Adherence to the Danish food-based dietary guidelines and risk of myocardial infarction: a cohort study

Intake of dietary flavonoids and incidence of ischemic heart disease in the Danish Diet, Cancer, and Health cohort

BACKGROUND/OBJECTIVES

Few studies have investigated the association between dietary flavonoid intake, including all major subclasses, and the long-term risk of ischemic heart disease (IHD). We examined whether dietary flavonoid intake associated with IHD incidence, assessing the possible modifying role of sex and smoking, in participants from the Danish Diet, Cancer, and Health study.

SUBJECTS/METHODS

In a cohort study design, 54,496 adults (46.8% male), aged 50-64 years, without a history of IHD, were followed for up to 23 years. Habitual dietary flavonoid intake was estimated from food frequency questionnaires using Phenol-Explorer. Incident cases of IHD were identified within Danish nationwide health registries. Restricted cubic splines in Cox proportional hazards models were used to examine associations between flavonoid intake and IHD risk.

RESULTS

During follow-up, 5560 IHD events were recorded. No overall association was seen between total flavonoid intake, nor any subclass, and IHD, following adjustment for demographics, lifestyle, and dietary confounders. Stratified by sex and smoking status, higher intakes of specific subclasses associated with lower IHD risk among ever-smokers [Q5 vs. Q1 flavonols HR (95% CI): 0.90 (0.82, 0.99); flavanol oligo+polymers: 0.88 (0.80, 0.97)], but not among never-smokers, nor either sex specifically.

CONCLUSIONS

While we did not find clear evidence that higher habitual dietary flavonoid intake was associated with lower IHD risk, these results do not exclude the possibility that certain subclasses may have a protective role in prevention of IHD among population sub-groups; this was evident among smokers, who are at a higher risk of atherosclerosis.

Glycemic Load, Dietary Fiber, Added Sugar, and Spontaneous Abortion in Two Preconception Cohorts

BACKGROUND

Spontaneous abortion (SAB)-pregnancy loss before the 20th week of gestation-has adverse psychological and physical sequelae. Some medical conditions known to affect insulin sensitivity, including polycystic ovary syndrome and diabetes, can affect the risk of SAB. No prior studies have examined glycemic load and incidence of SAB in populations without conditions known to affect insulin sensitivity.

OBJECTIVES

We prospectively evaluated the association between preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar and risk of SAB.

METHODS

During 2013-2020, we recruited pregnancy planners from Denmark (SnartForaeldre.dk; SF) and the United States and Canada (Pregnancy Study Online; PRESTO). Participants completed a baseline questionnaire and a cohort-specific FFQ evaluated for validity. We estimated preconception glycemic load and intake of carbohydrates, dietary fiber, and added sugar from individual foods and mixed recipes. We included 2238 SF and 4246 PRESTO participants who reported a pregnancy during the course of the study. SAB data were derived from questionnaires and population registries. We used Cox proportional hazards regression to estimate HRs and 95% CIs.

RESULTS

In the study population, 15% of SF participants and 22% of PRESTO participants experienced SAB. Across both cohorts, there was no appreciable association between glycemic load, carbohydrate quality, dietary fiber, or added sugar intake and SAB. Compared with daily mean glycemic load <110, the HR for women with daily mean glycemic load ≥130 was 0.76 (95% CI: 0.52, 1.10) in SF and 1.01 (95% CI: 0.86, 1.19) in PRESTO.

CONCLUSIONS

Diets with high glycemic load, carbohydrates, and added sugars were not consistently associated with risk of SAB in parallel analyses of 2 preconception cohort studies of women in North America and Denmark.

Dietary patterns and fecundability in 2 prospective preconception cohorts

BACKGROUND

Diet is increasingly recognized as an important determinant of human fertility, with most research focused on specific nutrients or food groups. However, there has been limited assessment of the effect of dietary patterns on fertility.

