Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study

Quality and Technological Properties of Flour with the Addition of Aesculus Hippocastanum and Castanea Sativa

The study of alternative food sources or ingredients that can partially replace or enrich today’s food is a perspective direction. The possibility of using horse chestnut (Aesculus hippocastanum) and chestnut (Castanea sativa) fruits in the baking industry as an admixture to wheat flour has been determined. The addition of flours from these fruits at a level of 10% increases the number of minerals in the flour mixture and also enriches the mixture in saponins, coumarins, and tannins. However, it is necessary to remove excess saponins from horse chestnut. The amylograph has shown that flour from horse chestnut fruit has optimal parameters for baking mixed bread. Farinograph tests showed that a 10% addition of ground horse chestnut to wheat flour had the best baking properties. Mixtures with 10 and 15% chestnut addition showed the best baking characteristic.

Dietary diversity score is associated with cardiometabolic risk factors in patients with hypertension (Hoveyzeh cohort study)

BACKGROUND: Dietary diversity score (DDS) is recognized as an essential factor of a high-quality diet. OBJECTIVE: To evaluate the relationship between DDS and cardiometabolic risk factors in hypertensive patients. METHODS: In this cross-sectional study, 972 hypertensive patients (322 males and 650 females) aged 35–70y participated were recruited. Dietary intake was evaluated using a semi-quantitative food frequency questionnaire and DDS was calculated. Metabolic syndrome was defined according to the IDF/AHA criteria. The anthropometric parameters, fasting blood sugar, lipid profile, and liver enzymes were measured. RESULTS: Male subjects who assigned to the top DDS tertile had 51% lower risk of having low serum HDL-C (OR: 0.49; 95% CI: 0.24–0.96) in the crude model. A similar association was observed for men in the second tertile of DDS after adjusting for covariates (OR: 0.47; 95% CI: 0.23–0.97). A significant inverse association was found between vegetable diversity score and odds of hyperglycemia in the male group in the adjusted model (OR: 0.44; 95% CI: 0.22–0.91). The vegetable diversity score was inversely associated with 67% decreased metabolic syndrome risk in the adjusted model (OR: 0.33; 95% CI: 0.15–0.70). CONCLUSION: These findings clarify the possible preventive role of higher DDS against metabolic syndrome.

Plant-based meat and dairy substitutes on the Norwegian market: comparing macronutrient content in substitutes with equivalent meat and dairy products

Objective: To assess and compare the macronutrient and salt content in meat and dairy substitutes available on the Norwegian market. Design: Comparison between substitute products and two groups of meat and dairy products where one group represented the healthiest option (Keyhole) and one the most used option (Regular). Kruskal–Wallis test with pairwise comparison was conducted on categories with more than two groups, and Mann–Whitney U test was conducted on categories with two groups. Setting: Online stores in Norway. Hundred and two meat substitute products and 173 milk and dairy substitute products on sale spring and autumn 2020 were assessed; additionally, ninety-eight equivalent meat products and 105 milk and dairy products. Results: While Keyhole and Regular meat did not contain fibre, meat substitutes contained 3⋅5–5⋅0 g fibre per 100 g. The saturated fat content in meat substitutes was on average 1⋅9 times lower than in Keyhole products and 5⋅8 times lower than in Regular products. Milk and dairy substitutes contained 3⋅2 and 3⋅4 times less protein than Keyhole and Regular products, respectively. Conclusions: The study results indicate that meat and dairy substitutes on the Norwegian market vary in nutritional composition. Compared to Keyhole and Regular, substitutes contained lower levels of saturated fat, meat substitutes contained higher levels of fibre and milk and dairy substitutes less protein. Future studies should include content of micronutrients for a more comprehensive assessment.

Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels

Calciotropic hormones, parathyroid hormone (PTH) and calcitonin are involved in the regulation of bone mineral metabolism and maintenance of calcium and phosphate homeostasis in the body. Therefore, an understanding of environmental and genetic factors influencing PTH and calcitonin levels is crucial. Genetic factors are estimated to account for 60% of variations in PTH levels, while the genetic background of interindividual calcitonin variations has not yet been studied. In this review, we analyzed the literature discussing the influence of environmental factors (lifestyle factors and pollutants) on PTH and calcitonin levels. Among lifestyle factors, smoking, body mass index (BMI), diet, alcohol, and exercise were analyzed; among pollutants, heavy metals and chemicals were analyzed. Lifestyle factors that showed the clearest association with PTH levels were smoking, BMI, exercise, and micronutrients taken from the diet (vitamin D and calcium). Smoking, vitamin D, and calcium intake led to a decrease in PTH levels, while higher BMI and exercise led to an increase in PTH levels. In terms of pollutants, exposure to cadmium led to a decrease in PTH levels, while exposure to lead increased PTH levels. Several studies have investigated the effect of chemicals on PTH levels in humans. Compared to PTH studies, a smaller number of studies analyzed the influence of environmental factors on calcitonin levels, which gives great variability in results. Only a few studies have analyzed the influence of pollutants on calcitonin levels in humans. The lifestyle factor with the clearest relationship with calcitonin was smoking (smokers had increased calcitonin levels). Given the importance of PTH and calcitonin in maintaining calcium and phosphate homeostasis and bone mineral metabolism, additional studies on the influence of environmental factors that could affect PTH and calcitonin levels are crucial.

Dietary diversity and food security status among heart failure patients in the north of Iran

Background

Dietary diversity score (DDS) is an indicator for assessing nutritional adequacy. Food security is another important measure in nutrition field which can be associated with several cardiovascular risk factors. Considering the importance of nutrition in heart failure (HF) patients, this study was designed to evaluate the DDS and food security of patients with HF.

Methods

A total of 200 HF patients were enrolled. DDS was evaluated using valid and reliable food frequency questionnaire and was calculated by scoring food intakes as 5 main groups. Household food insecurity access scale was applied to assess food security status. Data were analyzed using descriptive statistics, Chi-square and Kruskal-Wallis tests and multiple logistic regression models.

Results

The mean age of patients was 65 (standard deviation: 12) years and 59% of patients were male. Median of DDS was 1.96 (range: 0.29 to 6.12). Adjusted odds of greater DDS (> = median of 2) was 2.58 times higher for patients without hypertension than for patients with hypertension (95%CI: 1.31–5.08, P = 0.006). Also, odds of greater DDS were more in ex-smokers’ patients when compared to non-smokers (adjusted odds ratio (AOR): 2.70, 95%CI: 1.27–5.75, P = 0.010), patients with supplement use (AOR: 2.42, 95%CI: 1.16–5.05, P = 0.019), patients with lower total cholesterol level (AOR: 1.01, 95%CI: 1.00–1.02, P = 0.051), and patients with higher ejection fraction (AOR: 1.03, 95%CI: 1.00–1.05, with borderline.

P = 0.073). About 57% of patients had experienced degrees of food insecurity as mild (26%), moderate (16%) and severe (15%). On the other hand, women (AOR: 1.90, 95%CI: 0.90–3.71, with borderline P = 0.061) and patients with middle (AOR: 3.48, 95%CI: 1.79–6.76, P < 0.001) or high (AOR: 20.32, 95%CI: 2.56–161.19, P = 0.004) socio-economic status were more likely to be food secure or mild insecure. Also, no relation between DDS and food security was found (r = − 0.08, P = 0.262).

