Nutrition, metabolism, and cardiovascular diseases: NMCD

Published by Elsevier
Online ISSN: 0939-4753
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Article
Prebiotics is a recent novel food concept that includes food ingredients that are not digested in the human upper intestinal tract and hence arrive in the colon where they are selectively fermented by a limited number of colonic bacteria. Amongst these are bifidobacteria and lactobacilli, which are considered indicators of a well-balanced intestinal flora. Probiotics are bacteria that, while passing through the intestine, may exert specific beneficial effects on the host's physiology. In general, probiotics are members of the group of the lactic acid-producing bacteria. By means of a variety of experimental models it was demonstrated that prebiotic carbohydrates and probiotics consistently reduced processes of carcinogenesis and tumorigenesis. Synergistic chemopreventive actions were observed with combinations of the two, which together are called synbiotics. One of the most important causes of death in the ageing western population is colon cancer, which is typically associated with a western-style diet. On the basis of the available experimental data, an EU-funded research project (the SYNCAN project QLK1-1999-00346) was set up to evaluate whether synbiotics and prebiotics can be added to food without detriment to (and hopefully eventually improving) organoleptic properties. They are, as such, a good vector for importing nutritionally interesting properties into our diet.
 
Article
To assess the relationships between different diurnal triglyceride (TG) profiles (p) and the atherogenicity of the lipoprotein phenotype and adhesion molecule concentrations in patients with coronary artery disease (CAD). Repeated measurements of fasting TG and TGp were made in 29 CAD patients; fasting cholesterol levels (total-C, VLDL, LDL, HDL and small dense LDL) and soluble cell adhesion molecules (sCAM) (ICAM-1 and E-selectin) were measured once. Three different TGps were defined: fasting (137.0 +/- 60.7 mg/dL) and all other TG levels <200 mg/dL (LL; n=7); a fasting TG level <200 mg/dL (147.0 +/- 49.9 mg/dL) and maximum TG levels >200 mg/dL (LH; n=13); and both fasting (225.1+/-76.2 mg/dL) and maximum TG levels >200 mg/dL (HH; n=9). We then analysed the associations between the TGp types and the lipoprotein phenotype and CAMs. LL had significantly lower values than LH (p<0.05 for all parameters except sE-selectin) and HH (p<0.05 for all parameters) of VLDL (11.2 +/- 5.8, 18.8 +/- 9.4, 28.1 +/- 8.8 mg/dL), LDL-5 (11.6 +/- 3.3, 16.4 +/- 4.5, 22.1 +/-7.9 mg/dl) and LDL-6 (12.0 +/- 3.2, 17.0 +/- 5.7, 25.7 +/- 9.6 mg/dL), sICAM-1 (209.4 +/- 30.3, 267.5 +/- 60.6, 273.4 +/- 59.1 ng/dL) and sE-selectin (25.1 +/- 17.6, 35.5 +/- 11.5, 48.5 +/- 20.2 ng/dL). Although the differences in fasting TG levels between the LL and LH groups were not significantly different, LH had a more atherogenic lipoprotein phenotype and higher concentrations of adhesion molecules. TGp measurements seem to be suitable for identifying CAD patients with an unfavourable diurnal TG and atherosclerosis-prone lipoprotein metabolism.
 
Article
Italian National Food Consumption Survey, INRAN-SCAI 2005-06, is the third national food consumption survey performed in Italy. This study describes energy and nutrient intakes in Italy. A national cross-sectional food consumption survey was conducted using consecutive 3-day food records between October 2005 and December 2006. A sample of 3323 males and females aged 0.1-97.7 years living in private households was investigated. Individual food records were converted into energy and nutrient intakes with the use of recently updated national food composition databases. For each subject, intakes of energy and of 27 nutrients were calculated, including six minerals (i.e., iron, calcium, phosphorus, magnesium, potassium and zinc) and 10 vitamins (i.e., thiamine, riboflavin, vitamin C, vitamin B₆, retinol, β-carotene, vitamin A as retinol equivalents (REs), vitamin E, vitamin D and vitamin B₁₂. On average, 36% of calories appeared to derive from fat (11% from saturated fatty acids) and 45% from available carbohydrates (15% from soluble carbohydrates). The results of the INRAN-SCAI 2005-06 survey in terms of nutrient intakes provide an important piece of information for nutrition surveillance of the population and may also be used to identify priorities for further research.
 
Article
Peroxynitrite (ONOO-), a highly reactive species, modulates platelet activation and function. Modifications of platelet proteins induced by ONOO- may be an important factor in the pathogenesis of platelet-related diseases. The defence mechanisms against ONOO- are therefore crucial for normal cellular function. Recently, there has been an increased interest in the screening of natural products present in the diet and herbals for possible antioxidative agents (ONOO( scavengers). D-glucaro-1,4-lactone (1,4-GL), formed from D-glucaric acid (GA), a natural compound found in fruits and vegetables, possesses detoxifying and anticancerogenic properties. However, the effect of this compound on platelet activation is unknown. We investigated the effects of 1,4-GL on nitrative and oxidative alteration of platelet proteins and lipid peroxidation caused by two strong oxidants: ONOO- and hydroperoxide (H2O2). The action of 1,4-GL on platelet aggregation induced by adenosine diphosphate (ADP) was also studied. Exposure of platelets to ONOO- or H2O2 resulted in an increase in the level of carbonyl groups (approximately three-fold and two-fold, respectively). In the presence of 1,4-GL, a significant decrease (about 50% for the highest concentration of 1,4-GL) in carbonyl group formation was observed; however the level of nitrotyrosine residues in platelets treated with ONOO- remained unchanged. We demonstrated an inhibitory effect of 1,4-GL on lipid peroxidation in platelets treated with ONOO- (0.1mM) or H2O2 (2mM). 1,4-GL inhibited platelet lipid peroxidation by about 40%. In the presence of 1,4-GL, peroxidation of plasma lipids was also reduced by about 40%. These results demonstrate that 1,4-GL possesses antioxidative properties and reduces the activation of blood platelets.
 
Article
To evaluate the prevalence of overweight and obesity in children and adolescents from Sicily, we carried out a cross-sectional study in a large cohort of 48,897 (24,119 males and 24,778 females) randomly selected 11-15-year-old Sicilian schoolchildren. Anthropometric data (weight and height) were obtained in all children. Urban vs. rural areas were taken into account. Centiles were obtained using the LMS method. Obesity and overweight prevalence were defined using as references both the values of the National Center for Disease Control (CDC 2000) in the United States and those of the International Obesity Task Force (IOTF). Median body mass index (BMI) values in Sicily were comparable to values observed in South and Center-North Italy. BMI cut-off values in Sicilian children were higher than reference values established in the U.S. CDC growth chart 2000. Using both the IOTF or the U.S. CDC 2000 cut-off values the prevalence of overweight and obesity in 11-15-year-old Sicilian children was very high: nearly 40% at age 11 and, although progressively decreasing with age increase, still over 25% at age 15. The prevalence of overweight and obesity in 11-15-year-old Sicilian schoolchildren is one of the highest ever reported. The prevalence is much higher at a younger age; thereafter it progressively decreases and values tend to reconcile with those observed in other geographical areas at age 14-15.
 
