E J Feskens

Wageningen University, Wageningen, Gelderland, Netherlands

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Publications (453)1930.64 Total impact

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    ABSTRACT: OBJECTIVE The long-term association between dietary protein and type 2 diabetes incidence is uncertain. We aimed to investigate the association between total, animal, and plant protein intake and the incidence of type 2 diabetes.RESEARCH DESIGN AND METHODS The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from eight European countries, with an average follow-up time of 12.0 years. Pooled country-specific hazard ratios (HRs) and 95% CI of prentice-weighted Cox regression analyses were used to estimate type 2 diabetes incidence according to protein intake.RESULTSAfter adjustment for important diabetes risk factors and dietary factors, the incidence of type 2 diabetes was higher in those with high intake of total protein (per 10 g: HR 1.06 [95% CI 1.02-1.09], Ptrend <0.001) and animal protein (per 10 g: 1.05 [1.02-1.08], Ptrend = 0.001). Effect modification by sex (P < 0.001) and BMI among women (P < 0.001) was observed. Compared with the overall analyses, associations were stronger in women, more specifically obese women with a BMI >30 kg/m(2) (per 10 g animal protein: 1.19 [1.09-1.32]), and nonsignificant in men. Plant protein intake was not associated with type 2 diabetes (per 10 g: 1.04 [0.93-1.16], Ptrend = 0.098).CONCLUSIONS High total and animal protein intake was associated with a modest elevated risk of type 2 diabetes in a large cohort of European adults. In view of the rapidly increasing prevalence of type 2 diabetes, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered.
    Diabetes care 04/2014; · 7.74 Impact Factor
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    ABSTRACT: Epidemiological studies have shown associations between vitamin D, mental health and glucose homeostasis in the elderly. Causal evidence, however, is still lacking. The objective of this study was to investigate the importance of vitamin D in the prevention of emotional disturbances and cognitive decline in aging C57BL/6 mice, with pre-diabetes type II as potential effect modifier. Mice were exposed to one of four diets from 10 months till 24 months of age: low fat vitamin D adequate (LFD), LF vitamin D deficient (LF), moderate fat vitamin D adequate (MFD), and MF vitamin D deficient (MF). The MFD/MF diet was applied to induce a condition resembling pre-diabetes type II. Behavior was assessed twice in the same group of mice at 6-8 and at 22-23 months of age using the Open Field Test (OFT), Elevated Plus Maze (EPM), Object Recognition Test (ORT) and the Morris Water Maze (MWM). We successfully induced vitamin D deficiency in the LF/MF mice. Moreover, fasting glucose and fasting insulin levels were significantly higher in MFD/MF mice than in LFD/LF mice. A significant aging effect was observed for most behavioral parameters. A MF(D) diet was shown to delay or prevent the age-related increase in emotional reactivity in the EPM. No effect of vitamin D or vitamin D*fat on behavioral outcomes was measured. Aging significantly affected emotional reactivity and cognitive performance. Although other studies have shown effects of vitamin D on emotional reactivity and cognitive performance in mice, these findings could not be confirmed in aged C57BL/6 mice in this study.
    Behavioural brain research 03/2014; · 3.22 Impact Factor
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    ABSTRACT: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥7.5%) risk. During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.
    JAMA The Journal of the American Medical Association 03/2014; 311(12):1225-33. · 29.98 Impact Factor
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    ABSTRACT: Background/Objectives:The nutrient-rich food (NRF) index assesses nutrient quality of individual food items by ranking them according to their nutrient composition. The index reflects the nutrient density of the overall diet. We examined the associations between the NRF9.3 index-a score on the basis of nine beneficial nutrients (protein, fiber, vitamins and minerals) and three nutrients to limit (saturated fat, sugar and sodium)-incidence of cardiovascular disease (CVD) events and all-cause mortality.Subjects/Methods:A total of 4969 persons aged 55 and older from the Rotterdam Study, a prospective cohort study in the Netherlands, were studied. First, all foods were scored on the basis of their nutrient composition, resulting in an NRF9.3 score on food item level. Subsequently, they were converted into individual weighted scores on the basis of the amount of calories of each food item consumed by the subjects and the total energy intake. The hazard ratios (HRs) of the NRF9.3 index score were adjusted for age, gender, body mass index, smoking history, doctor-prescribed diet, alcohol consumption and education.Results:Food groups that contributed most to the NRF9.3 index score were vegetables, milk and milk products, fruit, bread and potatoes. A high NRF9.3 index score was inversely associated with all-cause mortality (HR Q4 versus Q1: 0.84 (95% confidence interval: 0.74, 0.96)). Associations were stronger in women than in men. The NRF9.3 index score was not associated with incidence of CVD.Conclusion:Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival.European Journal of Clinical Nutrition advance online publication, 19 March 2014; doi:10.1038/ejcn.2014.35.