Conclusion

This study found that HF patients had a low DDS and more than half of the patients were food insecure to some extents.

Dietary Intake of Vitamin D and Its Relation with Blood Pressure in the Elderly Population

Background

Population studies have demonstrated that there is an inverse association between dietary intake of vitamin D and the mean blood pressure in elderly in particular. So, we investigated the correlation between vitamin D intake and the mean blood pressure in the elderly with and without nursing care.

Methods

Based on a cross-sectional design, this study was conducted on 152 old people with and without nursing care. Assessment of the dietary intake of nutrients was done by an expert dietitian using food frequency questionnaire and nutritionist IV software analyzer. Also, the mean blood pressure was extracted from participants' files. The independent samplet-test, Chi-square test, and partial correlation test were used for data analysis.

Results

Mean ± SD age, weight, height, body mass index (BMI) of participants, and the percentage of male/females were 68.7 ± 5.5 years, 63.5 ± 7.9 kg, 162.5 ± 7.1 cm, 24.1 ± 3.4 kg/m² and 48.7/51.3, respectively. Also, a significant negative relationship was observed between vitamin D intake and systolic blood pressure in all participants (P value = 0.028, r = -0.179). There was no significant correlation between vitamin D intake and diastolic blood pressure (P value = 0.558, r = -0.048).

Conclusions

The findings revealed that the nursing care can improve dietary intake of vitamin D in the elderly population. Also, a negative correlation was found between vitamin D intake and systolic blood pressure among all the elderly.

Vitamin D Supplementation, Serum 25(OH)D Concentrations and Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis

Background: Cardiovascular disease (CVD) risk factors are associated with low serum 25 hydroxyvitamin D (25(OH)D) concentrations in observational studies; however, clinical trial findings are inconsistent.

Objective: We assessed the effect of vitamin D supplementation and increased serum 25(OH)D concentrations on CVD risk factors in a systemic review and meta-analysis of randomized controlled trials (RCTs).

Design: MEDLINE, CINAHL, EMBASE, and Google Scholar were searched for RCTs that evaluated vitamin D supplementation and cardiovascular outcomes [blood pressure, parathyroid hormone (PTH), serum high-sensitivity C-reactive protein (hs-CRP), total cholesterol, high and low density lipoprotein (HDL and LDL, respectively), triglycerides, peak wave velocity (PWV) and Augmentation Index (AI)] from 1992 through 2017. Meta-analysis was based on a random-effects model and inverse variance method to calculate standardized mean difference (SMD) as effect sizes, followed by a leave-one-out method for sensitivity analysis. Risk of publication bias was assessed using Cochrane checklist and Begg funnel plots. The systematic review is registered as CRD42015025346.

Results: We identified 2341 studies from which 81 met inclusion criteria. The meta-analysis indicated a significant reduction in systolic blood pressure (SMD = −0.102 ± 0.04 mmHg, 95% confidence interval (CI), −0.20 to −0.03), diastolic blood pressure (SMD = −0.07 ± 0.03 mmHg, 95% CI, −0.14 to −0.006), serum PTH (SMD = −0.66 ± 0.08 ng/L, 95% CI, −0.82 to −0.49), hs-CRP (SMD = −0.20 ± 0.07 mg/L, 95% CI, −0.34 to −0.06), total cholesterol (SMD = −0.15 ± 0.06 mmol/L, 95% CI, −0.25 to −0.04), LDL (SMD = −0.10 ± 0.05 mmol/L, 95% CI, −0.20 to −0.003), triglycerides (SMD = −0.12 ± 0.06 mmol/L, 95% CI, −0.23 to −0.003) and a significant increase in HDL (SMD = 0.09 ± 0.04 mmol/L, 95% CI, 0.00 to 0.17) with vitamin D supplementation. These findings remained significant in sensitivity analyses for blood pressure, lipid profile, serum PTH, and serum hs-CRP. There was no significant effect of vitamin D supplementation on PWV (SMD = −0.20 ± 0.13 m/s, 95% CI, −0.46 to 0.06, p = 0.14) and AI (SMD = −0.09 ± 0.14%, 95% CI, −0.37 to 0.19, p = 0.52) for vitamin D supplemented groups.

Conclusion: These findings suggest that vitamin D supplementation may act to protect against CVD through improving risk factors, including high blood pressure, elevated PTH, dyslipidemia, and inflammation.

Fermente Süt Ürünlerinin Kan Basıncını Düşürücü Etkisi

Hypertension (HTN) is a major risk factor for the development of cardiovascular diseases. Therefore, there is a need to lower blood pressure (BP) to reduce the risk of these degenerative diseases. Fermented milks contain several potential factors that can lower BP including calcium and microbial metabolites particularly the angiotension-converting enzyme (ACE) inhibitory peptides and γ-aminobutyric acid. &nbsp;Animal studies clearly demonstrated the BP lowering effect of fermented milk while results from clinical trials were controversial due to a large number of variables that should be considered in clinical trials. An overview on the antihypertensive effect of fermented milk products is presented and discussed in this review.

Cheese and Cardiovascular Disease Risk: A Review of the Evidence and Discussion of Possible Mechanisms

Currently, the effect of dairy products on cardiovascular risk is a topic much debated and with conflicting results. The purpose of this review is to give an overview of the existing literature regarding the effect of cheese intake and risk of cardiovascular disease (CVD). Studies included reporting the intake of cheese and risk of CVD or risk markers of CVD represent four human intervention studies, nine prospective studies, one prospective case-cohort study, one prospective nested case-control study, five case-control studies, five cross-sectional studies and three correlation studies. The possible mechanisms that may be of importance include calcium, protein, fermentation and the fatty acid composition of cheese. Results from four prospective studies reported no association between cheese intake and CVD risk, whereas one reported an increased risk, two reported a decreased risk and one reported no association in men but a decreased risk in women. In addition, results from four intervention studies indicated no harmful effect on cholesterol concentrations when comparing fat intake from cheese with fat from butter. The underlying mechanisms for these findings still need to be elucidated.

The Effect of Nutrition Consultation on Dietary Diversity Score of Cardiac Patients Referred to Cardiac Rehabilitation Research Center Isfahan Cardiovascular Research Institute during 2008-2013

BACKGROUND

Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose.

METHODS

Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant.

RESULTS

The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001).

CONCLUSIONS

Dietary diversity was increased after nutrition counseling among patients with cardiac disease.

Relationship between vitamin D receptor gene polymorphisms, cardiovascular risk factors and adiponectin in a healthy young population

AIM

To explore the association between VDR polymorphisms and several cardiovascular risk factors and adiponectin.

MATERIALS & METHODS

Three-hundred and sixty-nine healthy students were randomly selected. Five VDR polymorphisms were genotyped: BsmI rs1544410; Cdx2 rs11568820; ApaI rs7975232; TaqI rs731236 and FokI rs2228570. BMI, waist circumference (WC), blood pressure, lipid/glycemic profiles and adiponectin were assessed.

RESULTS

In men, BsmI, ApaI and TaqI were associated with BMI and WC (p < 0.05). FokI was associated with triglycerides and high-density lipoprotein levels (p = 0.0036; p = 0.005) whereas BsmI and Cdx2 were associated with adiponectin levels (p = 0.026; p = 0.048). Associations disappeared after BMI and WC adjustments. In women, ApaI was associated with systolic blood pressure (p = 0.02).