Article
Some studies recently reported a favourable effect for cis-9, trans-11 conjugated linoleic acid (CLA) on plasma lipoprotein profile of healthy subjects. Aim of this crossover intervention study was to evaluate the influence of a short-term dietary intake of a cheese derived from sheep's milk naturally rich in CLA on several atherosclerotic biomarkers, in comparison with a commercially available cheese. Ten subjects (6 F; 4 M) with a median age of 51.5 followed for 10 weeks a diet containing 200 g/week of cheese naturally rich in CLA (intervention period) and for the same period a diet containing a commercially available cheese of the same quantity (placebo period). Consumption of the dairy product naturally rich in cis-9, trans-11 CLA determined a significant (p<0.05) reduction in inflammatory parameters such as interleukin-6 (pre: 8.08+/-1.57 vs. post: 4.58+/-0.94 pg/mL), interleukin-8 (pre: 45.02+/-5.82 vs. post: 28.59+/-2.64 pg/mL), and tumour necrosis factor-alpha (pre: 53.58+/-25.67 vs. post: 32.09+/-17.42 pg/mL) whereas no significant differences in the placebo period were observed. With regard to haemorheological parameters, the test period significantly ameliorated erythrocytes' filtration rate (pre: 7.61+/-0.71% vs. post: 9.12+/-0.97%; p=0.03) with respect to the placebo period. Moreover, a reduction in the extent of platelet aggregation, induced by arachidonic acid [pre: 87.8+/-1.76% vs. post: 77.7+/-3.56%; p=0.04] was observed during the test period in comparison with the placebo period. Dietary short-term intake of the tested dairy product naturally rich in cis-9, trans-11 CLA appeared to cause favourable biochemical changes of atherosclerotic markers.
 
Article
Clinical trials have firmly established that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) can induce the regression of vascular atherosclerosis and reduce cardiovascular-related morbidity and death in patients with and without coronary artery disease. It is usually assumed that these beneficial effects are due to the ability of statins to reduce cholesterol synthesis. However, because mevalonic acid is not only the precursor of cholesterol but also of many non-steroidal isoprenoid compounds, the inhibition of HMG-CoA reductase may lead to pleiotropic effects. As shown by the data reported in this review, some statins can interfere with major events involved in the formation of atherosclerotic lesions, regardless of their hypolipidemic properties. The relevance of these effects in humans remains to be established (particularly in view of the high statin doses required to produce a direct vascular action), thus their contribution to the reduction in cardiovascular events observed in clinical trials has become one of the major challenges for future studies aimed at clarifying the anti-atherosclerotic benefits of statins.
 
Article
Functional foods enriched with plant sterols and stanols are on sale in many countries. Due to their structural similarity with cholesterol, these additives lower intestinal absorption of cholesterol, resulting in a 10-15% reduction in LDL-cholesterol when their daily intakes are 2-3 g. They are also effective as part of a cholesterol-lowering diet and in combination with cholesterol-lowering drugs. Estimates for the absorption of plant sterols (sitosterol and campesterol) and of campestanol are around 10%, and for sitostanol less than 5%. Lipid-standardized plasma levels are very low, but increase when statins are used. Extensive toxicological evaluation studies have not revealed any harmful side-effects. In human studies, side-effects were comparable to placebo treatment. However, lipid-standardized levels of the hydrocarbon carotenoids may decrease, without leaving the normal range. Together, these findings indicate that these functional foods have great potential in the prevention of coronary heart disease. However, post-marketing surveillance for example for functional foods in general is necessary to monitor possible adverse effects and describe consumers and consumption patterns.
 
Article
The preliminary findings of an epidemiological study conducted in 1989 in Ventimiglia di Sicilia (a rural village in the hilly hinterland 50 km from Palermo) described a population mainly made up of farmers, which had a very low incidence of early cardiovascular mortality, lower total cholesterol plasma concentration than the Italian average, and nutritional habits following the criteria of the Southern Italian Mediterranean diet. Since a high prevalence of body weight abnormalities was found in this population and an 11-year follow-up revealed that both body weight and fat distribution were significantly associated with total and cardiovascular mortality, we studied the eating behaviour, body weight and lipid levels of 249 school-children living in the village. The aim of the study was to verify whether the children showed similar body weight abnormalities and quantitative dietary excesses as the adults of the same families. The dietary habits of 97 children (about one third of the study population) had a higher total caloric, monounsaturated fatty acid and fibre intake, and a lower saturated fatty acid and cholesterol intake, than an all-Italy sample of school-children. The lipid profile of this group of very young subjects was fairly good, but 13% had LDL-cholesterol levels of more than 130 mg/dL and 11% had HDL-cholesterol levels of less than 35 mg/dL. About 28% were considered to be above the 95th percentile of body weight and this was associated with a higher daily total caloric intake. Because obesity is associated with a high total caloric intake and various other risk factors even in young children, it is possible that a successful prevention campaign including behavioural education in schools could reduce the incidence of cardiovascular disease at older ages.
 
Article
The aim of this study was to determine the validity of our previous hypothesis of adrenal 11 beta-hydroxylase (11-OH) dysregulation in "essential" low-renin hypertension. A comparison was made between 30 hypertensive patients and 30 age-matched controls (NC) in basal conditions and after ACTH stimulation (ACTH 1-17) test. The 11-deoxycortisol (S) and deoxycorticosterone (DOC) integrated areas under the curve (AUCs) of stimulus were significantly higher in the hypertensives (p < 0.001) and pointed to adrenal 11-OH dysregulation. The ACTH 1-17 test detects impairment of 11-OH activity of probable genetic origin. The relative mineralocorticoid excess thus provoked could be an additional cause of "essential" low-renin hypertension.
 
Article
Insulin resistance (IR) is commonly associated with other cardiovascular risk factors and is considered an independent risk factor for cardiovascular disease and events. The hyperinsulinemic euglycemic clamp technique is considered the gold standard for evaluating IR, but this technique is cumbersome and not easily applicable in large studies. Therefore, there are no long-term follow-up published studies on the relationship between IR determined by this technique and cardiovascular outcome. Thirteen years ago we performed a hyperinsulinemic euglycemic clamp in 31 hypertensive patients, 16 of whom manifested IR and 15 had normal insulin sensitivity. Thirteen years later we were able to re-evaluate or obtain medical records for all these patients. Over these years, 11 of the 16 insulin resistant patients developed cardiovascular disease and events, including two cardiovascular deaths, two myocardial infarctions, one angina pectoris, one peripheral vascular disease, and five carotid plaques or stenosis. Moreover, two patients developed new onset diabetes, one proteinuria and two impaired kidney function. Among insulin-sensitive patients, one developed peripheral vascular disease, one new onset diabetes and one proteinuria. In conclusion, this is the first longitudinal study of the relationship between insulin resistance, measured by the hyperinsulinemic euglycemic clamp and cardiovascular disease and events in a small cohort of patients with essential hypertension. The data suggest that hypertensive patients with IR are at greater risk of developing cardiovascular disease and events than hypertensive patients with normal insulin sensitivity.
 
Article
To summarize our present knowledge about vegetable omega-3 fatty acids. Alpha-linolenic acid (ALA) is one of the two essential fatty acids in humans. Epidemiological studies and dietary trials strongly suggest that this fatty acid is important in relation with the pathogenesis (and prevention) of coronary heart disease. Like other n-3 fatty acids from marine origin, it may prevent cardiac arrhythmias and sudden cardiac death. The optimal dietary intake of alpha-linolenic acid seems to be about 2 g per day or 0.6 to 1% of total energy intake. Obtaining an optimal ratio of the two essential fatty acids, linoleic and alpha-linolenic acids--ie a ratio of less than 4 to 1 in the diet--is a major issue. The main sources of alpha-linolenic acid for the European population should be canola oil (and canola-oil based margarine if available), nuts (English walnut), ground linseeds and green leafy vegetables such as purslane. Epidemiological studies and dietary trials in humans suggest that alpha-linolenic acid is a major cardio-protective nutrient.
 
