Article

Association Between Carbohydrate Nutrition and Successful Aging Over 10 Years

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Abstract

Background: We prospectively examined the relationship between dietary glycemic index (GI) and glycemic load (GL), carbohydrate, sugars, and fiber intake (including fruits, vegetable of breads/cereals fiber) with successful aging (determined through a multidomain approach). Methods: A total of 1,609 adults aged 49 years and older who were free of cancer, coronary artery disease, and stroke at baseline were followed for 10 years. Dietary data were collected using a semiquantitative Food Frequency Questionnaire. Successful aging status was determined through interviewer-administered questionnaire at each visit and was defined as the absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases (eg, cancer and coronary artery disease). Results: In all, 249 (15.5%) participants had aged successfully 10 years later. Dietary GI, GL, and carbohydrate intake were not significantly associated with successful aging. However, participants in the highest versus lowest (reference group) quartile of total fiber intake had greater odds of aging successfully than suboptimal aging, multivariable-adjusted odds ratio (OR), 1.79 (95% confidence interval [CI] 1.13–2.84). Those who remained consistently below the median in consumption of fiber from breads/cereal and fruit compared with the rest of cohort were less likely to age successfully, OR 0.53 (95% CI 0.34–0.84) and OR 0.64 (95% CI 0.44–0.95), respectively. Conclusions: Consumption of dietary fiber from breads/cereals and fruits independently influenced the likelihood of aging successfully over 10 years. These findings suggest that increasing intake of fiber-rich foods could be a successful strategy in reaching old age disease free and fully functional.

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... Carbohydrate nutrition is known to influence a range of health outcomes and disease states [4][5][6][7]. Certain carbohydrate-rich foods have less influence than others in increasing blood glucose levels [8]. This feature of individual foods is termed the glycemic index (GI), an indication of carbohydrate quality [8][9][10]. ...
... Other aspects of carbohydrate quality such as dietary fiber intake have been shown to influence risk of chronic diseases including cardio-metabolomic conditions [13,14]. We have previously shown that higher baseline consumption of energy-adjusted total fiber, breads/cereal fiber, and fruit fiber was all associated with a greater likelihood of aging successfully which was defined as: being free of chronic disease (coronary artery disease, stroke, diabetes, and cancer); having good mental health; functional independence; having good physical, respiratory, and cognitive function over a 10-year follow-up [7]. A recent umbrella review of systematic reviews with meta-analysis of observational studies [6] reported convincing evidence for associations between dietary fiber intake and a range of chronic diseases including, cardiovascular disease, type 2 diabetes, and pancreatic cancer. ...
... The independent prospective association between energyadjusted total fiber intake and reduced risk of incident IADL disability is a novel finding; to our best knowledge, no other population-based cohort study has reported this association. However, previously, we showed in the BMES that older adults whose diets are consistently high in fiber consumption had a greater likelihood of reaching old age disease-free and fully functional, that is, they were successful agers [7], which is consistent with findings from the present study. There are several mechanisms by which dietary fiber could exert a protective effect against IADL disability. ...
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Purpose We aimed to examine the prospective association between dietary glycemic index (GI) and glycemic load (GL) of foods consumed, intakes of carbohydrates and fiber, and the ability to perform activities of daily living (ADL) in older adults. Methods A total of 844 participants from the Blue Mountains Eye Study aged 60 years or older were examined from 2002–2004 to 2007–2009. Dietary information was collected using a validated, semi-quantitative food-frequency questionnaire. The Older Americans Resources and Services activities of daily living scale were administered to assess the functional status of participants. Multivariable logistic regression analysis was performed. Results After multivariable adjustment, participants who were in the second and third quartiles of energy-adjusted total fiber intake compared to those in the first quartile of intake (reference group) at baseline had reduced risk of incident impaired instrumental activities of daily living (IADL) 5 years later: OR, 0.39 (95% CI 0.22–0.70) and OR 0.54 (95% CI 0.30–0.95), respectively. Analyses that involved dichotomized total fiber intake showed that participants in the upper three quartiles of total fiber intake (> 19 g/day), compared to those in the lowest quartile of intake (≤ 19 g/day) or reference group, had reduced IADL disability risk 5 years later: OR 0.49 (95% CI 0.31–0.79). Non-significant associations were observed with total carbohydrates, GI, and GL and with risk of impaired total and basic ADL at 5-year follow-up. Conclusions Habitual fiber consumption might be beneficial in leading to improved health status subserving performance of instrumental daily activities, needed to function in the community.
... These findings have intensified the focus on the long-term mortality outcomes from major causes of death. However, previous studies investigating GI, GL, and mortality risks showed conflicting results and few studies have investigated deaths from causes other than circulatory system diseases [18][19][20][21][22][23]. In addition, previous investigations have been limited by small participant numbers and most of these studies have been conducted in Western populations with different dietary habits and mortality patterns from Asia. ...
... In five previous prospective studies [19][20][21][22][23], which examined the association of dietary GI and GL with all-cause HR, hazard ratios; CI, confidence intervals; No., number; BMI, body mass index a Basic Cox regression model adjusted for age (year, continuous), gender, and public health center (11 centers) b Multivariable Cox regression model adjusted for age (year, continuous), public health center (11 centers), gender, history of hypertension (yes or no), BMI (< 18.5, 18.5 to < 25, 25 to < 30, or 30 to < 45); physical activity (metabolic equivalent task, hour per day, continuous), smoking status and intensity (never; former; current: < 20 cigarettes per day; current: ≥ 20 cigarettes per day), alcohol consumption (g ethanol per week, continuous), and intakes of total energy (kcal per day, quartile), salt (g/day, tercile), red and process meat (g/day, continuous), and fish (g/day, continuous). All dietary intakes and glycemic index were energy-adjusted by residual method [20,23], whereas three studies incorporated the more updated 2008 database [19,21,22]. ...
... In five previous prospective studies [19][20][21][22][23], which examined the association of dietary GI and GL with all-cause HR, hazard ratios; CI, confidence intervals; No., number; BMI, body mass index a Basic Cox regression model adjusted for age (year, continuous), gender, and public health center (11 centers) b Multivariable Cox regression model adjusted for age (year, continuous), public health center (11 centers), gender, history of hypertension (yes or no), BMI (< 18.5, 18.5 to < 25, 25 to < 30, or 30 to < 45); physical activity (metabolic equivalent task, hour per day, continuous), smoking status and intensity (never; former; current: < 20 cigarettes per day; current: ≥ 20 cigarettes per day), alcohol consumption (g ethanol per week, continuous), and intakes of total energy (kcal per day, quartile), salt (g/day, tercile), red and process meat (g/day, continuous), and fish (g/day, continuous). All dietary intakes and glycemic index were energy-adjusted by residual method [20,23], whereas three studies incorporated the more updated 2008 database [19,21,22]. Additionally, GI values of the locally produced foods, which have different compositions of ingredients and processing procedures from the available datasets, can vary among studies. ...
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Purpose Long-term associations of dietary glycemic index (GI) and glycemic load (GL) with mortality outcomes remain unclear. Methods The present analysis included 72,783 participants of the Japan Public Health Center-based Prospective Study. Participants who responded to the 5-year follow-up questionnaire in 1995–1999 were followed-up until December 2015. We estimated the risk of total and cause-specific mortality associated with GI and GL using Cox proportional hazards regression models. Results During 1,244,553 person years of follow-up, 7535 men and 4913 women died. GI was positively associated with all-cause mortality. As compared with the lowest quartile, the multivariable HR for those who had the highest quartile of GI was 1.14 (95% CI 1.08–1.20). The HRs for death comparing the highest with the lowest quartile were 1.28 (95% CI 1.14–1.42) for circulatory system diseases, 1.33 (95% CI 1.14–1.55) for heart disease, 1.32 (95% CI 1.11–1.57) for cerebrovascular disease, and 1.45 (95% CI 1.18–1.78) for respiratory diseases. GI was not associated with mortality risks of cancer and digestive diseases. GL showed a null association with all-cause mortality (highest vs lowest quartile; HR 1.04; 95% CI 0.96–1.12). However, among those who had the highest quartile of GL, the HRs for death from circulatory system diseases was 1.24 (95% CI 1.05–1.46), cerebrovascular disease was 1.34 (95% CI 1.03–1.74), and respiratory diseases was 1.35 (95% CI 1.00–1.82), as compared with the lowest quartile. Conclusion In this large prospective cohort study, dietary GI and GL were associated with mortality risks.
... The studies by Nagata et al. (17) and Oba et al. (24) used the same study population; Nagata et al. had reported CVD mortality, whereas the components of CVD mortality were separately reported by Oba et al.; therefore, the extracted RRs were included in 2 separate meta-analyses for mortality from CVD and stroke. Three reports from the Blue Mountains Eye Study were included in the current metaanalysis (20,23,28), because different causes of mortality were reported in these investigations. The study of Gopinath et al. (28) reported the risk for all-cause mortality, whereas the study of Buyken et al. (20) considered mortality from CVD, and the one by Kaushik (29,30); one of these investigations was conducted on a healthy population and the other was done on individuals who were hospitalized for CVD; as there was no overlap between populations of these studies, both were included in our analysis. ...
... Detailed characteristics of the eligible studies are summarized in Table 1. Among 18 included studies published between 2007 and 2018, 4 were carried out in United States (22,31,38,39), 7 in European countries (18,19,21,25,27,29,30), 4 in Australia (20,23,28,40), 2 in Japan (17,24), and the last 1 in China (41). The age range of 251,497 participants was between 18 and 86 y. ...
Article
Background: Previous findings on the association of dietary glycemic index (GI) and glycemic load (GL) with mortality are conflicting. Objectives: The aim of this study was to summarize earlier findings on the association between dietary GI and GL and the risk of cardiovascular disease (CVD) and all-cause mortality. Methods: A comprehensive literature search was performed of electronic databases, including MEDLINE (PubMed), Scopus, ISI Web of Science, EMBASE, and Google scholar, up to September 2018. Prospective cohort studies that reported GI and GL as the exposure and all-cause or CVD mortality as the outcome were included in the analysis. The random-effects model was used to estimate pooled RR and 95% CIs of all-cause and CVD mortality. Results: Eighteen cohort studies with a total of 251,497 participants, reporting 14,774 cases of all-cause mortality and 3658 cases of CVD mortality, were included in the present analysis. No significant association was found between dietary GI and all-cause mortality (RR: 1.07; 95% CI: 0.96, 1.19) and CVD mortality (RR: 1.02; 95% CI: 0.87, 1.20). In addition, dietary GL was not associated with all-cause mortality (RR: 1.08; 95% CI: 0.93, 1.27) or CVD mortality (RR: 1.07; 95% CI: 0.92, 1.25). However, the highest dietary GI, in comparison to the lowest one, significantly increased the risk of all-cause mortality in women (RR: 1.17; 95% CI: 1.02, 1.35). No evidence for a nonlinear association between dietary GI or GL and all-cause and CVD mortality was found (P > 0.05). Conclusions: This meta-analysis of prospective cohort studies showed no significant association between either dietary GI or GL and all-cause and CVD mortality in men, but a positive association of GI with all-cause mortality in women.
... The normal aging group were all participants who were alive 10 years later, but who were not deemed as successful agers 2 . Among surviving participants at 10-year follow-up (aged 60+ years), we used a definition similar to that used by Sabia et al. 2 , which classified successful agers as filling the following criteria: absence of stroke, coronary artery disease, angina, acute myocardial infarction (AMI), cancer, or diabetes; optimal cognitive, physical, mental, respiratory and vascular function; and the lack of disability; and being functionally independent 14,15 . ...
... Similarly, aging outcomes were not objectively measured (e.g. respiratory function); hence, we cannot disregard possible measurement errors 15 . Finally, while our definition of successful aging was comprehensive, we were still not able to account for important social variables such as loneliness and financial stresses 18 , hence, the proportion of BMES participants aging successfully could be lower than that reported. ...