OBJECTIVES

We evaluated the association between 4 dietary patterns [the alternative Mediterranean Diet (aMed), the Healthy Eating Index-2010 (HEI-2010), the Danish Dietary Guidelines (DDGI), and the Dietary Inflammatory Index (DII)] and fecundability in 2 preconception cohorts of couples trying to conceive: SF (SnartForaeldre.dk) in Denmark and PRESTO (Pregnancy Study Online) in North America.

METHODS

Participants completed a baseline questionnaire on sociodemographic, anthropometric, and lifestyle factors and, 10 d later, a validated cohort-specific FFQ. We used data from these respective FFQs to calculate adherence to each dietary pattern. Participants completed bimonthly follow-up questionnaires for ≤12 mo or until pregnancy, whichever came first. We restricted analyses to 3429 SF and 5803 PRESTO participants attempting pregnancy for ≤6 cycles at enrollment. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs, adjusting for potential confounders.

RESULTS

Greater DII, indicative of a less anti-inflammatory diet (i.e., poorer diet quality), was associated with reduced fecundability in both SF and PRESTO (DII ≥ -1.5 compared with < -3.3: FR: 0.83; 95% CI: 0.71, 0.97 and FR: 0.82; 95% CI: 0.73, 0.93, respectively). In PRESTO, greater adherence to the aMed or to the HEI-2010 was associated with greater fecundability. In SF, there was no appreciable association between the aMed and fecundability, whereas greater adherence to the DDGI was associated with greater fecundability.

CONCLUSIONS

In prospective preconception cohort studies from Denmark and North America, higher-quality diets, including diets lower in inflammatory effects, were associated with greater fecundability.

Influence of Sociodemographic, Health-Related, and Behavioral Factors on Food Guidelines Compliance in Older Adults: A Hierarchical Approach from the Chilean National Health Survey 2016-17 Data

Dietary habits are determinants in the development of a range of conditions and age-related diseases. We explored the associations of sociodemographic, health-related indicators, and health behavioral factors on dietary guideline compliance in elderly Chileans. We used a cross-sectional design using the publicly available database from the last Chilean National Health Survey (2016−17). The sample of 1831 older adults (≥60 y) from a national representative sample. The dependent variable was compliance with Food Guidelines (FG) (daily consumption of water, dairy, and fruits and vegetables; and weekly consumption of legumes and fish). The independent variables included sociodemographic, health-related, and behavioral factors. Over half (51.8%) of the sample was female and 85.7% belonged to the 60−79 age group. Satisfactory compliance to FG was observed in 3.9% of the sample. In the adjusted analysis, for those between 60 and 79 y, marital status was the only significant variable associated with FG noncompliance (PR: 1.34; 95%CI: 1.04−1.71). For those over 80 y, income of >2 minimum wages (PR: 0.10; 95%CI: 0.02−0.61), living alone (PR: 1.72; 95%CI: 1.20−2.47), and self-reported cardiovascular disease (PR: 0.63; 95%CI: 0.43−0.93) were associated with FG noncompliance. We observed low FG compliance among elderly Chilean adults, especially in the oldest group. Factors associated with the FG compliance was different between age groups.

Adherence to the Danish food-based dietary guidelines and risk of colorectal cancer: a cohort study

BACKGROUND

National dietary guidelines contribute to primary prevention of a wide range of diseases. Yet, the importance of adhering to the Danish dietary guidelines for colorectal cancer prevention is unclear.

METHODS

We used the Danish Diet, Cancer and Health cohort (n = 55,744) to investigate adherence to the Danish dietary guidelines and the risk of colorectal cancer. Cox proportional hazard models were used to estimate hazard ratios (HRs) for colorectal cancer and subtypes across the Danish Dietary Guidelines Index score (ranging 0-6 points, 6 being the greatest adherence). Effect modification by BMI was explored on multiplicative and additive scales.

RESULTS

During a median follow-up of 18.9 years, 1030 men and 849 women developed colorectal cancer. Higher index scores were associated with a lower risk of colorectal cancer (HR 0.66; 95% confidence interval (CI) 0.53, 0.84, highest (≥5) versus lowest index score (<3 points) group). Similar inverse associations were observed between index scores and colon cancer. The risk difference was -0.8% (95% CI: -1.6, -0.1) among the overweight/obese group and 0.1% (95% CI: -0.7, 1.0) in the normal weight group for high compared to low adherence.

