representative Spanish surveys (n = 67,171). A latent class regression analysis was run to identify clusters of health-related lifestyle behaviours. Clusters were made according to sociodemographic factors, including a combined analysis of education and occupational social class. RESULTS Higher educational attainment and occupational social class were associated with a healthier lifestyle for both sexes. The combined analysis of education and social class indicated that women with secondary education showed a high risk combination of unhealthy behaviours, as men with middle, primary or no education. CONCLUSIONS Regardless of social class, a higher educational attainment redresses the effect of occupational social class on health-related behaviours. Our results suggest that education likely plays a crucial role in population health outcomes through its effects on lifestyle.
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Hosseinpour-Niazi S, Bakhshi B, Mirmiran P, Azizi F. Socioeconomic and lifestyle factors modifies the association between nut consumption and metabolic syndrome incidence. Clin Nutr 2021; 40:4055-4064. [PMID: 33642144 DOI: 10.1016/j.clnu.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS. METHODS We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (<median and ≥ median) and risk of MetS was assessed by Cox regression. RESULTS Nut consumption was inversely associated with MetS risk in multivariable-adjusted models. The highest tertiles of the constituents of nuts including fiber, polyphenol, MUFA and PUFA reduced MetS risk compared with the lowest tertiles, after adjustment for confounders. Among various types of nuts, the multivariable-adjusted HRs of MetS were 0.78 (0.63-0.96) for walnuts, and 0.77 (0.63-0.94) for pistachios, compared with the lowest intake. Among adult population, consuming nuts higher than the median and having moderate to high physical activity levels resulted in significant reduction in the MetS risk (HRs: 0.74, CI: 0.55-0.98 for moderate and HRs: 0.63, CI: 0.47-0.86 for high physical activity level). Participants who did not smoke had lower risk of MetS regardless of their amount of nuts consumption (HRs: 0.67, CI: 0.47-0.94 for intakes < median and HRs: 0.71, CI: 0.53-0.93 for intakes ≥ median). Stratification based on education status resulted in reduction in the risk of MetS in participants consuming nuts ≥ median in both educated and not-educated group (HRs: 0.81, CI: 0.66-0.98 for the non-educated group and HRs: 0.63, CI: 0.47-0.84 for the educated group). CONCLUSIONS Incorporating nuts, especially walnuts, into dietary patterns reduced the risk of MetS, especially among individuals with more physical activity levels.
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Affiliation(s)
- Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Bakhshi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Llavero-Valero M, Escalada San Martín J, Martínez-González MA, Alvarez-Mon MA, Alvarez-Alvarez I, Martínez-González J, Bes-Rastrollo M. Promoting exercise, reducing sedentarism or both for diabetes prevention: The "Seguimiento Universidad De Navarra" (SUN) cohort. Nutr Metab Cardiovasc Dis 2021; 31:411-419. [PMID: 33234383 DOI: 10.1016/j.numecd.2020.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Both physical activity (PA) and sedentary behaviors have demonstrated independent associations with the development of type 2 diabetes mellitus (T2DM). However, the combination of both, has been less explored. We aimed to compare the associations of PA-only versus the simultaneous effect of PA and sedentary behaviors on T2DM in a Mediterranean cohort. METHODS AND RESULTS Participants (n = 19,524) initially free of T2DM from the SUN Project were followed-up for a median of 10.4 years. Analyses were conducted in 2018. PA and sedentary parameters (TV viewing time and sitting time) were assessed through a validated questionnaire. The amount of each PA was expressed in METs-h/wk. After that, a previously developed 8-item active + sedentary lifestyle score was computed. T2DM was defined according to ADA criteria. To adjust for potential confounders, Cox regression models were adjusted. Among 19,524 participants, 175 cases of new-onset T2DM were observed during follow-up. After multivariable adjustment, higher PA was strongly inversely associated with T2DM, showing highly significant differences between extreme quartiles (HR = 0.51; 95% CI 0.32-0.79 p for trend<0.001). When considering not only PA, but also the more comprehensive active + sedentary lifestyle combined score, even stronger differences were found between the lowest and the highest categories (HR = 0.40; 95%CI 0.20-0.80; p for trend<0.001). CONCLUSION Sedentary lifestyles, in addition to PA patterns, should be included in the assessment of T2DM risk. Promoting PA should be coupled with the avoidance of a sedentary lifestyle to lower the risk of T2DM.