CONCLUSION

Our study demonstrated a gender-specific difference between VDR SNPs and various cardiovascular risk factors and adiponectin.

Serum parathyroid hormone levels predict coronary heart disease: the Tromsø Study

BACKGROUND

Primary hyperparathyroidism (PHPT) is associated with hypertension, coronary atherosclerosis and other cardiovascular diseases. We aimed to evaluate serum parathyroid hormone (PTH) levels as an independent risk factor for coronary heart disease (CHD) in subjects with serum calcium within the reference range.

DESIGN

Population-based cross-sectional study.

METHODS

The Tromsø Study was attended by 27159 subjects aged 25-79 years. Serum PTH was measured in 3570 subjects. They all completed a questionnaire on medical history, including questions on angina pectoris and myocardial infarction along with a food-frequency questionnaire. A total of 1459 men and 1753 women with serum calcium 2.20-2.60 mmol/l, serum creatinine<121 micromol/l and who did not use diuretics were included in the present study. Linear regression was used to reveal associations between PTH, age, body mass index, serum calcium, calcium intake, cholesterol, blood pressure, glycosylated haemoglobin (HbA1c) and smoking status. A logistic regression model was used to find the independent predictors of CHD.

RESULTS

When stratified for age the rate of CHD was higher in the subjects with serum PTH > 6.8 pmol/l than in those with normal or low serum PTH levels [relative risk 1.67, 95% confidence interval (CI) 1.26-2.23 in men and 1.78, 95% CI 1.22-2.57 in women]. The highest PTH quartile (> 3.50 pmol/l in men and > 3.30 pmol/l in women) predicted CHD, with odds ratios of 1.70 (95% CI 1.08-2.70) for men and 1.73 (95% CI 1.04-2.88) for women, versus the lowest PTH quartile (< 1.90 pmol/l for men and <1.80 pmol/l for women).

CONCLUSIONS

Serum PTH predicts CHD in subjects with calcium levels within the reference range. This may indicate a role for PTH in the development of CHD.

Comparison of dietary profile of a rural south Indian population with the current dietary recommendations for prevention of non-communicable diseases (CURES 147)

BACKGROUND & OBJECTIVES

Despite the rising prevalence of non-communicable diseases (NCDs) in rural India, data on the dietary profile of the rural Indian population in relation to the recommendations for prevention of NCDs are scarce. This study was conducted to assess the dietary intake of a rural south Indian population in relation to the current dietary recommendations for the prevention of NCDs.

METHODS

The dietary profiles of 6907 adults aged ≥ 20 yr, from a cluster of 42 villages in Kancheepuram district of Tamil Nadu State in southern India, were assessed using a validated food frequency questionnaire.

RESULTS

The prevalence of general obesity was 27.4 per cent and that of abdominal obesity, 14.0 per cent among this rural population. The median daily energy intake of the population was 2034 (IQR 543) kcals. More than 3/4 th of the calories (78.1%) were provided by carbohydrates. Refined cereals, mainly polished rice, was the major contributor to total calories. About 45 per cent of the population did not meet WHO recommendation for protein due to low intake of pulses, flesh foods and dairy products and more than half (57.1%) exceeded the limit of salt intake; 99 per cent of the population did not meet WHO recommendations for fruits and vegetables and 100 per cent did not meet the requirement of n-3 poly unsaturated fatty acids.

INTERPRETATION & CONCLUSIONS

The dietary profile of this rural south Indian population reflected unhealthy choices, with the high consumption of refined cereals in the form of polished white rice and low intake of protective foods like fruits, vegetables, n-3 poly and monounsaturated fatty acids. This could potentially contribute to the increase in prevalence of NCDs like diabetes, hypertension and cardiovascular diseases in rural areas and calls for appropriate remedial action.

Compositional Factors that Influence Lipid Peroxidation in Beef Juice and Standard Sausages

In order to identify how different additives influenced lipid peroxidation formation, a sausage only using beef juice as pigment source and a standard beef-pork meat sausage were studied. The effects of different additives, including fish oil, myoglobin, nitrite, clove extract, and calcium sources on oxidation and sensory properties were examined. Both sausage systems were stored in 3 different manners prior to testing: (1) frozen immediately at -80 °C; (2) chilled stored for 2.5 weeks followed by fluorescent light illumination at 4 °C for another 2 wk; (3) frozen at -20 °C for 5 mo. The frozen group 3 showed the highest peroxide formation and thiobarbituric acid reactive substances (TBARS) for both sausage systems. Unpolar peroxides dominated in both systems. The clove extract could offset the peroxide formation from myoglobin/beef juice and/or fish oil, but the addition of clove flavor was recognized by the sensory panelists. Calcium addition reduced lipid peroxide formation. Added nitrite and fish oil seemed to interact to stimulate nitroso-myoglobin formation. Nitrite was identified to interact with clove addition and thereby, relatively speaking, increased TBARS. The 2 sausage systems generally ranked the additives similarly as pro- and antioxidants.

Cheese consumption in relation to cardiovascular risk factors among Iranian adults- IHHP Study

BACKGROUND/OBJECTIVE

It is expected that dairy products such as cheeses, which are the main source of cholesterol and saturated fat, may lead to the development or increase the risk of cardiovascular and metabolic diseases; however, the results of different studies are inconsistent. This study was conducted to assess the association between cheese consumption and cardiovascular risk factors in an Iranian adult population.

SUBJECTS/METHODS

Information from the Isfahan Healthy Heart Program (IHHP) was used for this cross-sectional study with a total of 1,752 participants (782 men and 970 women). Weight, height, waist and hip circumference measurement, as well as fasting blood samples were gathered and biochemical assessments were done. To evaluate the dietary intakes of participants a validated food frequency questionnaire, consists of 49 items, was completed by expert technicians. Consumption of cheese was classified as less than 7 times per week and 7-14 times per week.

RESULTS

Higher consumption of cheese was associated with higher C-Reactive Protein (CRP), apolipoprotein A and high density lipoprotein cholesterol (HDL-C) level but not with fasting blood sugar (FBS), total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and apolipoprotein B. Higher consumption of cheese was positively associated with consumption of liquid and solid oil, grain, pulses, fruit, vegetable, meat and dairy, and negatively associated with Global Dietary Index. After control for other potential confounders the association between cheese intake and metabolic syndrome (OR: 0.81; 96%CI: 0.71-0.94), low HDL-C level (OR: 0.87; 96%CI: 0.79-0.96) and dyslipidemia (OR: 0.88; 96%CI: 0.79-0.98) became negatively significant.

CONCLUSION

This study found an inverse association between the frequency of cheese intake and cardiovascular risk factors; however, further prospective studies are required to confirm the present results and to illustrate its mechanisms.

Vitamin D status among patients visiting a tertiary care center in Riyadh, Saudi Arabia: a retrospective review of 3475 cases

BACKGROUND

Vitamin D deficiency has been implicated in several chronic, non-communicable diseases independent of its conventional role in bone and calcium homeostasis. In this retrospective study, we determined the prevalence of vitamin D deficiency and its association to several cardiometabolic indices among patients visiting King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia.

METHODS

A total of 3475 charts of out-patient subjects who visited KAMC from September 2009 until December 2010 were reviewed and included. Variables of interest included measurements of vitamin D status, glycemic and renal profile, as well as trace elements (calcium and phosphorous).