CONCLUSION

Adherence to the Danish Dietary Guidelines was associated with a lower risk of colorectal cancer, particularly among people with overweight/obesity.

Effects of substitution dietary guidelines targeted at prevention of IHD on dietary intake and risk factors in middle-aged Danish adults: the Diet and Prevention of Ischemic Heart Disease: a Translational Approach (DIPI) randomised controlled trial

The objective was to investigate the effects of substitution (SUB) dietary guidelines (DG) targeted at the prevention of IHD on dietary intake and IHD risk factors in Danish adults with minimum one self-assessed IHD risk factor. A 6-month single-blinded parallel randomised controlled trial with a follow-up at month 12 included 219 subjects (median age 51 years, 59 % female, 73 % overweight or obese) randomised into an SUB DG, an official (OFF) DG or a control group following their habitual diet (HAB). Participants in the DG intervention groups received bi-weekly reminders of their DG and recipes for dishes and the HAB group received a greeting. Dietary intake and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, month 6 and month 12. Linear regression analyses were applied. At month 6, when compared with the HAB, the SUB had a greater impact on the extent of dietary changes with increased intake of whole grains, dietary fibre and low fibre vegetables compared with the OFF DG, and both DG groups had similar decreased percentage of energy (E%) intake from SFA. The extent of dietary changes was similar at month 12. No overall significant changes from baseline were found in blood pressure, anthropometrics and IHD risk markers. In conclusion, both SUB and OFF DG resulted in cardioprotective dietary changes. However, neither the SUB nor the OFF DG resulted in any overall effects on the selected intermediate risk factors for IHD.

Vitamin K Intake and Atherosclerotic Cardiovascular Disease in the Danish Diet Cancer and Health Study

Background

Dietary vitamin K (K₁ and K₂) may reduce atherosclerotic cardiovascular disease (ASCVD) risk via several mechanisms. However, studies linking vitamin K intake with incident ASCVD are limited. We aimed to determine the relationship between dietary vitamin K intake and ASCVD hospitalizations.

Methods and Results

In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study, with no prior ASCVD, completed a food‐frequency questionnaire at baseline and were followed up for hospital admissions of ASCVD; ischemic heart disease, ischemic stroke, or peripheral artery disease. Intakes of vitamin K₁ and vitamin K₂ were estimated from the food‐frequency questionnaire, and their relationship with ASCVD hospitalizations was determined using Cox proportional hazards models. Among 53 372 Danish citizens with a median (interquartile range) age of 56 (52–60) years, 8726 individuals were hospitalized for any ASCVD during 21 (17–22) years of follow‐up. Compared with participants with the lowest vitamin K₁ intakes, participants with the highest intakes had a 21% lower risk of an ASCVD‐related hospitalization (hazard ratio, 0.79; 95% CI: 0.74–0.84), after multivariable adjustments for relevant demographic covariates. Likewise for vitamin K₂, the risk of an ASCVD‐related hospitalization for participants with the highest intakes was 14% lower than participants with the lowest vitamin K₂ intake (hazard ratio, 0.86; 95% CI, 0.81–0.91).

Conclusions

Risk of ASCVD was inversely associated with diets high in vitamin K₁ or K₂. The similar inverse associations with both vitamin K₁ and K₂, despite very different dietary sources, highlight the potential importance of vitamin K for ASCVD prevention.

Modifiable Lifestyle Recommendations and Mortality in Denmark: A Cohort Study

INTRODUCTION

Modifiable lifestyle behaviors represent a central target for public health interventions. This study investigates the association between adherence to 4 modifiable lifestyle recommendations and all-cause, cancer, or cardiovascular disease mortality.