Article
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We aimed to examine the temporal association between physical activity and successful aging. The analyses involved 1,584 adults aged 49 + years living west of Sydney (Australia), who did not have cancer, coronary artery disease and stroke at baseline and who were followed over 10 years. Participants provided information on the performance of moderate or vigorous activities and walking exercise and this was used to determine total metabolic equivalents (METs) minutes of activity per week. Successful aging status was determined through interviewer-administered questionnaire and was classified as the absence of: depressive symptoms, disability, cognitive impairment, respiratory symptoms and systemic conditions (e.g. cancer, coronary artery disease). 249 (15.7%) participants (mean age 59.9 ± 6.1) had aged successfully 10 years later. After multivariable adjustment; older adults in the highest level of total physical activity (≥5000 MET minutes/week; n = 71) compared to those in the lowest level of total physical activity (<1000 MET minutes/week; n = 934) had 2-fold greater odds of aging successfully than normal aging, odds ratio, OR, 2.08 (95% confidence intervals, CI, 1.12-3.88). Older adults who engaged in high levels of total physical activity, well above the current recommended minimum level had a greater likelihood of aging successfully 10 years later.
... It has been suggested that the increasing prevalence of mental disorders over recent decades might be attributed to lifestyle factors (2) . The effect of carbohydrate nutrition on health outcomes and disease has increasingly been the recent focus of research (3) . However, the link between the various aspects of carbohydrate nutrition and mental health outcomes in adults remains unclear. ...
... This property of individual foods is called the 'glycaemic index (GI)', a measure of carbohydrate quality (4)(5)(6) . Dietary glycaemic load (GL) is the product of a food's GI and total available carbohydrate content, and represents both the quantity and the quality of carbohydratesthat is, the total glycaemic impact of a portion of the food (3,7,8) . Moreover, other aspects of carbohydrate quality, such as intakes of sugary foods and dietary fibre, are also thought to influence various health outcomes. ...
Article
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We aimed to examine the relationship between dietary glycaemic index (GI) and glycaemic load of foods consumed, intakes of carbohydrates, sugars and fibre, and the prevalence of depressive symptoms in older adults. Data collected from 2334 participants aged 55+ years and 1952 participants aged 60+ years were analysed. Dietary information was collected using a semi-quantitative FFQ. Depressive symptoms were based on antidepressant use or either the 36-Item Short-Form Survey, which included the Mental Health Index (MHI), or the Center for Epidemiologic Studies Depression-10 Scale. Participants in the highest v. lowest tertile of dietary GI intake had increased odds of depressive symptoms (assessed by the MHI scale), multivariable-adjusted OR 1·55 (95 % CI 1·12, 2·14). Participants in the highest compared with lowest tertile of fruit consumption had reduced odds of prevalent depressive symptoms, multivariable-adjusted OR 0·66 (95 % CI 0·46, 0·95). Total fibre, vegetable fibre and breads/cereal fibre intakes were all inversely associated with the prevalence of depressive symptoms, with global P values of 0·03, 0·01 and 0·03, respectively. Participants in the second v. first tertile of vegetable consumption had 41 % reduced odds of prevalent depressive symptoms, multivariable-adjusted OR 0·59 (95 % CI 0·40, 0·88). We show that dietary GI and fibre intakes as well as consumption of fruits and vegetables are associated with the prevalence of depressive symptoms.
... Each 10 g increase in dietary fiber leads to 67 base pairs longer telomeres and a biologic aging difference of 4.3 years, after multivariate adjustment (Cassidy et al. 2010). Adequate fiber intake is also associated with successful aging and reduced risk of weakness, while low fiber consumption linked to increased risk of frailty in the elderly (Claesson et al. 2012;Wang et al. 2015;Gopinath et al. 2016;Jeffery et al. 2016). The Australian Blue Mountains Eye Study that included 1609 healthy individuals older than 49 years have declared that highest vs. lowest intake of dietary fibers has 79% increased multivariate-adjusted odds of aging (Gopinath et al. 2016). ...
... Adequate fiber intake is also associated with successful aging and reduced risk of weakness, while low fiber consumption linked to increased risk of frailty in the elderly (Claesson et al. 2012;Wang et al. 2015;Gopinath et al. 2016;Jeffery et al. 2016). The Australian Blue Mountains Eye Study that included 1609 healthy individuals older than 49 years have declared that highest vs. lowest intake of dietary fibers has 79% increased multivariate-adjusted odds of aging (Gopinath et al. 2016). ...
Chapter
The significant rise in burden of age-related chronic degenerative disorders is increasing the need for products that support active and healthy aging. Today’s sedentary lifestyle enhances the propensity to aging related diseases and premature death. Accumulating data establishes a beneficial relationship between food and health. The modern consumer has become aware of the valuable impact of Mediterranean diet (MD) on healthy aging. MD is largely plant based and rich in sources of unsaturated fatty acids like nuts and extra virgin olive oil, legumes, whole grains, fish, and fresh vegetables and fruits and it discourages the use of red and processed meat, added sugars as well as refined grains, has been associated with decreased risk of developing various chronic degenerative age-related disorders and increased life expectancy. With the advent of modern medicine and technological advancements the life expectancy has increased in the past few decades but the gap between the healthy life years and the extra years added to the life still remains there. Aging is a process that increases the vulnerability of an organism to challenges. During this process the oxidative stress leads towards various degenerative cascades that result in functional decline in aging population that is mainly associated with under nutrition in older people. Cognitive function declines, reduced mobility and sensory alterations are seen, oral and GI functions and health become compromised, and chronic diseases and age-related illness like osteoarthritis, diabetes type II, cardiovascular diseases, and certain types of cancer are also exhibited. The active and healthy aging is a prerequisite in order to enhance the quality of life as people age. The MD has proven to be the best tool to counteract the degenerative processes and promote an active healthy aging. Major effectors of MD are reduced caloric intake, decreased consumption of saturated fatty acids, microbiota derived metabolites, less amino acid utilization, and an increase in phytochemical consumption. MD protects against oxidative damage, injury, and inflammation and platelet aggregation, lowers lipid levels, modifies the hormones as well as growth factors that are involved in cancer pathogenesis, and inhibits the nutrient sensing pathway via restriction of specific amino acid as well as produces certain metabolites by gut microbiota and it influences the metabolic health. Thus, the molecular and metabolic health is chiefly associated with what we eat. Restriction of the calories can enhance the life span as well as the health span only if it is coupled with sufficient intake of all the essential nutrients and the micronutrients.
... In contrast, diets rich in fiber are associated with better cognitive outcomes [13e16]. A longitudinal study with a large cohort (N ¼ 1609) provided evidence for an association between regular higher fiber intake (29 g/day) and successful aging (defined as the absence of disability, depressive symptoms, cognitive impairment, and chronic diseases) 10 years later [15]. Thus, carbohydrate type can have opposing effects on brain function. ...
... Malnutrition with insufficient carbohydrate intake also correlates with poor cognitive scores in elderly adults as shown in longitudinal studies using the MMSE [22,25] and the short portable mental state questionnaire [24]. In contrast, fiber-rich diets are associated with optimal cerebral glucose metabolism [13] and ultimately better long-term outcomes, i.e., successful aging over 10 years in adults aged 49 and older [15]. Thus, age magnifies the carbohydrate effects on glucoregulation and cognition performance. ...
Article
Macronutrients – carbohydrates, fats, and proteins – supply the nutrients required for optimal functioning. Inadequate intake compromises both physical and brain health. We synthesized research on macronutrients from whole meals on cognitive function in healthy adults and identified underlying mechanisms. Intake of simple carbohydrates (‘sugars’) is consistently associated with decreased global cognition whereas consumption of complex carbohydrates correlates with successful brain aging and improved memory both in the short- and long-term. Saturated fatty acid intake correlates with decreased memory and learning scores whereas omega-3 intake correlates positively with memory scores. Protein intake boosts executive function and working memory when task-demands are high. Individual differences affecting the macronutrient-cognition relationship are age, physical activity, and glucose metabolism. Neural correlates reflect findings on cognitive functions: cortical thickness and cerebral amyloid burden correlate with sugar intake, inflammatory status and cerebral glucose metabolism correlate with fatty acid intake. Key mechanisms by which dietary macronutrients affect the brain and cognition include glucose and insulin metabolism, neurotransmitter actions, and cerebral oxidation and inflammation. In conclusion, macronutrient intake affects cognitive function both acutely and in the long-term, involving peripheral and central mechanisms. A healthy diet supports brain integrity and functionality, whereas inadequate nutrition compromises it. Studying diet can be key to nutritional recommendations, thereby improving the landscape of mental health and healthy brain aging.
... Each 10 g increase in dietary fiber leads to 67 base pairs longer telomeres and a biologic aging difference of 4.3 years, after multivariate adjustment (Cassidy et al. 2010). Adequate fiber intake is also associated with successful aging and reduced risk of weakness, while low fiber consumption linked to increased risk of frailty in the elderly (Claesson et al. 2012;Wang et al. 2015;Gopinath et al. 2016;Jeffery et al. 2016). The Australian Blue Mountains Eye Study that included 1609 healthy individuals older than 49 years have declared that highest vs. lowest intake of dietary fibers has 79% increased multivariate-adjusted odds of aging (Gopinath et al. 2016). ...
... Adequate fiber intake is also associated with successful aging and reduced risk of weakness, while low fiber consumption linked to increased risk of frailty in the elderly (Claesson et al. 2012;Wang et al. 2015;Gopinath et al. 2016;Jeffery et al. 2016). The Australian Blue Mountains Eye Study that included 1609 healthy individuals older than 49 years have declared that highest vs. lowest intake of dietary fibers has 79% increased multivariate-adjusted odds of aging (Gopinath et al. 2016). ...
Chapter
Nutrition plays a strong role in aging. Therefore, the absorption and metabolism of nutrients along with diet are a strong risk factor for aging related diseases. The nutritional requirements for the elderly are different as compared to the younger adults due to factors like drug and nutrient interactions, aging associated conditions, socioeconomic factors, etc. The amount and dosage of minerals, vitamins, and macronutrients are different in the elder population. Assessment of proper nutritional diet is important because in this age group, many people are malnourished that leads to various age-related disorders. Different nutraceuticals like the phytochemicals, carotenoids, vitamin B, D, E, various plant extracts have been reported to have rejuvenating properties. The use of nutraceuticals has beneficial effect on the metabolic and immune systems as they possess anti-oxidant properties.
... Some researchers have criticized Rowe and Kahn's three standards as providing a "perfect" definition, because Rowe and Kahn excluded older people with any evidence of incapacity and retained only a small "elite" group of the older adults (Lowry, Vallejo, & Studenski, 2012). Several studies in this review likewise classified healthy agers by only categorizing individuals who were free of any impairment or illness into a healthy aging group (Assmann et al., 2016;Bosnes et al., 2017;Campos, Ferreira, Vargas, & Gonçalves, 2016;García-Lara et al., 2017;Gopinath, Flood, Kifley, Louie & Mitchell, 2016;Liu et al., 2017;Sowa et al., 2016;Wada, Mortenson, & Hurd Clarke, 2016). According to Baltes and Baltes's SOC theory, many older people have impairment in one or more domains, but they may still be capable of taking advantage of their remaining capacities and compensating for any losses or limitations. ...
... Another study suggested that participants with lower incomes would attain lower healthy aging scores (Manasatchakun et al., 2016). Consuming more fiber-rich food or following nutritional intake guidelines was also proven to be beneficial for healthy aging (Assmann et al., 2016;Germain et al., 2013;Gopinath et al., 2016;Tyrovolas et al., 2014). ...