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Affiliation(s)
- María Llavero-Valero
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Department of Endocrinology and Nutrition, University of Navarra, Pamplona Spain
| | - Javier Escalada San Martín
- Department of Endocrinology and Nutrition, University of Navarra, Pamplona Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Ismael Alvarez-Alvarez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Centre for Nutrition Research, Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain
| | | | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain.
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29
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Fernández-Matarrubia M, Goni L, Rognoni T, Razquin C, Fernández-Lázaro CI, Bes-Rastrollo M, Martínez-González MÁ, Toledo E. An Active Lifestyle Is Associated with Better Cognitive Function Over Time in APOE ɛ4 Non-Carriers. J Alzheimers Dis 2021; 79:1257-1268. [DOI: 10.3233/jad-201090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Available evidence on the association of physical activity (PA) or sedentary behavior with cognitive decline is inconclusive. Objective: To assess the association between an active lifestyle score and leisure-time physical activity (LTPA) and changes in cognitive function in the Seguimiento Universidad de Navarra (SUN) prospective cohort. Methods: Cognitive function was evaluated in a subsample of 806 participants of the SUN cohort study using the validated Telephone Interview for Cognitive Status-modified (STICS-m) questionnaire at baseline and after 6 years. LTPA was evaluated with a previously validated 17-item self-administered questionnaire and with information on sedentary lifestyles. We also calculated a multidimensional 8-item PA score. Multivariable linear regression analysis evaluated the association between PA and changes in cognitive function and its interaction by APOE genotype. Results: Mean age of participants was 66 (SD 5.3) years and 69.7% were male. When stratifying by APOE variants, no significant associations between the active lifestyle score or LTPA and changes in cognitive performance over time were found among APOE ɛ4 carriers. However, we observed that a higher adherence to an active lifestyle (high versus low PA score β= 0.76 95% CI 0.15,1.36; p trend = 0.011) and a high LTPA (Q4 versus Q1 β= 0.63; 95% CI –0.01,1.26; p trend = 0.030) were associated with more favorable changes in cognitive function over time among APOE ɛ4 non-carriers with statistically significant interactions in both cases (p for interaction = 0.042 for PA score, and p = 0.039 for LTPA). Conclusion: The results of the present study suggest that an active lifestyle is associated with a better status of cognitive function over time only among APOE ɛ4 non-carriers.
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Affiliation(s)
- Marta Fernández-Matarrubia
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia Goni
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Rognoni
- Department of Neurology, Clínica Universidad de Navarra, Madrid, Spain
| | - Cristina Razquin
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - César Ignacio Fernández-Lázaro
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Maira Bes-Rastrollo
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ángel Martínez-González
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Estefanía Toledo
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Caprara G. Mediterranean-Type Dietary Pattern and Physical Activity: The Winning Combination to Counteract the Rising Burden of Non-Communicable Diseases (NCDs). Nutrients 2021; 13:nu13020429. [PMID: 33525638 PMCID: PMC7910909 DOI: 10.3390/nu13020429] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Non-communicable diseases (NCDs) (mainly cardiovascular diseases, cancers, chronic respiratory diseases and type 2 diabetes) are the main causes of death worldwide. Their burden is expected to rise in the future, especially in less developed economies and among the poor spread across middle- and high-income countries. Indeed, the treatment and prevention of these pathologies constitute a crucial challenge for public health. The major non-communicable diseases share four modifiable behavioral risk factors: unhealthy diet, physical inactivity, tobacco usage and excess of alcohol consumption. Therefore, the adoption of healthy lifestyles, which include not excessive alcohol intake, no smoking, a healthy diet and regular physical activity, represents a crucial and economical strategy to counteract the global NCDs burden. This review summarizes the latest evidence demonstrating that Mediterranean-type dietary pattern and physical activity are, alone and in combination, key interventions to both prevent and control the rise of NCDs.