RESULTS

The over-all prevalence of vitamin D deficiency in the cohort studied was 78.1% in females and 72.4% in males. 25(OH) vitamin D was significantly associated with increasing age and weight (p-values < 0.0001 and 0.005, respectively). It was also positively associated with albumin, calcium and phosphorous (p-values < 0.0001, < 0.0001 and 0.0007, respectively) and negatively associated with alkaline phosphatase as well as circulating levels of PTH (p-values 0.0002 and 0.0007, respectively).

CONCLUSION

In conclusion, vitamin D deficiency is overwhelmingly common among patients seen at KAMC regardless of the medical condition, and it is significantly associated with increasing age, weight and markers of calcium homeostasis. Findings of the present study further stress the spotlight on vitamin D deficiency epidemic in the country and region in general.

Association of vitamin D status and blood pressure response after renal denervation

BACKGROUND

Vitamin D deficiency is associated with hypertension; however, it is unclear whether vitamin D influences therapeutic blood pressure reduction. Renal sympathetic denervation (RDN) reduces blood pressure in resistant hypertension. We hypothesized that vitamin D might influence blood pressure response to RDN.

METHODS

Vitamin D was measured in 101 patients with resistant hypertension undergoing RDN. The associations between vitamin D status and systolic blood pressure (SBP) reduction 6 months after RDN were analyzed.

RESULTS

Mean office SBP at baseline was 171.5 ± 2 mmHg. After RDN, mean office SBP was reduced by 28.4 ± 2.3 mmHg (p = 0.007). 85 patients (84.2 %) had SBP reductions >10 mmHg (responders). Vitamin D concentrations were lower in non-responders as compared to responders (9.9 ± 4.5 vs. 13.7 ± 7.4 ng/ml, p = 0.008). Non-responders (n = 16, 15.8 %), more often had a vitamin D concentration below the median as compared to responders (81 vs. 46 %, p = 0.013). The percentage of patients with normal vitamin D concentrations increased with increasing tertiles of SBP reduction (p for trend = 0.020). In patients with vitamin D concentrations below the median, SBP reduction was lower as compared to patients with a vitamin D concentration above the median (23.5 ± 3.2 vs. 33.7 ± 3.2 mmHg, p = 0.026). Baseline vitamin D concentrations correlated with SBP reduction (r = 0.202, p = 0.043).

CONCLUSIONS

In patients with resistant hypertension, low vitamin D concentrations were associated with a decreased SBP response and a higher rate of non-response.

An update on the cardiovascular pleiotropic effects of milk and milk products

Hypertension is a major risk factor in addition to atherosclerosis and type 2 diabetes mellitus for the development of coronary heart disease and strokes. Several prospective clinical studies have demonstrated a possible protective effect of milk and dairy product consumption on these conditions. The putative effects of milk and dairy products are possibly mediated through their mineral content of calcium, magnesium, potassium, and vitamin D. These dairy substances exercise their blood pressure-lowering effect either directly on the arterial wall by these minerals or indirectly through blockade of the angiotensin-converting enzyme (ACE) by the amino acids contained in the casein and whey of milk. The blockade of ACE results in the inhibition of production of angiotensin II, a potent vasoconstrictive peptide, and the prevention of degradation of bradykinin, a potent vasodilating peptide. For this concise review, a Medline search of the English language literature was conducted from 2006 to September 2012 and 16 pertinent papers were selected. The potential beneficial pleiotropic effects from these studies together with collateral literature will be discussed in this review.

Consumption of dairy products and death from cardiovascular disease in the Japanese general population: the NIPPON DATA80

Background

Recent Western studies show an inverse association between milk and dairy product intake and cardiovascular disease (CVD). We studied the association between consumption of milk and dairy products and CVD death in Japan.

Methods

Men and women aged 30 years or older were followed for 24 years. All had participated in a national nutrition survey in 300 health districts throughout Japan in 1980. The Cox proportional hazards model was used to assess mortality risk according to tertiles of milk and dairy product intake, with the high consumption group as reference. Hazard ratios (HRs) per 100-g/day increase in consumption were also estimated.

Results

During the 24-year follow-up period, there were 893 CVD deaths, 174 deaths from coronary heart disease (CHD), and 417 stroke deaths among 9243 participants. For women, the HRs for death from CVD, CHD, and stroke in the low consumption group were 1.27 (95% CI: 0.99–1.58; P for trend = 0.045), 1.67 (0.99–2.80; P = 0.02), and 1.34 (0.94–1.90; P = 0.08), respectively, after adjustment for age, body mass index, smoking status, alcohol drinking habits, history of diabetes, use of antihypertensives, work category, and total energy intake. With each 100-g/day increase in consumption of milk and dairy products, HRs tended to decrease for deaths from CVD (HR, 0.86; 95% CI, 0.74–0.99), CHD (0.73; 0.52–1.03), and stroke (0.81; 0.65–1.01) in women. No significant association was observed in men.

Conclusions

Consumption of milk and dairy products was inversely associated with CVD death among women in Japan.

Inhibition of cytokine secretion from adipocytes by 1,25-dihydroxyvitamin D₃ via the NF-κB pathway

Adipose tissue inflammation is an important pathological process in obese people, associated with diabetes and cardiovascular disease. We hypothesized that 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] inhibits cytokine secretion from adipocytes via direct inhibition of transcription factor nuclear factor-κB (NF-κB). We utilized two different human models. Bone marrow-derived human mesenchymal stromal cells (hMSCs) differentiated into adipocytes, and adipocytes isolated from biopsies stimulated with lipopolysaccharide (LPS) were treated with or without 1,25(OH)(2)D(3). Expression and secretion of interleukin-6 (IL-6) were measured by quantitative RT-PCR analysis and ELISA. Assessment of NF-κB nuclear translocation, DNA binding activity was performed by immunofluorescence (IF) and electrophoretic mobility assay (EMSA). Inhibitor κB (IκB) and its phosphorylation were detected by Western blot (WB) analysis. Simultaneous 1,25(OH)(2)D(3) cotreatment significantly reduced LPS-stimulated (10 ng/ml) IL-6 secretion dose dependently by 15% at 10(-10) M and 26% at 10(-7) M (P<0.05) in hMSCs, while preincubation with 1,25(OH)(2)D(3) (10(-7) M) for 24 h reduced IL-6 secretion by 24 and 35% (P<0.001) and mRNA levels by 34 and 30% (P<0.05) in hMSCs and isolated adipocytes, respectively. 1,25(OH)(2)D(3) suppressed LPS-stimulated IκB phosphorylation-mediated NF-κB translocation into the nucleus were evident from WB, IF, and EMSA. 1,25(OH)(2)D(3) inhibits LPS-stimulated IL-6 secretion in two human adipocyte models via interference with NF-κB signaling.

Serum 25-hydroxyvitamin D3, parathyroid hormone and blood pressure in an elderly cohort from Germany: a cross-sectional study

Background

Although several studies indicate a link between vitamin D status and blood pressure (BP), the results are inconsistent. The purpose of this study is to investigate whether in predominantly non-obese elderly people without vitamin D deficiency or very high intact parathyroid hormone (iPTH) levels serum 25-hydroxyvitamin D₃ [25(OH)D₃] and iPTH are independently associated with BP.