Article
Background and aim: The Mediterranean Adequacy Index (MAI) is an overall indicator characterising a diet in comparison with a Reference Mediterranean Diet. We computed the MAI of random samples of men surveyed for their eating habits in the 16 cohorts of the Seven Countries Study, and found that it inversely correlated with the 25-year death rates from coronary heart disease in the 16 cohorts (R = -0.72; p = 0.001). The correlation coefficient was -0.84 (p < 0.001) when the MAI was converted into natural logarithms. Conclusions: These findings once again support the association between typical Mediterranean eating habits and protection against coronary heart disease.
 
Article
Clinical trials have reported lower mortality and repeated revascularization rate in diabetic patients treated with coronary artery bypass grafting (CABG) as compared to percutaneous revascularization. However, these studies were conducted in the era of bare-metal stents. Therefore, we performed a meta-analysis to compare CABG to PCI with drug-eluting stents (DES) in diabetic patients with multivessel and/or left main disease. The literature was scanned by formal search of electronic databases (Medline, EMBASE, and Cochrane databases), and major international scientific session abstracts from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4 randomized and 10 non-randomized) trials were finally included, with a total of 7072 patients. Up to 5 years follow-up, CABG was associated with a reduction in mortality (7.3% vs 10.4%, OR[95%CI] = 0.65[0.55-0.77], p < 0.0001; phet = 0.00001), with similar results in both RCTs (OR[95%CI] = 0.64[0.50-0.82], p = 0.0005) and NRCTs (OR[95%CI] = 0.75[0.6-0.94)], p = 0.01) (p int = 0.93). A significant relationship was observed between risk profile and benefits in mortality with CABG (p < 0.001). CABG reduced target vessel revascularization (TVR; 5.2% vs 15.7%, OR[95%CI] = 0.30[0.25-0.36], p < 0.00001, p het = 0.02), with a relationship between risk profile and the benefits from CABG as compared to DES (p < 0.0001). CABG was associated with a lower rate of MACCE (14.9% vs 22.9%, OR[95%CI] = 0.59[0.51-0.67], p < 0.00001, p het<0.00001) but higher risk of CVA (3.6% vs 1.4%, OR[95%CI] = 2.34[1.63-3.35], p < 0.00001, p het = 0.71). The present meta-analysis demonstrates that among diabetic patients with multivessel disease and/or left main disease, CABG provides benefits in mortality and TVR, especially in high-risk patients but it is counterbalanced by a higher risk of stroke. Future trials are certainly needed in the era of new DES and improved antiplatelet therapies.
 
Article
A large number of mitochondrial DNA (mtDNA) mutations have been implicated in degenerative diseases and aging. The aim of this study was to evaluate whether the 15497 G/A mtDNA polymorphism (G251S) in the cytochrome b subunit of respiratory complex III, which has been associated with obesity-related variables and lipid metabolism in a Japanese population, is associated with severe obesity also in adult Caucasians from southern Italy. Unrelated severely obese patients (n = 317; BMI > 40kg/m2) and controls (n = 217; BMI < 25kg/m2) from Southern Italy were genotyped by allelic discrimination TaqMan assay for the 15497 G/A mtDNA polymorphism. In obese patients fasting serum total cholesterol, triglycerides, HDL-cholesterol and glucose were measured enzymatically and sitting blood pressure and heart rate were also collected. Mean levels of total cholesterol, triglycerides and glucose were below the upper reference limit for healthy subjects. Female obese subjects showed lower levels of blood pressure and heart rate and higher levels of HDL cholesterol than male obese patients (P < 0.001). All the control subjects and 315/317 severely obese patients were homozygous for the G allele (wild type), whereas only 2/317, were females homozygous for the A allele. The mtDNA 15497 G/A polymorphism in cytochrome b was present in 0.6% obese subjects, two females whose lipid parameters and BMI were similar to those of the overall group. Therefore, this mutation may appear to contribute in rare instances to severe obesity but does not explain the majority of cases in our population. A more extensive genetic haplogroup characterization is required to identify associations to obesity in Caucasians.
 
Article
Obesity is the result of an imbalance between energy intake and energy expenditure. Controversial information exists about what are the strongest energy balance aspects influencing body fatness. This article is focused on food consumption facts that could be related to the risk of being obese in children and adolescents. It reviews whether energy intake, macronutrient composition of diet, eating patterns or other dietary intake factors are able to explain differences in body composition when obesity has been already developed or even in subjects at risk to become obese. There is not enough evidence to clarify the importance of diet on overweight children and adolescents, and conclusions derived are somewhat controversial. Cross-sectional and longitudinal studies do not show clear relationships between energy intake or food composition and body fatness. To find relations between dietary factors and childhood obesity perhaps eating patterns or different types of foods must be considered: meal patterns and meal frequency, snacking and beverage consumption, fast food intake, portion sizes, etc. There is no clear association between different aspects of dietary intake and the development of obesity in children and adolescents. Longitudinal and experimental studies are needed in the future.
 
Article
The Oslo Diet and Antismoking Study was a 5-year randomised controlled trial initiated in 1972-1973 and ended in 1977-1978, which showed that dietary change and smoking cessation reduced the incidence of coronary heart disease among high risk middle-aged men. In an extended follow-up we studied the incidence of myocardial infarction (MI) 16 years after the end of the trial in the intervention and control groups. The primary endpoint was the first occurrence of non-fatal and fatal MI including sudden death up to December 31 1993. Cases of fatal MI were identified by linkage to Statistics Norway using each subject's individual personal number. Cases of non-fatal MI were extracted from the hospital records. Cox proportional hazards regression models estimated relationships between changes in total cholesterol and triglyceride concentrations and smoking status and the primary endpoints up to 16 years following the end of the trial. At 5 and 10 years following the end of the trial the incidence of MI among the 604 men in the intervention (I) and 628 in the control (C) group differed significantly (5-year event rate (I/C) =0.059/0.090; P=0.038 and 10-year event rate (I/C) =0.111/0.155; P=0.023), but the difference faded slowly and subsequently (P=0.069 at 16 years). The reduction in MI in the intervention group was primarily explained by the differences in total cholesterol and triglyceride concentrations between the groups. This extended follow-up of the Oslo Diet and Antismoking Study found a prolonged benefit of the intervention lasting for at least a decade after the close of the trial. This finding is in accordance with statin and other studies showing that the effect of cholesterol lowering may be prolonged after the end of the intervention.
 
