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Jacobo Cejudo MG, van Laarhoven R, Voortman T, Geleijnse JM. The Beverage Quality Index and risk of cardiometabolic outcomes after a myocardial infarction: A prospective analysis in the Alpha Omega Cohort. Nutr Metab Cardiovasc Dis 2024; 34:2155-2164. [PMID: 38897845 DOI: 10.1016/j.numecd.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIMS Individual beverages have varying associations with cardiometabolic outcomes, but little is known about overall beverage quality and cardiometabolic risk after myocardial infarction (MI). We created the Beverage Quality Index (BQI) to assess beverage quality and examined its association with cardiometabolic outcomes after MI. METHODS AND RESULTS We included 4365 Dutch post-MI patients from the Alpha Omega Cohort, aged 60-80 years. Diet was assessed at baseline (2002-2006) with a 203-item FFQ. The BQI included eight components (coffee, tea, milk, juices, sugar-sweetened beverages, alcohol, added sugar to coffee and tea, and energy from beverages), and ranged from 0 to 80. Multivariable Cox models were used to estimate HRs for the BQI in relation to incident diabetes mellitus (DM), major adverse cardiovascular events (MACE), recurrent cardiovascular disease (CVD) and fatal CVD over 3.4 y of follow-up, with follow-up for fatal CVD extended through 2018 (12.4 y). The average BQI was 50.0 ± 12.5. During 3.4 y of follow-up, we identified 186 incident cases of DM, 601 of MACE, 310 of recurrent CVD and 140 of fatal CVD. In multivariable models, a higher BQI (T3 vs. T1) was associated with lower risk of MACE [HR: 0.73 (0.59-0.90)], and recurrent CVD [HR: 0.67 (0.50-0.91)], but not with DM or CVD mortality. After 12.4 y of follow-up, 903 CVD deaths occurred. A significant inverse association with CVD mortality during long-term follow-up was found [HR: 0.81 (0.68-0.96)]. CONCLUSION Overall beverage intake quality, as assessed by the BQI, may represent an important target for the prevention of recurrent CVD.
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Affiliation(s)
- Maria G Jacobo Cejudo
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
| | - Renée van Laarhoven
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
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van Lanen AS, Kok DE, Wesselink E, Derksen JWG, May AM, Smit KC, Koopman M, de Wilt J, Kampman E, van Duijnhoven FJB. Associations between low- and high-fat dairy intake and recurrence risk in people with stage I-III colorectal cancer differ by sex and primary tumour location. Int J Cancer 2024; 155:828-838. [PMID: 38700376 DOI: 10.1002/ijc.34959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 05/05/2024]
Abstract
We previously demonstrated that intake of low-fat dairy, but not high-fat dairy, was associated with a decreased colorectal cancer (CRC) recurrence risk. These risks, however, may differ by sex, primary tumour location, and disease stage. Combining data from two similar prospective cohort studies of people with stage I-III CRC enabled these subgroup analyses. Participants completed a food frequency questionnaire at diagnosis (n = 2283). We examined associations between low- and high-fat dairy intake and recurrence risk using multivariable Cox proportional hazard models, stratified by sex, and primary tumour location (colon and rectum), and disease stage (I/II and III). Upper quartiles were compared to lower quartiles of intake, and recurrence was defined as a locoregional recurrence and/or metastasis. During a median follow-up of 5.0 years, 331 recurrences were detected. A higher intake of low-fat dairy was associated with a reduced risk of recurrence (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.43-0.83), which seemed more pronounced in men (HR: 0.51, 95% CI: 0.34-0.77) than in women (HR: 0.84, 95% CI: 0.47-1.49). A higher intake of high-fat dairy was associated with an increased risk of recurrence in participants with colon cancer (HR: 1.60, 95% CI: 1.03-2.50), but not rectal cancer (HR: 0.88, 95% CI: 0.54-1.45). No differences in associations were observed between strata of disease stage. Concluding, our findings imply that dietary advice regarding low-fat dairy intake may be especially important for men with CRC, and that dietary advice regarding high-fat dairy intake may be specifically important in people with colon cancer.
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Affiliation(s)
- Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Jeroen W G Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel C Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes de Wilt
- Department of Surgery, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Oyelere AM, Kok DE, Bos D, Gunter MJ, Ferrari P, Keski-Rahkonen P, de Wilt JHW, van Halteren HK, Kouwenhoven EA, van Duijnhoven FJB, Kampman E. Coffee consumption is associated with a reduced risk of colorectal cancer recurrence and all-cause mortality. Int J Cancer 2024; 154:2054-2063. [PMID: 38346920 DOI: 10.1002/ijc.34879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 04/14/2024]
Abstract
Coffee consumption has been associated with a reduced risk of developing colorectal cancer (CRC). However, it is not clear whether coffee consumption is related to CRC progression. Hence, we assessed the association of coffee consumption with CRC recurrence and all-cause mortality using data from a prospective cohort study of 1719 stage I-III CRC patients in the Netherlands. Coffee consumption and other lifestyle characteristics were self-reported using questionnaires at the time of diagnosis. We retrieved recurrence and all-cause mortality data from the Netherlands Cancer Registry and the Personal Records Database, respectively. Cox proportional hazard regression models with and without restricted cubic splines were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, sex, education, smoking status, cancer stage and tumor location. We observed 257 recurrences during a 6.2-year median follow-up and 309 deaths during a 6.6-year median follow-up. Consuming more than 4 cups/d of coffee compared to an intake of <2 cups/d was associated with a 32% lower risk of CRC recurrence (95% CI: 0.49, 0.94,). The association between coffee consumption and all-cause mortality was U-shaped; coffee intake seemed optimal at 3-5 cups/d with the lowest risk at 4 cups/d (HR: 0.68, 95% CI: 0.53, 0.88). Our results suggest that coffee consumption may be associated with a lower risk of CRC recurrence and all-cause mortality. The association between coffee consumption and all-cause mortality appeared nonlinear. More studies are needed to understand the mechanism by which coffee consumption might improve CRC prognosis.
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Affiliation(s)
- Abisola M Oyelere
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Epidemiology and Biostatistics School of Public Health, Imperial College London, London, UK
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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van Lanen AS, Kok DE, Wesselink E, Winkels RM, van Halteren HK, de Wilt JHW, Kampman E, van Duijnhoven FJB. Pre- and post-diagnostic dairy intake in relation to recurrence and all-cause mortality in people with stage I-III colorectal cancer. Eur J Nutr 2023; 62:2891-2904. [PMID: 37393586 PMCID: PMC10468734 DOI: 10.1007/s00394-023-03201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Higher dairy consumption is associated with a lower risk of colorectal cancer (CRC), but no studies thus far have investigated its relation with recurrence in CRC. Few studies have investigated total dairy in relation to mortality in CRC, and yielded inconsistent results. METHODS In this prospective cohort study, people newly diagnosed with stage I-III CRC filled out a food frequency questionnaire at diagnosis (n = 1812) and six months after diagnosis (n = 1672). We examined associations between pre- and post-diagnostic intake of total dairy, low-fat dairy, high-fat dairy, milk, yoghurt, and cheese with recurrence and all-cause mortality using multivariable Cox proportional hazard models and restricted cubic splines (RCS). RESULTS A total of 176 recurrences and 301 deaths occurred during a median follow-up of 3.0 and 5.9 years, respectively. Before diagnosis, a higher low-fat dairy intake was associated with a lower risk of recurrence (HRQ4vsQ1: 0.42, 95% CI 0.26-0.67; PRCS: 0.008) and all-cause mortality (HRQ4vsQ1: 0.58, 95% CI 0.41-0.81; PRCS < 0.001), whereas a higher high-fat dairy consumption tended to be associated with an increased all-cause mortality risk (HRQ4vsQ1: 1.41, 95% CI 0.98-2.01; PRCS: 0.030). After diagnosis, only the associations between low- and high-fat dairy in relation to all-cause mortality remained. CONCLUSIONS This study demonstrated that higher pre- and post-diagnostic intakes of low-fat dairy were associated with a reduced all-cause mortality risk in people with stage I-III CRC, whereas higher intakes of high-fat dairy were associated with an increased all-cause mortality risk. Also, a higher pre-diagnostic low-fat dairy intake was associated with a reduced risk of recurrence. TRIAL REGISTRATION Clinical Trials.gov identifier: NCT03191110.
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Affiliation(s)
- Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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van Westing AC, Cruijsen E, Voortman T, Geleijnse JM. Dairy products and kidney function decline after myocardial infarction: A prospective analysis in the Alpha Omega Cohort. Clin Nutr 2023:S0261-5614(23)00166-8. [PMID: 37308369 DOI: 10.1016/j.clnu.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND & AIMS Population-based studies have shown both beneficial and neutral associations between dairy consumption and kidney function outcomes. We investigated the association between dairy products and kidney function decline in drug-treated post-myocardial infarction (MI) patients. METHODS We analysed data of 2169 post-MI patients (aged 60-80 years, 81% male) of the Alpha Omega Cohort. Dietary data were collected at baseline (2002-2006) using a validated 203-item food frequency questionnaire. The 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to estimate 40-months change in creatinine-cystatin C based glomerular filtration rate (eGFRcr-cysC, mL/min per 1.73 m2). Beta coefficients and 95% confidence intervals (CIs) for dairy products in relation to annual eGFRcr-cysC change were obtained from multivariable linear regression, adjusted for age, sex, energy intake, and other lifestyle and dietary factors. RESULTS Baseline energy-adjusted median intakes were 64 g/day for total milk, 20 g/day for hard cheeses, 18 g/day for plain yogurt, and 70 g/day for dairy desserts. Mean ± SD eGFRcr-cysC was 84 ± 20 (13% with CKD), and annual eGFRcr-cysC change was -1.71 ± 3.85. In multivariable models, high vs. low intakes of total milk, cheese, and dairy desserts were not associated with annual eGFRcr-cysC change (βtotal milk: -0.21 [-0.60; 0.19], βcheese: -0.08 [-0.52; 0.36], βdairy desserts: -0.24 [-0.72; 0.24]). High vs. low intake of yogurt was adversely associated with annual eGFRcr-cysC change (βtotal yogurt: -0.50 [-0.91;-0.09]), but subsequent spline analyses showed no clear dose-response association. CONCLUSIONS Intakes of milk, cheese or dairy desserts were not associated with a delayed kidney function decline after MI. The observed adverse association for yogurt should be interpreted with caution. Our findings require confirmation in other cohorts of coronary heart disease patients.
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Affiliation(s)
- Anniek C van Westing
- Division of Human Nutrition and Health, Wageningen University & Research, the Netherlands.
| | - Esther Cruijsen
- Division of Human Nutrition and Health, Wageningen University & Research, the Netherlands
| | - Trudy Voortman
- Division of Human Nutrition and Health, Wageningen University & Research, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University & Research, the Netherlands
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Osté MCJ, Duan MJ, Gomes-Neto AW, Vinke PC, Carrero JJ, Avesani C, Cai Q, Dekker LH, Navis GJ, Bakker SJL, Corpeleijn E. Ultra-processed foods and risk of all-cause mortality in renal transplant recipients. Am J Clin Nutr 2022; 115:1646-1657. [PMID: 35470855 PMCID: PMC9170470 DOI: 10.1093/ajcn/nqac053] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Renal transplant recipients (RTRs) have a 6-fold higher risk of mortality than age- and sex-matched controls. Whether high consumption of ultra-processed foods is associated with survival in RTRs is unknown. OBJECTIVES We aimed to study the association between high consumption of ultra-processed foods and all-cause mortality in stable RTRs. METHODS We conducted a prospective cohort study in adult RTRs with a stable graft. Dietary intake was assessed using a validated 177-item FFQ. Food items were categorized according to the NOVA classification system and the proportion ultra-processed foods comprised of total food weight per day was calculated. RESULTS We included 632 stable RTRs (mean ± SD age: 53.0 ± 12.7 y, 57% men). Mean ± SD consumption of ultra-processed foods was 721 ± 341 g/d (28% of total weight of food intake), whereas the intake of unprocessed and minimally processed foods, processed culinary ingredients, and processed foods accounted for 57%, 1%, and 14%, respectively. During median follow-up of 5.4 y [IQR: 4.9-6.0 y], 129 (20%) RTRs died. In Cox regression analyses, ultra-processed foods were associated with all-cause mortality (HR per doubling of percentage of total weight: 2.13; 95% CI: 1.46, 3.10; P < 0.001), independently of potential confounders. This association was independent from the quality of the overall dietary pattern, expressed by the Mediterranean Diet Score (MDS) or Dietary Approaches to Stop Hypertension (DASH) score. When analyzing ultra-processed foods by groups, only sugar-sweetened beverages (HR: 1.21; 95% CI: 1.05, 1.39; P = 0.007), desserts (HR: 1.24; 95% CI: 1.02, 1.49; P = 0.03), and processed meats (HR: 1.87; 95% CI: 1.22, 2.86; P = 0.004) were associated with all-cause mortality. CONCLUSIONS Consumption of ultra-processed foods, in particular sugar-sweetened beverages, desserts, and processed meats, is associated with a higher risk of all-cause mortality after renal transplantation, independently of low adherence to high-quality dietary patterns, such as the Mediterranean diet and the DASH diet.This trial was registered at clinicaltrials.gov as NCT02811835.