Methods

Cross-sectional data of 132 non-institutionalised subjects (90 women and 42 men, aged 66- 96 years) from Giessen, Germany, were analysed. Serum 25(OH)D₃ and iPTH were measured by an electrochemiluminescence immunoassay and BP was determined with a sphygmomanometer. We performed univariate and multiple regression analyses to examine the influence of 25(OH)D₃ and iPTH on BP with adjustments for age, body composition and lifestyle factors.

Results

While iPTH had no impact on BP, 25(OH)D₃ was negatively associated with systolic BP in men, but not in women. After splitting the cohort into antihypertensive medication users and non-users, 25(OH)D₃ was a significant predictor for systolic and diastolic BP only in men not receiving antihypertensive medicine, even after multiple adjustment. Adjustment for 25(OH)D₃ resulted in an inverse association of iPTH with diastolic BP also only in men without intake of antihypertensive medicine.

Conclusions

In elderly men without vitamin D deficiency and not taking antihypertensive medicine, 25(OH)D₃ may be a negative determinant of BP, independent of iPTH, body composition and lifestyle factors. Furthermore, iPTH may be an independent negative determinant of diastolic BP in men not taking antihypertensive medicine.

Dairy components and risk factors for cardiometabolic syndrome: recent evidence and opportunities for future research

Cardiometabolic syndrome (CMS), a cluster of metabolic abnormalities that increases the risk of cardiovascular disease (CVD) and type 2 diabetes, affects over one-third of American adults and accounts for billions of dollars in health care costs annually. Current evidence indicates an inverse association between consumption of dairy foods and risk of CMS and its related disease outcomes. Although the specific mechanism(s) underlying the beneficial effects of dairy consumption on the development of CMS, CVD, and type 2 diabetes have not been fully elucidated, there is evidence that specific components within dairy such as milkfat, vitamin D, calcium, magnesium, potassium, and whey proteins may be individually or collectively involved. Specifically, each of these dairy components has been implicated as having a neutral or beneficial effect on one or more elements of CMS, including the serum lipid profile, blood pressure, fasting glucose, and body composition. Although several mechanisms have been identified by which components in dairy may beneficially affect symptoms associated with CMS, further research is required to better understand how dairy and its components may contribute to metabolic health. The purpose of this review is to present the mechanisms by which specific dairy components modulate risk factors for CMS and identify opportunities for future research.

Dairy intake, blood pressure and incident hypertension in a general British population: the 1946 birth cohort

PURPOSE

We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors.

METHODS

We studied 1,750 British men and women from the 1946 British birth cohort from 1989 to 1999 (age 43 and 53 years, respectively). Diet was assessed by 5-day food diaries using photographs in the estimation of portion size. Systolic (sbp) and diastolic (dbp) blood pressure and prevalent hypertension were assessed at age 43 and 53 years. Linear regression and logistic regression were used to examine 10-year blood pressure levels and incident hypertension by baseline dairy intake.

RESULTS

There was a weak non-significant trend of a protective effect of total dairy intake on blood pressure and incident hypertension, but no evidence for a dose-response relationship (OR for incident hypertension: 0.88 (95% CI 0.68;1.14) 2nd vs. 1st tertile and 0.93 (95% CI 0.72;1.18) 3rd vs. 1st tertile). Higher intake of low-fat and fermented dairy was linked to a higher sbp but in a nonlinear manner. Adjustment for other dietary factors, health behaviours and BMI attenuated these associations.

CONCLUSIONS

Total dairy intake and specific dairy subgroups were not associated with blood pressure and incident hypertension among a representative sample of British adults after adjustment for confounding factors.

Vitamin d therapy and cardiovascular health

Vitamin D belongs to the family of nuclear steroid hormones, which has pleiotropic effects on several organ systems. Different vitamin D compounds have been studied as potential cardioprotective agents over the past 20 years. The results of these clinical studies vary based on the form and dosage of vitamin D administered during the trial. In the past 5 years, many have described an association of vitamin D compounds and cardiovascular health through reduction in blood pressure, reduction in inflammatory biomarkers, improved insulin sensitivity, and reduction in cardiovascular disease complications and death. Because there are several vitamin D compounds, it is important to consider the full breadth of the literature when examining vitamin D and cardiovascular health, to assist in hypothesis generation and understanding of the current state of the science. Although a growing body of evidence suggests that nutritional vitamin D supplementation and potentially even treatment with synthetic analogues of vitamin D may be cardioprotective, relatively few studies have examined either of these compounds in a randomized, controlled fashion. Studies examining the benefit of vitamin D supplementation are now beginning, but future studies considering calcitriol and analogue therapy also seem warranted.

The Role of Vitamin D in Human Health: A Paradigm Shift

Vitamin D deficiency is pandemic, spanning many continents and including all ages, genders and racial/ethnic groups. Currently, world-wide attention is focused on the importance of vitamin D in optimizing health and preventing disease. This focus is largely the result of the scientific discovery that vitamin D receptors are present in nearly every tissue and cell in the body and that adequate vitamin D status is essential for optimal functioning of these tissues and cells. An impressive body of research has accumulated over the past two decades providing new information about the role of vitamin D in prevention of a broad range of diseases. The purpose of this paper is to provide a review of this new information.

Vitamin D and the prevention of hypertension and cardiovascular diseases: a review of the current evidence

Vitamin D plays an essential role in bone mineralization and calcium homeostasis. More recently, there has been growing evidence for a role of vitamin D in extraskeletal health, including beneficial effects in the cardiovascular system. Daylight exposure and vitamin D intake in many western populations are insufficient for maintaining an adequate vitamin D status. It is at present unclear whether vitamin D supplementation could improve cardiovascular health. This paper summarizes the evidence from observational studies and randomized-controlled trials on the relation of vitamin D with blood pressure (BP) and risk of cardiovascular diseases (CVDs). Epidemiological data suggest that optimal vitamin D status is important for CVD prevention, but results from different studies are conflicting and confounding cannot be ruled out. Randomized-controlled trials of vitamin D supplementation and BP have yielded inconsistent results, and trials that addressed the effect of vitamin D on CVDs are lacking. It is therefore premature to recommend supplemental vitamin D intake specifically for the prevention of hypertension or CVDs. Data from large, well-controlled clinical trials in this field with vitamin D supplements of sufficiently high doses are awaited to settle this issue.

Vitamin D and cardiometabolic health: a review of the evidence

The cardiometabolic syndrome (MetS) is a clustering of related metabolic abnormalities including abdominal adiposity, insulin resistance, hypertension, dyslipidaemia and increased inflammatory and thrombotic markers, which is linked to increased risk of type 2 diabetes, CVD and overall mortality. Several cross-sectional and prospective studies have shown an association between low vitamin D status, as indicated by concentrations of serum 25-hydroxyvitamin D (s25(OH)D), and increased prevalence of the MetS and individual CVD risk factors. These epidemiological observations are supported by mechanistic studies but experimental data are limited. The available data from intervention studies are largely confounded as most vitamin D supplementation trials were mainly carried out to explore the role of Ca in CVD and include Ca in the treatment arms. Inadequate consideration of seasonal effects on s25(OH)D concentrations is also a common design flaw in most studies. Further complications arise from shared risk factors such as adiposity and ageing, which predispose individuals to exhibit both a more pronounced risk profile and relatively lower s25(OH)D concentrations. In conclusion, while epidemiological associations are promising and a rationale for low vitamin D status as a potentially modifiable risk factor for CVD is supported by mechanistic data, suitable experimental data from appropriately designed trials are just beginning to emerge. As yet, this body of literature is too immature to draw firm conclusions on the role of vitamin D in CVD prevention. Carefully controlled vitamin D trials in well-described population groups using intervention doses that are titrated against target s25(OH)D concentrations could yield potentially valuable outcomes that may have a positive impact on CVD risk modification.