    European journal of clinical nutrition 03/2014; · 3.07 Impact Factor
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    ABSTRACT: Complement C3 is a novel risk factor for cardiovascular disease (CVD), but the underlying mechanism is currently unknown. We determined the associations of the anaphylatoxin C3a, the activation product of C3, and of C3 itself with estimates of atherosclerosis and CVD. We studied associations of C3a and C3 with carotid intima-media thickness (cIMT), ankle-arm blood pressure index (AAIx) and CVD in cross-sectional analyses among 545 participants of the Cohort on Diabetes and Atherosclerosis Maastricht (CODAM) study (61% men, 59.4 ± 6.9 years) and examined effect modification by smoking. We conducted linear and logistic regression analyses with adjustments for age, sex, glucose metabolism status, lipids, adiposity, renal function, blood pressure, pack-years smoked, physical activity, use of medication and investigated mediation by inflammation. C3a was independently associated with cIMT (β=0.032 mm, [95% confidence interval: 0.004; 0.060]) and AAIx (β=-0.022, [-0.043; -0.001]), but C3 was not. Effect modification by smoking was only observed for CVD (Psmoking*C3a=0.008, Psmoking*C3=0.018), therefore these associations were stratified for smoking behaviour. Both C3a (odds ratio [OR] =2.96, [1.15; 7.62]) and C3 (OR =1.98, [1.21; 3.22]) were independently associated with CVD in heavy smokers. The association of C3 with CVD was independent of C3a. Low-grade inflammation did partially explain the association of C3a with AAIx, but not the other observed associations. This suggests that C3a and C3 have distinct roles in pathways leading to CVD. C3a may promote atherosclerosis and additionally advance CVD in heavy smokers. Conversely, C3 may be associated with CVD in heavy smokers via pathways other than atherosclerosis.
    Thrombosis and Haemostasis 02/2014; 111(6). · 6.09 Impact Factor
  • Alimentary Pharmacology & Therapeutics 02/2014; 39(3):340-1. · 4.55 Impact Factor
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    ABSTRACT: Aging is a biological process characterized by the progressive functional decline of many interrelated physiological systems. In particular, aging is associated with the development of a systemic state of low-grade chronic inflammation (inflammaging), and with progressive deterioration of metabolic function. Systems biology has helped in identifying the mediators and pathways involved in these phenomena, mainly through the application of high-throughput screening methods, valued for their molecular comprehensiveness. Nevertheless, inflammation and metabolic regulation are dynamical processes whose behavior must be understood at multiple levels of biological organization (molecular, cellular, organ, and systems level) and on multiple time scales. Mathematical modeling of such behavior, with incorporation of mechanistic knowledge on interactions between inflammatory and metabolic mediators, may help in devising nutritional interventions capable of preventing, or ameliorating, the age-associated functional decline of the corresponding systems.