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Affiliation(s)
- Greta Caprara
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, 20139 Milano, Italy
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The Association Between the Mediterranean Lifestyle Index and All-Cause Mortality in the Seguimiento Universidad de Navarra Cohort. Am J Prev Med 2020; 59:e239-e248. [PMID: 33220762 DOI: 10.1016/j.amepre.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/22/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Overall lifestyle patterns rather than individual factors may exert greater reductions on chronic disease risk and mortality. The objective is to study the association between a Mediterranean lifestyle index and all-cause and cause-specific mortality. METHODS Investigators analyzed data from 20,494 participants in the Seguimiento Universidad de Navarra cohort in 2019. The Mediterranean lifestyle index is composed of 28 items on food consumption, dietary habits, physical activity, rest, and social interactions that score 0 or 1 point; scores theoretically could range from 0 to 28 points. RESULTS After a median follow-up of 12.1 years, 407 deaths were observed. In the multivariable-adjusted model, high adherence (>14 points) to the Mediterranean lifestyle was associated with a 41% relative reduction in all-cause mortality (hazard ratio=0.59, 95% CI=0.42, 0.83) compared with low adherence (3-10 points, p<0.001 for trend). For each additional point, the multivariable hazard ratios for all-cause mortality were 0.95 (95% CI=0.89, 1.02) for food consumption; 1.00 (95% CI=0.92, 1.08) for dietary habits; and 0.73 (95% CI=0.66, 0.80) for physical activity, rest, social habits, and conviviality. Significant interaction with age at last contact (p<0.001) suggested a lower risk for each additional point among participants aged ≥50 years (hazard ratio=0.50, 95% CI=0.34, 0.74), whereas no association was found for participants aged <50 years (hazard ratio=1.15, 95% CI=0.54, 2.44). CONCLUSIONS Adherence to a Mediterranean lifestyle may reduce the risk of mortality in a Spanish cohort of university graduates. Inverse associations were found for the overall Mediterranean lifestyle score and lifestyle block, whereas no associations were observed for the dietary blocks. Future research should consider the Mediterranean lifestyle beyond the Mediterranean diet in different populations for the promotion of healthy longevity. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02669602.
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Katz DL, Green LW, Allegrante JP, Martínez-González MA, Trichopoulou A, Gardner CD, Crimarco A, Landry MJ, Fielding-Singh P. Knowing Well, Being Well: well-being born of understanding: How Humans Know. Am J Health Promot 2020; 34:945-954. [DOI: 10.1177/0890117120960580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chen X, Zhang Z, Yang H, Qiu P, Wang H, Wang F, Zhao Q, Fang J, Nie J. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutr J 2020; 19:86. [PMID: 32819372 PMCID: PMC7441617 DOI: 10.1186/s12937-020-00604-1] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Consumption of ultra-processed foods (UPFs) plays a potential role in the development of obesity and other diet-related noncommunicable diseases (NCDs), but no studies have systematically focused on this. This study aimed to summarize the evidence for the association between UPFs consumption and health outcomes. Methods A comprehensive search was conducted in PubMed, Embase, and Web of Science to identify all relevant studies. Epidemiological studies were included, and identified studies were evaluated for risk of bias.A narrative review of the synthesized findings was provided to assess the association between UPFs consumption and health outcomes. Results 20 studies (12 cohort and 8 cross-sectional studies) were included in the analysis, with a total of 334,114 participants and 10 health outcomes. In a narrative review, high UPFs consumption was obviously associated with an increased risk of all-cause mortality, overall cardiovascular diseases, coronary heart diseases, cerebrovascular diseases, hypertension, metabolic syndrome, overweight and obesity, depression, irritable bowel syndrome, overall cancer, postmenopausal breast cancer, gestational obesity, adolescent asthma and wheezing, and frailty. It showed no significant association with cardiovascular disease mortality, prostate and colorectal cancers, gestational diabetes mellitus and gestational overweight. Conclusions This study indicated a positive association between UPFs consumption and risk of several health outcomes. Large-scale prospective designed studies are needed to confirm our findings.
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Affiliation(s)
- Xiaojia Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Zhang Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Huijie Yang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Peishan Qiu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Haizhou Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China. .,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China. .,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
| | - Jiayan Nie
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China. .,Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
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Morales G, Martínez-González MA, Barbería-Latasa M, Bes-Rastrollo M, Gea A. Mediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort. Eur J Nutr 2020; 60:1489-1498. [PMID: 32737614 DOI: 10.1007/s00394-020-02342-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/21/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality. METHODS We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality. RESULTS During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33-3.07]. Similar results were found for cancer mortality and cardiovascular mortality. CONCLUSIONS Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet.