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Affiliation(s)
| | - Ming-Jie Duan
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Antonio W Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Petra C Vinke
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Carla Avesani
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - QingQing Cai
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Louise H Dekker
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Crowther ME, Ferguson SA, Reynolds AC. Longitudinal studies of sleep, physical activity and nutritional intake in shift workers: A scoping review. Sleep Med Rev 2022; 63:101612. [DOI: 10.1016/j.smrv.2022.101612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
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Cruijsen E, Indyk IM, Simon AWE, Busstra MC, Geleijnse JM. Potato Consumption and Risk of Cardiovascular Mortality and Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort. Front Nutr 2022; 8:813851. [PMID: 35155529 PMCID: PMC8829223 DOI: 10.3389/fnut.2021.813851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Higher potato intake, especially French fries, was unfavorably associated with cardiometabolic endpoints in population-based studies. Little is known about this in patients with ischemic heart disease (IHD). Objective Total and boiled potatoes and French fries intake were examined in relation to cardiovascular disease (CVD) mortality, all-cause mortality, and type 2 diabetes mellitus (T2DM) risk in Dutch post-myocardial infarction (MI) patients of the Alpha Omega Cohort. Methods We analyzed 3,401 patients (60–80 years, 78% male), free from T2DM at baseline, with an MI ≤ 10 years before enrolment. Diet was assessed at baseline (2002–2006) using a 203-item validated Food Frequency Questionnaire (FFQ) that includes potato preparation methods. Cause-specific mortality was monitored through December 2018, and T2DM incidence (self-reported physician diagnosis and/or prescribed anti-diabetes medication) was monitored during the first 40 months of follow-up. Multivariable Cox models were used to obtain hazard ratios (HRs) for fatal endpoints and incident T2DM in tertiles of potato intake. Results Patients had a median total potato intake (mainly boiled) of 111 g/d, 96% consumed >1 serving (200 g) per week. French fries were consumed by 48% of the patients (median of 6 g/d among consumers). During >12 years of follow-up (38,987 person-years), 1,476 deaths occurred of which 641 were from CVD, 394 were from IHD, and 119 were from a stroke. Total and boiled potatoes were not associated with CVD mortality, but a higher risk of all-cause mortality was observed (HR: 1.07; 95% CI: 1.01, 1.14; per 50 g/d). Potato consumption tended to be positively associated with incident T2DM (186 cases; HR: 1.11, 95% CI: 0.94, 1.32; per 50 g/d). Results for French fries were inconsistent for all outcomes. Conclusion In Dutch post-MI patients, potatoes (mainly boiled) were not associated with CVD mortality but possibly adversely associated with all-cause mortality and T2DM risk. These findings warrant confirmation in other IHD patient cohorts. The Alpha Omega Cohort is registered at ClinicalTrials.gov as NCT03192410.
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Pertiwi K, Küpers LK, de Goede J, Zock PL, Kromhout D, Geleijnse JM. Dietary and Circulating Long-Chain Omega-3 Polyunsaturated Fatty Acids and Mortality Risk After Myocardial Infarction: A Long-Term Follow-Up of the Alpha Omega Cohort. J Am Heart Assoc 2021; 10:e022617. [PMID: 34845924 PMCID: PMC9075367 DOI: 10.1161/jaha.121.022617] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Habitual intake of long-chain omega-3 fatty acids, especially eicosapentaenoic and docosahexaenoic acid (EPA+DHA) from fish, has been associated with a lower risk of fatal coronary heart disease (CHD) in population-based studies. Whether that is also the case for patients with CHD is not yet clear. We studied the associations of dietary and circulating EPA+DHA and alpha-linolenic acid, a plant-derived omega-3 fatty acids, with long-term mortality risk after myocardial infarction. Methods and Results We analyzed data from 4067 Dutch patients with prior myocardial infarction aged 60 to 80 years (79% men, 86% on statins) enrolled in the Alpha Omega Cohort from 2002 to 2006 (baseline) and followed through 2018. Baseline intake of fish and omega-3 fatty acids were assessed through a validated 203-item food frequency questionnaire and circulating omega-3 fatty acids were assessed in plasma cholesteryl esters. Hazard ratios (HRs) with 95% CIs were obtained from Cox regression analyses. During a median follow-up period of 12 years, 1877 deaths occurred, of which 515 were from CHD and 834 from cardiovascular diseases. Dietary intake of EPA+DHA was significantly inversely associated with only CHD mortality (HR, 0.69 [0.52-0.90] for >200 versus ≤50 mg/d; HR, 0.92 [0.86-0.98] per 100 mg/d). Similar results were obtained for fish consumption (HRCHD, 0.74 [0.53-1.03] for >40 versus ≤5 g/d; Ptrend: 0.031). Circulating EPA+DHA was inversely associated with CHD mortality (HR, 0.71 [0.53-0.94] for >2.52% versus ≤1.29%; 0.85 [0.77-0.95] per 1-SD) and also with cardiovascular diseases and all-cause mortality. Dietary and circulating alpha-linolenic acid were not significantly associated with mortality end points. Conclusions In a cohort of Dutch patients with prior myocardial infarction, higher dietary and circulating EPA+DHA and fish intake were consistently associated with a lower CHD mortality risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03192410.
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Affiliation(s)
- Kamalita Pertiwi
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands
| | - Leanne K Küpers
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands
| | - Janette de Goede
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands
| | - Peter L Zock
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands
| | - Daan Kromhout
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands.,Department of Epidemiology University Medical Center Groningen Groningen the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health Wageningen University Wageningen the Netherlands
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Jacobo Cejudo MG, Cruijsen E, Heuser C, Soedamah-Muthu SS, Voortman T, Geleijnse JM. Dairy Consumption and 3-Year Risk of Type 2 Diabetes after Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort. Nutrients 2021; 13:nu13093146. [PMID: 34579026 PMCID: PMC8467112 DOI: 10.3390/nu13093146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Population-based studies suggest a role for dairy, especially yogurt, in the prevention of type 2 diabetes (T2D). Whether dairy affects T2D risk after myocardial infarction (MI) is unknown. We examined associations of (types of) dairy with T2D incidence in drug-treated, post-MI patients from the Alpha Omega Cohort. The analysis included 3401 patients (80% men) aged 60-80 y who were free of T2D at baseline (2002-2006). Dairy intakes were assessed using a validated food-frequency questionnaire. Incident T2D was ascertained through self-reported physician diagnosis and/or medication use. Multivariable Cox models were used to calculate Hazard ratios (HRs) and 95% confidence intervals (CI) for T2D with dairy intake in categories and per 1-standard deviation (SD) increment. Most patients consumed dairy, and median intakes were 264 g/d for total dairy, 82 g/d for milk and 41 g/d for yogurt. During 40 months of follow-up (10,714 person-years), 186 patients developed T2D. After adjustment for confounders, including diet, HRs per 1-SD were 1.06 (95% CI 0.91-1.22) for total dairy, 1.02 (0.88-1.18) for milk and 1.04 (0.90-1.20) for yogurt. Associations were also absent for other dairy types and in dairy categories (all p-trend > 0.05). Our findings suggest no major role for dairy consumption in T2D prevention after MI.
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Affiliation(s)
- Maria G. Jacobo Cejudo
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (E.C.); (C.H.); (T.V.); (J.M.G.)
- Correspondence: ; Tel.: +31-629-155870
| | - Esther Cruijsen
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (E.C.); (C.H.); (T.V.); (J.M.G.)
| | - Christiane Heuser
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (E.C.); (C.H.); (T.V.); (J.M.G.)
| | - Sabita S. Soedamah-Muthu
- Center of Research on Psychological and Somatic Disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands;
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, UK
| | - Trudy Voortman
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (E.C.); (C.H.); (T.V.); (J.M.G.)
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Johanna M. Geleijnse
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (E.C.); (C.H.); (T.V.); (J.M.G.)
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11
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Kok DE, Arron MNN, Huibregtse T, Kruyt FM, Bac DJ, van Halteren HK, Kouwenhoven EA, Wesselink E, Winkels RM, van Zutphen M, van Duijnhoven FJB, de Wilt JHW, Kampman E. Association of Habitual Preoperative Dietary Fiber Intake With Complications After Colorectal Cancer Surgery. JAMA Surg 2021; 156:2781033. [PMID: 34132738 PMCID: PMC8209565 DOI: 10.1001/jamasurg.2021.2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/31/2021] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Postoperative complications are associated with increased morbidity and mortality among patients with colorectal cancer. As a modifiable factor associated with gut health, dietary fiber intake is of interest with regard to the risk of complications after surgery for colorectal cancer. OBJECTIVE To examine the association between preoperative dietary fiber intake and risk of complications after surgery for colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study, which recruited adult patients with colorectal cancer at any stage at diagnosis from 11 hospitals in the Netherlands between August 2010 and December 2017. The present study included patients with stage I to IV colorectal cancer who underwent elective abdominal surgery. Data were analyzed between December 2019 and September 2020. EXPOSURES Habitual dietary fiber intake was assessed at diagnosis using a 204-item food frequency questionnaire. MAIN OUTCOMES AND MEASURES Any complications, surgical complications, and anastomotic leakage occurring during the 30 days after surgery for colorectal cancer. The association between fiber intake and risk of postoperative complications was assessed using logistic regression analyses. Additional analyses stratified by sex, tumor location, and fiber source were performed. RESULTS Among the 1399 patients included in the analysis, the median age at inclusion was 66 years (interquartile range, 61-72 years) and 896 (64%) were men. Any complications occurred in 397 patients (28%), and surgical complications occurred in 235 patients (17%). Of 1237 patients with an anastomosis, 67 (5%) experienced anastomotic leakage. Higher dietary fiber intake (per 10 g per day) was associated with a lower risk of any complications (odds ratio [OR], 0.75; 95% CI, 0.62-0.92) and surgical complications (OR, 0.76; 95% CI, 0.60-0.97), whereas no association with anastomotic leakage was found (OR, 0.97; 95% CI, 0.66-1.43). Among women, higher dietary intake was associated with any complications (OR, 0.64; 95% CI, 0.44-0.94), whereas there was no association among men (OR, 0.79; 95% CI, 0.63-1.01). Fiber intake from vegetables (per 1 g per day) was inversely associated with any (OR, 0.90; 95% CI, 0.83-0.99) and surgical (OR, 0.87; 95% CI, 0.78-0.97) complications. CONCLUSIONS AND RELEVANCE In this cohort study, higher habitual dietary fiber intake before surgery was associated with a lower risk of postoperative complications among patients with colorectal cancer. The findings suggest that improving preoperative dietary fiber intake may be considered in future prehabilitation programs for patients undergoing surgery for colorectal cancer.