    Mechanisms of ageing and development 01/2014; · 4.18 Impact Factor
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    D Sluik, L van Lee, A Geelen, E J Feskens
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    ABSTRACT: Background/Objectives:The habitual consumption of a specific type of alcoholic beverage may be related to the overall dietary pattern. The objective of this cross-sectional study was to investigate associations between alcoholic beverage preference and dietary intake in The Netherlands.Subjects/Methods:A total of 2100 men and women from the Dutch National Food Consumption Survey 2007-2010 were studied. A general questionnaire assessed alcoholic beverage preference and two non-consecutive 24-h dietary recalls assessed overall diet. Mean nutrient and food group intakes, and adherence to the 2006 Dutch dietary guidelines across categories of alcoholic beverage preference were compared and adjusted for age, sex, body mass index (BMI), education, smoking, physical activity, energy intake and frequency and absolute alcohol consumption.Results:Largest differences in dietary habits were detected between persons who preferred wine and those who preferred beer. Persons with a beer preference had a higher absolute intake of meat, soft drinks, margarine and snacks. In contrast, persons with a wine preference had a higher absolute consumption of healthy foods. However, after multiple adjustments, wine consumers still consumed less energy and more vegetables and fruit juices compared with beer consumers. Adherence to the Dutch dietary guidelines did not differ between preference categories after multiple adjustments.Conclusions:In this cross-sectional analysis in a representative sample of the Dutch population, a beer preference was associated with less healthy dietary behaviour, especially compared with wine preference. However, these differences were largely explained by other socio-demographic and lifestyle factors. These results suggest that alcoholic beverage preference may not be independently related to diet.European Journal of Clinical Nutrition advance online publication, 8 January 2014; doi:10.1038/ejcn.2013.279.
    European journal of clinical nutrition 01/2014; · 3.07 Impact Factor
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    ABSTRACT: Background and aims Hyperhomocysteinemia is associated with arterial stiffness, but underlying pathophysiological mechanisms explaining this association are to be revealed. This study was aimed to explore two potential pathways concerning the one-carbon metabolism. A potential causal effect of homocysteine was explored using a genetic risk score reflecting an individual’s risk of having a long-term elevated plasma homocysteine level and also associations with B-vitamin levels were investigated. Methods and results Baseline cross-sectional data of the B-PROOF study were used. In the cardiovascular subgroup (n=567, 56% male, age 72.6 ± 5.6 yrs) pulse wave velocity (PWV) was determined using applanation tonometry. Plasma concentrations of vitamin B12, folate, methylmalonic acid (MMA) and holo transcobalamin (holoTC) were assessed and the genetic risk score was based on 13 SNPs being associated with elevated plasma homocysteine. Associations were examined using multivariable linear regression analysis. B-vitamin levels were not associated with PWV. The genetic risk score was also not associated with PWV. However, the homocysteine – gene interaction was significant (p < 0.001) in the association of the genetic risk score and PWV. Participants with the lowest genetic risk of having long-term elevated homocysteine levels, but with higher measured homocysteine levels, had the highest PWV levels. Conclusion Homocysteine is unlikely to be causally related to arterial stiffness, because there was no association with genetic variants causing hyperhomocysteinemia, whereas non-genetically determined hyperhomocysteinemia was associated with arterial stiffness. Moreover, the association between homocysteine and arterial stiffness was not mediated by B-vitamins. Possibly, high plasma homocysteine levels reflect an unidentified factor, that causes increased arterial stiffness.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2014; · 3.52 Impact Factor
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    ABSTRACT: An increased intake of dietary fiber has been associated with reduced appetite and reduced energy intake. Research on the effects of seemingly identical classes of dietary fiber on appetite has, however, resulted in conflicting findings. The present study investigated the effects of different fiber properties, including methods of supplementation, on appetite and energy intake. This was a randomized crossover study with 29 subjects (21 ± 2y, BMI 21.9 ± 1.8 kg/m2) consuming dairy based liquid test products (1.5 MJ, 435 g) containing either: no pectin, bulking pectin (10 g), viscous pectin (10 g), or gelled pectin (10 g). The gelled pectin was also supplemented as capsules (10 g), and as liquid (10 g). Physicochemical properties of the test products were assessed. Appetite, glucose, insulin and gastric emptying were measured before ingestion and after fixed time intervals. Energy intake was measured after 3 hours. Preload viscosity was larger for gelled > viscous > bulking > no pectin, and was larger for gelled > liquid > capsules. Appetite reduced after gelled pectin compared to bulking (p < 0.0001), viscous (p = 0.005) and no pectin (p < 0.0001), without differences in subsequent energy intake (p = 0.32). Gastric emptying rate was delayed after gelled pectin (82 ± 18 min) compared to no pectin (70 ± 19 min, p = 0.015). Furthermore, gelled (p = 0.002) and viscous (p < 0.0001) pectin lowered insulin responses compared to no pectin, with minor reductions in glucose response. Regarding methods of supplementation, appetite reduced after the gelled test product compared to after capsules (p < 0.0001) and liquid (p < 0.0001). Energy intake was lower after capsules compared to liquid (-12.4%, p = 0.03). Different methods of supplementation resulted in distinct metabolic parameters. Results suggest that different physicochemical properties of pectin, including methods of supplementation, impact appetite and energy intake differently. Reduced appetite was probably mediated by preload physical properties, whereas inconsistent associations with metabolic parameters were found.