Article
Effects of pistachio nuts consumption on plasma lipid profile and oxidative status were investigated in healthy volunteers with normal lipid levels. The study was conducted in 24 healthy men and 20 healthy women. All subjects consumed their regular diets during a 1-week period. After this period, half of the subjects (12 men and 10 women, mean age 32.8 +/- 6.7 years) were randomized to a regular diet group and the other half (12 men and 10 women, mean age 33.4 +/- 7.2 years) were randomized to a pistachio group which involved substituting pistachio nuts for 20% of their daily caloric intake for 3 weeks. Plasma total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, malondialdehyde (MDA) and antioxidant potential (AOP) were measured before and after the dietary modification from all the subjects. After 3 weeks, with the pistachio diet, the mean plasma total cholesterol, MDA levels and, total cholesterol/HDL and LDL/HDL ratios were found to be significantly decreased (P < 0.05, P < 0.05, P < 0.001 and P < 0.01, respectively); on the contrary, HDL and AOP levels, and AOP/MDA ratios were significantly increased (P < 0.001, P < 0.05 and P < 0.01, respectively). Triglyceride and LDL levels also decreased but this was not statistically significant (P > 0.05). These results indicated that consumption of pistachio nuts decreased oxidative stress, and improved total cholesterol and HDL levels in healthy volunteers.
 
Changes in adipose tissue sub-compartments of overweight men after 6 weeks of consuming structured and olive oil diets 
Article
Medium chain triglycerides (MCT) have been suggested as modulators of human energy expenditure (EE) and thus may influence total and regional body fat distribution. To investigate in overweight men the effects of structured medium and long chain triglycerides on EE, substrate oxidation and body adiposity, compared to extra virgin olive oil (OO). In a 6 week single-blind crossover study, 23 overweight men were randomly assigned to consume a standard high-fat diet of which 75% total fat was provided as either structured medium and long chain triglycerides referred to as structured oil (StO), or OO. EE and body composition were measured using indirect calorimetry and magnetic resonance imaging, respectively, at weeks 1 and 6 of each phase. Body weight decreased (p<0.01) from baseline to end-point during consumption of both the StO (-1.46+/-0.4k g) and OO (-1.17+/-0.4 kg); however, no significant treatment differences were observed. There were no changes in body composition among treatment groups. No differences between diets for EE measurements were reported. Fat oxidation rates did not differ between oils, but were reduced (p<0.05) in the StO group between baseline (0.0020+/-0.0003 g/kg fat free mass per min) in comparison to after week 6 (0.0013+/-0.0001 g/kg fat free mass per min). No differences in carbohydrate oxidation rate were noted across diets or time. The present structured medium and long chain triglyceride oil increases short-term fat oxidation but fails to modulate body weight or adiposity through a change in EE.
 
Article
The recent interest in the development of evidence-based nutrition recommendations has resulted in the development of frameworks which enable a more structured evaluation of the link between diet and chronic disease. This paper examines the application of the frameworks produced by the Scottish Intercollegiate Guidelines Network (SIGN) and the World Cancer Research Fund (WCRF), by using as a case study the association between trans unsaturated fatty acids (TFAs) and coronary heart disease. TFAs arise during industrial hydrogenation of vegetable or fish fats and oils and the natural digestion process in ruminant animals. Numerous studies have examined the effects of TFA intake on serum lipids and lipoproteins and the association between TFA consumption and cardiovascular disease. Metabolic studies and meta-analyses show a clear and consistent association between increasing TFA intakes and an adverse lipid profile. Evidence from case-control and prospective cohort studies examining the association between TFA intakes and coronary heart disease is more heterogeneous and there are limitations in several of the studies. While the evidence is sufficient to suggest a probable positive association between TFAs and coronary heart disease, and thus to justify a firm recommendation for a reduction in dietary TFA intake, the evaluation of the data underlines the difficulties in extrapolating the principles of evidence-based medicine to evidence-based nutrition. Furthermore, there is a paucity of research into the effects of animal-derived TFAs in amounts typically consumed in a western diet and their association with adverse lipid profiles or cardiovascular outcomes.
 
Article
Dyslipidemia (increased triglyceride and low high-density lipoprotein [HDL] levels, with normal or slightly increased total cholesterol levels) is a common characteristic of type 2 diabetics and a major risk factor for cardiovascular diseases. The aim of this study was to evaluate the long-term efficacy of atorvastatin in a cohort of type 2 diabetics. Participants were divided into 3 groups on the basis of whether they had evidence of myocardial infarction or coronary lesions (group A), a family history of hypercholesterolemia (and/or cardiovascular diseases) and total cholesterol levels constantly above 270 mg/dL in blood samples taken at regular 4-month intervals and previously never at target level (group B), or clinical and/or instrumental (electrocardiogram) evidence of cardiovascular risk (group C). Their mean age was 64 +/- 7 years, known disease duration 0.5 +/- 3 years, body mass index (BMI) 27.7 +/- 1.3 Kg/m2, and haemoglobin A1c 8 +/- 0.6%. Total cholesterol was 256 +/- 24 mg/dL in group A, 298 +/- 25 mg/dL in group B and 244 +/- 31 mg/dL in group C (p < 0.05: group B vs groups A and C). HDL-cholesterol (HDL-C) was 45 +/- 7 mg/dL, triglycerides 225 +/- 20 mg/dL, systolic and diastolic blood pressure (DBP) respectively 144 +/- 7 and 85 +/- 8 mmHg, fibrinogen 330 +/- 23 mg/dL and microalbuminuria 58 +/- 9 mg/L. Eighteen months' atorvastatin treatment (10 mg/day in 106 subjects, 20 mg in 14 subjects, 30 mg in 5 subjects, and 40 mg in 30 subjects) led to a significant decrease in total and low-density lipoprotein (LDL)-cholesterol and triglyceride levels (p < 0.01), with about 86% of the patients achieving target levels, and a significant (p < 0.05) increase in HDL-C. There was a significant decrease in fibrinogen, microalbuminuria and DBP (p < 0.01), without any change in diet, BMI, physical activity or antihypertensive treatment. No new cardiovascular events or hospital admissions due to cardiovascular diseases were recorded during the 18 months of the study. These long-term treatment findings confirm and validate previous medium-term results, and suggest that atorvastatin therapy is effective and safe in the primary and secondary prevention of cardiovascular complications in type 2 diabetes.
 
Article
Antimicrobial peptides (AMPs) are components of the innate immune system. In addition, evidence suggests that these peptides are associated with various inflammatory diseases. We examined whether expression of the cathelicidin LL-37 in peripheral blood mononuclear cells (PBMCs) is associated with cardiovascular risk factors. A total of 90 men and 87 women selected from STANISLAS cohort were studied. Expression of LL-37 mRNA isolated from PBMCs of these subjects was quantified by quantitative RT-PCR. Anthropometric measurements and biochemical profiles were assessed for each individual. In women, LL-37 mRNA expression was significantly and positively correlated with body mass index (BMI) (p<or=0.001); waist circumference (WC) (p<or=0.01); systolic blood pressure (SBP) (p<or=0.05) and triglycerides (TG) level (p<or=0.05) and negatively with plasma levels of HDL-C (p<or=0.05). In men however, LL-37 was positively associated with waist to hip ratio (WHR) (p<or=0.05); SBP (p<or=0.001); TG (p<or=0.05); fasting glucose levels (p<or=0.01); alanine aminotransferase (ALT) activity (p<or=0.01); neutrophils counts (p<or=0.01) and negatively with lymphocyte counts (p<or=0.001); serum HDL-C (p<or=0.001) and apoA-I (p<or=0.05) levels. After adjustment for WC and BMI, multiple regression analysis showed that LL-37 remained significantly associated with SBP; HDL-C; fasting glucose level; ALT activity; neutrophil and lymphocyte counts (p<or=0.001 to p<or=0.05) in men. Our results suggest that LL-37 gene expression may be closely associated with cardiovascular risk factors independently of BMI and WC. However, functional studies are required to confirm these data.
 