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Affiliation(s)
- Dieuwertje E. Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Melissa N. N. Arron
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tess Huibregtse
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Flip M. Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Dirk Jan Bac
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Henk K. van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | | | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M. Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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12
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van Westing AC, Eckl MR, Küpers LK, Pertiwi K, Hoogeveen EK, Geleijnse JM. Plasma fatty acids and kidney function decline in post-myocardial infarction patients of the Alpha Omega Cohort. Nutr Metab Cardiovasc Dis 2021; 31:1467-1476. [PMID: 33744039 DOI: 10.1016/j.numecd.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/18/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Age-related kidney function decline is accelerated in patients with coronary heart disease (CHD). CHD and chronic kidney disease may share common etiologies. We examined plasma fatty acids (FAs) as novel biomarkers of kidney function decline after myocardial infarction (MI). METHODS AND RESULTS The analysis included 2329 Dutch post-MI patients aged 60-80y (Alpha Omega Cohort) most receiving state-of-the-art medications. Plasma FAs (% total FAs) in cholesteryl esters were assessed at baseline (2002-2006), and ∼40 months change in creatinine-cystatin C based glomerular filtration rate was estimated (eGFR, in ml/min per 1.73 m2). Beta coefficients for annual eGFR change in relation to plasma linoleic acid (LA; 50.1% of total FAs in CE), omega-3 FAs (EPA + DHA; 1.7%), odd-chain FAs (C15:0 and C17:0; 0.2%), and C14:0 (0.7%) were obtained from linear regression analyses adjusted for age, sex, smoking, and alcohol intake. Mean baseline eGFR ±SD was 78.5 ± 18.7, which declined by 4.7 ± 13.1 during follow-up, or 1.4 ± 3.9 per year. The annual decline in eGFR was less in patients with higher plasma LA (adjusted beta: 0.40 for LA >47 vs ≤ 47%, 95% CI: 0.01; 0.78; p = 0.046). Associations of plasma LA with annual eGFR decline were stronger in 437 patients with diabetes (1.21, 0.24; 2.19) and in 402 patients with CKD (eGFR<60; 0.90, -0.09; 1.89). Weaker, non-significant associations with kidney function decline were observed for the other plasma FAs. CONCLUSION Higher plasma LA may be a good predictor of less kidney function decline after MI, particularly in patients with diabetes. The Alpha Omega Cohort is registered with clinicaltrials.gov, NCT03192410.
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Affiliation(s)
- Anniek C van Westing
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
| | - Marion R Eckl
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Leanne K Küpers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Kamalita Pertiwi
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
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13
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Cruijsen E, Jacobo Cejudo MG, Küpers LK, Busstra MC, Geleijnse JM. Dairy consumption and mortality after myocardial infarction: a prospective analysis in the Alpha Omega Cohort. Am J Clin Nutr 2021; 114:59-69. [PMID: 33826695 PMCID: PMC8246616 DOI: 10.1093/ajcn/nqab026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Population-based studies generally show neutral associations between dairy consumption and ischemic heart disease (IHD) mortality, whereas weak inverse associations were found for cardiovascular disease (CVD) and stroke mortality. Whether dairy consumption affects long-term survival after myocardial infarction (MI) is unknown. OBJECTIVES We studied types of dairy and long-term mortality risk in drug-treated post-MI patients. METHODS We included 4365 Dutch patients from the Alpha Omega Cohort aged 60-80 y (21% women) with an MI ≤10 y before enrollment. Dietary data were collected at baseline (2002-2006) using a 203-item FFQ and patients were followed for cause-specific mortality through December 2018. HRs of CVD, IHD, stroke, and all-cause mortality for types of dairy were obtained from Cox models, adjusting for age, sex, energy intake, physical activity, smoking, alcohol intake, diabetes, obesity, and dietary factors. RESULTS Most patients were Dutch, 24% were obese, 20% had diabetes, and 97% used cardiovascular medication. Median intakes were 39 g/d for plain yogurt, 88 g/d for total nonfermented milk, and 17 g/d for hard cheeses. Of the cohort, 10% consumed high-fat milk. During ∼12 y of follow-up (48,473 person-years) 2035 deaths occurred, including 903 from CVD, 558 from IHD, and 170 from stroke. Yogurt was linearly inversely associated with CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99; per 25 g/d) and nonlinearly inversely associated with all-cause mortality. Milk was not associated with any of the outcomes (HRs: ∼1.0 per 100 g/d), except for a higher mortality risk in high-fat milk consumers (HR: 1.30; 95% CI: 1.13, 1.49). Other dairy groups were not associated with mortality risk. CONCLUSIONS In Dutch post-MI patients, yogurt consumption was inversely associated with CVD mortality and all-cause mortality. Associations for milk and other dairy products were neutral or inconsistent.This trial was registered at clinicaltrials.gov as NCT03192410.
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Affiliation(s)
| | - Maria G Jacobo Cejudo
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Leanne K Küpers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Maria C Busstra
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
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14
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Coerts FB, Gout-Zwart JJ, Gruppen EG, van der Veen Y, Postma MJ, Bakker SJL. Modelling the Cost-Effectiveness of Implementing a Dietary Intervention in Renal Transplant Recipients. Nutrients 2021; 13:nu13041175. [PMID: 33918259 PMCID: PMC8066697 DOI: 10.3390/nu13041175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The Dietary Approach to Stop Hypertension (DASH) and potassium supplementation have been shown to reduce the risk of death with a functioning graft (DWFG) and renal graft failure in renal transplant recipients (RTR). Unfortunately, a key problem for patients is the adherence to these diets. The aim of this study is to evaluate the cost-effectiveness and budget impact of higher adherence to either the DASH or potassium supplementation. Methods: A Markov model was used to simulate the life course of 1000 RTR in the Netherlands. A societal perspective with a lifetime time horizon was used. The potential effect of improvement of dietary adherence was modelled in different scenarios. The primary outcomes are the incremental cost-effectiveness ratio (ICER) and the budget impact. Results: In the base case, improved adherence to the DASH diet saved 27,934,786 and gained 1880 quality-adjusted life years (QALYs). Improved adherence to potassium supplementation saved €1,217,803 and gained 2901 QALYs. Both resulted in dominant ICERs. The budget impact over a five-year period for the entire Dutch RTR population was €8,144,693. Conclusion: Improving dietary adherence in RTR is likely to be cost-saving and highly likely to be cost-effective compared to the current standard of care in the Netherlands.
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Affiliation(s)
- Friso B Coerts
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Judith J Gout-Zwart
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Asc Academics, Professor Enno Dirk Wiersmastraat 5, 9713 GH Groningen, The Netherlands
| | - Eke G Gruppen
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Yvonne van der Veen
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Nettelbosje 2, 9747 AE Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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15
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Association of Circulating Trimethylamine N-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study. Nutrients 2021; 13:nu13010262. [PMID: 33477634 PMCID: PMC7831477 DOI: 10.3390/nu13010262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background. Due to the critical shortage of kidneys for transplantation, the identification of modifiable factors related to graft failure is highly desirable. The role of trimethylamine-N-oxide (TMAO) in graft failure remains undetermined. Here, we investigated the clinical utility of TMAO and its dietary determinants for graft failure prediction in renal transplant recipients (RTRs). Methods. We included 448 RTRs who participated in the TransplantLines Cohort Study. Cox proportional-hazards regression analyses were performed to study the association of plasma TMAO with graft failure. Net Benefit, which is a decision analysis method, was performed to evaluate the clinical utility of TMAO and dietary information in the prediction of graft failure. Results. Among RTRs (age 52.7 ± 13.1 years; 53% males), the baseline median TMAO was 5.6 (3.0–10.2) µmol/L. In multivariable regression analysis, the most important dietary determinants of TMAO were egg intake (Std. β = 0.09 [95%CI, 0.01; 0.18]; p = 0.03), fiber intake (Std. β = −0.14 [95%CI, −0.22, −0.05]; p = 0.002), and fish and seafood intake (Std. β = 0.12 [95%CI, 0.03,0.21]; p = 0.01). After a median follow-up of 5.3 (4.5–6.0) years, graft failure was observed in 58 subjects. TMAO was associated with an increased risk of graft failure, independent of age, sex, the body mass index (BMI), blood pressure, lipids, albuminuria, and the Estimated Glomerular Filtration Rate (eGFR) (Hazard Ratio per 1-SD increase of TMAO, 1.62 (95% confidence interval (CI): 1.22; 2.14, p < 0.001)). A TMAO and dietary enhanced prediction model offered approximately double the Net Benefit compared to a previously reported, validated prediction model for future graft failure, allowing the detection of 21 RTRs per 100 RTRs tested, with no false positives versus 10 RTRs, respectively. Conclusions. A predictive model for graft failure, enriched with TMAO and its dietary determinants, yielded a higher Net Benefit compared with an already validated model. This study suggests that TMAO and its dietary determinants are associated with an increased risk of graft failure and that it is clinically meaningful.
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16
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Inflammation Is a Mediating Factor in the Association between Lifestyle and Fatigue in Colorectal Cancer Patients. Cancers (Basel) 2020; 12:cancers12123701. [PMID: 33317113 PMCID: PMC7763620 DOI: 10.3390/cancers12123701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023] Open
Abstract
Simple Summary Fatigue is common among colorectal cancer patients. A healthier lifestyle may beneficially affect fatigue, although data are sparse. A healthier lifestyle may result in lower levels of inflammation, which is one of the suggested mechanisms by which lifestyle could influence fatigue. In an observational study, we investigated 1) whether a healthier lifestyle was associated with less fatigue among colorectal cancer patients, and 2) whether this association could be explained by inflammation. We showed that a healthier lifestyle was associated with less fatigue, and that inflammation levels mediated this association. Future intervention studies should investigate whether improving lifestyle after cancer diagnosis results in lowering of inflammation markers and subsequent fatigue. Abstract Fatigue is very common among colorectal cancer (CRC) patients. We examined the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and fatigue among stage I-III CRC patients, and whether inflammation mediated this association. Data from two prospective cohort studies were used. Adherence to the WCRF/AICR recommendations was expressed as a score ranging from 0–7, and assessed shortly after diagnosis. Six months post-diagnosis, fatigue was assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire C30 (EORTC QLQ-C30), and in a subpopulation, the plasma levels of inflammation markers (IL6, IL8, TNFα, and hsCRP) were assessed. Multiple linear regression analyses were performed to investigate the association between adherence to the WCRF/AICR recommendations and fatigue. To test mediation by inflammation, the PROCESS analytic tool developed by Hayes was used. A higher WCRF/AICR adherence score was associated with less fatigue six months after diagnosis (n = 1417, β −2.22, 95%CI −3.65; −0.78). In the population of analysis for the mediation analyses (n = 551), the total association between lifestyle and fatigue was (β −2.17, 95% CI −4.60; 0.25). A statistically significant indirect association via inflammation was observed (β −0.97, 95% CI −1.92; −0.21), explaining 45% of the total association between lifestyle and fatigue (−0.97/−2.17 × 100). Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.
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17
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Alferink LJM, Erler NS, de Knegt RJ, Janssen HLA, Metselaar HJ, Darwish Murad S, Kiefte-de Jong JC. Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population. Eur J Epidemiol 2020; 35:1069-1085. [PMID: 32323115 PMCID: PMC7695656 DOI: 10.1007/s10654-020-00627-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Dietary lifestyle intervention is key in treating non-alcoholic fatty liver disease (NAFLD). We aimed to examine the longitudinal relation between well-established dietary patterns as well as population-specific dietary patterns and NAFLD. Participants from two subsequent visits of the Rotterdam Study were included. All underwent serial abdominal ultrasonography (median follow-up: 4.4 years) and filled in a food frequency questionnaire. Secondary causes of steatosis were excluded. Dietary data from 389 items were collapsed into 28 food groups and a posteriori dietary patterns were identified using factor analysis. Additionally, we scored three a priori dietary patterns (Mediterranean Diet Score, Dutch Dietary Guidelines and WHO-score). Logistic mixed regression models were used to examine the relation between dietary patterns and NAFLD. Analyses were adjusted for demographic, lifestyle and metabolic factors. We included 963 participants of whom 343 had NAFLD. Follow-up data was available in 737 participants. Incident NAFLD was 5% and regressed NAFLD was 30%. We identified five a posteriori dietary patterns (cumulative explained variation [R2] = 20%). The patterns were characterised as: vegetable and fish, red meat and alcohol, traditional, salty snacks and sauces, high fat dairy & refined grains pattern. Adherence to the traditional pattern (i.e. high intake of vegetable oils/stanols, margarines/butters, potatoes, whole grains and sweets/desserts) was associated with regression of NAFLD per SD increase in Z-score (0.40, 95% CI 0.15–1.00). Adherence to the three a priori patterns all showed regression of NAFLD, but only the WHO-score showed a distinct association (0.73, 95% CI 0.53–1.00). Hence, in this large elderly population, adherence to a plant-based, high-fibre and low-fat diet was related to regression of NAFLD.