    Physiology & Behavior 01/2014; · 3.16 Impact Factor
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    ABSTRACT: Background Metabolomics, defined as the comprehensive identification and quantification of low-molecular-weight metabolites to be found in a biological sample, has been put forward as a potential tool for classifying individuals according to their risk of coronary heart disease (CHD). Here, we investigated whether a single-point blood measurement of the metabolome is associated with and predictive for the risk of CHD. Methods & Results We obtained proton nuclear magnetic resonance (1H-NMR) spectra in 79 cases who developed CHD during follow-up (median 8.1 years) and in 565 randomly selected individuals. In these spectra 100 signals representing 36 metabolites were identified. Applying LASSO regression, we defined a weighted metabolite score consisting of 13 1H-NMR signals that optimally predicted CHD. This metabolite score, including signals representing a lipid fraction, glucose, valine, ornithine, glutamate, creatinine, glycoproteins, citrate and 1.5-anhydrosorbitol, was associated with the incidence of CHD independent of traditional risk factors (TRFs) (HR = 1.50; 95%CI = 1.12-2.01). Predictive performance of this metabolite score on its own was moderate (C-index = 0.75; 95%CI = 0.70-0.80) but after adding age and sex the C-index was only modestly lower than that of TRFs (C-index = 0.81; 95%CI = 0.77-0.85 and C-index = 0.82; 95%CI = 0.78-0.87, respectively). The metabolite score was also associated with prevalent CHD independent of TRFs (OR = 1.59; 95%CI = 1.19-2.13). Conclusion A metabolite score derived from a single-point metabolome measurement is associated with CHD and metabolomics may be a promising tool for refining and improving the prediction of CHD.
    American Heart Journal. 01/2014;
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    ABSTRACT: Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend < 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile: 0.81; 95% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% CI: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D.
    Journal of Nutrition 12/2013; · 4.20 Impact Factor
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    Edith J. M. Feskens, Diewertje Sluik, Huaidong Du
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    ABSTRACT: This review summarizes evidence from two projects embedded within the European Prospective Investigation into Cancer and Nutrition (EPIC) on the association between dietary factors and obesity risk, in particular change in weight and waist circumference. A total of 12 publications from DiOGenes and six from EPIC-PANACEA were reviewed. The results show that dietary fiber, especially cereal fiber, was inversely associated with weight or waist change, as well as fruit/vegetable intake and the Mediterranean dietary pattern. Energy density and meat consumption were positively associated with the anthropometric changes, as was glycemic index with waist change. Clear associations with macronutrient composition were not observed. In additional studies, interactions with genetic polymorphism were investigated and shown to be present for protein intake and GI, although effect estimates were small. These interactions require replication. These results show that in European populations dietary factors are independently associated with weight/waist change. The findings provide further clues for the prevention of obesity.