Article
Background and aims: Few studies have described the association between time-of-day of macronutrient intake and diabetes. This study examined the prospective association between time-of-day and nutrient composition of eating occasions in relation to diabetes incidence in the 1946 British birth cohort. Methods and results: The study included 1618 survey members who completed dietary assessment at age 43 (1989) and for whom data on glycosylated haemoglobin at age 53 years (1999) were available. Diet was assessed using 5d estimated diaries, divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Diabetes was defined by glycosylated haemoglobin (HbA1c) ≥ 6.5% or diabetes medication use. The association between time-of-day of macronutrient intake at age 43 years and diabetes at age 53 years was assessed using logistic multivariate nutrient density models after adjustment for potential confounders. There were 66 cases of diabetes at age 53 years. Survey members with diabetes obtained 50.4% of their energy from carbohydrate at breakfast compared to 55.9% in survey members without diabetes (P = 0.001). Increasing carbohydrate intake at breakfast at the expense of fat was related to lower odds ratio (OR) of diabetes (OR = 0.86; 95%CI = 0.79-0.93; P < 0.001). This relationship was attenuated after adjustment for body mass index and waist circumference. Conclusion: Increasing energy intake from carbohydrate at the expense of fat at breakfast is inversely associated with 10-year diabetes incidence. However, further studies are required to elucidate whether the type or source of carbohydrates or fat influences the above association.
 
Article
Increasing cardiovascular disease (CVD) mortality in the People's Republic of China (PRC) led to the 1981 establishment of the PRC-USA Study of Cardiovascular and Cardiopulmonary Epidemiology which, among other objectives, is concerned with the correlates of CVD morbidity and mortality in Chinese populations among other objectives. This report describes changes in total cholesterol (TC) levels in four PRC populations from 1983 to 1993 and identifies factors related to the changes. Population screenings carried out in 1983-1984, 1987-1988 and 1993-1994 involved the collection of demographic data, specimens (including blood), medical history and physical examination data. The data from cohort and independent samples were used to assess TC changes in urban and rural men and women over the decade, with and without adjustment for age and body mass index (BMI) changes. For Guangzhou men and women, the cohort analyses (aged 35-54 at baseline) showed increases in TC of 10-20 mg/dL after adjustment for age and changes in BMI; the independent sample analyses (aged 35-44) also showed higher average TC levels in 1993-1994 than in 1983-1984. For the Beijing cohorts, the results showed decreases in TC during the decade in men, an increase in TC in urban women and no change in rural women; the independent sample analyses indicated declines in TC for Beijing men and women. Possible reasons for the Guangzhou TC increases are economic growth, and dietary and BMI changes. The mean age-adjusted BMI significantly increased (5-10%) over the 10-year period in all of the studied groups. TC increased 10-20 mg/dL in Guangzhou men and women, probably as a result of socioeconomic development during the decade. The inconsistent patterns of TC changes in Beijing require further study.
 
Article
From 1986 to 1996, 1339 autopsies were performed on children and young adults, aged 5-34 years, in 18 countries of five continents in the course of the multinational investigation of the World Health Organization/International Society and Federation Cardiology (WHO/ISFC), "Pathobiological Determinants of Atherosclerosis in Youth" (PBDAY). A set of 966 left-half thoracic and 947 left-half abdominal aortae and 958 right coronary arteries were processed in the Center of Investigations and References of Atherosclerosis of Havana (CIRAH), i.e., one of the Reference Centers of the PBDAY. Pathomorphological and morphometrical analyses were carried out by a well-established method, the Atherometric System (AS). By qualitative analysis AS permitted the identification of each type of atherosclerotic lesions (AL). The quantitative analysis, using a digitizer (MYPAC-Japan, a PC-Pentium 200 Mhz-32 MB RAM), and the software Atherosoft, allowed the measurement of the intima surface occupied by any kind of AL, and estimation of the volume occupied and thus the degree of obstruction and stenosis of the lumen. The autopsy data were divided into three age groups: a) 5 to 14 years; b) 15 to 24 years and c) 25 to 34 and processed by age and sex. The commercial package NCSS was utilized for statistical analysis of the data. Of particular interest were the following findings: a) Atherosclerosis increases with age; b) Fatty streaks (FS) were always present already at 5 years of age, independent of the country, climate, state of nourishment, type and amount of foods and the habits and lifestyle of the population studied. FS progressed most rapidly from 15 to 24 years. The fibrous plaque began to appear slowly at the end of the second and rapidly progressed after the third decades. The severe plaque was rarely observed before 30 years of age; it appeared in the fourth decade and then progressed slowly, but steadily.
 
Article
Background and aims: Breakfast consumption and meal frequencies have been linked to the risk of obesity in youth but their associations with metabolic syndrome (MetS) in young populations are yet to be studied. We examined associations of three meal patterns on weekdays--five meals including breakfast, ≤four meals including breakfast and ≤four meals without breakfast--with overweight/obesity and MetS components in Finnish adolescents. Methods and results: A population-based sample of 16-year-old boys and girls (n = 6247) from the Northern Finland Birth Cohort 1986 was used. Adolescents were clinically examined and dietary data were collected using self-administered questionnaires. Overweight/obesity and MetS features were defined according to the International Obesity Task Force cut-offs and the International Diabetes Federation MetS paediatric criteria and their associations with meal patterns assessed using logistic regression, adjusted separately for early life factors (birth size, maternal health) and later childhood factors (health behaviours, weight status, parental education). After adjustment for early life factors, the adolescents who ate five meals/day were at lower risk for overweight/obesity (OR [95% CI] for boys: 0.47 [0.34, 0.65]; girls: 0.57 [0.41, 0.79]), abdominal obesity (OR [95% CI] for boys: 0.32 [0.22, 0.48]; girls: 0.54 [0.39, 0.75]) and hypertriglyceridaemia (boys only). Adjusting for later childhood factors, the five-meal-a-day pattern was associated with decreased odds of overweight/obesity (OR [95% CI] for boys: 0.41 [0.29, 0.58]; girls: 0.63 [0.45, 0.89]) and abdominal obesity in boys (OR 0.32, 95% CI 0.16, 0.63). Conclusion: Among 16-year-olds, the five-meal-a-day pattern was robustly associated with reduced risks of overweight/obesity in both genders and abdominal obesity in boys.
 
Article
The present work is a chapter in an investigation directed by the World Health Organization on the Pathobiological Determinants of Atherosclerosis In Youth (WHO-PBDAY). Our aim was to study the development of atherosclerotic lesions in a young population. Samples of left anterior descending coronary artery (LDC) and thoracic (TA) and abdominal aorta (AA) from five Collaborating Centres (Budapest/Hungary, Havana/Cuba, Heidelberg/Germany, Mexico City/Mexico, Peradeniya/Sri Lanka) of 214 subjects who died aged 15 and 34 were analysed at the Budapest Reference Centre. Slides stained with haematoxylin-eosin and with stains for extracellular matrix were quantitatively and qualitatively evaluated. Mean intima/media (I/M) ratio and the prevalence of type III-IV lesions (preatheroma; atheroma; calcified and fibrous atheroma) were determined and compared in different risk factor (high blood pressure, smoking) groups. High I/M ratio was found in the LDC and type III-IV lesions were frequently found both in the LDC and in the AA. I/M ratio and the occurrence of type III-IV lesions increased in all arteries by age. Atherosclerotic lesions in men were more severe, particularly in the LDC. Geographic origin had a limited effect on the histologic lesion parameters. Appearance of type III-IV lesions was associated with substantially different extracellular matrix changes. Myoelastic layer formation was found in each artery in both early and type III-IV lesions. Hypertension was associated with higher prevalence of type III-IV lesions in all arteries, in particular, in the TA; smoking showed a significant effect on the AA only. Atherosclerotic lesions were found in many of these young subjects. The effect of hypertension and smoking on their development suggests that control of risk factors, beginning in early adolescence, could help to prevent cardiovascular diseases.
 