Article
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Purpose of the study: Few studies have recommended the essential domains of healthy aging and their relevant measurement to assess healthy aging comprehensively. This review is to fill the gap, by conducting a literature review of domains and measures of healthy aging in epidemiological studies. Design and methods: A literature search was conducted up to March 31, 2017, supplemented by a search of references in all relevant articles in English. We made a final selection of 50 studies across 23 countries or regions. Results: Nineteen studies applied Rowe and Kahn's three standards to assess healthy aging. Thirty-seven studies measured physical capabilities mainly by (instrumental) activities of daily living. Cognitive functions were included in 33 studies. Nineteen of them applied Mini-Mental State Examination (MMSE). Twenty-six studies considered metabolic and physiological health, but they mainly asked the self-reported absence of diseases. Twenty-four studies assessed psychological well-being by employing diverse scales. Questions about participation in social activities were mainly asked to measure social well-being in 22 studies. Sixteen studies considered individuals' general health status, which was mainly measured by self-rated health. Security questions were asked in five studies. Health behaviors were taken into account by three studies. Fifteen studies either applied SF-12/36 or developed health indices to assess healthy aging. Implications: This review summarizes detailed scales or methods that have been used to assess healthy aging in previous epidemiological studies. It also discusses and recommends the essential domains of healthy aging, and the relevant instruments for further epidemiological research to use in the assessment of healthy aging.
... diets rich in nuts, berries, fish, beans, olive oil and WG are associated with slower rate of cognitive decline in both observational [6] and in intervention studies [7]. Prospective studies further revealed that DF from cereals (primarily from WG breads and rolled oats) were positively correlated with "successful" ageing including aspects such as good cognitive function and absence of depressive syndrome [8]. ...
Article
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Background Whole grain (WG) intake is associated with reduced risk of obesity, type 2 diabetes and cardiovascular disease, whereas type 2 diabetes increases the risk of cognitive decline and dementia. The purpose of this study was to investigate the effects of short-term intervention with WG rye on cognitive functions, mood and cardiometabolic risk markers in middle-aged test subjects. Method Rye-based breads were provided to 38 healthy test subjects (aged 52-70y) during three consecutive days in a crossover study design, using white wheat flour bread (WWB) as a reference. The rye-based bread consisted of a WG rye kernel/flour mixture (1:1 ratio) supplemented with resistant starch type 2 (RS2) (RB + RS2). The last bread portion was ingested at 2100 h, and cognitive function, mood and cardiometabolic risk markers were determined the following morning, 11 − 14 h post intake. Results In comparison to WWB, the RB + RS2 product increased ratings of mood parameters (valance, P < 0.001; activation P < 0.05). No differences were seen in the cognitive tests depending on intervention (P > 0.05). RB + RS2 increased insulin sensitivity (P < 0.05), fasting levels of gut hormones (PYY, P < 0.05; GLP-2, P < 0.01) and fasting concentrations of plasma acetate, butyrate and total SCFA (P < 0.001). In contrast, fasting levels of IL − 1β were decreased (P < 0.05). Insulin sensitivity was positively correlated with working memory test performance (P < 0.05). Conclusions This study display novel findings regarding effects of WG rye products on mood, and glucose and appetite regulation in middle-aged subjects, indicating anti-diabetic properties of WG rye. The beneficial effects are suggested to be mediated through gut fermentation of dietary fiber in the RB + RS2 product. Trial registration The study was retrospectively registered at ClinicalTrials.gov, register number NCT03275948. Registered September 8 2017.
... Dietary fiber is a component that is strongly associated with the health benefits of plant-based foods (16,22,24,41). In particular, dietary fiber from cereals is more effective in protecting against lifestyle-related, noncommunicable diseases than are fibers from vegetables and fruit (24,28). ...
Article
Poor diet is recognized as a major risk factor that can be modified to prevent the growing prevalence of noncommunicable diseases globally and the deaths attributed to them. Enhancing the nutritional quality of staple foods such as cereals offers a promising strategy for addressing poor diets. Whole grain wheat is of particular importance in this strategy because of its well-established health-promoting potential and its versatility as an ingredient, which can be used to produce foods that appeal to consumers. With this in mind we utilized wheat breeding strategies to develop a wheat with a high amylose content (>80%) in the starchy endosperm and have shown that this improves indices of glycemic and digestive health. Testing revealed the high amylose content resulted in significantly more resistant starch (RS) in breads and popped wheat (>200% more RS), udon noodles (60-fold more RS), and ramen noodles (15-fold more RS) than was found in equivalent products made using conventional wheats. These increases in RS were obtained using refined (white) high-amylose wheat (HAW) flour, which did not compromise processing, end-product quality, or sensory properties. Further product development and clinical intervention trials will expand the range of foods that can be made with HAW and provide a deeper understanding of the benefits HAW can provide for improving health and preventing noncommunicable diseases.
... Mediterranean diets are notable for being rich in monounsaturated fatty acids and have been linked to lower rates of frailty (14). Gopinath and coworkers use data from the Australian Blue Mountain Eye Study to examine the relationship between dietary glycemic index, glycemic load and fiber intake, and healthy aging over 10 years (15). The study population was 49 years of age at baseline. ...
... Participants with the highest intake of fruit had 49% better odds for successful aging and lower risk of premature death by 23% compared to those with low fruit intake. Successful aging odds improved by 2% for each 1-g increase in total fiber intake and those consistently consuming fruit fiber below the median intake were 36% less likely to age successfully compared to those above the median intake of fruit fiber [283]. A meta-analysis (20 cohort studies; 760,629 participants) found a linear dose-response relationship with reduced stroke risk for fruits by 32% and for vegetables by 11% per 200 g/day with citrus fruits, apples, pears, and green leafy vegetables being the most effective in reducing stroke risk [284]. ...
Article
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Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.
... Older people people tend to have little variation in diet [20], where preference is given to processed products, fats and simple carbohydrates rather than unprocessed products, complex carbohydrates, fruits, legumes and vegetables. These habits compromise the beneficial actions of food on the intestinal microbiota [21]. Short-chain fatty acids, which are generated by the microbial fermentation of dietary polysaccharides in the intestine, are an important source of energy for colonocytes and also function as signaling molecules, modulating intestinal inflammation and the metabolism [22]. ...
Article
The prevalence of obese older individuals with multi morbidity has increased in developing countries. The indication of bariatric surgery in this group, such as Roux-en-Y Gastric Bypass Surgery (RYGB) and vertical gastrectomy (VG), is the focus of intense debate and controversy, mainly due to the nutritional and microbiota alterations it provokes. Within this context, this mini review aims to discuss the indication of bariatric surgery in the older individuals and its impact on intestinal microbiota.
... Al igual que en otros indicadores, puede deberse a estudiar un tema de ámbito general y, en consecuencia, no se estén recogiendo temas derivados mucho más específicos que si estudian los grupos de investigación consolidados. Como ejemplo, se podrían citar las investigaciones con biomarcadores 14 o sobre envejecimiento 15 . En todo caso, estos resultados pueden disminuir la visibilidad y el impacto de la materia general estudiada y no contribuir a fomentar el desarrollo del conocimiento, sobre fibra dietética, como elemento central. ...
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Introduction: To evaluate the scientific literature on dietary fiber collected in PubMed database by bibliometric analysis. Material and methods: It is a descriptive study. It was calculated the sample size by estimating population parameters in an infinite population (n=386). The sampling method was simple random without replacement. Results: The most common type of document was original articles with 177 documents (45.9%; 95% CI: 40.9 to 50.1), being the productivity index of 2.25. The age of the documents analyzed was 17.7 (95% CI: 16.4 to 18.9), with a median of 15.5 years. Revised documents were predominantly written in English, 352 cases (91.2%; 95% CI: 88.4 to 94.0), followed by German in 11 articles (2.9%; 95% CI: 1.2 to 4.5), Russian 7 times (1.8%; 95% CI: 0.5 to 3.1) and Spanish with 6 items (1.6%; 95% CI: 0.3 to 2.8). The magazines that had 15 or more jobs in search results made, are 4: American Journal of Clinical Nutrition with 31 references (8.0%; 95% CI: 5.3 to 10.7), Journal of Animal Science with 20 references (5.2%; 95% CI: 3.0 to 7.4), British Journal of Nutrition with 16 references (4.2%; 95% CI: 2.2 to 6.1) and European Journal of Clinical Nutrition with 15 references (3.9%; 95% CI: 2.0 to 5.8). Conclusions: This study indicates that dietary fiber is a topic highly researched subject where English is still the majority language. The descriptors are in line with the subject studied.
... The favorable role of fruits and vegetables could, among others, be related to the overall elevated content of antioxidant vitamins and minerals, polyphenols, and dietary fiber. These three dietary components have all been related to an increased probability of multidimensional HA in previous studies (14,17,18). However, the consideration of isolated food groups does not take synergic effects into account-which are thought to largely contribute to the overall positive role of adherence to specific dietary patterns such as the Mediterranean diet. ...
Article
Background: The Mediterranean diet has been suggested as a key element for the prevention of age-related chronic diseases. However, very few studies have examined its relation with multidimensional concepts of healthy aging (HA). Our objective was thus to investigate the association between adherence to the Mediterranean diet at midlife and HA. Methods: We analyzed data from 3,012 participants of the French SUpplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) study aged 45-60 years at baseline (1994-1995) and initially free of major chronic diseases, with available data on HA status in 2007-2009. We defined HA as not developing major chronic disease (cancer, cardiovascular disease, or diabetes), good physical and cognitive functioning (evaluated by validated, standardized tests), independence in instrumental activities of daily living, no depressive symptoms, good social functioning, good self-perceived health, and no function-limiting pain. An index assessing adherence to the Mediterranean diet, the Literature-based Adherence Score to the Mediterranean Diet (LAMD) was calculated using baseline data from repeated 24-hour dietary records. Results: In 2007-2009, 38% of participants met the HA criteria. Multivariable logistic regression revealed that higher scores on the LAMD (ORTertile 3 vs Tertile 1: 1.36 [1.12; 1.65]) were associated with higher odds of HA. Supplementary analyses using structural equation modeling revealed a potential mediation of the observed associations by metabolic health-related factors. Conclusions: Our results suggest a favorable role of a high adherence to the Mediterranean diet at midlife for maintaining good overall health during aging.
... Unhealthy habits like sedentary lifestyle and poor nutrition have been linked with obesity and inflammatory state leading to progressive telomere attrition. Moreover, dietary patterns in general and nutrient composition in particular have commonly been accepted as a cornerstone of treatment for these risk factors directly related with aging (8). However, recent evidence shows that general dietary recommendations may not be beneficial for all individuals, the extent of benefit could change due to genetic background (9). ...
Article
Background Leukocyte telomere length (LTL) attrition has been associated with age-related diseases. Telomerase RNA Component (TERC) genetic variants have been associated with LTL; whereas fatty acids (FAs) can interact with genetic factors and influence in aging. We explore whether variability at the TERC gene locus interacts with FA profile and two healthy diets (low-fat diet vs Mediterranean diet [MedDiet]) modulating LTL, glucose metabolism, and inflammation status in coronary heart disease (CHD) patients. Methods Inflammation status (high-sensitivity C-reactive protein [hsCRP], glucose metabolism—glucose, insulin, and glycated hemoglobin [HbA1c], and homeostasis model assessment of insulin resistance [HOMA-IR]), LTL, FAs, and single nucleotide polymorphisms (SNPs) of the TERC gene (rs12696304, rs16847897, and rs3772190) were determined in 1,002 patients from the CORDIOPREV study (NCT00924937). Results We report an interaction of the TERC rs12696304 SNP with monounsaturated fatty acid (MUFA) affecting LTL (p interaction = .01) and hsCRP (p interaction = .03). Among individuals with MUFA levels above the median, CC individuals showed higher LTL and lower hsCRP than G-allele carriers. Moreover, MedDiet interacted with TERC rs12696304 SNP (p interaction = .03). Specifically, CC individuals displayed a greater decrease in hsCRP than G-allele carriers. These results were not adjusted for multiple statistical testing and p less than .05 was considered significant. Conclusions Our findings suggest that the TERC rs12696304 SNP interacts with MUFA improving inflammation status and telomere attrition related with CHD. Moreover, the MedDiet intervention improves the inflammatory profile in CC individuals compared with the G-allele carriers. These interactions could provide a right strategy for personalized nutrition in CHD patients.