Extraskeletal effects of vitamin D in older adults: cardiovascular disease, mortality, mood, and cognition

BACKGROUND

Vitamin D insufficiency is prevalent among older adults and may be associated with higher risk for cardiovascular (CV) disease, mortality, depression, and cognitive deficits.

OBJECTIVE

The aim of this article was to review published observational and experimental studies that explored the association between vitamin D insufficiency and CV disease, mortality, mood, and cognition with an emphasis on older adults.

METHODS

PubMed and Web of Science databases were searched for English-language articles from January 1966 through June 2009 relating to vitamin D, using the following MeSH terms: aged, vitamin D deficiency, physiopathology, drug therapy, cardiovascular diseases, blood pressure, mortality, delirium, dementia, cognitive disorders, depression, depressive disorder, seasonal affective disorder, mental disorders, and vitamin D/therapeutic use. Publications had to include patients > or =65 years of age who had > or =1 recorded measurement of 25-hydroxyvitamin D (25[OH]D) or were receiving vitamin D supplementation. All case-control, cohort, and randomized studies were reviewed.

RESULTS

Forty-two case-control, cohort, and randomized trials were identified and included in the review. Based on these publications, the prevalence of vitamin D insufficiency (25[OH]D concentration <30 ng/mL) in communitydwelling older adults (> or =65 years of age) ranged from 40% to 100%. Epidemiologic data and several small randomized trials found a potential association between vitamin D deficiency (25[OH]D concentration <10 ng/mL) and CV disease, including hypertension and ischemic heart disease. Although subgroup analyses of data from the Women's Health Initiative Randomized Trial (the largest randomized, placebo-controlled trial of vitamin D plus calcium therapy) did not find reductions in blood pressure, myocardial infarction, or CV disease-related deaths, intervention contamination limited the findings. Observational studies and a meta-analysis of randomized controlled trials found a mortality benefit associated with higher serum 25(OH)D concentrations or vitamin D(2) or D(3) supplementation (mean dose, 528 IU/d). Observational and small randomized trials found a potential benefit of sunlight or vitamin D on symptoms of depression and cognition, but the findings were limited by methodologic problems.

CONCLUSIONS

Vitamin D insufficiency appears to be highly prevalent among older adults. Evidence from epidemiologic studies and small clinical trials suggests an association between 25(OH)D concentrations and systolic blood pressure, risk for CV disease-related deaths, symptoms of depression, cognitive deficits, and mortality. The Women's Health Initiative Randomized Trial did not find a benefit of vitamin D supplementation on blood pressure, myocardial infarction, or mortality in postmenopausal women.

High serum 25-hydroxyvitamin D concentrations are associated with a favorable serum lipid profile

BACKGROUND/OBJECTIVES

Low serum 25-hydroxyvitamin D (25(OH)D) concentrations are related to increased mortality. One possible explanation could be an association between serum 25(OH)D and serum lipids.

SUBJECTS/METHODS

The study was performed at the University of Tromsø, Northern Norway. In total, 8018 nonsmoking and 2087 smoking subjects were included in a cross-sectional study performed in 2008, and 1762 nonsmoking and 397 smoking subjects in a longitudinal study from 1994/1995 to 2008. Nonfasting serum 25(OH)D, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), LDL-C/HDL-C ratio and triacylglycerol (TAG) were measured.

RESULTS

After adjustment for gender, age, sample month and body mass index in the cross-sectional study, there was a significant increase in serum TC, HDL-C and LDL-C, and a significant decrease in serum LDL-C/HDL-C ratio and TAG across increasing serum 25(OH)D quartiles. For serum HDL-C and TAG in nonsmokers the differences between the means for the highest and lowest serum 25(OH)D quartiles were 6.0 and 18.5%, respectively. In the longitudinal study, an increase in serum 25(OH)D was associated with a significant decrease in serum TAG.

CONCLUSIONS

There is a cross-sectional association between serum 25(OH)D and serum lipids, and a longitudinal association over 14 years between serum 25(OH)D and TAG, which may contribute to explain the relation between low serum 25(OH)D concentrations and mortality.

Effect of a high-calcium energy-reduced diet on abdominal obesity and cardiometabolic risk factors in obese Brazilian subjects

BACKGROUND

Clinical trials designed to examine the effects of calcium supplementation on abdominal obesity have had ambiguous results.

AIMS

This study aimed to evaluate, during energy restriction, the effects of a high-calcium diet (HCD) on measures of abdominal obesity and cardiometabolic risk factors in Brazilian obese subjects of multiethnic origin.

METHODS

We conducted a randomised clinical trial. Fifty obese subjects of both sexes, aged 22-55 years, with stable body weight and a low calcium intake were randomised into the following outpatient dietary regimens: (i) a low-calcium diet (LCD; < 500 mg/day) or (ii) a HCD [1200-1300 mg/day, supplemented with non-fat powdered milk (60 g/day)]. Both groups followed an energy-restricted diet (-800 kcal/day) throughout the study (16 weeks).

RESULTS

Thirty-nine participants completed the study. After 16 weeks of energy restriction, a significant reduction was observed in all anthropometric parameters, metabolic variables (except for high-density lipoprotein cholesterol) and blood pressure levels in both the groups. Insulin was significantly reduced only in the HCD group. Subjects on the HCD compared with those on the LCD exhibited a greater reduction in waist circumference (p = 0.002), waist-to-hip ratio (p = 0.0001), diastolic blood pressure (p = 0.04) and mean blood pressure (p = 0.03).

CONCLUSIONS

Our study suggests that increased calcium intake may enhance the beneficial effects of energy restriction on abdominal obesity and blood pressure.

Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromsø study

OBJECTIVE

Ecologic and observational studies have suggested an association between serum 25-hydroxyvitamin D (25(OH)D) levels and cardiovascular disease (CVD) risk factors, CVD mortality, and cancer mortality. Based on this, low serum 25(OH)D levels should be associated with higher all-cause mortality in a general population. This hypothesis was tested in the present study.

DESIGN

The Tromsø study is a longitudinal population-based multipurpose study initiated in 1974 with focus on lifestyle-related diseases. Our data are based on the fourth Tromsø study carried out in 1994-1995.

METHODS

Information about death and cause of death was registered by obtaining information from the National Directory of Residents and the Death Cause Registry. Serum 25(OH)D was measured in 7161 participants in the fourth Tromsø study. Results are presented for smokers (n=2410) and non-smokers (n=4751) separately as our immunoassay seems to overestimate 25(OH)D levels for smokers.

RESULTS

During a mean 11.7 years of follow-up, 1359 (19.0%) participants died. In multivariate regression models, there was a significantly increased risk of all-cause mortality (hazard ratio (HR) 1.32, confidence interval (CI) 1.07-1.62) among non-smoking participants in the lowest 25(OH)D quartile when compared with participants in the highest quartile. Equivalent results for smokers were not significant (HR 1.06, CI 0.83-1.35).