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Affiliation(s)
- Gladys Morales
- Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Universidad de La Frontera, Temuco, Chile
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - María Barbería-Latasa
- Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain.
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, IdisNA, University of Navarra, Pamplona, Spain
- Biomedical Research Network Center for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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Mirmiran P, Bakhshi B, Hosseinpour-Niazi S, Sarbazi N, Hejazi J, Azizi F. Does the association between patterns of fruit and vegetables and metabolic syndrome incidence vary according to lifestyle factors and socioeconomic status? Nutr Metab Cardiovasc Dis 2020; 30:1322-1336. [PMID: 32513582 DOI: 10.1016/j.numecd.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The aim of this study is to investigate the association between the identified patterns of fruits and vegetables and metabolic syndrome (MetS) incidence, and to investigate whether lifestyle factors and socioeconomic status modify the effect of the patterns on MetS risk. METHODS AND RESULTS We prospectively studied 1915 participants of the Tehran Lipid and Glucose Study, who were aged 19-74 years and followed up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. After adjustment for confounding factors, total vegetable intake was inversely related to the risk of MetS. Total fruit and total fruit and vegetable were not associated with MetS risk. We identified four major patterns of fruits and vegetables by factor analysis: "fresh fruit pattern", "vegetable pattern", "dried fruit and cruciferous vegetable pattern", and "potatoes and fruit juice pattern". "Vegetable pattern" was negatively associated with MetS risk, and "potatoes and fruit juice pattern" increased the risk of MetS. Among participants with weight gain <7% during follow-up, all four identified patterns reduced MetS risk. When stratified by smoking, "vegetable pattern" and "dried Fruit and cruciferous vegetable pattern" lowered MetS risk among non-smokers. Stratification based on education resulted in MetS risk reduction across tertiles of "fresh fruit pattern" and "vegetable pattern". First and second tertiles of "dried fruit and cruciferous vegetable pattern" lowered MetS risk among educated participants, compared to the reference. CONCLUSIONS The reduction in MetS risk caused by fruits and vegetables intake depends on the modifying effect of lifestyle and socioeconomic factors.
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Affiliation(s)
- Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Bakhshi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Narges Sarbazi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Hejazi
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Gómez-Donoso C, Martínez-González MÁ, Perez-Cornago A, Sayón-Orea C, Martínez JA, Bes-Rastrollo M. Association between the nutrient profile system underpinning the Nutri-Score front-of-pack nutrition label and mortality in the SUN project: A prospective cohort study. Clin Nutr 2020; 40:1085-1094. [PMID: 32768318 DOI: 10.1016/j.clnu.2020.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Front-of-pack nutrition labelling is a key public health policy that can be adopted as part of a comprehensive set of measures to promote healthy diets. The Nutri-Score, a five-colour summary label based on a modified version of the British Food Standards Agency Nutrient Profiling System (FSAm-NPS), is being considered for implementation in several European countries including Spain. This study aimed to prospectively assess the association between the FSAm-NPS and mortality rate in a Spanish cohort of university graduates. METHODS Analyses included 20 503 participants (mean [SD] age: 38 [12] years) from the SUN cohort. Dietary intake was assessed at baseline and after 10-years of follow-up with a validated semi-quantitative food-frequency questionnaire. The FSAm-NPS was calculated for each food/beverage based on their amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes, nuts, rapeseed, walnut and olive oils per 100 g of product. The FSAm-NPS Dietary Index (DI) was computed as an energy-weighted mean of the FSAm-NPS scores of all foods and beverages consumed by each participant. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to baseline and updated FSAm-NPS DI scores. RESULTS Over a median follow-up of 10.9 years, 407 participants died. A higher baseline FSAm-NPS DI score, reflecting consumption of foods with lower nutritional quality and hence less favourable Nutri-Score rating, was directly associated with all-cause mortality (HR Q4 versus Q1 = 1.82; 95% CI: 1.34 to 2.47; p-trend<0.001) and cancer mortality (HR: 2.44; 95% CI: 1.54 to 3.85; p-trend<0.001). No association was found for cardiovascular mortality. CONCLUSIONS The consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher rate of all-cause and cancer mortality in a large prospective cohort of Spanish, middle-aged university graduates. These findings further support the implementation of Nutri-Score in Euro-Mediterranean countries.