... Older people people tend to have little variation in diet [20], where preference is given to processed products, fats and simple carbohydrates rather than unprocessed products, complex carbohydrates, fruits, legumes and vegetables. These habits compromise the beneficial actions of food on the intestinal microbiota [21]. Short-chain fatty acids, which are generated by the microbial fermentation of dietary polysaccharides in the intestine, are an important source of energy for colonocytes and also function as signaling molecules, modulating intestinal inflammation and the metabolism [22]. ...
... Nonetheless, it should be noted that the findings of this study concerning the association of whole grain intake on successful aging are in line with those of previous studies investigating the association of whole grain intake on some of the parameters related to successful aging [26,29]. It is also suggested that an increase in fiber intake could potentially lead to better aging trajectories, since whole grains and fiber help maintain normal body weight and achieve better lipid profile, endothelial function, glycemic control, insulin sensitivity and maintenance of digestive health [26,30,31]. ...
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The quality of carbohydrates in the diet, including whole grains, matters greatly to health. There is emerging evidence supporting various protective effects from whole grain consumption against certain chronic diseases. However, being free of disease is not a requirement for healthy ageing, as many older adults have one or more health conditions but, when well controlled, have little influence on their wellbeing. The present study aimed to evaluate the association between whole grain consumption on successful aging, through an analysis of a sample of n = 3349, over-50-years-old men and women participating in the ATTICA and MEDIS population-based cross-sectional studies. Successful aging was evaluated using the validated successful aging index (SAI, range 0–10) comprising of health-related social, lifestyle and clinical components. High whole grain intake was positively associated with SAI as compared with low (b ± SE: 0.278 ± 0.091, p = 0.002), whereas no significant associations were observed between moderate whole grain consumption and SAI (p > 0.05). Increased whole grain intake has been associated with several health benefits, and, as is shown here, with higher successful aging levels. Therefore, consumption of whole grains should be encouraged, especially by replacing refined grains, without increasing total energy intake.
... Dietary and lifestyle data were collected for all participants through a 145-item, semi-quantitative food frequency questionnaire (FFQ), modified for Australian diet and vernacular from an early Willett FFQ (26,27) and originally developed and validated as part of the Blue Mountains Eye Study (28,29). The FFQ was later updated to reflect new foods commonly available in the Australian food supply (30). A nine-category frequency scale was used to indicate the usual frequency of consumption of food items during the past year, and included portion size estimates. ...
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Objectives: There is limited information about the dietary habits of patients with Parkinson's Disease (PD), or associations of diet with clinical PD features. We report on nutritional intake in an Australian PD cohort. Methods: 103 PD patients and 81 healthy controls (HCs) completed a validated, semi-quantitative food frequency questionnaire. Food and nutrient intake was quantified, with consideration of micronutrients and macronutrients (energy, protein, carbohydrate, fat, fibre, and added sugar). Participants also completed PD-validated non-motor symptom questionnaires to determine any relationships between dietary intake and clinical disease features. Results: Mean daily energy intake did not differ considerably between PD patients and HCs (11,131 kJ/day vs. 10,188 kJ/day, p = 0.241). However, PD patients reported greater total carbohydrate intake (279 g/day vs. 232 g/day, p = 0.034). This was largely attributable to increased daily sugar intake (153 g/day vs. 119 g/day, p = 0.003) and in particular free sugars (61 g/day vs. 41 g/day, p = 0.001). PD patients who (1) experienced chronic pain, (2) were depressed, or (3) reported an impulse control disorder, consumed more total sugars than HCs (all p < 0.05). Increased sugar consumption was associated with an increase in non-motor symptoms, including poorer quality of life, increased constipation severity and greater daily levodopa dose requirement. Conclusions: We provide clinically important insights into the dietary habits of PD patients that may inform simple dietary modifications that could alleviate disease symptoms and severity. The results of this study support clinician led promotion of healthy eating and careful management of patient nutrition as part of routine care.
... A positive association between dietary fiber intake and cognitive function in older adults has been previously described by prospective, observational studies. 13,14 In this regard, a low dietary fiber intake was associated with cognitive decline in a 13-year cohort of older adult women. 13 In addition, a significant improvement in cognitive function over a 10-year period following a diet highly enriched in fiber in a cohort of adults ≥50 years who were free of major comorbidities (ie, cancer, stroke, coronary artery disease). ...
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Background: Aging is a global health challenge that is associated with a decline in cognitive function. In the United States, most older adults (≥50 years) do not meet the recommended daily fiber intake, although preliminary evidence suggests that dietary fiber consumption could elicit clinical benefits on cognitive function. We investigated the associations between dietary fiber intake and cognitive function in older adults. Methods: We analyzed data from the US National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014, with a study cohort of 1070 older adults (≥60 years). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning Test (WLT), Word Recall Test (WRT) and their Intrusion Word Count Tests (WLT-IC and WRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression and cubic spline analyses were employed to examine the association between dietary fiber intake and cognitive performance on a test-by-test basis, after covariates adjustment (ie, age, sex, race, socioeconomic status, educational level, medical history, body mass index, alcohol, and energy intake). Results: Participants had a mean age of 69.2 years and were primarily non-Hispanic white of middle-high socioeconomic status with a college degree at minimum. The mean dietary fiber intake was 17.3 g/d. The analysis showed that dietary fiber intake was positively associated with DSST (P = .031). No associations with CERAD WLT (P = .41), WRT (P = .68), WLT-IC (P = .07), and WRT-IC (P = .28), and AFT (P = .40) scores were observed. A plateau in DSST score was revealed at a dietary fiber intake of 34 g/d. Conclusions: Higher dietary fiber intake is associated with improved specific components of cognitive function in older adults aged 60 years and older. Public health interventions that target a recommended dietary fiber intake may provide a promising strategy to combat cognitive decline in high-risk groups of older adults.
... Few studies relate the effects of a diet high in fibers on gastrointestinal function, glycemic or lipid metabolism, or on body weight [124]. Gopinath et al. [125] examined the relationship between total dietary carbohydrate intake, glycemic index (GI), glycemic load (GL), and fiber intake, with the state of successful aging [3,4] and with mortality risk, for a follow-up period of 10 years in a cohort of 1609 adults from The Blue Mountains Eye Study [126]. The authors showed that higher intake of total fiber, and particularly vegetable fibers and fruit fibers, was associated with greater odds of successful aging (OR = 1.79, 95% CI = 1.13-2.84; ...
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Increase in the aging population is a phenomenon all over the world. Maintaining good functional ability, good mental health, and cognitive function in the absence of severe disease and physical disability define successful aging. A healthy lifestyle in middle age predisposes successful aging. Longevity is the result of a multifactorial phenomenon, which involves feeding. Diets that emphasize fruit and vegetables, whole grains rather than refined grains, low-fat dairy, lean meats, fish, legumes, and nuts are inversely associated with mortality or to a lower risk of becoming frail among elderly subjects. A regular physical activity and a regular intake of whole grain derivatives together with the optimization of the protein/carbohydrate ratio in the diet, where the ratio is significantly less than 1 such as in the Mediterranean diet and the Okinawan diet, reduces the risk of developing aging-related diseases and increases healthy life expectancy. The purpose of our review was to analyze cohort and case-control studies that investigated the effects of cereals in the diet, especially whole grains and derivatives as well as the effects of a diet with a low protein–carbohydrate ratio on the progression of aging, mortality, and lifespan.
... Regarding prevention component, as chronic conditions had a negative relationship with successful aging (18,(50)(51)(52), the prevention of these conditions is considered to be an important factor for successful aging. Furthermore, nutrition is essential for improving the quality of life of seniors (53). Regarding physical activity, Adams-Fryatt (54) reported that engaging in regular physical activity can result in dramatic physical, mental, and social benefits for seniors. ...
Article
Background: Successful aging is a prominent and worldwide theme in gerontology. However, until recently, only few studies were conducted about successful aging in Iran. This study examined whether a healthy lifestyle could predict successful aging among older Iranians. Methods: This cross sectional and descriptive study included 975 older Iranians who were selected through a multistage cluster-quota method from the health centers of Shiraz, Iran. A 5-part questionnaire, including demographic characteristics, the Seniors' Healthy Lifestyle, Barthel Index, the Diner Life Satisfaction and Quality of Life, was used to collect the data. A logistic regression analysis was used in data analysis; data were analyzed using SPSS 21; and significance level was set at α = 0.05. Results: The prevalence of successful aging among older Iranians was calculated at 24.0%. Results of multiple logistic regression analysis revealed that age (95% CI = 1.129- 1.702 and OR = 1.352), gender (95% CI = 0.412-0.764 and OR = 0.687), education level (95% CI = 1.443 - 1.699 and OR = 1.454), job (95% CI = 1.063-1.413 and OR = 1.185), monthly income (95% CI = 1.355-4.055 and OR = 2.272), insurance (95% CI = 0.344-0.842 and OR = 0.540), source of income (95% CI = 1.014-1.298 and OR = 1.145), and healthy lifestyle (95% CI = 0.772 - 0.858 and OR = 0.814) were predictors for successful aging. Conclusion: Findings indicated that successful agers were mostly younger men, with higher education level and monthly income, who had insurance and a job and a healthy lifestyle. Thus, to age successfully, one must maintain and improve healthy lifestyle to prolong one's health.
... Doing so revealed a significant association with decelerated aging for all three food components ( Figures 3D-F, right panels). Together, these findings are in line with general observations known to benefit health in humans, such as how higher fiber intake is linked to lower mortality (Gopinath et al., 2016), magnesium deficiency is associated to age-related diseases in the elderly (Barbagallo and Dominguez, 2018), and vitamin E may benefit the lifespan of certain human populations (Hemilä and Kaprio, 2011). We Frontiers in Aging | www.frontiersin.org ...
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Intervening in aging processes is hypothesized to extend healthy years of life and treat age-related disease, thereby providing great benefit to society. However, the ability to measure the biological aging process in individuals, which is necessary to test for efficacy of these interventions, remains largely inaccessible to the general public. Here we used NHANES physical activity accelerometer data from a wearable device and machine-learning algorithms to derive biological age predictions for individuals based on their movement patterns. We found that accelerated biological aging from our “MoveAge” predictor is associated with higher all-cause mortality. We further searched for nutritional or pharmacological compounds that associate with decelerated aging according to our model. A number of nutritional components peak in their association to decelerated aging later in life, including fiber, magnesium, and vitamin E. We additionally identified one FDA-approved drug associated with decelerated biological aging: the alpha-blocker doxazosin. We show that doxazosin extends healthspan and lifespan in C. elegans. Our work demonstrates how a biological aging score based on relative mobility can be accessible to the wider public and can potentially be used to identify and determine efficacy of geroprotective interventions.
... Regarding prevention component, as chronic conditions had a negative relationship with successful aging (18,(50)(51)(52), the prevention of these conditions is considered to be an important factor for successful aging. Furthermore, nutrition is essential for improving the quality of life of seniors (53). Regarding physical activity, Adams-Fryatt (54) reported that engaging in regular physical activity can result in dramatic physical, mental, and social benefits for seniors. ...
... Previous studies have indicated that people with healthier lifestyles, including not smoking, moderate consumption of alcohol, physical activity, and a healthy diet, have a higher probability of healthy aging, and that socioeconomic factors such as higher education level and higher income are also predictors of healthy aging (8)(9)(10)(11). However, only 2 studies have examined the association between social participation and healthy aging; one of these studies reported that social participation was associated with a higher likelihood of healthy aging, whereas the other one found a null association (12,13). ...