    Current Obesity Reports. 12/2013;
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    ABSTRACT: The development of a chronic, low grade, inflammatory status named "inflammaging" is a major characteristic of aging, which plays a critical role in the pathogenesis of age-related diseases. Inflammaging is both local and systemic, and a variety of organs and systems contribute inflammatory stimuli that accumulate lifelong. The NU-AGE rationale is that a one year Mediterranean whole diet (considered by UNESCO a heritage of humanity), newly designed to meet the nutritional needs of the elderly, will reduce inflammaging in fully characterized subjects aged 65-79 year of age, and will have systemic beneficial effects on health status (physical and cognitive). Before and after the dietary intervention a comprehensive set of analyses, including omics (transcriptomics, epigenetics, metabolomics, metagenomics) will be performed to identify the underpinning molecular mechanisms. NU-AGE will set up a comprehensive database as a tool for a systems biology approach to inflammaging and nutrition. NU-AGE is highly interdisciplinary, includes leading research centres in Europe on nutrition and aging, and is complemented by EU multinational food industries and SMEs, interested in the production of functional and enriched/advanced traditional food tailored for the elderly market, and European Federations targeting policy makers and major stakeholders, from consumers to EU Food & Drink Industries.
    Mechanisms of ageing and development 12/2013; · 4.18 Impact Factor
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    ABSTRACT: To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania. A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously known to have diabetes, participated during usual ante-natal clinic visits. Capillary blood samples were collected at fasting and 2h after 75g glucose load and were measured using HemoCue. Diagnosis of GDM was made using 1999 World Health Organization (WHO) criteria. Women in rural areas were younger (26.6 years) than in urban areas (27.5 years). Mean gestational age, height, and mid-upper arm circumference (MUAC) were similar for the two areas. Overall prevalence of GDM averaged 5.9%, with 8.4% in urban area and 1.0% in rural area. Prevalence of GDM was higher for women who had a previous stillbirth (OR 2.8, 95% CI 1.5-5.4), family history of type 2 diabetes (OR 2.1, 95% CI 1.1-4.2), and MUAC above 28cm (OR 1.9, 95% CI 1.1-3.3), and lower for women with normal hemoglobin compared with anemia (OR 0.45, 95% CI 0.22-0.93). Prevalence of GDM is higher than expected in urban areas in Tanzania, indicating an increasing population who are at risk for delivery complications and type 2 diabetes in Sub-Saharan Africa.
    Diabetes research and clinical practice 12/2013; · 2.74 Impact Factor
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    ABSTRACT: The proportion of European elderly is expected to increase to 30% in 2060. Combining dietary components may modulate many processes involved in ageing. So, it is likely that a healthful diet approach might have greater favourable impact on age-related decline than individual dietary components. This paper describes the design of a healthful diet intervention on inflammageing and its consequences in the elderly. The NU-AGE study is a parallel randomized one year trial in 1,250 apparently healthy, independently living European participants aged 65 to 80 years. Participants are randomised into either the diet group or control group. Participants in the diet group received dietary advice aimed at meeting the nutritional requirements of the ageing population. Special attention was paid to nutrients that may be inadequate or limiting in diets of elderly, such as vitamin D, vitamin B12, and calcium. C-reactive protein is measured as primary outcome. The NU-AGE study is the first dietary intervention investigating the effect of a healthful diet providing targeted nutritional recommendations for optimal health and quality of life in apparently healthy European elderly. Results of this intervention will provide evidence on the effect of a healthful diet on the prevention of age related decline.