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Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - J Alfredo Martínez
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Madrid Institute for Advanced Studies in Food (IMDEA Food), CEI UAM+CSIC, Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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Insights on Mediterranean Diet from the SUN Cohort: Cardiovascular and Cognitive Health. Nutrients 2020; 12:nu12051332. [PMID: 32397062 PMCID: PMC7284864 DOI: 10.3390/nu12051332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022] Open
Abstract
Epidemiological evidence has demonstrated the association between dietary factors and non-communicable diseases. Great attention has been payed to the Mediterranean dietary pattern, given its richness in anti-oxidant and anti-inflammatory molecules. Numerous reports from the SUN (Seguimiento Universidad De Navarra) cohort have shown that higher adherence to the Mediterranean dietary pattern may be inversely associated with mortality, type 2 diabetes and cardiovascular diseases. Likewise, a link with mental health outcomes, such as depressive symptoms, cognitive status and quality of life was also found, suggesting its beneficial effects toward brain health.
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Skonieczna-Żydecka K, Łoniewski I, Stachowska E, Marlicz W, Correll CU. Current and Novel Approaches to Mitigate Cardiometabolic Adverse Effects of Second-Generation Antipsychotics. Int J Neuropsychopharmacol 2020; 23:491-495. [PMID: 32239144 PMCID: PMC7689205 DOI: 10.1093/ijnp/pyaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
Second-generation antipsychotic-related weight gain and metabolic disturbances are a major public health issue given the widespread prescribing of these medications. The lack of clearly known mechanisms of cardiometabolic adverse effects and the relevance of cardiometabolic health for survival make this an important area for research. While nonpharmacologic and some pharmacologic treatments have shown benefits vs control conditions or placebo, the effects are modest and long-term benefits are less clear. Therefore, new approaches to mitigate second-generation antipsychotic-associated cardiometabolic burden are sorely needed.
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Affiliation(s)
- Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland,Correspondence: Karolina Skonieczna-Żydecka, PhD, Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Broniewskiego 24, 71-460 Szczecin, Poland ()
| | - Igor Łoniewski
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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Briguglio M, Vitale JA, Galentino R, Banfi G, Zanaboni Dina C, Bona A, Panzica G, Porta M, Dell'Osso B, Glick ID. Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice. Neuropsychiatr Dis Treat 2020; 16:55-70. [PMID: 32021199 PMCID: PMC6955623 DOI: 10.2147/ndt.s229206] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
Neuropsychiatric disorders stem from gene-environment interaction and their development can be, at least in some cases, prevented by the adoption of healthy and protective lifestyles. Once full blown, neuropsychiatric disorders are prevalent conditions that patients live with a great burden of disability. Indeed, the determinants that increase the affliction of neuropsychiatric disorders are various, with unhealthy lifestyles providing a significant contribution in the interplay between genetic, epigenetic, and environmental factors that ultimately represent the pathophysiological basis of these impairing conditions. On one hand, the adoption of Healthy Eating education, Physical Activity programs, and Sleep hygiene promotion (HEPAS) has the potential to become one of the most suitable interventions to reduce the risk to develop neuropsychiatric disorders, while, on the other hand, its integration with pharmacological and psychological therapies seems to be essential in the overall management of neuropsychiatric disorders in order to reduce the disability and improve the quality of life of affected patients. We present an overview of the current evidence in relation to HEPAS components in the prevention and management of neuropsychiatric disorders and provide suggestions for clinical practice.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | | | - Roberta Galentino
- IRCCS Orthopedic Institute Galeazzi, Tourette's Syndrome and Movement Disorders Centre, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy.,Department of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alberto Bona
- Neurosurgery Department, ICCS Istituto Clinico Città Studi, Milan, Italy
| | - Giancarlo Panzica
- Department of Neuroscience, Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Mauro Porta
- IRCCS Orthopedic Institute Galeazzi, Tourette's Syndrome and Movement Disorders Centre, Milan, Italy
| | - Bernardo Dell'Osso
- University of Milan, Department of Clinical and Biomedical Sciences Luigi Sacco, ASST Fatebenefratelli-Sacco, Ospedale Sacco Polo Universitario, Milan, Italy.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Ira David Glick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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40
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Adaptation and predictive utility of a Mediterranean diet screener score. Clin Nutr 2019; 38:2928-2935. [DOI: 10.1016/j.clnu.2018.12.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/09/2018] [Accepted: 12/28/2018] [Indexed: 01/26/2023]
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41
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Ojeda-Rodríguez A, Zazpe I, Alonso-Pedrero L, Zalba G, Guillen-Grima F, Martinez-Gonzalez MA, Marti A. Association between diet quality indexes and the risk of short telomeres in an elderly population of the SUN project. Clin Nutr 2019; 39:2487-2494. [PMID: 31767135 DOI: 10.1016/j.clnu.2019.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Ana Ojeda-Rodríguez
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain.