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Affiliation(s)
- Louise J M Alferink
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Harry L A Janssen
- Toronto Centre of Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
- Department of Public Health and Primary Care/LUMC Campus The Hague, Leiden University Medical Center, Postzone VO-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
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18
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Osté MCJ, Flores-Guerrero JL, Gruppen EG, Kieneker LM, Connelly MA, Otvos JD, Dullaart RPF, Bakker SJL. High Plasma Branched-Chain Amino Acids Are Associated with Higher Risk of Post-Transplant Diabetes Mellitus in Renal Transplant Recipients. J Clin Med 2020; 9:jcm9020511. [PMID: 32069900 PMCID: PMC7073569 DOI: 10.3390/jcm9020511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/11/2020] [Indexed: 01/21/2023] Open
Abstract
Post-transplant diabetes mellitus (PTDM) is a serious complication in renal transplant recipients. Branched-chain amino acids (BCAAs) are involved in the pathogenesis of insulin resistance. We determined the association of plasma BCAAs with PTDM and included adult renal transplant recipients (≥18 y) with a functioning graft for ≥1 year in this cross-sectional cohort study with prospective follow-up. Plasma BCAAs were measured in 518 subjects using nuclear magnetic resonance spectroscopy. We excluded subjects with a history of diabetes, leaving 368 non-diabetic renal transplant recipients eligible for analyses. Cox proportional hazards analyses were used to assess the association of BCAAs with the development of PTDM. Mean age was 51.1 ± 13.6 y (53.6% men) and plasma BCAA was 377.6 ± 82.5 µM. During median follow-up of 5.3 (IQR, 4.2–6.0) y, 38 (9.8%) patients developed PTDM. BCAAs were associated with a higher risk of developing PTDM (HR: 1.43, 95% CI 1.08–1.89) per SD change (p = 0.01), independent of age and sex. Adjustment for other potential confounders did not significantly change this association, although adjustment for HbA1c eliminated it. The association was mediated to a considerable extent (53%) by HbA1c. The association was also modified by HbA1c; BCAAs were only associated with renal transplant recipients without prediabetes (HbA1c < 5.7%). In conclusion, high concentrations of plasma BCAAs are associated with developing PTDM in renal transplant recipients. Alterations in BCAAs may represent an early predictive biomarker for PTDM.
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Affiliation(s)
- Maryse C. J. Osté
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (L.M.K.); (S.J.L.B.)
- Correspondence: ; Tel.: +31-50-371-3449
| | - Jose L. Flores-Guerrero
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (L.M.K.); (S.J.L.B.)
| | - Eke G. Gruppen
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (E.G.G.); (R.P.F.D.)
| | - Lyanne M. Kieneker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (L.M.K.); (S.J.L.B.)
| | - Margery A. Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (M.A.C.); (J.D.O.)
| | - James D. Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (M.A.C.); (J.D.O.)
| | - Robin P. F. Dullaart
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (E.G.G.); (R.P.F.D.)
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (L.M.K.); (S.J.L.B.)
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Pertiwi K, Wanders AJ, Harbers MC, Küpers LK, Soedamah-Muthu SS, de Goede J, Zock PL, Geleijnse JM. Plasma and Dietary Linoleic Acid and 3-Year Risk of Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort. Diabetes Care 2020; 43:358-365. [PMID: 31727685 PMCID: PMC6971780 DOI: 10.2337/dc19-1483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study plasma and dietary linoleic acid (LA) in relation to type 2 diabetes risk in post-myocardial infarction (MI) patients. RESEARCH DESIGN AND METHODS We included 3,257 patients aged 60-80 years (80% male) with a median time since MI of 3.5 years from the Alpha Omega Cohort and who were initially free of type 2 diabetes. At baseline (2002-2006), plasma LA was measured in cholesteryl esters, and dietary LA was estimated with a 203-item food-frequency questionnaire. Incident type 2 diabetes was ascertained through self-reported physician diagnosis and medication use. Hazard ratios (with 95% CIs) were calculated by Cox regressions, in which dietary LA isocalorically replaced the sum of saturated (SFA) and trans fatty acids (TFA). RESULTS Mean ± SD circulating and dietary LA was 50.1 ± 4.9% and 5.9 ± 2.1% energy, respectively. Plasma and dietary LA were weakly correlated (Spearman r = 0.13, P < 0.001). During a median follow-up of 41 months, 171 patients developed type 2 diabetes. Plasma LA was inversely associated with type 2 diabetes risk (quintile [Q]5 vs. Q1: 0.44 [0.26, 0.75]; per 5%: 0.73 [0.62, 0.86]). Substitution of dietary LA for SFA+TFA showed no association with type 2 diabetes risk (Q5 vs. Q1: 0.78 [0.36, 1.72]; per 5% energy: 1.18 [0.59, 2.35]). Adjustment for markers of de novo lipogenesis attenuated plasma LA associations. CONCLUSIONS In our cohort of post-MI patients, plasma LA was inversely related to type 2 diabetes risk, whereas dietary LA was not related. Further research is needed to assess whether plasma LA indicates metabolic state rather than dietary LA in these patients.
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Affiliation(s)
- Kamalita Pertiwi
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Anne J Wanders
- Unilever Research and Development, Vlaardingen, the Netherlands
| | - Marjolein C Harbers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Leanne K Küpers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | | | - Janette de Goede
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Peter L Zock
- Unilever Research and Development, Vlaardingen, the Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
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Esmeijer K, Geleijnse JM, de Fijter JW, Kromhout D, Hoogeveen EK. Dietary protein intake and kidney function decline after myocardial infarction: the Alpha Omega Cohort. Nephrol Dial Transplant 2020; 35:106-115. [PMID: 30768201 PMCID: PMC8205500 DOI: 10.1093/ndt/gfz015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Post-myocardial infarction (MI) patients have a doubled rate of kidney function decline compared with the general population. We investigated the extent to which high intake of total, animal and plant protein are risk factors for accelerated kidney function decline in older stable post-MI patients. METHODS We analysed 2255 post-MI patients (aged 60-80 years, 80% men) of the Alpha Omega Cohort. Dietary data were collected with a biomarker-validated 203-item food frequency questionnaire. At baseline and 41 months, we estimated glomerular filtration rate based on the Chronic Kidney Disease Epidemiology Collaboration equations for serum cystatin C [estimated glomerular filtration rate (eGFRcysC)] alone and both creatinine and cystatin C (eGFRcr-cysC). RESULTS Mean [standard deviation (SD)] baseline eGFRcysC and eGFRcr-cysC were 82 (20) and 79 (19) mL/min/1.73 m2. Of all patients, 16% were current smokers and 19% had diabetes. Mean (SD) total protein intake was 71 (19) g/day, of which two-thirds was animal and one-third plant protein. After multivariable adjustment, including age, sex, total energy intake, smoking, diabetes, systolic blood pressure, renin-angiotensin system blocking drugs and fat intake, each incremental total daily protein intake of 0.1 g/kg ideal body weight was associated with an additional annual eGFRcysC decline of -0.12 (95% confidence interval -0.19 to -0.04) mL/min/1.73 m2, and was similar for animal and plant protein. Patients with a daily total protein intake of ≥1.20 compared with <0.80 g/kg ideal body weight had a 2-fold faster annual eGFRcysC decline of -1.60 versus -0.84 mL/min/1.73 m2. Taking eGFRcr-cysC as outcome showed similar results. Strong linear associations were confirmed by restricted cubic spline analyses. CONCLUSION A higher protein intake was significantly associated with a more rapid kidney function decline in post-MI patients.
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Affiliation(s)
- Kevin Esmeijer
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daan Kromhout
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
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Proton-Pump Inhibitors and Hypomagnesaemia in Kidney Transplant Recipients. J Clin Med 2019; 8:jcm8122162. [PMID: 31817776 PMCID: PMC6947083 DOI: 10.3390/jcm8122162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Proton-pump inhibitors (PPIs) are commonly used after kidney transplantation and there is rarely an incentive to discontinue treatment. In the general population, PPI use has been associated with hypomagnesaemia. We aimed to investigate whether PPI use is associated with plasma magnesium, 24-h urinary magnesium excretion and hypomagnesaemia, in kidney transplant recipients (KTR). Plasma magnesium and 24-h urinary magnesium excretion were measured in 686 stable outpatient KTR with a functioning allograft for ≥1 year from the TransplantLines Food and Nutrition Biobank and Cohort-Study (NCT02811835). PPIs were used by 389 KTR (56.6%). In multivariable linear regression analyses, PPI use was associated with lower plasma magnesium (β: −0.02, P = 0.02) and lower 24-h urinary magnesium excretion (β: −0.82, P < 0.001). Moreover, PPI users had a higher risk of hypomagnesaemia (plasma magnesium <0.70 mmol/L), compared with non-users (Odds Ratio (OR): 2.12; 95% confidence interval (CI) 1.43–3.15, P < 0.001). This risk tended to be highest among KTR taking high PPI dosages (>20 mg omeprazole Eq/day) and was independent of adjustment for potential confounders (OR: 2.46; 95% CI 1.32–4.57, P < 0.005). No interaction was observed between PPI use and the use of loop diuretics, thiazide diuretics, tacrolimus, or diabetes (Pinteraction > 0.05). These results demonstrate that PPI use is independently associated with lower magnesium status and hypomagnesaemia in KTR. The concomitant decrease in urinary magnesium excretion indicates that this likely is the consequence of reduced intestinal magnesium absorption. Based on these results, it might be of benefit to monitor magnesium status periodically in KTR on chronic PPI therapy.
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Alferink LJM, Kiefte-de Jong JC, Erler NS, de Knegt RJ, Hoorn EJ, Ikram MA, Janssen HLA, Metselaar HJ, Franco OH, Darwish Murad S. Diet-Dependent Acid Load-The Missing Link Between an Animal Protein-Rich Diet and Nonalcoholic Fatty Liver Disease? J Clin Endocrinol Metab 2019; 104:6325-6337. [PMID: 30977830 DOI: 10.1210/jc.2018-02792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Our group recently showed that animal protein was independently associated with nonalcoholic fatty liver disease (NAFLD). We hypothesize that this may be explained by a high diet-dependent acid load [dietary acid load (DAL)]. METHODS This cross-sectional study is embedded in a prospective population-based cohort. We estimated DAL proxies via food-frequency questionnaires using potential renal acid load (PRAL; using dietary protein, phosphorus, potassium, calcium, and magnesium intake), net endogenous acid production (NEAP; using protein and potassium intake), and the animal protein-to-potassium ratio (A:P). We defined NAFLD using ultrasound after excluding secondary steatogenic causes. We used logistic regression models-adjusted for sociodemographic, lifestyle, and metabolic traits-on categorized [quartile (Q)1 to 4] and continuous DAL proxies (allowing for nonlinearity) and NAFLD. RESULTS We included 3882 participants, of which 1337 had NAFLD. All DAL proxies were higher, meaning more acidic, in individuals with NAFLD (PRAL, -2.9 vs -5.5 mEq/d; NEAP, 37.0 vs 35.1 mEq/d; and A:P, 13.3 vs 12.4; all P < 0.001). The highest Q of DAL proxies was associated with NAFLD independent of sociodemographic and lifestyle confounders, but significance dissipated after correction for metabolic confounders and multiple testing. However, the P value for nonlinearity was significant in all DAL proxies (P < 0.001). Natural cubic splines performed better with than without DAL proxies in the fully adjusted model (all P ≤ 0.038). The highest probability of NAFLD was found for an acidic diet. CONCLUSIONS This study showed an independent nonlinear association between an acidic diet and NAFLD. Further studies with acid-base biomarkers are needed, but our findings might provide a mechanistic explanation for the harmful association between an animal protein-rich diet and NAFLD.