CONCLUSIONS

Low serum 25(OH)D levels were associated with increased all-cause mortality for non-smokers, but the results did not reach statistical significance for smokers. However, low 25(OH)D levels are known to be associated with impaired general health, and randomized controlled studies are needed to address the question of causality.

Dairy consumption and patterns of mortality of Australian adults

BACKGROUND/OBJECTIVES

Dairy foods contain various nutrients that may affect health. We investigated whether intake of dairy products or related nutrients is associated with mortality due to cardiovascular disease (CVD), cancer and all causes.

SUBJECTS/METHODS

We carried out a 16-year prospective study among a community-based sample of 1529 adult Australians aged 25-78 years at baseline. Habitual intakes of dairy products (total, high/low-fat dairy, milk, yoghurt and full-fat cheese), calcium and vitamin D were estimated as mean reported intake using validated food frequency questionnaires (FFQs) self-administered in 1992, 1994 and 1996. National Death Index data were used to ascertain mortality and cause of death between 1992 and 2007. Hazard ratios (HRs) were calculated using Cox regression analysis.

RESULTS

During an average follow-up time of 14.4 years, 177 participants died, including 61 deaths due to CVD and 58 deaths due to cancer. There was no consistent and significant association between total dairy intake and total or cause-specific mortality. However, compared with those with the lowest intake of full-fat dairy, participants with the highest intake (median intake 339 g/day) had reduced death due to CVD (HR: 0.31; 95% confidence interval (CI): 0.12-0.79; P for trend=0.04) after adjustment for calcium intake and other confounders. Intakes of low-fat dairy, specific dairy foods, calcium and vitamin D showed no consistent associations.

CONCLUSIONS

Overall intake of dairy products was not associated with mortality. A possible beneficial association between intake of full-fat dairy and cardiovascular mortality needs further assessment and confirmation.

Vitamin D supplement consumption is required to achieve a minimal target 25-hydroxyvitamin D concentration of > or = 75 nmol/L in older people

Population level data on how older individuals living at high latitudes achieve optimal vitamin D status are not fully explored. Our objective was to examine the intake of vitamin D among healthy older individuals with 25-hydroxyvitamin D [25(OH)D] concentrations > or =75 nmol/L and to describe current sources of dietary vitamin D. We conducted a population-based, cross-sectional study of 404 healthy men and women aged 69 to 83 y randomly selected from the NuAge longitudinal study in Québec, Canada. Dietary intakes were assessed by 6 24-h recalls. We examined the contribution of foods and vitamin/mineral supplements to vitamin D intake. Serum 25(OH)D was assessed by RIA. We assessed smoking status, season of 25(OH)D measurement, physical activity, and anthropometric and sociodemographic variables. Vitamin D status was distributed as follows: 7% (<37.5 nmol/L), 48% (37.5-74.9 nmol/L), and 45% (> or = 75 nmol/L). Vitamin D intake from supplements varied across the 3 vitamin D status groups: 0.5, 4.1, and 8.9 microg/d, respectively (P < 0.0001). Adding food sources, these total intakes were 4.6, 8.7, and 14.1 microg/d, respectively. In multivariate analysis, vitamin D from foods and supplements and by season was associated with vitamin D status. These healthy, community-dwelling older men and women with 25(OH)D concentrations >75 nmol/L had mean intakes of 14.1 microg/d from food and supplements. Supplement use is an important contributor to achieve a minimal target of 25(OH)D concentration > or = 75 nmol/L.

Serum 25-hydroxyvitamin D levels are strongly related to systolic blood pressure but do not predict future hypertension

Vitamin D receptors have been detected in vascular smooth muscle cells, and 1,25-dihydroxyvitamin D inhibits the renin mRNA expression. Epidemiological studies show an inverse relation between serum 25-hydoxyvitamin D levels and blood pressure, and low serum 25-hydoxyvitamin D levels are reported to be predictors of future development of hypertension. This may indicate an important role for vitamin D in blood pressure regulation. In the present study, 25-hydoxyvitamin D was measured in sera collected in 1994 from 4125 subjects who did not use blood pressure medication, and thereafter measurement was repeated in 2008 for 2385 of these subjects. In sera from 1994 there was a significant decrease in age, body mass index, and systolic blood pressure and a significant increase in physical activity score across increasing 25-hydoxyvitamin D quartiles. After adjusting for sex, age, body mass index, and physical activity, the difference in systolic blood pressure between the lowest and highest serum 25-hydoxyvitamin D quartiles was 3.6 mm Hg. After adjustment for confounders, serum 25-hydoxyvitamin D from 1994 did not predict future hypertension or increase in blood pressure, nor was there any significant association between change in serum 25-hydoxyvitamin D from 1994 to 2008 and change in blood pressure. Our results do not support a causal role for vitamin D in blood pressure regulation, and large randomized clinical trials, preferably including subjects with hypertension and/or low serum 25-hydoxyvitamin D levels, are greatly needed to clarify whether vitamin D supplementation affects the blood pressure.

Do lifestyle interventions affect dietary diversity score in the general population?

Objective

The dietary diversity score (DDS) is a good indicator of diet quality as well as of diet–disease relationships; therefore, the present study was undertaken to reveal the effect of a lifestyle intervention on this index.

Design

A baseline and three evaluation studies were conducted in two intervention districts (Isfahan and Najaf-Abad) and a reference area (Arak), all located in central Iran. The Isfahan Healthy Hearth Programme (IHHP) targeted the entire population of nearly 2 million in urban and rural areas of the intervention communities. One of the main strategies of the lifestyle intervention phase in the IHHP was healthy nutrition. Usual dietary intake was assessed using a forty-nine-item FFQ. A diversity score for each food group was calculated and the DDS was considered the sum of the diversity scores of the food groups.

Results

There were significant increases in DDS in both intervention areas (P = 0·0001) after controlling for confounding factors. There was a significant interaction between area and evaluation stage with regard to DDS (P = 0·0001). The effect of the intervention on the diversity scores of all food groups was also significant (P = 0·0001 for all) after adjusting for socio-economic status.

Conclusion

The community-based lifestyle intervention in the IHHP was successful in improving DDS which might be related to an increase of diet quality of the population that in turn might decrease the risks of chronic diseases.

Milk products, dietary patterns and blood pressure management

High blood pressure (BP) is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. Inverse associations between dairy product consumption and systolic blood pressure (SBP) and diastolic blood pressure (DBP) have been observed in cross-sectional studies; some studies, however, have reported an inverse association with only one BP parameter, predominantly SBP. Randomized clinical trials examining the effect of calcium and the combination of calcium, potassium and magnesium provide evidence for causality. In these studies, reductions in BP were generally modest (-1.27 to -4.6 mmHg for SBP, and -0.24 to -3.8 mmHg for DBP). Dairy nutrients, most notably calcium, potassium and magnesium, have been shown to have a blood pressure lowering effect. A low calcium intake increases intracellular calcium concentrations which increases 1,25-dihydroxyvitamin D(3) and parathyroid hormone (PTH), causing calcium influx into vascular smooth muscle cells, resulting in greater vascular resistance. New research indicates that dairy peptides may act as angiotensin converting enzyme (ACE) inhibitors, thereby inhibiting the renin angiotensin system with consequent vasodilation. A growing evidence base shows that dairy product consumption is involved in the regulation of BP. Consequently, inclusion of dairy products in a heart healthy diet is an important focal point to attain BP benefits.