| | - Itziar Zazpe
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain; Department of Preventive Medicine and Public Health, School of Medicine-Clínica Universidad de Navarra, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Lucía Alonso-Pedrero
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain.
| | - Guillermo Zalba
- IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain; Department of Biochemistry and Genetics, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain.
| | - Francisco Guillen-Grima
- IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain; Department of Health Sciences, Public University of Navarre, Avenida de Barañain, 31008, Pamplona, Spain; Department of Preventive Medicine, University of Navarra Clinic, C/Pío XII, 36, 31008, Pamplona, Spain.
| | - Miguel A Martinez-Gonzalez
- IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain; Department of Preventive Medicine and Public Health, School of Medicine-Clínica Universidad de Navarra, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.
| | - Amelia Marti
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, C/ Irunlarrea, 1, 31008, Pamplona, Spain; IdiSNA, Navarre's Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain; Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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Soltani S, Jayedi A, Shab-Bidar S, Becerra-Tomás N, Salas-Salvadó J. Adherence to the Mediterranean Diet in Relation to All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Adv Nutr 2019; 10:1029-1039. [PMID: 31111871 PMCID: PMC6855973 DOI: 10.1093/advances/nmz041] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/11/2018] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
A previous meta-analysis provided convincing evidence for an inverse association between adherence to a Mediterranean diet (MedDiet) and the risk of all-cause mortality. Since then, 19 prospective studies have been published. We updated the evidence from these prospective studies and conducted a dose-response meta-analysis to test the linear and potential nonlinear dose-response associations between adherence to a MedDiet and the risk of all-cause mortality. The PubMed, Scopus, ISI Web of Knowledge, and Embase bibliographic databases were systematically searched up to August 24, 2018. Summary HRs were estimated with the use of a random-effects meta-analysis to assess the association between a 2-point increment in MedDiet adherence and the risk of all-cause mortality. Sensitivity and subgroup analyses were performed and potential publication bias was tested. Twenty-nine prospective studies with 1,676,901 participants and 221,603 cases of all-cause mortality were included in the final analysis. The pooled HR of all-cause mortality was 0.90 (95% CI: 0.89, 0.91; I2 = 81.1%) for a 2-point increment in adherence to a MedDiet. Subgroup analyses showed that a significant inverse association was stronger in participants who lived in the Mediterranean region compared with non-Mediterranean areas (HRs: 0.82 compared with 0.92, respectively), and in studies that used the Panagiotakos MedDiet score. A nonlinear dose-response meta-analysis indicated that the risk of all-cause mortality linearly decreased with the increase in adherence to a MedDiet. The robustness of findings was confirmed in the sensitivity analyses. In conclusion, low-quality evidence from prospective cohort studies suggests an inverse association between adherence to a MedDiet and the risk of all-cause mortality, especially in Mediterranean regions. An inverse linear dose-response relation was also observed between adherence to a MedDiet and the risk of all-cause mortality.