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Affiliation(s)
- Louise J M Alferink
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, LUMC-Campus, VA The Hague, Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, CN Rotterdam, Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
- Toronto Centre of Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, CA Rotterdam, Netherlands
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23
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Pertiwi K, Küpers LK, Wanders AJ, de Goede J, Zock PL, Geleijnse JM. Associations of dairy and fiber intake with circulating odd-chain fatty acids in post-myocardial infarction patients. Nutr Metab (Lond) 2019; 16:78. [PMID: 31754368 PMCID: PMC6854617 DOI: 10.1186/s12986-019-0407-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background Circulating odd-chain fatty acids pentadecanoic (15:0) and heptadecanoic acid (17:0) are considered to reflect dairy intake. In cohort studies, higher circulating 15:0 and 17:0 were associated with lower type 2 diabetes risk. A recent randomized controlled trial in humans suggested that fiber intake also increased circulating 15:0 and 17:0, potentially resulting from fermentation by gut microbes. We examined the associations of dairy and fiber intake with circulating 15:0 and 17:0 in patients with a history of myocardial infarction (MI). Methods We performed cross-sectional analyses in a subsample of 869 Dutch post-MI patients of the Alpha Omega Cohort who had data on dietary intake and circulating fatty acids. Dietary intakes (g/d) were assessed using a 203-item food frequency questionnaire. Circulating 15:0 and 17:0 (as % of total fatty acids) were measured in plasma phospholipids (PL) and cholesteryl esters (CE). Spearman correlations (rs) were computed between intakes of total dairy, dairy fat, fiber, and circulating 15:0 and 17:0. Results Patients were on average 69 years old, 78% was male and 21% had diabetes. Total dairy intake comprised predominantly milk and yogurt (69%). Dairy fat was mainly derived from cheese (47%) and milk (15%), and fiber was mainly from grains (43%). Circulating 15:0 in PL was significantly correlated with total dairy and dairy fat intake (both rs = 0.19, p < 0.001), but not with dietary fiber intake (rs = 0.05, p = 0.11). Circulating 17:0 in PL was correlated both with dairy intake (rs = 0.14 for total dairy and 0.11 for dairy fat, p < 0.001), and fiber intake (rs = 0.19, p < 0.001). Results in CE were roughly similar, except for a weaker correlation of CE 17:0 with fiber (rs = 0.11, p = 0.001). Circulating 15:0 was highest in those with high dairy intake irrespective of fiber intake, while circulating 17:0 was highest in those with high dairy and fiber intake. Conclusions In our cohort of post-MI patients, circulating 15:0 was associated with dairy intake but not fiber intake, whereas circulating 17:0 was associated with both dairy and fiber intake. These data suggest that cardiometabolic health benefits previously attributed to 17:0 as a biomarker of dairy intake may partly be explained by fiber intake.
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Affiliation(s)
- Kamalita Pertiwi
- 1Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Leanne K Küpers
- 1Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Anne J Wanders
- 2Future Health & Wellness, Unilever R&D, Vlaardingen, The Netherlands
| | - Janette de Goede
- 1Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Peter L Zock
- 2Future Health & Wellness, Unilever R&D, Vlaardingen, The Netherlands
| | - Johanna M Geleijnse
- 1Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
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24
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Urinary Excretion of N1-Methylnicotinamide, as a Biomarker of Niacin Status, and Mortality in Renal Transplant Recipients. J Clin Med 2019; 8:jcm8111948. [PMID: 31726722 PMCID: PMC6912198 DOI: 10.3390/jcm8111948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022] Open
Abstract
Renal transplant recipients (RTR) commonly suffer from vitamin B6 deficiency and its functional consequences add to an association with poor long-term outcome. It is unknown whether niacin status is affected in RTR and, if so, whether this affects clinical outcomes, as vitamin B6 is a cofactor in nicotinamide biosynthesis. We compared 24-h urinary excretion of N1-methylnicotinamide (N1-MN) as a biomarker of niacin status in RTR with that in healthy controls, in relation to dietary intake of tryptophan and niacin as well as vitamin B6 status, and investigated whether niacin status is associated with the risk of premature all-cause mortality in RTR. In a prospective cohort of 660 stable RTR with a median follow-up of 5.4 (4.7-6.1) years and 275 healthy kidney donors, 24-h urinary excretion of N1-MN was measured with liquid chromatography-tandem mass spectrometry LC-MS/MS. Dietary intake was assessed by food frequency questionnaires. Prospective associations of N1-MN excretion with mortality were investigated by Cox regression analyses. Median N1-MN excretion was 22.0 (15.8-31.8) μmol/day in RTR, compared to 41.1 (31.6-57.2) μmol/day in healthy kidney donors (p < 0.001). This difference was independent of dietary intake of tryptophan (1059 ± 271 and 1089 ± 308 mg/day; p = 0.19), niacin (17.9 ± 5.2 and 19.2 ± 6.2 mg/day; p < 0.001), plasma vitamin B6 (29.0 (17.5-49.5), and 42.0 (29.8-60.3) nmol/L; p < 0.001), respectively. N1-MN excretion was inversely associated with the risk of all-cause mortality in RTR (HR 0.57; 95% CI 0.45-0.71; p < 0.001), independent of potential confounders. RTR excrete less N1-MN in 24-h urine than healthy controls, and our data suggest that this difference cannot be attributed to lower dietary intake of tryptophan and niacin, nor vitamin B6 status. Importantly, lower 24-h urinary excretion of N1-MN is independently associated with a higher risk of premature all-cause mortality in RTR.
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Douwes RM, Gomes-Neto AW, Eisenga MF, Vinke JSJ, de Borst MH, van den Berg E, Berger SP, Touw DJ, Hak E, Blokzijl H, Navis G, Bakker SJL. Chronic Use of Proton-Pump Inhibitors and Iron Status in Renal Transplant Recipients. J Clin Med 2019; 8:E1382. [PMID: 31484461 PMCID: PMC6780301 DOI: 10.3390/jcm8091382] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
Proton-pump inhibitor (PPI) use may influence intestinal iron absorption. Low iron status and iron deficiency (ID) are frequent medical problems in renal transplant recipients (RTR). We hypothesized that chronic PPI use is associated with lower iron status and ID in RTR. Serum iron, ferritin, transferrin saturation (TSAT), and hemoglobin were measured in 646 stable outpatient RTR with a functioning allograft for ≥ 1 year from the "TransplantLines Food and Nutrition Biobank and Cohort Study" (NCT02811835). Median time since transplantation was 5.3 (1.8-12.0) years, mean age was 53 ± 13 years, and 56.2% used PPI. In multivariable linear regression analyses, PPI use was inversely associated with serum iron (β = -1.61, p = 0.001), natural log transformed serum ferritin (β = -0.31, p < 0.001), TSAT (β = -2.85, p = 0.001), and hemoglobin levels (β = -0.35, p = 0.007), independent of potential confounders. Moreover, PPI use was independently associated with increased risk of ID (Odds Ratio (OR): 1.57; 95% Confidence Interval (CI )1.07-2.31, p = 0.02). Additionally, the odds ratio in RTR taking a high PPI dose as compared to RTR taking no PPIs (OR 2.30; 95% CI 1.46-3.62, p < 0.001) was higher than in RTR taking a low PPI dose (OR:1.78; 95% CI 1.21-2.62, p= 0.004). We demonstrated that PPI use is associated with lower iron status and ID, suggesting impaired intestinal absorption of iron. Moreover, we found a stronger association with ID in RTR taking high PPI dosages. Use of PPIs should, therefore, be considered as a modifiable cause of ID in RTR.
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Affiliation(s)
- Rianne M Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Joanna Sophia J Vinke
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Else van den Berg
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Eelko Hak
- Unit PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands.
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
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26
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Winkels RM, van Brakel L, van Baar H, Beelman RB, van Duijnhoven FJB, Geijsen A, van Halteren HK, Hansson BME, Richie JP, Sun D, Wesselink E, van Zutphen M, Kampman E, Kok DE. Are Ergothioneine Levels in Blood Associated with Chronic Peripheral Neuropathy in Colorectal Cancer Patients Who Underwent Chemotherapy? Nutr Cancer 2019; 72:451-459. [PMID: 31298929 DOI: 10.1080/01635581.2019.1637005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN) is highly prevalent among colorectal cancer (CRC) patients. Ergothioneine (ET) - a dietary antioxidant -protected against CIPN in experimental models, but human studies are lacking. We explored whether whole blood ET levels were associated with chronic peripheral neuropathy among CRC patients who had completed chemotherapy.Methods: At diagnosis, median ET-concentration in whole blood of 159 CRC patients was 10.2 μg/ml (7.2-15.8). Patients completed questionnaires on peripheral neuropathy 6 months after completion of chemotherapy. We calculated prevalence ratios (PR) to assess associations of ET-concentrations and prevalence of peripheral neuropathy and used linear regression to assess associations with severity of peripheral neuropathy.Results: Prevalence of total and sensory peripheral neuropathy were both 81%. Higher ET-concentrations tended to be associated with lower prevalence of total and sensory peripheral neuropathy, but not statistically significant (highest versus lowest tertile of ET: PR = 0.93(0.78, 1.11) for total neuropathy, and PR = 0.84(0.70, 1.02) for sensory neuropathy). ET-concentrations were not associated with severity of neuropathy.Conclusion: Statistically significant associations were not observed, possibly because of limited sample size. Although data may putatively suggest higher levels of ET to be associated with a lower prevalence of neuropathy, analyses should be repeated in larger populations with larger variability in ET-concentrations.
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Affiliation(s)
- Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Lieve van Brakel
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Harm van Baar
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Robert B Beelman
- Department of Food Science, Penn State College of Agricultural Sciences, University Park, PA, USA
| | | | - Anne Geijsen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Bibi M E Hansson
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Dongxiao Sun
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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27
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Alferink LJ, Kiefte-de Jong JC, Erler NS, Veldt BJ, Schoufour JD, de Knegt RJ, Ikram MA, Metselaar HJ, Janssen HLA, Franco OH, Darwish Murad S. Association of dietary macronutrient composition and non-alcoholic fatty liver disease in an ageing population: the Rotterdam Study. Gut 2019; 68:1088-1098. [PMID: 30064987 DOI: 10.1136/gutjnl-2017-315940] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A healthy lifestyle is the first-line treatment in non-alcoholic fatty liver disease (NAFLD), but specific dietary recommendations are lacking. Therefore, we aimed to determine whether dietary macronutrient composition is associated with NAFLD. DESIGN Participants from the Rotterdam Study were assessed on (1) average intake of macronutrients (protein, carbohydrate, fat, fibre) using a Food Frequency Questionnaire and (2) NAFLD presence using ultrasonography, in absence of excessive alcohol, steatogenic drugs and viral hepatitis. Macronutrients were analysed using the nutrient density method and ranked (Q1-Q4). Logistic regression analyses were adjusted for sociodemographic, lifestyle and metabolic covariates. Moreover, analyses were adjusted for and stratified by body mass index (BMI) (25 kg/m2). Also, substitution models were built. RESULTS In total, 3882 participants were included (age 70±9, 58% female). NAFLD was present in 1337 (34%) participants of whom 132 were lean and 1205 overweight. Total protein was associated with overweight NAFLD after adjustment for sociodemographic and lifestyle covariates (ORQ4vsQ1 1.40; 95% CI 1.11 to 1.77). This association was driven by animal protein (ORQ4vsQ1 1.54; 95% CI 1.20 to 1.98). After adjustment for metabolic covariates, only animal protein remained associated with overweight NAFLD (ORQ4vsQ1 1.36; 95% CI 1.05 to 1.77). Monosaccharides and disaccharides were associated with lower overall NAFLD prevalence (ORQ4vsQ1 0.66; 95% CI 0.52 to 0.83) but this effect diminished after adjustment for metabolic covariates and BMI. No consistent associations were observed for fat subtypes or fibre. There were no substitution effects. CONCLUSION This large population-based study shows that high animal protein intake is associated with NAFLD in overweight, predominantly aged Caucasians, independently of well-known risk factors. Contrary to previous literature, our results do not support a harmful association of monosaccharides and disaccharides with NAFLD.