Article
Background Our study examined the association between social participation and healthy aging using a community-based cohort study among Japanese elderly. Methods This prospective study was conducted in Ohsaki City, Japan, and included 7,226 subjects aged ≥65 years at the baseline survey in 2006. We obtained information on frequency of participation in three types of community activities (i.e. neighborhood activities, hobbies, and volunteer activities) at baseline. Exposure was measured by the number of types of community activities participated in and subjects were categorized into four groups (i.e. none, one type, two types, and three types). The primary outcome was healthy aging as assessed by a questionnaire survey conducted in 2017, and was defined as meeting the following four criteria: free of disability, free of depression, high health-related quality of life, and high life satisfaction. We used multiple logistic regression models to calculate the corresponding odds ratios (ORs) and 95% confidence intervals (95%CIs). Results During 11 years of follow-up, 574 (7.9%) subjects attained healthy aging. Compared with subjects not participating in any activity, the multivariable-adjusted ORs (95%CIs) were 1.90 (1.40, 2.59) for those participating in one type, 2.49 (1.84, 3.38) for two types, and 3.06 (2.30, 4.07) for three types (P for trend <.0001). Furthermore, for each type of community activity, a higher frequency of participation was related to higher probability of healthy aging. Conclusions Our study suggests that social participation is associated with the promotion of healthy aging, and that the benefits were observed across different types of community activities.
... Indeed, dietary factors have been shown to directly shape the microbiota in both rodents ( Daniel et al., 2014 ;de Wit et al., 2012 ;Marques et al., 2015 ;Mujico et al., 2013 ;Murphy et al., 2010 ;Patterson et al., 2014 ;Ravussin et al., 2012 ) and humans ( De Filippo et al., 2010 ;Turnbaugh et al., 2009 ;Xu and Knight, 2015 ), and diet therefore represents a modifiable determinant of gut microbiota composition. For example, studies have already shown that high fiber diets and Mediterranean diets, promote a diverse gut microbiota, and are associated with a reduced likelihood of depression ( Gopinath et al., 2016 ). In addition, fermented foods may also have potential to modify the gut microbiota and to alter gut physiology and mental health ( Aslam et al., 2018 ). ...
Article
Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions. There are common beliefs about the health effects of certain foods that are not supported by solid evidence and the scientific evidence demonstrating the unequivocal link between nutrition and mental health is only beginning to emerge. Current epidemiological data on nutrition and mental health do not provide information about causality or underlying mechanisms. Future studies should focus on elucidating mechanism. Randomized controlled trials should be of high quality, adequately powered and geared towards the advancement of knowledge from population-based observations towards personalized nutrition. Here, we provide an overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health. We conclude that an experimental medicine approach and a mechanistic understanding is required to provide solid evidence on which future policies on diet and nutrition for mental health can be based.
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Holistic health involves competent physical, mental, social, and spiritual components. As the incidence of mental health problems advances among the global population, it becomes pertinent to look into alternative methods of their prevention and treatment. As diet is an essential part of our daily life, it is easier to make modifications and understand its linkage with mental health if adequate awareness is generated. This review presents an analysis of the significance of mental health, various problems associated with it, and nutrients that directly or indirectly affect the ascent of these problems. Studies suggest that adequate nutrition is positively correlated to mental health, no matter where one lies in the spectrum. Therefore, it becomes important to understand the evident linkage between nutrition and mental well-being and recognize gaps in current knowledge.
Chapter
People are now living longer than at any other time in history, but many people are aging poorly with decreased healthy life expectancy. For most people, the aging process is not genetically predetermined as the rate at which people age can be modified by diet, exercise, personal habits, and psychosocial factors. Healthy aging is marked by good mental health and social engagement, lack of physical disability, and the absence of premature chronic disease or death.
Chapter
Low fiber intake is a major public health concern. Inadequate fiber intake is associated with increased risk of weight gain and obesity, chronic disease, and premature aging and mortality.
Article
Non-communicable diseases such as diabetes, cardiovascular diseases and certain cancers are now the leading cause of death and disability, and their prevalence is rising worldwide. Poor diet is a major modifiable risk factor but changing eating habits has had limited success. Enhancing the nutritional quality of staple foods offers a complimentary intervention strategy for alleviating the burden of diet-related chronic disease. Wholegrain cereals, such as wheat, are prime targets. Their nutritional credentials and health-promoting potential are well established. Wheat is the major source of protein, minerals and vitamins, and dietary fibre for most people. Importantly, wheat is a versatile ingredient for producing foods that have high consumer appeal. Their popularity is expanding globally and small improvements in wheat grain composition conceivably translate to substantial dietary change across entire populations. A newly developed, high amylose wheat line illustrates the capacity for developing healthier processed staple food products with potential for remediating chronic disease risk. Dietary fibre density of this novel grain is markedly improved due to a >10 fold increase in resistant starch content. The sensory attributes of finished products are not compromised and preliminary studies demonstrate that consumption of the new wheat significantly improves indices of metabolic and digestive health.
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The long-term impact of carbohydrate quality on abdominal weight gain is not fully understood. We aimed to examine the prospective relation of a carbohydrate quality index (CQI; defined by four criteria: dietary fiber, glycemic index, whole grain-to-total grain ratio, and solid-to-total carbohydrate ratio), total, cereal grain, vegetable, and fruit fiber, carbohydrate-to-total fiber ratio, and carbohydrate-to-cereal fiber ratio with changes in waist circumference (WC). Subjects were middle-aged to older, mostly white, participants in the Framingham Offspring cohort (n = 3101 subjects), with mean baseline age 54.9 ± 0.2 years (mean ± SE) and body mass index (BMI) 27.2 ± 0.1 kg/m2. Food frequency questionnaire (FFQ), health, and lifestyle data were collected approximately every four years over a median total follow-up of 18 years. Repeated measure mixed models were used to estimate adjusted mean change in WC per four-year interval across quartiles of carbohydrate variables. In the most adjusted model, a higher CQI was marginally associated with a smaller increase in WC (2.0 ± 0.1 vs. 2.4 ± 0.1 cm in highest vs. lowest quartile, p-trend = 0.04). Higher ratios of carbohydrate-to-fiber and carbohydrate-to-cereal fiber were associated with greater increases in WC per four-year interval (2.6 ± 0.1 vs. 2.0 ± 0.1 cm, p-trend < 0.001, and 2.5 ± 0.1 vs. 2.1 ± 0.1 cm in highest versus lowest categories, p-trend = 0.007, respectively); whereas higher intake of total fiber (1.8 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001), cereal fiber (2.0 ± 0.1 vs. 2.5 ± 0.1 cm, p-trend = 0.001), and fruit fiber (2.0 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001) were associated with smaller increases in WC compared to lower intakes. There was a significant interaction between total fiber and total carbohydrate (as % of total energy intake). After stratification, the association between fiber intake and change in WC was not maintained in the context of a high carbohydrate diet. Better carbohydrate quality, primarily higher fiber intake and lower carbohydrate-to-fiber ratios, may help attenuate increases in abdominal adiposity over time.
Chapter
Currently, healthy aging is a major public concern. In between, nutritional interventions and dietary patterns are supposed to play crucial roles in regulation/delaying the aging process. High intake of dietary fiber is inversely associated with reduced risk of several age-related diseases. A bulk of evidence indicated that consumption of dietary fiber is implicated with lower concentrations of inflammatory and oxidative stress markers, resulting in improving health status during aging and extending the life span. Even, it was proven that inadequate amounts of dietary fiber are accelerating the aging process. Significant intake of dietary fiber is an essential parameter of a healthy aging. The current chapter reviews the specific roles of dietary fiber in conjunction with age-associated-gastrointestinal system, age-associated-metabolic status, age-associated cardiovascular diseases, age-associated neurodegenerative diseases, cancer, immune system, and allergic disorders.
Article
En este trabajo se hace una revisión bibliográfica sobre el desarrollo evolutivo humano y longevidad, desde un enfoque biopsicosocial (Engel, 1977; Gliedt et al., 2017; Lehman et al., 2017). Tras aplicar el método de análisis PRISMA, se obtuvieron diversos resultados relacionados con un desarrollo evolutivo más longevo; así, en el área biológica, 3 factores: los SNPs, los telómeros y la química del estrés; en el área psicológica, 5 factores: la metacognición, la resiliencia, la espiritualidad, las relaciones personales y la depresión; y en el área social, 8 factores: la pseudo-heredabilidad, las relaciones conyugales, la maternidad, el nivel educativo, estilos de vida, dieta y restricción calórica, actividad física y mental y tecnología sanitaria. Ante los datos obtenidos en las tres áreas, de este enfoque biopsicosocial, y el repetido solapamiento entre factores del área psicológica y del área social, se plantea que pudieran considerarse estas dos como una conjunta, proponiéndose un enfoque explicativo con dos áreas: bio-psicosocial que, por factores encontrados en este trabajo, quedarían un 18,7% de biológica y un 81,3% psicosocial. Actualmente, hay suficiente información sobre desarrollo evolutivo humano y longevidad, pero una ausencia de investigaciones que estudien esos factores desde una perspectiva integrada. Mucha de esa información privilegiada se podría aplicar ya, psicológica y socialmente, a la población en general, para una mejora de su salud, en cualquier fase del desarrollo evolutivo humano.
Article
Background: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). Methods: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45-69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. Results: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95% CI 0.001; 0.059 in men; b = 0.056, 95% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95% CI 0.013; 0.071 in men; b = 0.035, 95% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95% CI 0.024; 0.082 in men; b = 0.063, 95% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95% CI 0.002;0.060 in men; b = 0.054, 95% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. Conclusions: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.
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Background: We aimed to prospectively examine the relationship between overall diet quality (reflecting adherence to dietary guidelines) and successful aging in a population-based cohort of older adults. Methods: In this population-based cohort study, we analyzed 10-year follow-up data from 1,609 adults aged 49 years and older, who were free of cancer, coronary artery disease, and stroke at the baseline and who had complete dietary data. Dietary data were collected using a semiquantitative food frequency questionnaire. Total diet scores (TDS) were allocated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Higher scores indicated closer adherence to dietary guidelines. Successful aging was defined as the absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases (cancer, coronary artery disease, and stroke). Results: At 10-year follow-up, 610 (37.9%) participants had died and 249 (15.5%) participants aged successfully. After multivariable adjustment, each 1-unit increase in TDS at baseline was associated with a 8% increased odds of successful aging 10 years later, odds ratio 1.08 (95% confidence interval 1.00-1.15). Participants in the highest (high adherence to dietary guidelines) versus lowest quartile (poor adherence to guidelines) of TDS at baseline had 58% higher odds of successful aging after 10 years, odds ratio 1.58 (95% confidence interval 1.02-2.46). Conclusions: Greater compliance with recommended national dietary guidelines (higher diet quality) was associated with an increased likelihood of successful aging, as determined through a multidomain approach.
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Chronic low-grade inflammation is a likely intermediary between quality of carbohydrate and chronic disease risk. We conducted a systematic literature search to evaluate the relevance of carbohydrate quality on inflammatory markers in observational and intervention studies. MEDLINE, EMBASE, and the Cochrane Library were searched for studies on associations between glycemic index (GI), glycemic load (GL), dietary fiber or fiber supplements or whole grain intake, and high-sensitivity C-reactive protein (hsCRP) or interleukin 6 (IL-6). Included studies had to be conducted on adults (healthy, overweight, with type 2 diabetes or metabolic syndrome features, but without inflammatory disease) with ≥20 participants and a 3-wk duration. In total, 22 of the 60 studies that met our inclusion criteria examined GI/GL: 5 of 9 observational studies reported lower concentrations of hsCRP or IL-6 among persons with a lower dietary GI/GL; 3 of 13 intervention studies showed significant antiinflammatory effects of a low-GI/GL diet, and 4 further studies suggested beneficial effects (trends or effects in a subgroup). For fiber intake, 13 of 16 observational studies reported an inverse relation with hsCRP or IL-6, but only 1 of 11 intervention studies showed a significant antiinflammatory effect of fiber intake, and a further trial reported a beneficial trend. For whole-grain intake, 6 of 7 observational studies observed an inverse association with inflammatory markers, but only 1 of 7 intervention studies reported significant antiinflammatory effects, 1 further study was suggestive (in a subgroup) of such, and another study found an adverse effect (trend only). Evidence from intervention studies for antiinflammatory benefits is less consistent for higher-fiber or whole-grain diets than for low-GI/GL diets. Benefits of higher fiber and whole-grain intakes suggested by observational studies may reflect confounding.
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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.