Article
This paper is an overview of the PBDAY Study--a ten-year multinational collaborative study. It provides condensed information on the background, objectives and methods of the study, as well as a summary of its most significant results and recommendations for further morphometric and special studies.
 
Article
In this study we assessed the prevalence of diagnosed type 2 diabetes and the quality of care during the period 1988-2000 in an Italian population. Two population-based surveys, using similar methods and centralized measurements, were conducted in 1988 and 2000 in a representative Italian area to identify people with known diabetes. The adjusted prevalence (reference, 2001 Italian population) was computed. The age- and sex-adjusted prevalence rates of diabetes in the population of Casale Monferrato were 2.13% (2.05-2.22) in 1988 and 3.07% (2.97-3.17) in 2000. In comparison with diabetic persons recruited in 1988 and independently of age and sex, persons recruited in 2000 had a lower likelihood of having HbA1c > or = 7.0% (OR=0.48; 0.42-0.56), diastolic blood pressure > or = 80 mmHg (OR=0.61; 0.49-0.75), LDL cholesterol > or = 2.59 mmol/l (OR=0.77; 0.63-0.93) and AER > or = 20 microg/min (OR=0.53; 0.45-0.61; they had a higher likelihood of having BMI > or = 25 kg/m(2) (OR=1.49; 1.2-1.74). However, 45.4% of patients still had HbA1c > or = 7.0%, 80% blood pressure > or = 130/80 mmHg and 79% LDL-cholesterol values > or =2.59 mmol/l. More than two-thirds of Italians with diabetes are now aged 65 years and more. The quality of control of glycemia, lipids and blood pressure improved and the prevalence of diabetic nephropathy decreased over time, although complete adherence to international guidelines has not yet been achieved.
 
Article
To examine trends in initiation and continuation of statin treatment after myocardial infarction (MI) and their determinants, during a period of increasing usage. 9367 patients aged 30-84 with a first Myocardial Infarction (MI) in 1997-2006 were identified in DIN-LINK, an anonymised, UK primary care database. We assessed statin initiation (prescription within 6 months of MI) and continued therapy (% covered by a prescription on a given day of those prescribed a statin within 6 months). The influences of co-morbidities and socio-economic deprivation (Index of Multiple Deprivation) were examined. Statin initiation increased from 37% for MIs in 1997 to 92% in 2006. Continuation at 1 year remained stable over successive cohorts at approximately 80%, settling to about 76% in patients with 5-10 years follow up. Younger age, affluence, revascularisation in 6 months after MI, and absence of congestive heart failure, predicted higher initiation and continuation; a diagnosis of hypertension or diabetes predicted higher initiation, while smoking was associated with poorer continuation. Men had higher initiation and continued therapy, but these effects were largely explained by their younger age. Type of statin initially prescribed did not influence continued usage. Statin use after MI increased markedly between 1997 and 2006, whilst continued therapy remained high and stable. Importantly, first choice of statin had no effect on continuation. Whilst the high current levels of initiation may have reached a ceiling, increasing continuation rates among smokers, older patients and those from lower socio-economic groups, should remain a priority.
 
Article
This study was designed to elucidate the effects of obesity, self-reported physical activity and cardiorespiratory fitness on blood pressure, inflammation, and insulin resistance. Data from 950 Caucasian subjects ranging in age from 19 to 49 years from the National Health and Nutrition Survey (NHANES), 1999-2002, were included to construct a population-based observational study. Cardiorespiratory fitness (VO(2) max) was predicted from a submaximal exercise stress test. Self-reported physical activity was measured by metabolic equivalent score transformed from a questionnaire. A structural equation model (SEM) was developed to examine the relationship between obesity, cardiorespiratory fitness, self-reported physical activity, and hypertension, inflammation, and insulin resistance. The model showed that obesity was positively linked to hypertension (B=0.50, P<0.001) and C-reactive protein (CRP; B=0.15, p<0.05), which in turn led to insulin resistance (B=0.44, P<0.05). Increased cardiorespiratory fitness was negatively associated with CRP (Γ=-0.23, P<0.01), but not correlated to hypertension after adjustment for potential confounding factors. No significant association was found between self-reported physical activity and hypertension, insulin resistance, and CRP. Obesity contributes to the development of hypertension, inflammation, and insulin resistance. Improved cardiorespiratory fitness might lead to clinical and biochemical improvement in insulin resistance by reducing the inflammatory state.
 
Article
Cholesteryl ester transfer protein (CETP) is an enzyme with a key role in lipoprotein metabolism. A common genetic polymorphism, the Taq 1B, influences CETP activity and HDL-cholesterol levels, with individual homozygotes for the B1 allele exhibiting higher enzyme activity and lower HDL-cholesterol levels than carriers of at least one B2 allele. Our aim was to analyze the influence of Taq 1B CETP polymorphism on cardiovascular risk factors in a representative sample of adult subjects from Canary population. A total of 518 adult subjects from the Canary Islands, enrolled in a nutritional survey (the ENCA study), were included. The Taq 1B polymorphism was analyzed by PCR-RFLP. Compared with individuals with at least one B2 allele, and after adjusting for age, sex, BMI, waist perimeter, smoking and alcohol intake, carriers of the B1B1 genotype showed lower HDL-cholesterol levels (geometric mean (95% CI): 46.6 (44.5-48.8) vs. 50.6 (49.1-52.9)mg/dl; P=0.003); and higher insulin (geometric mean (95% CI): 11.1 (10.5-11.9) vs. 10.0 (9.5-10.5μU/ml; P=0.008) and HOMA levels (geometric mean (95% CI): 2.3 (2.1-2.5) vs. 2.1 (1.9-2.1); P=0.009). In addition, the B1B1 genotype was more frequent in individuals who had low levels of HDL-cholesterol according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria (Odds Ratio (OR): 1.563; 95% CI: 1.04-2.34; P=0.030), and in those included in the upper quartile of insulinemia (OR: 1.90; 95% CI: 1.20-3.03; P=0.007) and HOMA (OR: 1.61; 95% CI: 1.02-2.57; P=0.043). The observed influence of Taq 1B polymorphism on insulin levels and HOMA highlights the possible role of CETP in the regulation of glucose homeostasis.
 