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Affiliation(s)
- Sepideh Soltani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Food (Salt) Safety Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran,Address correspondence to SS-B (e-mail: )
| | - Nerea Becerra-Tomás
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Rovira i Virgili University, Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Rovira i Virgili University, Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
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Abstract
The beneficial association of the Mediterranean diet (MedDiet) with longevity has been consistently demonstrated, but the associations of MedDiet components have not been accordingly evaluated. We performed an updated meta-analysis of prospective cohort studies published up to 31 December 2017, to quantify the association of adherence to MedDiet, expressed as an index/score (MDS) and of its components with all-cause mortality. We estimated summary relative risks (SRR) and 95 % CI using random effects models. On the basis of thirty studies (225 600 deaths), SRR for the study-specific highest/lowest and per 1sd MDS increment were 0·79 (95 % CI 0·77, 0·81, Ι 2=42 %, P-heterogeneity 0·02) and 0·92 (95 % CI 0·90, 0·94, Ι 2 56 %, P-heterogeneity <0·01), respectively. Inversely, statistically significant associations were evident in stratified analyses by country, MDS range and publication year, with some evidence for heterogeneity across countries overall (P-heterogeneity 0·011), as well as across European countries (P=0·018). Regarding MDS components, relatively stronger and statistically significant inverse associations were highlighted for moderate/none-excessive alcohol consumption (0·86, 95 % CI 0·77, 0·97) and for above/below-the-median consumptions of fruit (0·88, 95 % CI 0·83, 0·94) and vegetables (0·94, 95 % CI 0·89, 0·98), whereas a positive association was apparent for above/below-the-median intake of meat (1·07, 95 % CI 1·01, 1·13). Our meta-analyses confirm the inverse association of MedDiet with mortality and highlight the dietary components that influence mostly this association. Our results are important for better understanding the role of MedDiet in health and proposing dietary changes to effectively increase adherence to this healthy dietary pattern.
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Ortolá R, García-Esquinas E, García-Varela G, Struijk EA, Rodríguez-Artalejo F, López-García E. Influence of Changes in Diet Quality on Unhealthy Aging: The Seniors-ENRICA Cohort. Am J Med 2019; 132:1091-1102.e9. [PMID: 30981558 DOI: 10.1016/j.amjmed.2019.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether adopting a better diet in late life influences the aging process is still uncertain. Thus, we examined the association between changes in diet quality and unhealthy aging. METHODS Data came from 2042 individuals aged ≥60 years recruited in the Seniors-ENRICA cohort in 2008-2010 (wave 0) and followed-up in 2012 (wave 1) and 2015 (wave 2). Diet quality was assessed with the Mediterranean Diet Adherence Screener (MEDAS), the Mediterranean Diet Score (MDS), and the Alternate Healthy Eating Index-2010 (AHEI-2010) at waves 0 and 1. Unhealthy aging was measured using a 52-item health deficit accumulation index with 4 domains (functional, self-rated health/vitality, mental health, and morbidity/health services use) at each wave. An increase in dietary indices represents a diet improvement, and a lower deficit accumulation index indicates a health improvement. RESULTS Compared with participants with a >1-point decrease in MEDAS or MDS, those with a >1-point increase showed lower deficit accumulation from wave 0 to wave 2 (multivariate β, -1.49 [95% confidence interval (CI), -2.88 to -0.10], P-trend = .04 for MEDAS; and -2.20 [95% CI, -3.56 to -0.84], P-trend = .002 for MDS) and from wave 1 to wave 2 (-1.34 [95% CI, -2.60 to -0.09], P-trend = .04 for MEDAS). Also, participants with a >5-point increase in AHEI-2010 showed lower deficit accumulation from wave 0 to wave 1 (-1.15 [95% CI, -2.01 to -0.28], P-trend = .009) and from wave 0 to wave 2 (-1.21 [95% CI, -2.31 to -0.10], P-trend = .03) than those with a >5-point decrease. These results were mostly due to a strong association between improved diet quality and less functional deterioration. CONCLUSIONS In older adults, adopting a better diet was associated with less deficit accumulation, particularly functional deterioration. Improving dietary habits may delay unhealthy aging. Our results have clinical relevance because we have observed that the deficit accumulation index decreases an average of 0.74 annually.