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The health benefits of dietary fiber have long been appreciated. Higher intakes of dietary fiber are linked to less cardiovascular disease and fiber plays a role in gut health, with many effective laxatives actually isolated fiber sources. Higher intakes of fiber are linked to lower body weights. Only polysaccharides were included in dietary fiber originally, but more recent definitions have included oligosaccharides as dietary fiber, not based on their chemical measurement as dietary fiber by the accepted total dietary fiber (TDF) method, but on their physiological effects. Inulin, fructo-oligosaccharides, and other oligosaccharides are included as fiber in food labels in the US. Additionally, oligosaccharides are the best known "prebiotics", "a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-bring and health." To date, all known and suspected prebiotics are carbohydrate compounds, primarily oligosaccharides, known to resist digestion in the human small intestine and reach the colon where they are fermented by the gut microflora. Studies have provided evidence that inulin and oligofructose (OF), lactulose, and resistant starch (RS) meet all aspects of the definition, including the stimulation of Bifidobacterium, a beneficial bacterial genus. Other isolated carbohydrates and carbohydrate-containing foods, including galactooligosaccharides (GOS), transgalactooligosaccharides (TOS), polydextrose, wheat dextrin, acacia gum, psyllium, banana, whole grain wheat, and whole grain corn also have prebiotic effects.
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Higher intake of carbohydrates and high-glycemic index (high-GI) diets could lead to small vessel dysfunction. We aimed to assess the associations between intakes of high-GI and high-glycemic load (high-GL) diets, carbohydrate, and the main carbohydrate-containing food groups and retinal microvascular changes in preadolescents. Students aged 12 y (n = 2353) from a random cluster sample of 21 schools underwent detailed eye examinations. Retinal vessel caliber and fractal dimension were measured from digital retinal images. A validated semiquantitative food-frequency questionnaire was administered. After multivariable adjustment, children who consumed soft drinks once or more per day had significantly narrower mean retinal arterioles (∼1.9 μm) than did those who never or rarely consumed soft drinks (P-trend = 0.03). When the highest to lowest tertiles of carbohydrate consumption were compared, girls had significantly narrower retinal arterioles (∼1.4 μm; P-trend = 0.03) and boys had wider venules (∼2.3 μm; P-trend = 0.02). In girls only, a higher-GI diet was associated with narrower retinal arterioles (0.98-μm narrowing of retinal arteriolar caliber per SD increase in GI, P = 0.01). Carbohydrate intake and a high-GL diet were associated with greater retinal fractal dimension in girls (highest compared with lowest tertiles: P-trend = 0.003 and 0.01, respectively). Greater consumption of carbohydrates and soft drinks was associated with retinal arteriolar narrowing and venular widening. Because these microvascular signs have been shown to be markers of future cardiovascular disease risk, the presence of this risk factor in children could support the need for healthy dietary patterns that include lower consumption of high-GI foods and soft drinks.
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It has been shown that dietary glycemic index (GI) and fiber could have a role in the development of chronic diseases; however, the link between carbohydrate nutrition and development of chronic kidney disease (CKD) is unclear. We aimed to determine whether cross-sectional and longitudinal associations exist between carbohydrate nutrition (mean dietary GI, dietary intakes of carbohydrate, sugar, starch, and fiber) and CKD. Data included 2600 Blue Mountains Eye Study (1997-1999) participants aged ≥50 y. Baseline biochemistry including serum creatinine was measured. Moderate CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL·min(-1)·1.73 m(-2). Dietary data were collected in a semiquantitative FFQ. Cross-sectionally, participants in the 4th quartile of mean dietary GI intake compared with those in the first quartile (reference) had a 55% increased likelihood of having eGFR < 60 mL·min(-1)·1.73 m(-2) [multivariable-adjusted OR = 1.55 (95% CI = 1.07-2.26); P-trend = 0.01]. After multivariable adjustment, participants in the 4th quartile of dietary cereal fiber intake compared with those in the first quartile (reference) had a 50% reduced risk of incident moderate CKD (P-trend = 0.03). Higher baseline consumption of energy-dense, nutrient-poor sources of carbohydrate (e.g. cookies) yielded a 3-fold higher risk of incident CKD (P-trend = 0.01). In summary, we observed a novel link between high cereal fiber intake and reduced incidence of moderate CKD and this was supported by the cross-sectional association with dietary GI. Conversely, our data suggest that higher intake of energy-dense, nutrient-poor sources of carbohydrate, potentially through acute hyperglycemia, could impair renal function.
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Objective: To assess the ability of a food-frequency questionnaire (FFQ) to rank Australians according to their intake of total carbohydrate, sugar, starch, fibre, glycaemic index (GI) and glycaemic load (GL). Design: Cross-sectional sample from a population cohort. Setting: Two postcode areas west of Sydney, Australia. Subjects: From 1992 to 1994, a total of 2868 older Australians provided dietary data using a 145-item Willett-derived FFQ. A representative sub-sample of 78 subjects completed three 4-day weighed food records (WFRs). Pearson and Spearman correlations, Bland-Altman plots and weighted kappa values were calculated. Results: Compared with the WFR, the FFQ provided higher mean estimates of all nutrients except starch and GI. All Pearson and/or Spearman correlations were greater than 0.5, except for GL. For GI, sugar, starch and fibre, the regression lines from the Bland-Altman analysis indicated a non-significant linear trend (P = 0.07, P = 0.36, P = 0.28 and P = 0.10, respectively). For GL and total carbohydrate, however, there was a significant linear trend (P = 0.006 and P < 0.0001, respectively), indicating that as the GL and carbohydrate intake of individuals increased, so did the magnitude of the error between the FFQ and WFR. Weighted kappa values all indicated moderate to good agreement, with the exception of GL which was only fair. The proportions of subjects correctly classified within one quintile for all of the nutrients were over 50% and gross misclassification was low (<10%). Conclusion: This FFQ was able to rank individuals according to their intakes of total carbohydrate, sugar, starch, fibre and GI, but not as well for GL.
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Several studies suggest that carbohydrate nutrition is related to oxidative stress and inflammatory markers. We examined whether dietary glycemic index (GI), dietary fiber, and carbohydrate-containing food groups were associated with the mortality attributable to noncardiovascular, noncancer inflammatory disease in an older Australian cohort. Analysis included 1490 postmenopausal women and 1245 men aged ge 49 y at baseline (1992-1994) from a population-based cohort who completed a validated food-frequency questionnaire. Cox proportional hazards ratios were calculated both for death from diseases in which inflammation or oxidative stress was a predominant contributor and for cardiovascular mortality. Over a 13-y period, 84 women and 86 men died of inflammatory diseases. Women in the highest GI tertile had a 2.9-fold increased risk of inflammatory death compared with women in the lowest GI tertile [multivariate hazard ratio in energy-adjusted tertile 3 (tertile 1 as reference): 2.89; 95% CI: 1.52, 5.51; P for trend: 0.0006, adjusted for age, smoking, diabetes, and alcohol and fiber consumption]. Increasing intakes of foods high in refined sugars or refined starches (P = 0.04) and decreasing intakes of bread and cereals (P = 0.008) or vegetables other than potatoes (P = 0.007) also independently predicted a greater risk, with subjects' GI partly explaining these associations. In men, only an increased consumption of fruit fiber (P = 0.005) and fruit (P = 0.04) conferred an independent decrease in risk of inflammatory death. No associations were observed with cardiovascular mortality. These data provide new epidemiologic evidence of a potentially important link between GI and inflammatory disease mortality among older women.
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The immune system responds to pathogens by a variety of pattern recognition molecules such as the Toll-like receptors (TLRs), which promote recognition of dangerous foreign pathogens. However, recent evidence indicates that normal intestinal microbiota might also positively influence immune responses, and protect against the development of inflammatory diseases. One of these elements may be short-chain fatty acids (SCFAs), which are produced by fermentation of dietary fibre by intestinal microbiota. A feature of human ulcerative colitis and other colitic diseases is a change in 'healthy' microbiota such as Bifidobacterium and Bacteriodes, and a concurrent reduction in SCFAs. Moreover, increased intake of fermentable dietary fibre, or SCFAs, seems to be clinically beneficial in the treatment of colitis. SCFAs bind the G-protein-coupled receptor 43 (GPR43, also known as FFAR2), and here we show that SCFA-GPR43 interactions profoundly affect inflammatory responses. Stimulation of GPR43 by SCFAs was necessary for the normal resolution of certain inflammatory responses, because GPR43-deficient (Gpr43(-/-)) mice showed exacerbated or unresolving inflammation in models of colitis, arthritis and asthma. This seemed to relate to increased production of inflammatory mediators by Gpr43(-/-) immune cells, and increased immune cell recruitment. Germ-free mice, which are devoid of bacteria and express little or no SCFAs, showed a similar dysregulation of certain inflammatory responses. GPR43 binding of SCFAs potentially provides a molecular link between diet, gastrointestinal bacterial metabolism, and immune and inflammatory responses.
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Observational studies in adults suggest that a diet with a high glycemic index (GI) or glycemic load (GL), a high intake of sugary foods, or a low fiber intake may increase the risk of overweight. We aimed to examine prospectively whether dietary GI, GL, added sugar intake, or fiber intake between age 2 and 7 y are associated with the development of body composition. If so, we aimed to ascertain whether these associations are modified by meal frequency. Linear mixed-effect regression analyses were performed in 380 participants of the DOrtmund Nutrition and Anthropometric Longitudinally Designed (DONALD) Study for whom 4-6 weighed 3-d dietary records and anthropometric data were obtained between ages 2 and 7 y. Changes in dietary GI, GL, or added sugar intake between ages 2 and 7 y were not associated with concurrent changes in percentage body fat (%BF, as estimated from skinfold thicknesses) or body mass index SD scores. An increase in fiber intake was related to a concurrent decrease in %BF between ages 2 and 7 y only in children who consumed <6 meals/d as toddlers (beta +/- SE from fully adjusted model: -0.26 +/- 0.09%BF per 1-SD increase in fiber intake, P = 0.005), whereas children with a higher meal frequency had no concurrent change (0.07 +/- 0.07%BF per 1-SD increase in fiber intake, P = 0.3). Dietary GI, GL, or added sugar intake between ages 2 and 7 y does not appear to influence the development of body composition. Potential benefits associated with increasing fiber intake throughout childhood may be limited to toddlers with a lower meal frequency.
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The use of a mailed, self-administered, semiquantitative food frequency questionnaire to describe past dietary intake was evaluated in 1984 among a group of 150 Boston-area women who had completed four one-week diet records three to four years previously. Correlation coefficients comparing calorie-adjusted nutrient intakes computed from the questionnaire with those obtained from a compressed version of the questionnaire completed during diet record keeping ranged from 0.44 for total carbohydrate to 0.62 for vitamin C including supplements. Coefficients comparing calorie-adjusted nutrient intakes measured by questionnaire with those assessed by the diet records completed three to four years previously ranged from 0.28 for iron without supplements to 0.61 for total carbohydrate. An evaluation of the incremental contribution provided by several open-ended sections of the questionnaire to the estimation of nutrient intake suggested that in this population most of these items might be eliminated without material loss of information. These findings demonstrate that useful estimates of nutrient intake several years previously can be obtained by a relatively inexpensive, mailed, self-administered questionnaire.
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The glycemic index concept is an extension of the fiber hypothesis, suggesting that fiber consumption reduces the rate of nutrient influx from the gut. The glycemic index has particular relevance to those chronic Western diseases associated with central obesity and insulin resistance. Early studies showed that starchy carbohydrate foods have very different effects on postprandial blood glucose and insulin responses in healthy and diabetic subjects, depending on the rate of digestion. A range of factors associated with food consumption was later shown to alter the rate of glucose absorption and subsequent glycemia and insulinemia. At this stage, systematic documentation of the differences that exist among carbohydrate foods was considered essential. The resulting glycemic index classification of foods provided a numeric physiologic classification of relevant carbohydrate foods in the prevention and treatment of diseases such as diabetes. Since then, low-glycemic-index diets have been shown to lower urinary C-peptide excretion in healthy subjects, improve glycemic control in diabetic subjects, and reduce serum lipids in hyperlipidemic subjects. Furthermore, consumption of low-glycemicindex diets has been associated with higher HDL-cholesterol concentrations and, in large cohort studies, with decreased risk of developing diabetes and cardiovascular disease. Case-control studies have also shown positive associations between dietary glycemic index and the risk of colon and breast cancers. Despite inconsistencies in the data, sufficient, positive findings have emerged to suggest that the dietary glycemic index is of potential importance in the treatment and prevention of chronic diseases.