Article
Elevated serum levels of gamma-glutamyltransferase (GGT) are a marker of liver injury, but may also be associated with other diseases and death. Currently, the association of serum GGT concentrations with chronic kidney disease has not been established in the U.S. general population. We performed a cross-sectional analysis of data from the National Health and Nutrition Examination Survey 2001 through 2006 and examined the association between serum GGT concentrations and chronic kidney disease in a nationally representative sample of 13,188 adults aged 20 years or older. Glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease formula. The prevalence of chronic kidney disease defined as eGFR <60 ml/min/1.73 m(2) or abnormal albuminuria in those with eGFR ≥60 ml/min/1.73 m(2) was 13.9% (n = 1842). Serum GGT elevation was associated with an increased odds of chronic kidney disease (odds ratio 2.38, 95% confidence intervals 2.02-2.80, p<0.0001). After adjustment for demographics, comorbidities, daily alcohol consumption, lipid-lowering medications, viral hepatitis status and laboratory measures, the odds ratio of chronic kidney disease per log serum GGT increase was 1.79 (1.41, 2.27; p<0.0001). These results show a strong, independent, relationship of increased serum GGT concentrations with chronic kidney disease in the US adult population.
 
Article
A Mediterranean diet has been associated with lower all-cause and cardiovascular disease (CVD) morbidity and mortality, but the clinical and behavioral pathway has not been well understood and appreciated. The aim of this work was to explore the path between adherence to a Mediterranean-type diet, lifestyle behaviors, clinical status, and a 10-year incidence of CVD. The ATTICA study was carried out in the Athens area during 2001-2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18-89). Adherence to a Mediterranean diet was assessed using the MedDietScore (range 0-55). During 2011-2012, 2583 out of the 3042 participants were found during the 10-year follow-up (15% lost to follow-up). Adherence to a Mediterranean diet decreased CVD risk (relative Risk (RR) per 1/55 unit = 0.96, 95% confidence interval (CI): 0.93, 1.00), independently of various sociodemographic, lifestyle, and clinical factors. Subgroup analyses revealed that participants with an unhealthy lifestyle (i.e., smokers, and obese and sedentary persons) remained protected from CVD through a greater adherence to a Mediterranean diet (RR for smokers = 0.92, 95%CI: 0.88, 0.97; RR for obese participants = 0.90, 95%CI: 0.82, 0.979; and RR for sedentary participants = 0.95, 95%CI: 0.90, 0.99). Path analysis revealed that adherence to a Mediterranean diet not only decreases the levels of C-reactive protein and interleukin-6 but also has an independent protective role against CVD risk per se (total effect of the MedDietScore on CVD = -0.003, 95%CI: -0.005 to 0.000). Adherence to a Mediterranean diet confers a considerable reduction on CVD risk, independent of various factors. Therefore, even subjects with unhealthy lifestyle behaviors may benefit from adherence to this diet, suggesting another dimension to prevention strategies. Copyright © 2014 Elsevier B.V. All rights reserved.
 
Article
To estimate the prevalence of metabolic syndrome (MS) and determine its association with white blood cell (WBC) count as a marker of low-grade systemic inflammation in children and adolescents in Korea. We investigated the prevalence of MS and its association with WBC count in 928 children and adolescents. MS was defined as having 3 or more conditions based on the modified criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). The odds ratios (ORs) for MS were also calculated using multivariate logistic regression analysis across WBC count quartiles (Q1, <5200; Q2, 5200-6100; Q3, 6200-7200; and Q4, >or=7300 cells/microL for boys; Q1, <5200; Q2, 5200-6000; Q3, 6100-7000; and Q4, >or=7100 cells/microL for girls). The prevalence of MS in children and adolescents in Korea was 6.7% (8.5% in boys, 4.5% in girls, P<0.001). MS was more prevalent in overweight and obese children and adolescents in both boys and girls. The mean WBC counts continuously increased with each additional component of MS in both boys and girls. The ORs (95% CIs) for MS in each WBC quartile were 1.00, 1.56 (0.43-5.67), 4.47 (1.42-14.07), and 5.25 (1.71-16.07) in boys and 1.00, 1.05 (0.15-7.61), 2.89 (0.55-15.17), and 7.47 (1.61-36.67) in girls after adjusting for age, household income, and residential area. In summary, this study shows that a substantial number of children and adolescents in Korea have MS, and elevated WBC count may be a surrogate marker for MS.
 
Article
Metabolically obese normal weight (MONW) subjects are a subgroup of individuals who have a normal weight and body mass index (BMI), but exhibit obesity-related abnormalities. The objective of this study was to analyze the prevalence of metabolic syndrome (MetS) and characteristics of diet patterns in MONW Koreans. We analyzed the data of 3050 adults > 20 years of age with a normal BMI (18.5~24.9 kg/m(2)) obtained from the Korea National Health and Nutrition Examination Survey III. Anthropometric measurements and information on health behaviors were obtained. The diagnostic criteria for MetS were defined by the International Diabetes Federation consensus. Dietary intake was assessed by the 24-h recall method. The weighted prevalence of MONW was 14.3%. The risk of MONW correlated inversely with the frequency of snacking and positively with the type of snack, particularly those with high carbohydrates. A high carbohydrate diet (≥73.9% of energy intake) compared to a low carbohydrate diet (<59.9% of energy intake) was positively associated with the risk of MONW (OR = 2.54; 95% CI: 1.41, 4.56), whereas a high protein diet (≥17.1% of energy intake) compared to a low protein diet (<12.2% of energy intake) reduced the risk of MONW (OR = 0.60; 95% CI: 0.39, 0.92) in females, but not in males. This study suggests that a reduced intake of carbohydrates and carbohydrate snacks were associated with a lower prevalence of MONW in females.
 
Article
The need to update tools for the estimate of cardiovascular risk prompted the "Gruppo di Ricerca per la Stima del Rischio Cardiovascolare in Italia" to produce a new chart and new software called Riskard 2005. Data from 9 population studies in 8 Italian regions, for a grand total of 17,153 subjects (12,045 men and 5,108 women) aged 35-74 and for a total exposure of about 194,000 person/years were available. A chart for the estimate of cardiovascular risk (major coronary, cerebrovascular and peripheral artery disease events) in 10 years was produced for men and women aged 45-74 free from cardiovascular diseases. Risk factors employed in the estimate were sex, age (6 classes), systolic blood pressure (4 classes), serum cholesterol (5 classes), diabetes, and cigarette smoking (4 classes). Estimates were produced for absolute risk and for relative risk, the latter against levels expected in the general population that produced the risk functions. Software was produced for the separate estimate of major coronary, cerebrovascular and cardiovascular events (the latter made by coronary, cerebrovascular and peripheral artery disease of atherosclerotic origin) for follow-up at 5, 10 or 15 years, in men a women aged 35-74 years at entry and free from cardiovascular diseases. Risk factors employed here were sex, age, body mass index, mean physiological blood pressure, HDL cholesterol, non-HDL cholesterol, cigarette smoking, diabetes and heart rate. The output is based on several indicators: absolute risk, relative risk (as defined above), ideal risk (for a very favourable risk profile), biological age of risk, comparisons among the above indicators, the percent contribution of risk factors to the excess of estimated risk above the level of the ideal risk, and the description of trends in risk estimate in relation to repeated measurements. These tools represent progress compared to similar tools produced some years ago by the same Research Group.
 
Article
To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy. The ARNO observatory database, containing the 20-year medical prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner. In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584-2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50-1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79-1.82), that of service use, € 488 (rate ratio, 1.07 (0.93-1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost. The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.
 