METHODS

Investigators used data from the Danish Diet, Cancer and Health cohort (1993-2013; N=54,276). Lifestyle recommendations included smoking (never smoking), diet (adherence to 6 national food-based dietary guidelines), alcohol consumption (≤7 units per week for women and ≤14 units per week for men), and physical activity (≥30 minutes per day of moderate-to-vigorous leisure-time physical activity). Pseudo-values were used to estimate the adjusted risk differences and 95% CIs for all-cause, cancer, or cardiovascular disease mortality. Data were analyzed in 2019-2020.

RESULTS

A total of 8,860 participants died during a median follow-up of 17.0 years. Adherence to all modifiable lifestyle recommendations was associated with an 18.46% (95% CI= -20.52%, -16.41%) lower absolute risk of all-cause mortality than no adherence. Never smokers had a 13.19% (95% CI= -13.95%, -12.44%) lower risk, those adhering to dietary guidelines (diet score ≥5) had a 7.52% (95% CI= -8.89%, -6.14%) lower risk, and those adhering to recommended levels of alcohol (2.11%, 95% CI= -2.75%, -1.48%) and physical activity (1.58%, 95% CI= -2.20%, -1.00%) had a lower risk than those who did not adhere. Stronger associations were observed in men than in women and in older than in middle-aged participants.

CONCLUSIONS

Findings suggest that adherence to modifiable lifestyle recommendations is associated with a lower risk of mortality from all causes, cancer, and cardiovascular disease, underlining the importance of supporting adherence to national guidelines for lifestyle recommendations.

Sociodemographic Factors Associated with Adherence to Dietary Guidelines in Women with Gestational Diabetes: A Cohort Study

Dietary advice is the cornerstone of care for women with gestational diabetes mellitus (GDM). However, adherence to this advice is variable. We aimed to identify the proportion of women with GDM who adhere to the New Zealand nutrition guideline recommendations and assess the sociodemographic factors linked to dietary adherence. We assessed dietary intake at 36 weeks’ gestation in a cohort of 313 women with GDM and compared this with the dietary recommendations for the management of GDM. Associations between maternal characteristics and dietary adherence were assessed using ANOVA, chi square, logistic regression, and linear regression tests. Women with GDM had an average adherence score of 6.17 out of 10 to dietary recommendations, but no one adhered to all the recommendations. Adherence to recommendations was lowest for saturated fat, and wholegrain breads and cereals. While 85% visited a dietitian, only 28% of women achieved their recommended weight gain. Maternal factors associated with lower dietary adherence were primiparity, no previous history of GDM, being underweight, and smoking. Adherence to the dietary recommendations by women with GDM in New Zealand for the management could be improved. Further research is needed to identify ways for women with GDM to improve their dietary adherence.

Vegetable nitrate intake, blood pressure and incident cardiovascular disease: Danish Diet, Cancer, and Health Study

Whether the vascular effects of inorganic nitrate, observed in clinical trials, translate to a reduction in cardiovascular disease (CVD) with habitual dietary nitrate intake in prospective studies warrants investigation. We aimed to determine if vegetable nitrate, the major dietary nitrate source, is associated with lower blood pressure (BP) and lower risk of incident CVD. Among 53,150 participants of the Danish Diet, Cancer, and Health Study, without CVD at baseline, vegetable nitrate intake was assessed using a comprehensive vegetable nitrate database. Hazard ratios (HRs) were calculated using restricted cubic splines based on multivariable-adjusted Cox proportional hazards models. During 23 years of follow-up, 14,088 cases of incident CVD were recorded. Participants in the highest vegetable nitrate intake quintile (median, 141 mg/day) had 2.58 mmHg lower baseline systolic BP (95%CI − 3.12, − 2.05) and 1.38 mmHg lower diastolic BP (95%CI − 1.66, − 1.10), compared with participants in the lowest quintile. Vegetable nitrate intake was inversely associated with CVD plateauing at moderate intakes (~ 60 mg/day); this appeared to be mediated by systolic BP (21.9%). Compared to participants in the lowest intake quintile (median, 23 mg/day), a moderate vegetable nitrate intake (median, 59 mg/day) was associated with 15% lower risk of CVD [HR (95% CI) 0.85 (0.82, 0.89)]. Moderate vegetable nitrate intake was associated with 12%, 15%, 17% and 26% lower risk of ischemic heart disease, heart failure, ischemic stroke and peripheral artery disease hospitalizations respectively. Consumption of at least ~ 60 mg/day of vegetable nitrate (~ 1 cup of green leafy vegetables) may mitigate risk of CVD.