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Metabolism of many of the most commonly consumed carbohydrates in the United States results in a high plasma glucose response, which can be quantified by the glycemic load. Although hyperglycemia is a risk factor for cataract, there is no information on the potential effect of a high dietary glycemic load on the incidence of age-related cataract. Our objective was to prospectively examine the association between dietary glycemic load and incident age-related cataract. We studied 2 cohorts-71 919 women and 39 926 men-aged > or =45 y who had no previous diagnosis of cataract, diabetes mellitus, or cancer and who were followed for 14 and 12 y, respectively, for the occurrence of cataract extraction. We calculated dietary glycemic load from data reported on multiple validated food-frequency questionnaires and used pooled logistic regression models to estimate the association with incident cataract extraction. We performed analyses separately for each cohort and then calculated pooled estimates across cohorts. During 980 683 person-years of follow-up, we confirmed 4865 incident age-related cataract extractions. After adjustment for age, cigarette smoking, body mass index, total caloric intake, dietary intake of lutein and zeaxanthin, and alcohol consumption, there was no significant relation of dietary glycemic load to risk of cataract extraction (P for trend = 0.10). The pooled relative risk between the highest and lowest quintiles of dietary glycemic load was 0.95 (95% CI: 0.81, 1.11; P for heterogeneity by cohort = 0.1). These prospective epidemiologic data do not support the hypothesis that a high dietary glycemic load, primarily a result of consumption of refined carbohydrates, increases the risk of cataract extraction.
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To examine whether retinal vascular calibre independently predicts risk of coronary heart disease (CHD) -related death. In a population-based cohort study of 3654 Australians aged > or = 49 years, retinal arteriolar and venular calibres were measured from baseline retinal photographs and the arteriole to venule ratio (AVR) was calculated. CHD-related death was confirmed from the Australian National Death Index. Over nine years, 78 women (4.1%) and 114 men (7.8%) had incident CHD-related deaths. In people aged 49-75 years, wider venules were associated with CHD death, with relative risk (RR) 1.8 (95% confidence interval (CI) 1.1 to 2.7) and RR 2.0 (95% CI 1.1 to 3.6) per standard deviation (SD) increase in venular calibre for men and women, respectively, after adjustment for traditional risk factors. Additionally, in women aged 49-75 years, smaller AVR and narrower arterioles were associated with CHD death (RR 1.5, 95% CI 1.1 to 2.2, and RR 1.9, 95% CI 1.0 to 3.5 per SD decrease in AVR and arteriolar calibre, respectively, after adjustment). These associations were not observed in people aged > 75 years. These findings suggest that microvascular disease processes may have a role in CHD development in middle-aged people, particularly in women. Retinal photography may be useful in cardiovascular risk prediction.
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In women, dietary glycemic index (GI) and dietary glycemic load (GL) have been associated with cardiovascular disease; in men, however, the evidence for an association is weaker. We tested the hypothesis that men consuming diets high in GI or GL have a greater risk of cardiovascular disease. At baseline, we assessed dietary GI and dietary GL by using food-frequency questionnaires in 36 246 Swedish men aged 45-79 y without diabetes or prior cardiovascular disease. Participants were followed through inpatient, cause-of-death, and death registries from 1 January 1998 until 31 December 2003 for myocardial infarction, ischemic stroke, hemorrhagic stroke, and cardiovascular mortality and until 31 December 2005 for all-cause mortality. We used Cox models with age as the time scale to estimate relative risks adjusted for cigarette smoking, body mass index, physical activity, demographic characteristics, and nutritional factors. Dietary GI and dietary GL were not associated with myocardial infarction (n = 1324), ischemic stroke (n = 692), cardiovascular mortality (n = 785), or all-cause mortality (n = 2959). Dietary GL was associated with hemorrhagic stroke [n = 165; relative risk = 1.44 comparing extreme quartiles (95% CI: 0.91, 2.27); P for trend = 0.047]. Dietary GI and dietary GL were not associated with ischemic cardiovascular disease or mortality, but dietary GL was associated with a greater risk of hemorrhagic stroke. Discrepancies between these findings and those of previous studies may be due to variations in the associations by sex or to differences in dietary contributions to GI and GL.
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Dietary fiber appears to decrease the risk of cardiovascular morbidity and mortality. Microvascular abnormalities can be observed by retinal examination and contribute to the pathogenesis of various cardiovascular diseases. The impact of dietary fiber on the retinal microvasculature is not known. We aimed to examine the association between dietary fiber intake and retinal vascular caliber. At the third visit (1993-1995) of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based cohort of adults in 4 US communities, the retinal vascular caliber of 10,659 participants was measured and summarized from digital retinal photographs. Usual dietary intake during the same period was assessed with a 66-item food-frequency questionnaire. After control for potential confounders including hypertension, diabetes, lipids, demographic factors, cigarette smoking, total energy intake, micronutrients intake, and other cardiovascular disease risk factors, higher intake of fiber from all sources and from cereal were significantly associated with wider retinal arteriolar caliber and narrower venular caliber. Participants in the highest quintile of fiber intake from all sources had a 1.05-microm larger arteriolar caliber (P for trend = 0.012) and a 1.11-microm smaller venular caliber (P for trend = 0.029). Dietary fiber was related to wider retinal arteriolar caliber and narrower venular caliber, which are associated with a lower risk of cardiovascular disease. These data add to the growing evidence of the benefits of fiber intake on various aspects of cardiovascular pathogenesis.
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Inconsistent findings from observational studies have prolonged the controversy over the effects of dietary glycemic index (GI) and glycemic load (GL) on the risk of certain chronic diseases. The objective was to evaluate the association between GI, GL, and chronic disease risk with the use of meta-analysis techniques. A systematic review of published reports identified a total of 37 prospective cohort studies of GI and GL and chronic disease risk. Studies were stratified further according to the validity of the tools used to assess dietary intake. Rate ratios (RRs) were estimated in a Cox proportional hazards model and combined by using a random-effects model. From 4 to 20 y of follow-up across studies, a total of 40 129 incident cases were identified. For the comparison between the highest and lowest quantiles of GI and GL, significant positive associations were found in fully adjusted models of validated studies for type 2 diabetes (GI RR = 1.40, 95% CI: 1.23, 1.59; GL RR = 1.27, 95% CI: 1.12, 1.45), coronary heart disease (GI RR = 1.25, 95% CI: 1.00, 1.56), gallbladder disease (GI RR = 1.26, 95% CI: 1.13, 1.40; GL RR = 1.41, 95% CI: 1.25, 1.60), breast cancer (GI RR = 1.08, 95% CI: 1.02, 1.16), and all diseases combined (GI RR = 1.14, 95% CI: 1.09, 1.19; GL RR = 1.09, 95% CI: 1.04, 1.15). Low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases. In diabetes and heart disease, the protection is comparable with that seen for whole grain and high fiber intakes. The findings support the hypothesis that higher postprandial glycemia is a universal mechanism for disease progression.
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High-glycemic index diets have been linked to greater risk of cardiovascular disease and type 2 diabetes. Postprandial glycemia within the normal range may promote oxidative stress and inflammatory processes underlying the development of disease. We explored acute differences in the activation of the inflammatory marker nuclear factor-kappaB after consumption of 2 carbohydrate meals matched for macronutrient and micronutrient composition but differing in glycemic index. After an overnight fast, 10 young, lean healthy subjects were fed in random order 3 meals providing 50 g of available carbohydrate as glucose, white bread, or pasta. Venous blood samples were collected at 0, 1, 2, and 3 h, and nuclear proteins were extracted from mononuclear cells. Changes in nuclear factor-kappaB-p65 proteins were detected by Western blotting. Acute changes in other markers of oxidative stress (nitrotyrosine and soluble intercellular adhesion molecule-1) were also assessed. The maximum increase in nuclear factor-kappaB activation was similar after the bread meal [mean (+/-SEM) area under the curve: 69 +/- 16% optical density x h] and the glucose challenge (75 +/- 9% optical density x h), but was 3 times higher than after the pasta meal (23 +/- 5% optical density x h) (P < 0.05). Similarly, changes in nitrotyrosine, but not soluble intercellular adhesion molecule-1, were higher after glucose and bread than after pasta (P = 0.01 at 2 h). The findings suggest that high-normal physiologic increases in blood glucose after meals aggravate inflammatory processes in lean, young adults. This mechanism may help to explain relations between carbohydrates, glycemic index, and the risk of chronic disease.
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Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood. To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes. Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120-159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure. (1) A high-glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low-glycemic index (40%), high-carbohydrate diet; (3) a high-glycemic index, low-carbohydrate diet (40% energy); and (4) a low-glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet. The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure. At high dietary carbohydrate content, the low- compared with high-glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (-20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low- compared with high-glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (-5%, P = .02). In the primary diet contrast, the low-glycemic index, low-carbohydrate diet, compared with the high-glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (-23%, P ≤ .001). In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance. clinicaltrials.gov Identifier: NCT00608049.
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The fundamental questions of what represents a macronutritionally balanced diet and how this maintains health and longevity remain unanswered. Here, the Geometric Framework, a state-space nutritional modeling method, was used to measure interactive effects of dietary energy, protein, fat, and carbohydrate on food intake, cardiometabolic phenotype, and longevity in mice fed one of 25 diets ad libitum. Food intake was regulated primarily by protein and carbohydrate content. Longevity and health were optimized when protein was replaced with carbohydrate to limit compensatory feeding for protein and suppress protein intake. These consequences are associated with hepatic mammalian target of rapamycin (mTOR) activation and mitochondrial function and, in turn, related to circulating branched-chain amino acids and glucose. Calorie restriction achieved by high-protein diets or dietary dilution had no beneficial effects on lifespan. The results suggest that longevity can be extended in ad libitum-fed animals by manipulating the ratio of macronutrients to inhibit mTOR activation.
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Objectives: To examine associations between dietary patterns identified by factor analysis, and successful ageing. Design: Prospective cohort study with diet measured in 1990-4, and successful ageing in 2003-7. Ordered logistic regression with outcome determined as dead/usual ageing/successful ageing was used to examine associations with quintile groups of dietary factor scores. Participants: Men and women (n=6308), without history of major illness at baseline, and aged >70 years at follow-up, or who had died before follow-up but would have been aged >70 at the commencement of follow-up, from the Melbourne Collaborative Cohort Study. Measurements: Frequencies of intake of 121 foods at baseline were collected in a food frequency questionnaire. Anthropometry and other health and lifestyle data were collected. At follow-up, questionnaire data relating to mental health, physical function and medical history were used to define successful ageing. Results: Four dietary factors were identified, characterized by higher loadings for (1) vegetables; (2) fruit, (3) feta, legumes, salad, olive oil, and inverse loadings for tea, margarine, cake, sweet biscuits and puddings; (4) meat, white bread, savoury pastry dishes and fried foods. In models excluding body size, the second factor 'Fruit' was positively associated with successful ageing (OR in top 20% vs lowest 20% of score 1.31, 95%CI (1.05-1.63), p trend across quintile groups 0.001); while the fourth factor 'Meat/fatty foods' was inversely associated (OR in top 20% vs lowest 20% of score 0.69, 95%CI (0.55-0.86), p trend across quintile groups 0.001). Factors 1 and 3 did not show significant associations with successful ageing. The association for 'Fruit' was little altered after adjustment for body size, while for 'Meat/fatty foods' the association was somewhat attenuated. Conclusion: A dietary pattern including plenty of fruit while limiting meat and fried foods may improve the likelihood of ageing successfully.