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Affiliation(s)
- Louise Jm Alferink
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Department of Global Public Health, Leiden University College, The Hague, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Bart J Veldt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Harry LA Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Toronto Centre of Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Osté MCJ, Gomes‐Neto AW, Corpeleijn E, Gans ROB, de Borst MH, van den Berg E, Soedamah‐Muthu SS, Kromhout D, Navis GJ, Bakker SJL. Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients. Am J Transplant 2018; 18:2523-2533. [PMID: 29464830 PMCID: PMC6175360 DOI: 10.1111/ajt.14707] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 01/25/2023]
Abstract
Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177-item food frequency questionnaire and an overall DASH-score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow-up of 5.3 (interquartile range, 4.1-6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death-censored graft failure, and 128 (20.3%) died. In Cox-regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33-0.96, P = .03) and all-cause mortality (HR = 0.52; 95%CI, 0.32-0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH-style diet is associated with lower risk of both renal function decline and all-cause mortality. These results suggest that a healthful diet might benefit long-term outcome in RTR.
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Affiliation(s)
- Maryse C. J. Osté
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - António W. Gomes‐Neto
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Eva Corpeleijn
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Rijk O. B. Gans
- Department of Internal MedicineUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Martin H. de Borst
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Else van den Berg
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Sabita S. Soedamah‐Muthu
- Department of Medical and Clinical PsychologyCenter of Research on Psychology in Somatic DiseasesTilburg UniversityTilburgThe Netherlands
| | - Daan Kromhout
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Gerjan J. Navis
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Rius-Ottenheim N, Kromhout D, Sijtsma FPC, Geleijnse JM, Giltay EJ. Dietary patterns and mental health after myocardial infarction. PLoS One 2017; 12:e0186368. [PMID: 29036212 PMCID: PMC5642887 DOI: 10.1371/journal.pone.0186368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/28/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Diet has been associated with better mental health in general populations, but less is known on this association in patients with a history of coronary heart disease. The objective of this study is to examine the cross-sectional associations between dietary patterns and mental health in elderly patients with a history of myocardial infarction. METHODS Data were drawn from the final assessment of the Alpha Omega cohort that monitored patients with a history of myocardial infarction (age range 60-80 years). 2171 patients with complete data for diet and mental health were included in this study. Diet was assessed with the 203-item Food Frequency Questionnaire, and subsequently categorized into two scores: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). Depressive symptoms, assessed with the Geriatric Depression Scale (GDS-15), and dispositional optimism, assessed with the 4-item questionnaire (4Q), were cross-sectionally analyzed in relation to dietary patterns using linear regression analysis. RESULTS Patients were on average 72.2 years old and 79.5% were male. The DHNaFS score was associated with less depressive symptoms and higher dispositional optimism (β = -0.108; P<0.001; and β = 0.074; P<0.001), whereas no associations were found with the DUNaFS score. Particularly, consumption of vegetables, fruits, whole grains, fish, and low fat-dairy were associated with less depressive symptoms and higher optimism. Similar associations were found when analyzing the association between average DHNaFS score over the preceding 41 months with depression β = -0.085; P<0.001) and higher dispositional optimism (β = 0.084; P<0.001). CONCLUSIONS A healthy dietary pattern, in particular a higher consumption of vegetables, fruit, whole grains, fish and low-fat dairy, was associated with less depressive symptoms and higher optimism. However, given the cross-sectional nature of our analyses, our findings may also be explained by more optimistic participants making healthier food choices. Therefore, future prospective or interventions studies are needed to establish the direction of causality of this association. TRIAL REGISTRATION ClinicalTrials.gov NCT03192410.
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Affiliation(s)
- Nathaly Rius-Ottenheim
- Leiden University Medical Centre, Department of Psychiatry, Leiden, the Netherlands
- Spaarne Gasthuis Hospital, Department of Psychiatry, Haarlem, the Netherlands
- * E-mail:
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- Department of Epidemiology, University Medical Centre, University of Groningen, Groningen, the Netherlands
| | - Femke P. C. Sijtsma
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | | | - Erik J. Giltay
- Leiden University Medical Centre, Department of Psychiatry, Leiden, the Netherlands
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Mölenberg FJM, de Goede J, Wanders AJ, Zock PL, Kromhout D, Geleijnse JM. Dietary fatty acid intake after myocardial infarction: a theoretical substitution analysis of the Alpha Omega Cohort. Am J Clin Nutr 2017; 106:895-901. [PMID: 28793994 PMCID: PMC5573025 DOI: 10.3945/ajcn.117.157826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Replacement of saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs), especially polyunsaturated fatty acids (PUFAs), has been associated with a lower risk of ischemic heart disease (IHD). Whether this replacement is beneficial for drug-treated patients with cardiac disease is not yet clear. OBJECTIVE In a prospective study of Dutch patients with cardiac disease (Alpha Omega Cohort), we examined the risk of cardiovascular disease (CVD) and IHD mortality when the sum of SFAs and trans fatty acids (TFAs) was theoretically replaced by total UFAs, PUFAs, or cis monounsaturated fatty acids (MUFAs). DESIGN We included 4146 state-of-the-art drug-treated patients aged 60-80 y with a history of myocardial infarction (79% male patients) and reliable dietary data at baseline (2002-2006). Cause-specific mortality was monitored until 1 January 2013. HRs for CVD mortality and IHD mortality for theoretical, isocaloric replacement of dietary fatty acids (FAs) in quintiles (1-5) and continuously (per 5% of energy) were obtained from Cox regression models, adjusting for demographic factors, medication use, and lifestyle and dietary factors. RESULTS Patients consumed, on average, 17.5% of energy of total UFAs, 13.0% of energy of SFAs, and <1% of energy of TFAs. During ∼7 y of follow-up, 372 CVD deaths and 249 IHD deaths occurred. Substitution modeling yielded significantly lower risks of CVD mortality when replacing SFAs plus TFAs with total UFAs [HR in quintile 5 compared with quintile 1: 0.45 (95% CI: 0.28, 0.72)] or PUFAs [HR: 0.66 (95% CI: 0.44, 0.98)], whereas HRs in cis MUFA quintiles were nonsignificant. HRs were similar for IHD mortality. In continuous analyses, replacement of SFAs plus TFAs with total UFAs, PUFAs, or cis MUFAs (per 5% of energy) was associated with significantly lower risks of CVD mortality (HRs between 0.68 and 0.75) and IHD mortality (HRs between 0.55 and 0.70). CONCLUSION Shifting the FA composition of the diet toward a higher proportion of UFAs may lower CVD mortality risk in drug-treated patients with cardiac disease. This study was registered at clinicaltrials.gov as NCT03192410.
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Affiliation(s)
- Famke JM Mölenberg
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Janette de Goede
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Anne J Wanders
- Unilever Research and Development, Vlaardingen, Netherlands; and
| | - Peter L Zock
- Unilever Research and Development, Vlaardingen, Netherlands; and
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;,Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands
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Blauw LL, Aziz NA, Tannemaat MR, Blauw CA, de Craen AJ, Pijl H, Rensen PCN. Diabetes incidence and glucose intolerance prevalence increase with higher outdoor temperature. BMJ Open Diabetes Res Care 2017; 5:e000317. [PMID: 28405341 PMCID: PMC5372132 DOI: 10.1136/bmjdrc-2016-000317] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/16/2016] [Accepted: 01/03/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Rising global temperatures might contribute to the current worldwide diabetes epidemic, as higher ambient temperature can negatively impact glucose metabolism via a reduction in brown adipose tissue activity. Therefore, we examined the association between outdoor temperature and diabetes incidence in the USA as well as the prevalence of glucose intolerance worldwide. RESEARCH DESIGN AND METHODS Using meta-regression, we determined the association between mean annual temperature and diabetes incidence during 1996-2009 for each US state separately. Subsequently, results were pooled in a meta-analysis. On a global scale, we performed a meta-regression analysis to assess the association between mean annual temperature and the prevalence of glucose intolerance. RESULTS We demonstrated that, on average, per 1°C increase in temperature, age-adjusted diabetes incidence increased with 0.314 (95% CI 0.194 to 0.434) per 1000. Similarly, the worldwide prevalence of glucose intolerance increased by 0.170% (95% CI 0.107% to 0.234%) per 1°C rise in temperature. These associations persisted after adjustment for obesity. CONCLUSIONS Our findings indicate that the diabetes incidence rate in the USA and prevalence of glucose intolerance worldwide increase with higher outdoor temperature.
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Affiliation(s)
- Lisanne L Blauw
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N Ahmad Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anton J de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanno Pijl
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick C N Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Traditionally only a small proportion of the workforce was engaged in shift work. Changing economic pressures have resulted in increased engagement in shift work, with approximately 17 % of the workforce in Europe engaged in this work pattern. The present narrative review aimed to summarise the data on the effects of shift work on the diet, lifestyle and health of employees, while addressing the barriers to, and opportunities for, improving health among shift workers. Shift work can result in low-quality diet and irregular eating patterns. Adverse health behaviours are also reported; particularly increased smoking and poor sleep patterns. These altered lifestyle habits, in conjunction with disruption to circadian rhythms, can create an unfavourable metabolic phenotype which facilitates the development and progression of chronic disease. Although the data are inconclusive due to issues such as poor study design and inadequate control for confounding factors; shift workers appear to be at increased mental and physical health risk, particularly with regard to non-communicable diseases. Information is lacking on the obstacles to leading a healthier lifestyle while working shifts, and where opportunities lie for intervention and health promotion among this group. In order to provide an informed evidence base to assist shift workers in overcoming associated occupational hazards, this gap must be addressed. This review highlights the unique nutritional issues faced by shift workers, and the subsequent effect on health. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for education and behaviour change interventions among this group.
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Sijtsma FPC, Soedamah-Muthu SS, de Goede J, Oude Griep LM, Geleijnse JM, Giltay EJ, de Boer MJ, Jacobs DR, Kromhout D. Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment. Am J Clin Nutr 2015; 102:1527-33. [PMID: 26490494 PMCID: PMC4658460 DOI: 10.3945/ajcn.115.112276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/15/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Little is known about dietary scores and mortality risk in cardiac patients who are well treated with drugs with attendant relatively low risk of cardiovascular diseases (CVDs). OBJECTIVE We assessed whether healthy eating lowers the risk of CVD and all-cause mortality in cardiac patients. DESIGN We included 4307 patients from the Alpha Omega Trial aged 60-80 y with a clinically diagnosed myocardial infarction and monitored mortality for 10 y. Diet was assessed at baseline (2002-2006) with a validated 203-item food-frequency questionnaire. We created 2 dietary scores on the basis of nonoverlapping sets of foods: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). The associations of both dietary scores with CVD and all-cause mortality were assessed by using multivariable-adjusted Cox regression models. RESULTS The median time after myocardial infarction at baseline was 3.7 y (IQR: 1.7-6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3-7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost to follow-up. A substantially higher average amount of DHNaFS foods (∼1750 g/d) than DUNaFS foods (∼650 g/d) was consumed. Almost all patients received drug treatment: 86% used statins, 90% used antihypertensive medication, and 98% used antithrombotic medication. Patients in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55, 0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower all-cause mortality risk than did patients in the first quintile. The DUNaFS was unrelated to both CVD and all-cause mortality. CONCLUSION Beyond state-of-the-art drug treatment, healthy eating was associated with a lower risk of CVD and all-cause mortality in cardiac patients. This trial was registered at clinicaltrials.gov as NCT00127452.