    Mechanisms of ageing and development 11/2013; · 4.18 Impact Factor
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    ABSTRACT: Complement factor 3 (C3) has been identified as a novel risk factor for obesity-associated cardiometabolic diseases. Data in the literature suggest that C3 concentrations may be influenced by diet. Therefore, we investigated the associations of intake of total fat, specific fatty acids, and fat-soluble vitamin E (and individual tocopherols) and vitamin A (and its dietary precursors) with circulating C3. In a white cohort [Cohort on Diabetes and Atherosclerosis Maastricht (CODAM)]; n = 501; 59.4 ± 7.1 y; 61% men], associations of habitual nutrient intake (assessed by a food-frequency questionnaire) with circulating C3 were evaluated by using cross-sectional multiple linear regression analyses. Adjustments were first performed for age, sex, glucose metabolism status (i.e., impaired glucose metabolism or type 2 diabetes), and energy intake and subsequently for BMI, waist circumference, alcohol intake, smoking behavior, and season of blood collection. No associations with C3 were observed for total dietary fat intake or intake of specific fatty acids [saturated, monounsaturated, polyunsaturated, n-6 (ω6), and n-3 (ω3) fatty acids], vitamin E, or individual tocopherols. We observed an inverse association with intake of provitamin A carotenoids α-carotene (in μg/d; regression coefficient β = -0.075; 95% CI: -0.140, -0.010; P = 0.025) and β-carotene (in μg/d; β = -0.021; 95% CI: -0.044, 0.002; P = 0.068) with C3 (in mg/L). In contrast, and only in women, dietary retinol intake (in μg/d) was positively associated with C3 (β = 0.116; 95% CI: 0.014, 0.218; P = 0.026; n = 196). In conclusion, these data suggest that fasting concentrations of C3 may, in a complex manner, be modifiable by variation in dietary provitamin A carotenoids and/or retinol content of the usual diet but most likely not by variations in fat composition and vitamin E content.
    Journal of Nutrition 10/2013; · 4.20 Impact Factor
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    ABSTRACT: OBJECTIVE To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations.RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study included 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants from among 340,234 participants with 3.99 million person-years of follow-up in eight European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the Phenol-Explorer, the U.K. Food Standards Agency, and the U.S. Department of Agriculture databases. Hazard ratios (HRs) from country-specific Prentice-weighted Cox regression models were pooled using random-effects meta-analysis.RESULTSIn multivariable models, a trend for an inverse association between total flavonoid intake and type 2 diabetes was observed (HR for the highest vs. the lowest quintile, 0.90 [95% CI 0.77-1.04]; P value trend = 0.040), but not with lignans (HR 0.88 [95% CI 0.72-1.07]; P value trend = 0.119). Among flavonoid subclasses, flavonols (HR 0.81 [95% CI 0.69-0.95]; P value trend = 0.020) and flavanols (HR 0.82 [95% CI 0.68-0.99]; P value trend = 0.012), including flavan-3-ol monomers (HR 0.73 [95% CI 0.57-0.93]; P value trend = 0.029), were associated with a significantly reduced hazard of diabetes.CONCLUSIONS Prospective findings in this large European cohort demonstrate inverse associations between flavonoids, particularly flavanols and flavonols, and incident type 2 diabetes. This suggests a potential protective role of eating a diet rich in flavonoids, a dietary pattern based on plant-based foods, in the prevention of type 2 diabetes.
    Diabetes care 10/2013; · 7.74 Impact Factor
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    ABSTRACT: The role of diet in inflammatory bowel disease (IBD) is supported by migration studies and increasing incidences in line with Westernisation. To give a complete overview of studies associating habitual diet with the onset or relapses in ulcerative colitis (UC) or Crohn's disease (CD). A structured search in Pubmed, the Cochrane Library and EMBASE was performed using defined key words, including only full text papers in English language. Forty-one studies were identified, investigating onset (n = 35), relapses (n = 5) or both (n = 1). Several studies reported high intake of sugar or sugar-containing foods (n = 7 UC, n = 12 CD), and low intake of fruits and/or vegetables (n = 5 UC, n = 10 CD) to be associated with an increased onset risk. However, these findings could not be confirmed by similar or higher numbers of other studies. A possible protective role was found for grain-derived products in CD onset, but results were inconsistent for dietary fibre in UC and CD and grain-derived products in UC. No definite conclusions could be drawn for unsaturated fatty acids (UFA), protein and energy intake due to limited and/or inconsistent results. Six studies reported on diet and relapse risk, of which only two (n = 1 UC, n = 1 CD) had a prospective follow-up. The current evidence is not sufficient to draw firm conclusions on the role of specific food components or nutrients in the aetiology of IBD. Furthermore, large prospective studies into the role of habitual diet as a trigger of relapses are needed, to identify new therapeutic or preventive targets.