Vitamin D status and arterial hypertension: a systematic review

Vitamin D deficiency is common and is primarily caused by a lack of ultraviolet-B (UVB) radiation from reduced sun exposure, and the consequent limiting of vitamin D production in the skin. The vitamin D endocrine system regulates about 3% of the human genome. Observational data support the concept that vitamin D is involved in the pathogenesis of cardiovascular diseases and arterial hypertension. The antihypertensive properties of vitamin D include renoprotective effects, suppression of the renin-angiotensin-aldosterone system, direct effects on vascular cells, and effects on calcium metabolism, including prevention of secondary hyperparathyroidism. The results of clinical studies largely, but not consistently, favor the hypothesis that vitamin D sufficiency promotes lowering of arterial blood pressure. Randomized, placebo-controlled trials are greatly needed to clarify and definitively prove the effect of vitamin D on blood pressure. In general, the antihypertensive effects of vitamin D seem to be particularly prominent in vitamin-D-deficient patients with elevated blood pressure. Thus, in view of the relatively safe and inexpensive way in which vitamin D can be supplemented, we believe that vitamin D supplementation should be prescribed to patients with hypertension and 25-hydroxyvitamin D levels below target values.

Dietary intake, blood pressure and osteoporosis

Both hypertension and osteoporosis have common underlying nutritional aetiology, with regards to dietary cations intake. We tested the hypothesis that sodium intake reflected in urinary Na/Cr and blood pressure would be negatively associated with bone mineral density (BMD), whereas other cations may have opposite associations. Subjects were part of a study of bone health in 4000 men and women aged 65 years and over. A total of 1098 subjects who were not on antihypertensive drugs or calcium supplements and who provided urine samples were available for analysis. Logistic regression was used to examine associations between total hip and lumbar spine BMD, age, gender, body mass index (BMI), urinary Na/Cr, K/Cr, calcium and magnesium intake, systolic blood pressure and diastolic blood pressure. Total hip BMD was inversely associated with age, being female and urinary Na/Cr, and positively associated with BMI, urine K/Cr and dietary calcium intake. Lumbar spine BMD was inversely associated with being female and urinary Na/Cr, and positively associated with BMI, dietary calcium intake and SBP. We conclude that sodium intake, reflected by urinary Na/Cr, is the major factor linking blood pressure and osteoporosis as shown by the inverse relationship with BMD. The findings lend further emphasis to the health benefits of salt reduction in our population both in terms of hypertension and osteoporosis.

Vitamin D and living in northern latitudes--an endemic risk area for vitamin D deficiency

OBJECTIVES

To review the current literature on the health effects of vitamin D, especially the effects on inhabitants living in the northern latitudes.

STUDY DESIGN

Literature review.

METHODS

The scientific literature concerning health effects of vitamin D was reviewed and the current dietary recommendations for inhabitants living in northern latitudes were discussed.

RESULTS

Vitamin D is a steroid-structured hormone produced in the skin upon exposure to UVB-radiation or obtained from certain food products (for example, liver). Its production is mediated by the vitamin D receptor, which belongs to the nuclear receptor family, and exerts its function as a transcription factor regulating several target genes. Active metabolites of vitamin D play an important role in calcium and phosphate homeostasis. Deficiency of vitamin D results in diminished bone mineralization and an increased risk of fractures. In addition, vitamin D is connected to a variety of other diseases that include different cancer types, muscular weakness, hypertension, autoimmune diseases, multiple sclerosis, type 1 diabetes, schizophrenia and depression.

CONCLUSIONS

Vitamin D plays a fundamental role in calcium and phosphate homeostasis. A deficiency of vitamin D has been attributed to several diseases. Since its production in the skin depends on exposure to UVB-radiation via the sunlight, the level of vitamin D is of crucial importance for the health of inhabitants who live in the Nordic latitudes where there is diminished exposure to sunlight during the winter season. Therefore, fortification or supplementation of vitamin D is necessary for most of the people living in the northern latitudes during the winter season to maintain adequate levels of circulating 25(OH)D3 to maintain optimal body function and prevent diseases.

Serum parathyroid hormone is associated with carotid intima-media thickness in postmenopausal women

OBJECTIVES

To test whether parathyroid hormone (PTH) might be related to the development of atherosclerosis in postmenopausal women, we measured serum levels of PTH, the carotid intima-media thickness (IMT), and other clinical and biochemical parameters.

METHODS

One hundred and seven postmenopausal women were recruited for this study. The serum level of PTH was measured by immunoradiometric assay, and carotid IMT was measured with high resolution B-mode ultrasonography.

RESULTS

On the basis of bivariate correlation analyses or unpaired t-tests, the body mass index (BMI), waist circumference, estimated glomerular filtration rate, and 25-hydroxyvitamin D were not associated with carotid IMT. In contrast, age (r = 0.414, p < 0.001), serum level of PTH (r = 0.304, p = 0.001), hypertension (p < 0.001), and hypercholesterolaemia (p = 0.004) were related to carotid IMT. On the basis of multiple regression analysis, the serum level of PTH (beta = 0.198, p = 0.029), as well as age (beta = 0.309, p = 0.001) and hypertension (beta = 0.262, p = 0.006), were independent predictors of carotid IMT.

CONCLUSIONS

Our results have demonstrated that serum PTH is an independent determinant of carotid IMT in postmenopausal women. This result suggests that serum PTH, even in the reference range, might be associated with the development of atherosclerosis or cardiovascular diseases in postmenopausal women. Further study is necessary in males and premenopausal women to fully elucidate the clinical significance of this finding.

Nutritional strategies in the prevention and treatment of metabolic syndrome

The metabolic syndrome (MetS) is a clustering of metabolic abnormalities that increase the risk of developing atherosclerotic cardiovascular disease and type 2 diabetes. The exact etiology remains unclear, but it is known to be a complex interaction between genetic, metabolic, and environmental factors. Among environmental factors, dietary habits are of central importance in the prevention and treatment of this condition. However, there is currently no firm consensus on the most appropriate dietary recommendations. General recommendations include decreasing obesity, increasing physical activity, and consuming an anti-atherogenic diet, and have traditionally focused on low total fat intake. A major problem with the focus on low fat is that high-carbohydrate diets can contribute to increasing triglyceride and decreasing high-density lipoprotein (HDL) concentrations. Low-carbohydrate diets have been popular in recent years. However, such diets are typically higher in saturated fat and lower in fruits, vegetables, and whole grains than national dietary recommendations. More recently the quality of carbohydrate has been studied in relation to MetS, including a focus on dietary fiber and glycemic index. Similarly, there has been a move from limiting total fat to a focus on the quality of the fat, with evidence of beneficial effects of replacing some carbohydrate with monounsaturated fat. Other nutrients examined for possible importance include calcium, vitamin D, and magnesium. Together, the evidence suggests that the components of diet currently recommended as "healthy" are likely also protective against MetS, including low saturated and trans fat (rather than low total fat) and balanced carbohydrate intake rich in dietary fiber, as well as high fruit and vegetable intake (rather than low total carbohydrate); and the inclusion of low-fat dairy foods. Accelerating research on gene-diet interactions is likely to contribute interesting information that may lead to further individualized dietary guidance in the future.