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Affiliation(s)
- Femke P C Sijtsma
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | | | - Janette de Goede
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Linda M Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Menko Jan de Boer
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and Department of Nutrition, University of Oslo, Oslo, Norway
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
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van Gemert WA, Monninkhof EM, May AM, Peeters PH, Schuit AJ. Effect of exercise on insulin sensitivity in healthy postmenopausal women: the SHAPE study. Cancer Epidemiol Biomarkers Prev 2014; 24:81-7. [PMID: 25342388 DOI: 10.1158/1055-9965.epi-14-0722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An inactive lifestyle is a risk factor for several types of cancer. A proposed pathway through which exercise influences cancer risk is via insulin. We aim to investigate the effect of a one-year exercise intervention on insulin sensitivity, and the role of body fat in this association, in healthy, normal to overweight/obese, postmenopausal women. METHODS In the Sex Hormones And Physical Exercise (SHAPE) study, 189 healthy, inactive and postmenopausal women [ages, 50-69 years; body mass index (BMI), 22-40 kg/m(2)] were randomly assigned to a one-year aerobic and strength exercise intervention (150 min/wk), or a control group. Between-group differences in fasting insulin, glucose, and homeostatic model assessment of insulin resistance (HOMA2) over time were estimated using linear mixed models. RESULTS Follow-up measurements of insulin sensitivity were available for 181 (95.8%) and 182 (96.3%) women at 4 and 12 months, respectively. The intention-to-treat analysis showed no significant differences between the two study groups [treatment effect ratio of the exercise group vs. control (β; 95% confidence interval): insulin, β, 1.07 (0.96-1.19); glucose, β, 1.01 (0.99-1.02); and HOMA2, β, 1.07 (0.96-1.20)]. Similar results were found in a per protocol analysis in compliant women, and in a subgroup of women who lost >2% body fat [measured by dual-energy X-ray absorptiometry (DEXA)]. CONCLUSIONS Participation in a one-year aerobic and strength exercise intervention program did not result in changes in insulin sensitivity in healthy postmenopausal and inactive women. IMPACT Our findings suggest that 150 min/wk of exercise, as recommended by current guidelines, is not enough to achieve improvements in insulin sensitivity and subsequent cancer risk, in healthy postmenopausal women.
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Affiliation(s)
- Willemijn A van Gemert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petra H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Albertine J Schuit
- Department of Health Science, VU University, Amsterdam, the Netherlands. Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Winkels RM, Heine-Bröring RC, van Zutphen M, van Harten-Gerritsen S, Kok DEG, van Duijnhoven FJB, Kampman E. The COLON study: Colorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life. BMC Cancer 2014; 14:374. [PMID: 24886284 PMCID: PMC4046039 DOI: 10.1186/1471-2407-14-374] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is clear evidence that nutrition and lifestyle can modify colorectal cancer risk. However, it is not clear if those factors can affect colorectal cancer treatment, recurrence, survival and quality of life. This paper describes the background and design of the "COlorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life" - COLON - study. The main aim of this study is to assess associations of diet and other lifestyle factors, with colorectal cancer recurrence, survival and quality of life. We extensively investigate diet and lifestyle of colorectal cancer patients at diagnosis and during the following years; this design paper focusses on the initial exposures of interest: diet and dietary supplement use, body composition, nutrient status (e.g. vitamin D), and composition of the gut microbiota. METHODS/DESIGN The COLON study is a multi-centre prospective cohort study among at least 1,000 incident colorectal cancer patients recruited from 11 hospitals in the Netherlands. Patients with colorectal cancer are invited upon diagnosis. Upon recruitment, after 6 months, 2 years and 5 years, patients fill out food-frequency questionnaires; questionnaires about dietary supplement use, physical activity, weight, height, and quality of life; and donate blood samples. Diagnostic CT-scans are collected to assess cross-sectional areas of skeletal muscle, subcutaneous fat, visceral fat and intermuscular fat, and to assess muscle attenuation. Blood samples are biobanked to facilitate future analyse of biomarkers, nutrients, DNA etc. Analysis of serum 25-hydroxy vitamin D levels, and analysis of metabolomic profiles are scheduled. A subgroup of patients with colon cancer is asked to provide faecal samples before and at several time points after colon resection to study changes in gut microbiota during treatment. For all patients, information on vital status is retrieved by linkage with national registries. Information on clinical characteristics is gathered from linkage with the Netherlands Cancer Registry and with hospital databases. Hazards ratios will be calculated for dietary and lifestyle factors at diagnosis in relation to recurrence and survival. Repeated measures analyses will be performed to assess changes over time in dietary and other factors in relation to recurrence and survival.
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Affiliation(s)
- Renate M Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Sethi R, Singh R, Singh V. Effect of physical exercise on the body morphology of obese females. J ANAT SOC INDIA 2013. [DOI: 10.1016/j.jasi.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Broekhuizen K, Kroeze W, van Poppel MNM, Oenema A, Brug J. A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update. Ann Behav Med 2013; 44:259-86. [PMID: 22767052 PMCID: PMC3442159 DOI: 10.1007/s12160-012-9384-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A review update is necessary to document evidence regarding the effectiveness of computer-tailored physical activity and nutrition education. Purpose The purpose of this study was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review. Methods Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education aimed at primary prevention in adults, published from September 2004 through June 2011. Results Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no information, including those for physical activity promotion. Effect sizes were small and generally at short- or medium-term follow-up. Conclusions The results of the 2006 review were confirmed and reinforced. Future interventions should focus on establishing larger effect sizes and sustained effects and include more generic health education control groups and objective measurements of dietary behavior. Electronic supplementary material The online version of this article (doi:10.1007/s12160-012-9384-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Broekhuizen
- EMGO+ Institute for Health and Care Research, Amsterdam, Netherlands.
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Beurskens LWJE, Schrijver LH, Tibboel D, Wildhagen MF, Knapen MFCM, Lindemans J, de Vries J, Steegers-Theunissen RPM. Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring. ACTA ACUST UNITED AC 2013; 97:60-6. [PMID: 23283831 DOI: 10.1002/bdra.23093] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/17/2012] [Accepted: 09/25/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vitamin A has been related to the etiology of congenital diaphragmatic hernia (CDH). We performed a case-control study to investigate whether maternal dietary vitamin A intake is related to CDH in the offspring. METHODS Thirty-one pregnancies diagnosed with CDH and 46 control pregnancies were included during the study. After CDH diagnosis and inclusion of controls by risk set sampling, maternal vitamin A intake was investigated with a food frequency questionnaire. Serum retinol and retinol-binding protein were determined. Univariable and multivariable logistic regression models were used to calculate risk estimates with adjustment for potential confounders. RESULTS We found no significant differences in the overall nutrient and vitamin A intake between case and control mothers. After stratification in body mass index (BMI) categories, case mothers with normal weight showed a lower energy adjusted vitamin A intake (685 vs. 843 μg retinol activity equivalents [RAEs] / day; p = 0.04) and a slightly lower serum retinol (1.58 vs. 1.67 μmol/L; p = 0.08) than control mothers. Vitamin A intake <800 μg retinol activity equivalents (recommended daily intake) in normal weight mothers was associated with a significantly increased CDH risk (odds ratio [OR], 7.2; 95% confidence interval [CI], 1.5-34.4; p = 0.01). Associations were not significantly different in underweight and overweight mothers. CONCLUSIONS In normal-weight mothers, dietary vitamin A intake during pregnancy below the recommended daily intake is significantly associated with an increased risk of a child with CDH. This finding supports the retinoid hypothesis in human CDH, but warrants further investigation in larger study populations. Birth Defects Research (Part A), 2013. © 2013 Wiley Periodicals, Inc.
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Althuizen E, van Poppel MN, de Vries JH, Seidell JC, van Mechelen W. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum. BMC Public Health 2011; 11:165. [PMID: 21410953 PMCID: PMC3068095 DOI: 10.1186/1471-2458-11-165] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 03/16/2011] [Indexed: 01/12/2023] Open
Abstract
Background Postpartum weight retention affects many women and increases the risk of becoming overweight. The research objective was to study modifiable factors contributing to weight change at one year postpartum. Methods In this prospective cohort, postpartum behavior, such as physical activity, sedentary behavior, sleep, and intake of total energy, total fat and saturated fatty acids of 118 Dutch women were assessed in 2003/2004 by self-report at 6 weeks, 6 and 12 months postpartum. Mean postpartum scores were computed for the behavioral measures. In linear regression models it was determined which factors were associated with average weight change from before pregnancy to one year postpartum. Furthermore, factors associated with substantial postpartum weight retention (≥ 5 kg) were also studied in logistic regression models. Results At one year postpartum, the average weight of participants had increased by 0.9 kg (SD 4.4). Moreover, 20% of the women retained ≥ 5 kg. Women who perceived themselves more physically active than others were almost ten times less likely to retain ≥ 5 kg than women who perceived themselves equally active (OR = 0.11, 95%CI: 0.02 - 0.66). Exceeding the guideline for saturated fatty acid intake (OR = 3.40, 95%CI: 1.04 - 11.11), total gestational weight gain (OR = 1.14/kg, 95%CI: 1.01 - 1.27), and not having completed post high school education (OR = 5.13, 95%CI: 1.66 - 15.90) increased the odds of retaining ≥ 5 kg. Conclusions Since one in five women had substantial weight retention postpartum, effective interventions for the prevention of weight retention are much needed. Future studies should evaluate whether interventions focusing on the identified modifiable postpartum factors are successful in reducing weight retention after childbirth.
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Affiliation(s)
- Ellen Althuizen
- Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Albert I, Villeret G, Paris A, Verger P. Integrating variability in half-lives and dietary intakes to predict mercury concentration in hair. Regul Toxicol Pharmacol 2010; 58:482-9. [PMID: 20804806 DOI: 10.1016/j.yrtph.2010.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 08/24/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
Methylmercury (MeHg) is a bioaccumulative environmental toxin that exerts its effect on fetal and infant neurodevelopment. Mercury concentration in hair is a good biomarker of MeHg accumulation in the body, with seafood being the main source of MeHg in humans. Therefore, modeling the link between food intake and mercury concentration in hair is a key step in assessing the risk of MeHg exposure. Using repeated measurements of diet and mercury concentration in hair, we studied 125 French pregnant women who consumed seafood (e.g., fish, mollusks and crustaceans) and compared their individual estimated dietary MeHg intakes with their hair mercury concentrations. We used a one-compartment toxicokinetic model for these comparisons. We integrated and estimated the between-person variability in MeHg half-life into the model. In a second model, we took into account an intra-individual MeHg intake variability to improve the performance of the toxicokinetic model.
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Affiliation(s)
- Isabelle Albert
- INRA, UR 1204 Met@risk, Food Risk Analysis Methodologies, AgroParisTech, 16, rue Claude Bernard, 75231 Paris Cedex 5, France.
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Hertogh EM, Schuit AJ, Peeters PHM, Monninkhof EM. Noncompliance in lifestyle intervention studies: the instrumental variable method provides insight into the bias. J Clin Epidemiol 2010; 63:900-6. [PMID: 20189770 DOI: 10.1016/j.jclinepi.2009.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 09/09/2009] [Accepted: 10/29/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In lifestyle intervention trials, participants of the control group often change their behavior despite the request to maintain their usual lifestyle pattern. These changes in the control group and changes in addition to the intended in the intervention group can lead to undesirable confounding effects. STUDY DESIGN AND SETTING We address several considerations for study design to prevent noncompliance or minimize its effects. Furthermore, we demonstrate how the instrumental variable method can give insight into the extent of bias introduced by noncompliance in randomized trials, within the context of the Sex Hormones and Physical Exercise study. RESULTS Noncompliance can be prevented by measures taken in the design phase of a study, for example, limited duration of the study, clear recommendations, power calculation, intensity of the intervention, involvement of the control group, waiting-list control group, and single-consent design nested within an observational study. When nevertheless noncompliance does occur, the instrumental variable method estimates the intervention effect of treatment among the compliers. CONCLUSION Noncompliance can seriously affect validity of lifestyle trial results. Its occurrence should be prevented by taking measures during the design phase of a study. The instrumental variable method can give insight into confounding by noncompliance in randomized trials.