    Alimentary Pharmacology & Therapeutics 10/2013; · 4.55 Impact Factor
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    ABSTRACT: Background Viscous or gel-forming dietary fibers can increase satiety by a more firm texture and increased eating time. Effects of viscous or gel-forming fibers on satiety by post ingestive mechanisms such as gastric emptying, hormonal signals, nutrient absorption or fermentation are unclear. Moreover, it is unclear whether effects persist after repeated exposure.Objective To investigate satiety and energy intake after single and repeated exposure to gelled fiber by post ingestive mechanisms.DesignIn a two-arm crossover design, 32 subjects (24 females, 21±2 y, BMI 21.8±1.9 kg/m(2)) consumed test foods once daily for 15 consecutive days, with two weeks washout. Test foods were isocaloric (0.5 MJ, 200 g) with either 10 g gel forming pectin or 3 g gelatin and 2 g starch, matched for texture and eating time. Hourly satiety ratings, ad libitum energy intake, and body weight were measured on days 1 (single exposure) and 15 (repeated exposure). In addition hourly breath hydrogen, fasting glucose, insulin, leptin and short chain fatty acids were measured.ResultsSubjects rated hunger, desire to eat and prospective intake about 2% lower (P<0.015) and fullness higher (+1.4% P=0.041) when they received pectin compared to control. This difference was similar after single and repeated exposure (P>0.64). After receiving pectin, energy intake was lower (-5.6%, P=0.012) and breath hydrogen was elevated (+12.6%, P=0.008) after single exposure, but not after repeated exposure. Fasting glucose concentrations were higher both after single and repeated exposure to pectin (+2.1%, P=0.019). Body weight and concentrations of insulin, leptin and short chain fatty acids did not change during the study.Conclusions Gelled pectin can increase satiety and reduce energy intake by post ingestive mechanisms. Although the effects were small, the effects on satiety were consistent over time, whereas the effects on energy intake reduction were not.International Journal of Obesity accepted article preview online, 13 September 2013. doi:10.1038/ijo.2013.176.
    International journal of obesity (2005) 09/2013; · 5.22 Impact Factor

Publication Stats

12k Citations
1,930.64 Total Impact Points


  • 1996–2014
    • Wageningen University
      • Division of Human Nutrition
      Wageningen, Gelderland, Netherlands
    • University of Groningen
      • Department of Internal Medicine
      Groningen, Province of Groningen, Netherlands
  • 2013
    • Sokoine University of Agriculture (SUA)
      • Department of Food Science and Nutrition
      Murogoro, Morogoro Region, Tanzania
    • Medical Research Council (UK)
      Londinium, England, United Kingdom
    • Catharina Hospital
      Eindhoven, North Brabant, Netherlands
  • 2003–2013
    • Maastricht University
      • • Humane Biologie
      • • Interne Geneeskunde
      Maastricht, Provincie Limburg, Netherlands
  • 2012
    • University Medical Center Utrecht
      • Julius Center for Health Sciences and Primary Care
      Utrecht, Provincie Utrecht, Netherlands
  • 2003–2012
    • Leiden University Medical Centre
      • Department of Medical Statistics and Bioinformatics
      Leyden, South Holland, Netherlands
  • 1993–2012
    • National Institute for Public Health and the Environment (RIVM)
      • • Centre for Prevention and Health Services Research (PZO)
      • • Centre for Nutrition and Health
      Utrecht, Utrecht, Netherlands
  • 2009–2011
    • University of Cambridge
      • Department of Public Health and Primary Care
      Cambridge, England, United Kingdom
  • 2010
    • University of Oxford
      • Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)
      Oxford, ENG, United Kingdom
  • 2001
    • Erasmus Universiteit Rotterdam
      • Department of Public Health (MGZ)
      Rotterdam, South Holland, Netherlands
  • 2000
    • University of Tampere
      • Department of Paediatrics
      Tampere, Western Finland, Finland
  • 1999
    • VU University Amsterdam
      • Institute for Cardiovascular Research VU
      Amsterdam, North Holland, Netherlands
  • 1997–1998
    • University of Glasgow
      • Human Nutrition Section
      Glasgow, SCT, United Kingdom
  • 1996–1998
    • Universiteit Utrecht
      Utrecht, Utrecht, Netherlands