Article
Background and aims: Several studies demonstrated that reading nutrition labels was associated with healthier food choices, despite some controversy. This study investigated the association between the use of nutrition labels and metabolic syndrome (MetS) in Korean adults. Methods and results: This cross-sectional study included 7756 individuals who participated in the 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES). A self-reported questionnaire was used to determine participant's awareness of nutrition labels. Modified Asian criteria based on a harmonizing definition of MetS were adopted. Individuals in the group that read nutrition labels (the Reading Group) were youngest and leanest, but their daily caloric intake fell between that of the group that did not read nutrition labels (the Non-Reading Group) and the group that did not know about them (the Not-Knowing Group). The prevalence of MetS was 16.8% in the Reading Group, 27.2% in the Non-Reading Group, and 47.3% in the Not-Knowing Group. In comparison to participants in the Reading Group, the odds ratios (95% confidence interval) for MetS in the participants in the Non-Reading Group and Not-Knowing Group were 1.85 (1.60-2.14) and 4.44 (3.79-5.20), respectively, when not adjusted. The relationship between the use of nutrition labels and MetS remained statistically significant even after adjusting for covariates such as age, sex and socioeconomic status including household income and education level [1.27 (1.05-1.53) in the Non-Reading Group and 1.34 (1.05-1.70) in the Not-Knowing Group]. Conclusion: Reading nutrition labels appeared to be associated with a lower prevalence of MetS in a nationally representative sample of Korean adults.
 
Article
Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).
 
Structure, process and outcome indicator examples (full list online).
Article
The Italian Standards for the Treatment of Diabetes Mellitus represent a consensus document of the two Italian scientific diabetes societies (AMD and SID), providing specific recommendations for the diagnosis and treatment of diabetes and its complications. The level of scientific evidence behind every recommendation has been classified in accordance with the National Guidelines Plan. An original processing system was employed: the document prepared by the Editorial Team was published online for 20 days, and the suggestions and criticisms of about 30 persons were evaluated and integrated to those provided by a panel of diabetologists and members of other healthcare professions dedicated to diabetes care, as well as lay members. Lastly, the document was approved by AMD and SID National Steering Committees. In this version, some highlights of the full document (www.siditalia.it; www.aemmedi.it) concerning the main and most representative recommendations on diagnosis and treatment of diabetes and its complications as well as on diabetes care in some specific contexts, are reported.
 
Article
The '2009 2nd Italian Consensus Conference on LDL-apheresis' was held in Rome, Italy, 15 May 2009. The latest scientific evidence and the information processed in more than two decades of LDL-apheresis application require new guidelines. Experts were invited by the Consensus Panel to give a scientific specific contribution in their clinical area of specialty. The experts of interdisciplinary affiliation participated in the extension of 'The new guidelines and recommendations for the indications and the appropriate use of LDL-apheresis'. The summary statement describing the frame and the lines of action of the scientific event and a supplementary document inherent to the Consensus available online at http://ees.elsevier.com/nmcd/ are reported.
 
Article
New guidelines from the American College of Cardiology and the American Heart Association on cholesterol management introduced substantial changes from the previous Adult Treatment Panel III guidelines and generated an immediate storm of controversy upon their release in November 2013. Four categories of individuals that can benefit from statin therapy, including three high-risk groups, have been identified. The fourth category of primary prevention has proven to be the most contentious, with criticism centering on the algorithm used to estimate ten-year risk for atherosclerotic cardiovascular disease and the optimal threshold for statin therapy. Although the risk assessment algorithm can be further refined, it represents an improvement from the previous calculator since it better captures risk in women and African Americans. However, the elimination of lipid targets in the new guidelines discounts a wealth of clinical trial and epidemiological evidence indicating that, with regards to low-density lipoprotein cholesterol, "lower is better." Recommendations regarding the use of nonstatin drugs, while appropriate, could potentially be revised in the future. In general, the new guidelines stress the necessity of addressing the multiple factors that contribute to cardiovascular risk, and they provide a valuable opportunity for physicians to address the importance of lifestyle modifications to lower a patient's overall risk.
 
Article
To assess the reliability and reproducibility of estimations of group mean 24-h urinary sodium (Na) excretion through timed spot urines compared to 24 h urinary Na output in two independent cross-sectional population samples including men and women and different ethnic groups. Study 1 was carried out in Britain and included 915 untreated 40-59 yrs male and female participants (297 white, 326 of black African origin and 292 South Asian). Study 2 was carried out in Italy and included 148 white men (mean age 58.3 yrs). All participants provided both a 24-h urine collection and a timed urine sample as part of population surveys. Na, creatinine (Cr) and volume (V) were measured in all samples. Age, body mass index (BMI) and blood pressure (BP) were also measured. We compared the daily Na excretion through 24-h urine (gold standard) with its estimate from timed urine samples with two methods: Tanaka's predictions and Arithmetic extrapolations, and assessed them with correlation coefficients, Bland-Altman plot, prediction of quintile position and Receiver Operating Characteristic (ROC) Areas Under the Curve (AUC) for a cut-off of <100 mmol of Na/day. In Study 1 (discovery study) with the Tanaka method there were poor correlations between predicted and measured 24-h Na excretions in different ethnic groups and genders (rSpearman from 0.055 [R(2) = 0.003] in black women to 0.330 [R(2) = 0.11] in white women). The Bland-Altman plots indicated consistent bias with overestimate for low and underestimate for high intakes. ROC AUCs varied from 0.521 to 0.652 with good sensitivity (95-100%) but very poor specificity (0-9%). With the Arithmetic extrapolations correlations varied from 0.116 [R(2) = 0.01] to 0.367 [R(2) = 0.13]. Bias was detected with both Bland-Altman plots and through quintile analyses (underestimate at low levels and overestimate at high levels). Finally, ROC AUCs varied from 0.514 to 0.640 with moderate sensitivity (64-70%) but low specificity (20-53%). In Study 2 (validation study) results were consistent with the discovery phase in white men. Based on these results, 24-h urinary collection for the measurement of Na excretion remains the preferred tool for assessing salt intake when compared with reported methods based on timed spot urine samples.
 
Article
Hepatic lipase (HL) catalyzes the hydrolysis of triglycerides and phospholipids from lipoproteins, and promotes the hepatic uptake of lipoproteins. A common G-250A polymorphism in the promoter of the hepatic lipase gene (LIPC) has been described. The aim was to study the effects of the G-250A polymorphism on HL activity, serum lipid profile and insulin sensitivity. Altogether 151 healthy subjects (age 49+/-8 years, BMI 26.5+/-3.0kg/m(2)) were randomly assigned for 3 months to an isoenergetic diet containing either a high proportion of saturated fatty acids (SFA diet) or monounsaturated fatty acids (MUFA diet). Within groups there was a second random assignment to supplements with fish oil (3.6g n-3 FA/day) or placebo. At baseline, the A-250A genotype was associated with high serum LDL cholesterol concentration (P=0.030 among three genotypes). On the MUFA diet carriers of the A-250A genotype presented a greater decrease in LDL cholesterol concentration than subjects with other genotypes (P=0.007 among three genotypes). The rare -250A allele was related to low HL activity (P<0.001 among three genotypes). The diet did not affect the levels of HL activity among the genotypes. The A-250A genotype of the LIPC gene was associated with high LDL cholesterol concentration, but the MUFA-enriched diet reduced serum LDL cholesterol concentration especially in subjects with the A-250A genotype.
 
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Nicoletta Pellegrini
  • University of Udine
Daniele Del Rio
  • Università di Parma
Salwa W Rizkalla
  • Assistance Publique – Hôpitaux de Paris
Gabriele Riccardi
  • University of Naples Federico II
Bengt O. H. Vessby
  • Uppsala University