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Affiliation(s)
- Emmy M Hertogh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Althuizen E, van Poppel MNM, Seidell JC, van Mechelen W. Correlates of absolute and excessive weight gain during pregnancy. J Womens Health (Larchmt) 2010; 18:1559-66. [PMID: 19788365 DOI: 10.1089/jwh.2008.1275] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Factors associated with weight gain during pregnancy that may be linked to maternal overweight and obesity were examined. METHODS In this observational study, 144 women reported on demographics, (prepregnancy) body weight, and lifestyles in self-reported questionnaires at 30 weeks gestation. Body weight at the end of pregnancy (self-reported at 6 weeks postpartum) was used to determine total gestational weight gain. Multivariate prediction models were developed to identify factors associated with total gestational weight gain and excessive gestational weight gain (i.e., higher weight gain than recommended by the Institute of Medicine). RESULTS Women gained 14.4 (+/-5.0) kg during pregnancy. Obese women gained almost 4 kg less than normal weight women. Pregnant women judging themselves to be less physically active or women who reported increased food intakes during pregnancy gained significantly more weight. Over one third of women (38%) gained more weight than recommended. Being overweight, judging yourself to be less physically active than others, and a perceived elevated food intake during pregnancy were significantly associated with excessive weight gain (odds ratio [OR] = 6.33, 95% confidence interval [CI]: 2.01-19.32; OR = 3.96, 95% CI: 1.55l, 10.15; and OR = 3.14, 95% CI: 1.18, 8.36, respectively). A higher age at menarche and hours of sleep reduced the odds for excessive weight gain (OR = 0.75, 95% CI: 0.57, 0.99; and OR = 0.35, 95% CI: 0.57, 0.93, respectively). CONCLUSIONS Mean hours of sleep, perceived physical activity, and measures of food intake at 30 weeks gestation were identified as modifiable behavioral correlates for excessive gestational weight gain. Strategies to optimize gestational weight gain need to be explored, with a focus on the identified factors.
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Affiliation(s)
- Ellen Althuizen
- Department of Public and Occupational Health, EMGO Institute, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
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Pouzaud F, Ibbou A, Blanchemanche S, Grandjean P, Krempf M, Philippe HJ, Verger P. Use of advanced cluster analysis to characterize fish consumption patterns and methylmercury dietary exposures from fish and other sea foods among pregnant women. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2010; 20:54-68. [PMID: 19293844 DOI: 10.1038/jes.2009.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 11/24/2008] [Indexed: 05/20/2023]
Abstract
On account of the interspecies variability in contamination and nutrient contents, consumers must balance the risks and benefits of fish consumption through their choice of species, meal size and frequency. The objectives of this study were to better characterize the risk of methylmercury (MeHg) exposure in a sample of 161 French pregnant women consuming sea food, including fish, molluscs and crustaceans, and to explore the use of unsupervised statistical learning as an advanced type of cluster analysis to identify patterns of fish consumption that could predict exposure to MeHg and the coverage of the Recommended Daily Allowance for n-3 polyunsaturated fatty acid (PUFA). The proportion of about 5% of pregnant women exposed at levels higher than the tolerable weekly intake for MeHg is similar to that observed among women of childbearing age in earlier French studies. At the same time, only about 50% of the women reached the recommended intake of 500 mg/day n-3 PUFA. Cluster analysis of the fish consumption showed that they could be grouped in five major clusters that are largely predictable of the intake of both MeHg and n-3 PUFA. This study shows that a global increase in seafood consumption could lead to MeHg exposure above the toxicological limits for pregnant women, thereby questioning the overall balance between this potential risk and potential beneficial effects of n-3 PUFA intakes. Only pregnant women consuming a high proportion of fatty fish meet the n-3 PUFA intake requirements without exceeding the toxicological limit for MeHg. The clusters identified suggest that different intervention strategies may be needed to address the dual purpose of ensuring high PUFA intakes at acceptable MeHg exposures.
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Affiliation(s)
- François Pouzaud
- INRA Mét@risk, Research Unit for Methodologies of Food Risk Analysis,Paris, France
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Abstract
UNLABELLED The aim of this study was to investigate the effect of a 12-month moderate-to-vigorous exercise program combining aerobic and muscle strength training on body composition among sedentary, postmenopausal women. METHODS A randomized controlled trial was conducted. A total of 189 sedentary postmenopausal women (age 50-69 y, body mass index 22-40 kg/m2) were randomly assigned to an exercise (n = 96) or a control group (n = 93). Study parameters measured at baseline, 4 months, and 12 months were as follows: body weight and body height (body mass index), waist and hip circumference (body fat distribution), and dual-energy x-ray absorptiometry (total body fat and lean mass). Differences in changes in study parameters between exercise and control group were examined with generalized estimating equations analysis. RESULTS The exercise program did not result in significant effects on weight, body mass index, and hip circumference. The exercise group experienced a statistically significant greater loss in total body fat, both absolute (-0.33 kg) (borderline) as in a percentage (-0.43%) compared with the control group. In addition, lean mass increased significantly (+0.31 kg), whereas waist circumference (-0.57 cm) decreased significantly compared with the control group. CONCLUSIONS We conclude that a 12-month exercise program combining aerobic and muscle strength training did not affect weight but positively influenced body composition of postmenopausal women. Affecting body fat distribution and waist circumference may have important health implications because it is an independent risk factor in obese but also in nonobese people. Therefore, this study gives further credence to efforts of public health and general practitioners aiming to increase physical activity levels of postmenopausal women.
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Monninkhof EM, Velthuis MJ, Peeters PHM, Twisk JWR, Schuit AJ. Effect of exercise on postmenopausal sex hormone levels and role of body fat: a randomized controlled trial. J Clin Oncol 2009; 27:4492-9. [PMID: 19687339 DOI: 10.1200/jco.2008.19.7459] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the effects of a 1-year exercise intervention on sex hormone levels in postmenopausal women and whether any effects are mediated by changes in body fat composition. METHODS We randomly assigned 189 sedentary postmenopausal women (age 50 to 69 years, body mass index of 22 to 40 kg/m(2)) to an exercise intervention (n = 96) or a control group (n = 93). The intervention combined aerobic and strength training and comprised supervised group sessions and home-based exercises (a total of 2.5 h/wk). Between-group differences in sex hormone levels (at baseline and 4 and 12 months) were examined with generalized estimating equations. RESULTS In total, 183 women (97%) completed the study. Overall, the exercise intervention did not result in favorable effects on sex hormone levels. Among women who lost more than 2% body fat, declines in all estrogens were not significantly different between exercisers and controls. Androgen levels decreased significantly in the exercise group who lost body fat compared with their peers in the control group. Furthermore, this study confirmed that fat loss was significantly associated with declines in postmenopausal estrogen levels. Although not significant, a similar trend was observed for the androgens. CONCLUSION This study confirms that fat loss is associated with changes in postmenopausal sex hormone levels and suggests that exercise may be effective in inducing favorable changes in these hormones.
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Affiliation(s)
- Evelyn M Monninkhof
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
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Anschutz DJ, Van Strien T, Van De Ven MO, Engels RC. Eating styles and energy intake in young women. Appetite 2009; 53:119-22. [DOI: 10.1016/j.appet.2009.03.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 03/24/2009] [Accepted: 03/30/2009] [Indexed: 11/25/2022]
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Monninkhof EM, Peeters PHM, Schuit AJ. Design of the sex hormones and physical exercise (SHAPE) study. BMC Public Health 2007; 7:232. [PMID: 17767724 PMCID: PMC2031900 DOI: 10.1186/1471-2458-7-232] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 09/04/2007] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity has been associated with a decreased risk for breast cancer. The biological mechanismn(s) underlying the association between physical activity and breast cancer is not clear. Most prominent hypothesis is that physical activity may protect against breast cancer through reduced lifetime exposure to endogenous hormones either direct, or indirect by preventing overweight and abdominal adiposity. In order to get more insight in the causal pathway between physical activity and breast cancer risk, we designed the Sex Hormones and Physical Exercise (SHAPE) study. Purpose of SHAPE study is to examine the effects of a 1-year moderate-to-vigorous intensity exercise programme on endogenous hormone levels associated with breast cancer among sedentary postmenopausal women and whether the amount of total body fat or abdominal fat mediates the effects. Methods/Design In the SHAPE study, 189 sedentary postmenopausal women, aged 50–69 years, are randomly allocated to an intervention or a control group. The intervention consists of an 1-year moderate-to-vigorous intensity aerobic and strenght training exercise programme. Partcipants allocated to the control group are requested to retain their habitual exercise pattern. Primary study parameters measured at baseline, at four months and at 12 months are: serum concentrations of endogenous estrogens, endogenous androgens, sex hormone binding globuline and insuline. Other study parameters include: amount of total and abdominal fat, weight, BMI, body fat distribution, physical fitness, blood pressure and lifestyle factors. Discussion This study will contribute to the body of evidence relating physical activity and breast cancer risk and will provide insight into possible mechanisms through which physical activity might be associated with reduced risk of breast cancer in postmenopausal women. Trial registration NCT00359060
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Affiliation(s)
- Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Public Health and Health Care, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Petra HM Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albertine J Schuit
- Division of Public Health and Health Care, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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van de Laar FA, van de Lisdonk EH, Lucassen PLBJ, Stafleu A, Mulder J, van den Hoogen HJM, Rutten GEHM, van Weel C. Eating behaviour and adherence to diet in patients with Type 2 diabetes mellitus. Diabet Med 2006; 23:788-94. [PMID: 16842485 DOI: 10.1111/j.1464-5491.2006.01885.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To assess restrained, emotional and external eating behaviour in patients newly diagnosed with Type 2 diabetes compared with the general population, and to assess the relationship of eating behaviour to changes in fat and energy. METHODS We assessed emotional, external, and restrained eating behaviour and measured fat and energy intake in a cohort of patients with newly diagnosed Type 2 diabetes. Data from a comparable sample of the general population served as reference figures. We calculated correlation coefficients of the three different types of eating behaviour at diagnosis between: (i) energy and fat intake at diagnosis and (ii) changes in energy and fat intake between diagnosis and both 8 weeks and 4 years later. In addition, we used a stepwise multiple regression model with energy and fat intake or changes in energy and fat intake as dependent variables. RESULTS The distribution of the three types of eating behaviour was similar in patients with Type 2 diabetes and the general population. Emotional and external eating was associated with increased intake of energy and fat. Conversely, restrained eating showed an inverse correlation with energy and fat intake. External eating, but not emotional eating, showed a statistically significant relation with a decrease in energy intake in women. We found no statistically significant correlations between eating behaviour (measured at diagnosis) and changes in energy and fat intake between diagnosis and 4 years. CONCLUSIONS Patients newly diagnosed with Type 2 diabetes have similar eating behaviour compared with the general population. At diagnosis, external eating behaviour and emotional eating behaviour are associated with high-energy intake and restrained eating behaviour with low-energy intake. Women with high scores for emotional eating behaviour seem to be less able to make initial dietary changes after being diagnosed and having received dietary advice.
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Affiliation(s)
- F A van de Laar
- Radboud University Nijmegen medical Center, Department of General Practice, Nijmegen, The Netherlands.
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Capita R, Alonso-Calleja C. Comparison of a Newly Developed Spanish Food Frequency Questionnaire and Multiple Dietary Records for Measuring Food and Nutrient Intakes in Young Populations: Influence of Sex and Meal Type. Ecol Food Nutr 2005. [DOI: 10.1080/03670240590904290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Amelsvoort LGPM, Schouten EG, Kok FJ. Impact of One Year of Shift Work on Cardiovascular Disease Risk Factors. J Occup Environ Med 2004; 46:699-706. [PMID: 15247809 DOI: 10.1097/01.jom.0000131794.83723.45] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the study was to investigate whether the reported increased cardiovascular disease risk in shift workers could be explained by changes in cardiovascular risk factors. In a cohort of 239 shift and 157 daytime workers, 1-year changes in biological and lifestyle cardiovascular risk factors were monitored between the start of a new job and 1 year later. Both body mass index and low-density lipoprotein/high-density lipoprotein cholesterol ratio decreased significantly in shift workers compared with daytime workers (body mass index change: -0.31 and +0.13 kg/m; low-density lipoprotein/high-density lipoprotein ratio change: -0.33 and -0.13 respectively). Cigarettes smoked per day increased significantly in shift compared with daytime workers (+1.42 and -1.03, respectively). Therefore, only for smoking, an unfavorable change was observed. This may explain, at most, only a part of the excess cardiovascular disease risk reported in shift workers.
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Affiliation(s)
- Ludovic G P M van Amelsvoort
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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