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Affiliation(s)
- Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Giselle García-Varela
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
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Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients 2019; 11:nu11092039. [PMID: 31480506 PMCID: PMC6770785 DOI: 10.3390/nu11092039] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
The Mediterranean diet is considered as the foremost dietary regimen and its adoption is associated with the prevention of degenerative diseases and an extended longevity. The preeminent features of the Mediterranean diet have been agreed upon and the consumption of olive oil stands out as the most peculiar one. Indeed, the use of olive oil as the nearly exclusive dietary fat is what mostly characterizes the Mediterranean area. Plenty of epidemiological studies have correlated that the consumption of olive oil was associated with better overall health. Indeed, extra virgin olive oil contains (poly)phenolic compounds that are being actively investigated for their purported biological and pharma-nutritional properties. On 18 and 19 May 2018, several experts convened in Jaen (Spain) to discuss the most recent research on the benefits of olive oil and its components. We reported a summary of that meeting (reviewing several topics related to olive oil, not limited to health) and concluded that substantial evidence is accruing to support the widespread opinion that extra virgin olive oil should, indeed, be the fat of choice when it comes to human health and sustainable agronomy.
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46
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Polenova NV, Kosura SD, Varaeva YR, Livancova EN, Starodubova AV. [Non-pharmaceutical treatment of dyslipidemia: review of current methods of diet and nutraceuticals]. ACTA ACUST UNITED AC 2019; 59:4-14. [PMID: 31441736 DOI: 10.18087/cardio.2549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022]
Abstract
The role of nutrition in the development and progression of atherosclerosis is well known. The correction of diet in patients with dyslipidemia is important as an independent intervention (in the group of patients with low and, partially, moderate cardiovascular risk), and as an addition to drug therapy in patients with at higher risk of cardiovascular events. The current review describes the effect of modern methods of diet therapy, as well as the use of a number of nutraceutical agents in terms of evidence-based medicine.
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Affiliation(s)
- N V Polenova
- Federal Research Center of Nutrition and Biotechnology
| | - S D Kosura
- Federal Research Center of Nutrition and Biotechnology
| | - Yu R Varaeva
- Federal Research Center of Nutrition and Biotechnology
| | - E N Livancova
- Federal Research Center of Nutrition and Biotechnology
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Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RDD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ 2019; 365:l1949. [PMID: 31142450 PMCID: PMC6538973 DOI: 10.1136/bmj.l1949] [Citation(s) in RCA: 265] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%. STUDY REGISTRATION ClinicalTrials.gov NCT02669602.
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Affiliation(s)
- Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ismael Alvarez-Alvarez
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Raquel de Deus Mendonça
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Department of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
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Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RDD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ 2019. [PMID: 31142450 DOI: 10.n36/bmj.l1949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%. STUDY REGISTRATION ClinicalTrials.gov NCT02669602.
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Affiliation(s)
- Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ismael Alvarez-Alvarez
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Raquel de Deus Mendonça
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Department of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
- IDISNA, Navarra Institute for Health Research, Pamplona, Spain
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Martinez-Lacoba R, Pardo-Garcia I, Amo-Saus E, Escribano-Sotos F. Mediterranean diet and health outcomes: a systematic meta-review. Eur J Public Health 2019; 28:955-961. [PMID: 29992229 DOI: 10.1093/eurpub/cky113] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The Mediterranean diet (MeDi) is considered a healthy dietary pattern, and greater adherence to this diet may improve health status. It also may reduce the social and economic costs of diet-related illnesses. This meta-review aims to summarize, synthesize and organize the effects of MeDi pattern on different health outcomes. Methods This meta-review was performed following the PRISMA guidelines. A systematic search was conducted in the electronic databases PubMed, Web of Science and Scopus. Two researchers screened all the records to eliminate any duplicate, and they selected the articles to be fully reviewed. A third researcher was consulted to resolve discrepancies and so reach a consensus agreement. Results Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs. Conclusion MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.
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Affiliation(s)
- Roberto Martinez-Lacoba
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Isabel Pardo-Garcia
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Elisa Amo-Saus
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Francisco Escribano-Sotos
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), Albacete, Spain.,Sociosanitary Research Centre, Castilla-La Mancha University (UCLM), Albacete, Spain
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50
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Cassambai S, Salzano A, Yazaki Y, Bernieh D, Wong M, Israr MZ, Heaney LM, Suzuki T. Impact of acute choline loading on circulating trimethylamine N-oxide levels. Eur J Prev Cardiol 2019; 26:1899-1902. [DOI: 10.1177/2047487319831372] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shabana Cassambai
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Andrea Salzano
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Yoshiyuki Yazaki
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Max Wong
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - M Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Liam M Heaney
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
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