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Background: Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging. Methods: We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes). Results: At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis. Interpretation: Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.
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This study assesses the validity and reproducibility of a 145-item self-administered food frequency questionnaire (FFQ) in a representative older population aged 63 to 80. Semi-quantitative FFQs were completed by 89% of 3,654 residents attending a community-based eye study in Sydney, Australia. The FFQ's validity was assessed against three, four-day weighed food records (WFRs) completed four months apart by 79 people. A further 152 subjects completed a repeat FFQ about a year after the baseline FFQ, of whom 131 completed a second repeat FFQ about six weeks later. Both short and long-term reproducibility of the FFQ were assessed using data from these subjects. Comparison of the FFQ with the average of the three, four-day weighed food records resulted in energy-adjusted Spearman correlations above 0.5 for most of the nutrients. The proportion of subjects correctly classified to within one quintile category for each nutrient intake ranged from 57% for zinc to 82% for vitamin C, with most nutrients correctly classified within one quintile for about 70% of subjects. Quadratic weighted kappas were reasonable, between 0.3 and 0.5 for most nutrients. The FFQ was highly reproducible in the short term, with correlations for most nutrients about 0.70 to 0.80 and acceptably reproducible in the longer term, with correlations mostly 0.60 to 0.70. The results verity that it is possible to use relatively simple, but comprehensive, self-administered FFQs to study nutrient exposures in large-scale epidemiological studies of the elderly and to expect reasonably high FFQ response rates.
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Associations of inflammation with age-related pathologies are documented; however, it is not understood how changes in inflammation over time impact healthy aging. We examined associations of long-term change in C-reactive protein (CRP) and interleukin-6 (IL-6) with concurrent onset of physical and cognitive impairment, subsequent cardiovascular disease (CVD), and mortality in 1,051 participants in the Cardiovascular Health Study All Stars Study. Biomarkers were measured in 1996-1997 and 2005-2006. In 2005-2006, median age was 84.9 years, 63% were women and 17% non-white; 21% had at least a doubling in CRP over time and 23% had at least a doubling in IL-6. Adjusting for demographics, CVD risk factors, and 1996-1997 CRP level, each doubling in CRP change over 9 years was associated with higher risk of physical or cognitive impairment (odds ratio 1.29; 95% confidence interval 1.15, 1.45). Results were similar for IL-6 (1.45; 1.20, 1.76). A doubling in IL-6 change over time, but not CRP, was associated with incident CVD events; hazard ratio (95% confidence interval) 1.34 (1.03, 1.75). Doubling in change in each biomarker was individually associated with mortality (CRP: 1.12 [1.03, 1.22]; IL-6 1.39 [1.16, 1.65]). In models containing both change and 2005-2006 level, only level was associated with CVD events and mortality. Although increases in inflammation markers over 9 years were associated with higher concurrent risk of functional impairment and subsequent CVD events and mortality, final levels of each biomarker appeared to be more important in determining risk of subsequent events than change over time.
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Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons. The effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated. Within the category of normal aging, a distinction can be made between usual aging, in which extrinsic factors heighten the effects of aging alone, and successful aging, in which extrinsic factors play a neutral or positive role. Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.
Article
The Blue Mountains Eye Study is a population-based study of vision and the causes of visual impairment and blindness in a well-defined urban, Australian population 49 years of age and older. The logarithm of the minimum angle of resolution (logMAR) visual acuity was measured before and after refraction in 3647 persons, representing an 88% response rate in two postcode areas in the Blue Mountains area, west of Sydney. Refraction improved visual acuity by one or more lines in 45% of participants and by three or more lines in 13%. Visual impairment (visual acuity 20/40 or worse in the better eye) was found in 170 participants (4.7%). Mild visual impairment (Snellen equivalent 20/40 to 20/60 in the better eye) was found in 3.4% moderate visual impairment (20/80 to 20/160 in the better eye) in 0.6%, and severe visual impairment or blindness (20/200 or worse in the better eye) in 0.7%. Visual impairment increased with age from 0.8% of persons 49 to 54 years of age to 42% of persons 85 years of age or older. Visual impairment was significantly more frequent in females at all ages. Among persons with severe visual impairment, 79% were female. After adjusting for age, females were less likely to achieve 20/20 best-corrected visual acuity than males (odds ratio, 0.57; confidence interval, 0.48-0.66). After adjusting for age and sex, no association was found between visual acuity and socioeconomic status. Age-related macular degeneration was the cause of blindness in 21 of the 24 persons with corrected visual acuity of 20/200 or worse. Increasing age and female sex were independent predictors of visual impairment.
Article
This study assesses the validity and reproducibility of a 145-item self-administered food frequency questionnaire (FFQ) in a representative older population aged 63 to 80. Semi-quantitative FFQs were completed by 89% of 3,654 residents attending a community-based eye study in Sydney, Australia. The FFQ's validity was assessed against three, four-day weighed food records (WFRs) completed four months apart by 79 people. A further 152 subjects completed a repeat FFQ about a year after the baseline FFQ, of whom 131 completed a second repeat FFQ about six weeks later. Both short and long-term reproducibility of the FFQ were assessed using data from these subjects. Comparison of the FFQ with the average of the three, four-day weighed food records resulted in energy-adjusted Spearman correlations above 0.5 for most of the nutrients. The proportion of subjects correctly classified to within one quintile category for each nutrient intake ranged from 57% for zinc to 82% for vitamin C. with most nutrients correctly classified within one quintile for about 70% of subjects. Quadratic weighted kappas were reasonable, between 0.3 and 0.5 for most nutrients. The FFQ was highly reproducible in the short term, with correlations for most nutrients about 0.70 to 0.80 and acceptably reproducible in the longer term, with correlations mostly 0.60 to 0.70. The results verify that it is possible to use relatively simple, but comprehensive, self-administered FFQs to study nutrient exposures in large-scale epidemiological studies of the elderly and to expect reasonably high FFQ response rates.
Article
To test the hypothesis that fasting hyperglycemia (FHG) and 2-h postchallenge glycemia (2hPG) independently increase the risk for cardiovascular disease (CVD). During 1991-1995, we examined 3,370 subjects from the Framingham Offspring Study who were free from clinical CVD (coronary heart disease, stroke, or intermittent claudication) or medication-treated diabetes, and we followed them for 4 years for incident CVD events. We used proportional-hazards regression to assess the risk associated with FHG (fasting plasma glucose > or =7.0 mmol/l) and 2hPG, independent of the risk predicted by standard CVD risk factors. Mean subject age was 54 years, 54% were women, and previously undiagnosed diabetes was present in 3.2% by FHG and 4.9% (164) by FHG or a 2hPG > or =11.1 mmol/l. Of these 164 subjects, 55 (33.5%) had 2hPG > or =11.1 without FHG, but these 55 subjects represented only 1.7% of the 3,261 subjects without FHG. During 12,242 person-years of follow-up, there were 118 CVD events. In separate sex- and CVD risk-adjusted models, relative risk (RR) for CVD with fasting plasma glucose > or =7.0 mmol/l was 2.8 (95% CI 1.6-5.0); RR for CVD per 2.1 mmol/l increase in 2hPG was 1.2 (1.1-1.3). When modeled together, the RR for FHG decreased to 1.5 (0.7-3.6), whereas the RR for 2hPG remained significant (1.1, 1.02-1.3). The c-statistic for a model including CVD risk factors alone was 0.744; with addition of FHG, it was 0.746, and with FHG and 2hPG, it was 0.752. Postchallenge hyperglycemia is an independent risk factor for CVD, but the marginal predictive value of 2hPG beyond knowledge of standard CVD risk factors is small.
Article
To assess the accuracy of the Australian National Death Index (NDI) in identifying deaths and recording cardiovascular and cancer causes of death. Adjudicated mortality data from Australian participants in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study up until September 1999 were used as reference. Nine hundred and eighty deceased subjects and 4,841 surviving subjects were matched to the NDI by name, date of birth, date of death and postcode. Matching rigour was confirmed by manual review. Deaths ascribed to cardiovascular and cancer causes within the NDI were also compared against LIPID-adjudicated causes. The NDI displayed 93.7% sensitivity and 100% specificity for the identification of deaths. Mis-recording of identifiers was responsible for 69% of known deaths not matching to the NDI and, if eliminated, would have increased the sensitivity to 98.0%. Among deceased subjects who matched to the NDI, cause of death was recorded in 96.2%. The sensitivity and specificity for cardiovascular deaths were 92.5% and 89.6%, respectively, and for cancer deaths 95.2% and 99.2%, respectively. Much of the inaccuracy of the NDI could potentially be overcome by the use of unique identifiers. Among deaths identified by the NDI, those due to cardiovascular disease are more likely to be inaccurately recorded than cancer-related deaths, probably because less uncertainty surrounds the presence or absence of terminal malignant disease.
Article
High-carbohydrate diets with a high glycemic response may exacerbate the metabolic consequences of the insulin-resistance syndrome. The effect on the incidence of gallstone disease is not clear. We examined the associations between high-carbohydrate diets with a high glycemic response and the risk of cholecystectomy in a cohort of women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 years both their carbohydrate intake and whether they had undergone cholecystectomy. During 16 years of follow-up, we ascertained 5771 new cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, the relative risk for the highest compared with the lowest quintile of dietary carbohydrate was 1.35 (95% CI: 1.17-1.55, P for trend < .0001). The relative risks for the highest compared with the lowest quintile were 1.50 for glycemic load (95% CI: 1.32-1.71, P for trend < .0001) and 1.32 for glycemic index (95% CI: 1.20-1.45, P for trend < .0001). Independent positive associations were also seen for intakes of starch and sucrose. Our findings suggest that a higher intake of carbohydrate, dietary glycemic load, and glycemic index may enhance risk of cholecystectomy in women.
Article
Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages' high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.
Article
The aim of this article is to present recent findings from epidemiological studies on the effects of dietary glycemic load and whole grain foods on systemic inflammation in diabetic patients and to postulate potential mechanisms. Diets low in glycemic index/load or high in whole grain products have been associated with decreased concentrations of inflammatory markers and increased adiponectin levels among diabetic patients. These associations appear to be independent of body weight, glycemic control, and other cardiovascular risk factors. The protective effects of low glycemic load and high whole grains on systemic inflammation may be explained, in part, by reduction in hyperglycemia-induced overproduction of oxidative stress and by amelioration in insulin resistance, adiposity, dyslipidemia, and hypertension. Diets low in glycemic load and high in whole grains may have a protective effect against systemic inflammation in diabetic patients. Such diets can be recommended to diabetic patients for the prevention of cardiovascular complications.
Dietary fibre's co-passengers: is it the fibre or the co-passengers? In: van der Dietary Fibre: New Frontiers for Food and Health
  • Jm Jones
  • Jw Kamp
  • Jm Jones
  • Bv Mccleary
Jones JM. Dietary fibre's co-passengers: is it the fibre or the co-passengers? In: van der Kamp JW, Jones JM, McCleary BV, Topping DL, eds. Dietary Fibre: New Frontiers for Food and Health. Wageningen, The Netherlands: Wageningen Academic Publishers; 2010:365–378.
OR = odds ratio; CI = confidence interval. Values in bold indicate significant associations
  • Note
Note. OR = odds ratio; CI = confidence interval. Values in bold indicate significant associations.
Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study
  • J B Meigs
  • D M Nathan
  • D 'agostino
  • R B Sr
  • P W Wilson
Meigs JB, Nathan DM, D'Agostino RB, Sr, Wilson PW. Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study. Diabetes Care. 2002;25:1845-1850. doi:10.2337/diacare.25.10.1845
Dietary fibre's co-passengers: is it the fibre or the co-passengers?
  • J M Jones
Jones JM. Dietary fibre's co-passengers: is it the fibre or the co-passengers? In: van der Kamp JW, Jones JM, McCleary BV, Topping DL, eds. Dietary Fibre: New Frontiers for Food and Health. Wageningen, The Netherlands: Wageningen Academic Publishers; 2010:365-378.