Meat consumption, stratified by dietary quality, and risk of heart disease

Associations between meat consumption and heart disease have been assessed in several studies, but it has been suggested that other dietary factors influence these associations. The aim of the present study was to assess whether meat consumption is associated with ischaemic heart disease (IHD), and if the association is modified by dietary quality. The analyses were based on the cohort of adult participants in the Danish National Survey on Diet and Physical Activity in 2000–2002, 2003–2008 and 2011–2013. From these surveys, information on meat consumption and dietary quality was extracted. The cohort was followed in national registers to identify incident IHD. Associations were estimated using Cox regression analyses adjusting for socio-demographic and lifestyle factors. Analyses of associations between meat consumption and IHD stratified by dietary quality were subsequently evaluated. Among the 8007 participants, the median follow-up was 9·8 years and 439 cases of IHD were recorded. The results suggested a trend between consumption increments of 100 g/d of red meat (hazard ratio (HR) = 1·23; 95 % CI 0·99, 1·53) or of 50 g/d of processed meat (HR = 1·09; 95 % CI 0·93, 1·29) and higher risk of IHD. The trends were, however, not statistically significant. Stratification by dietary quality did not suggest that associations between meat consumption and risk of IHD were modified by dietary quality. This population-based cohort study with detailed dietary information suggested a trend with higher meat consumption being associated with higher risk of IHD, but the association was not statistically significant. Results did not indicate that dietary quality modifies such associations.

Adherence to the Danish food-based dietary guidelines and risk of type 2 diabetes: the Danish diet, cancer, and health cohort

BACKGROUND/OBJECTIVES

We evaluated the association between adherence to the 2013 Danish dietary guidelines and the risk of type 2 diabetes (T2D) in a Danish cohort.

SUBJECTS/METHODS

We used data from the Danish Diet, Cancer, and Health cohort. Participants aged 50-64 years were included from 1993-1997. Information on diet and covariates was collected at baseline using questionnaires and physical assessments. A diet index was developed to assess adherence to the Danish dietary guidelines. T2D cases were identified using the Danish National Diabetes Register. Cox proportional hazards regression was used to estimate hazard ratios (HR), and the pseudo-observation method was used to estimate risk differences, and 95% confidence intervals (CI).

RESULTS

A total of 54,305 subject were included. During a median follow-up of 15 years, 7136 participants were diagnosed with T2D. After multivariable adjustment, the HR for high versus low adherence to the index was 0.57 (95 % CI: 0.48, 0.69) in men, and 0.71 (95% CI: 0.60, 0.83) in women. Compared with the lowest adherence to the index, high adherence was associated with a 6.58% (95% CI: -8.69; -4.47%) or 3.17% (95% CI: -4.90, -1.44%) lower risk of T2D in men and women, respectively.

CONCLUSIONS

High adherence to the Danish food-based dietary guidelines was associated with lower risk of T2D in a Danish cohort, both on a relative and an absolute scale. Shifting from low to high adherence to the dietary guidelines may provide public health benefit.

Substitutions of Oatmeal and Breakfast Food Alternatives and the Rate of Stroke

Background and Purpose- Studies indicate that consuming breakfast every day, and particularly oatmeal, is associated with lower risk of stroke. However, few studies have considered replacement foods when considering foods usually consumed at breakfast. We, therefore, aimed to model substitutions between the breakfast food products oatmeal, eggs, yogurt, or white bread and subsequent risk of stroke. Methods- Participants from the Danish cohort study (Diet, Cancer and Health; n=55 095) were followed for 13.4 years, during which 2260 subjects experienced a first-ever stroke. Breakfast foods were assessed using a validated 192-item food-frequency questionnaire at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% CIs for associations between hypothetical substitutions of standard portion sizes of breakfast foods and stroke. Results- Modeling replacement of white bread or eggs with oatmeal was associated with a lower rate of total stroke (hazard ratio [HR]=0.96 [95% CI, 0.95-0.98]; HR=0.96 [95% CI, 0.93-0.98], respectively), total ischemic stroke (HR=0.96 [95% CI, 0.94-0.98]; HR=0.96 [95% CI, 0.94-0.99], respectively), and ischemic stroke due to small-artery occlusion (HR=0.95 [95% CI, 0.93-0.98]; HR=0.95 [95% CI, 0.91-0.99], respectively). Furthermore, modeling replacement of eggs with oatmeal was associated with a lower rate of total hemorrhagic stroke (HR=0.94 [95% CI, 0.89-0.99]). Modeling replacement of yogurt with oatmeal was not associated with stroke. Conclusions- Our findings suggest that a diet containing oatmeal instead of white bread or eggs may be associated with a lower rate of stroke.

Clinical study of serum procalcitonin level in patients with myocardial infarction complicated by pulmonary infection

This study determined the serum procalcitonin (PCT) levels in patients with myocardial infarction complicated by pulmonary infection and explore its clinical significance and diagnostic value. A total of 473 patients who were admitted to the Third Affiliated Hospital of Qiqihar Medical University from January 2016 to June 2017 were enrolled as research subjects. Patients were divided into four groups based on their symptom status in myocardial infarction and pulmonary infection. There were 109 patients in normal control group who did not experience symptoms of either myocardial infarction or pulmonary infection. Blood samples were collected from each patient, and PCT levels were measured. The data were analyzed. The serum PCT levels prior to treatment were compared with each other. The PCT levels in the myocardial infarction and the pulmonary infection group were all higher than that in the normal control group (0.040±0.015) (p<0.05). On the contrary, the serum PCT level in the myocardial infarction complicated by pulmonary infection group was higher than that in the normal control group (p<0.001). The serum PCT level after treatment was compared with that before treatment within the same group. The serum PCT levels in the three disease groups were comparable after treatment. The differences in PCT levels before and after treatment were all statistically significant within all three groups (p<0.05). A patient's serum PCT level was correlated with myocardial infarction complicated by pulmonary infection, which suggested it can be used as an important diagnostic marker for this complication. This finding has important clinical value for predicting and evaluating the complicated condition of myocardial infarction and pulmonary infection by providing a more accurate, sensitive, and specific method for early diagnosis of the disease.

Adherence to national food-based dietary guidelines and incidence of stroke: A cohort study of Danish men and women

Background and purpose

National dietary guidelines are intended to promote primary prevention of lifestyle-related diseases, but little is known about their effectiveness in prevention of stroke.

Methods

We used the Danish cohort Diet, Cancer and Health (n = 57 053) to investigate whether adherence to the Danish food-based dietary guidelines was associated with risk of stroke. Adherence was assessed by the Danish Dietary Guidelines Index, score 0 [no adherence] to 6 [complete adherence]. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for stroke and subtypes of stroke in men and women separately.

Results

Incident stroke was determined in 1357 men and 900 women during follow-up (median 12.5 years and 13.0 years, respectively). A higher Danish Dietary Guidelines Index score was inversely associated with total stroke in men but not in women. In men, a high Index score (≥4) was also inversely associated with total ischemic stroke (hazard ratio 0.75, 95% confidence interval 0.65–0.86), large-artery atherosclerosis (hazard ratio 0.63, 95% confidence interval 0.44–0.92) and small artery occlusion (hazard ratio 0.68, 95% confidence interval 0.54–0.84) compared to a low Index score (<4). In women, inverse associations were found for total ischemic stroke (hazard ratio 0.84, 95% confidence interval 0.72–0.98) and intracerebral hemorrhage (hazard ratio 0.64, 95% confidence interval 0.43–0.96).

Conclusions

Our findings suggest that adherence to the Danish Dietary Guidelines is associated with a lower rate of stroke, and thus may be useful in primary prevention of disease.