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Lopez-Garcia E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 80, 1029-1035
Abstract
Endothelial dysfunction is one of the mechanisms linking diet and the risk of cardiovascular disease.
We evaluated the hypothesis that dietary patterns (summary measures of food consumption) are directly associated with markers of inflammation and endothelial dysfunction, particularly C-reactive protein (CRP), interleukin 6, E-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1).
We conducted a cross-sectional study of 732 women from the Nurses' Health Study I cohort who were 43-69 y of age and free of cardiovascular disease, cancer, and diabetes mellitus at the time of blood drawing in 1990. Dietary intake was documented by using a validated food-frequency questionnaire in 1986 and 1990. Dietary patterns were generated by using factor analysis.
A prudent pattern was characterized by higher intakes of fruit, vegetables, legumes, fish, poultry, and whole grains, and a Western pattern was characterized by higher intakes of red and processed meats, sweets, desserts, French fries, and refined grains. The prudent pattern was inversely associated with plasma concentrations of CRP (P = 0.02) and E-selectin (P = 0.001) after adjustment for age, body mass index (BMI), physical activity, smoking status, and alcohol consumption. The Western pattern showed a positive relation with CRP (P < 0.001), interleukin 6 (P = 0.006), E-selectin (P < 0.001), sICAM-1 (P < 0.001), and sVCAM-1 (P = 0.008) after adjustment for all confounders except BMI; with further adjustment for BMI, the coefficients remained significant for CRP (P = 0.02), E-selectin (P < 0.001), sICAM-1 (P = 0.002), and sVCAM-1 (P = 0.02).
Because endothelial dysfunction is an early step in the development of atherosclerosis, this study suggests a mechanism for the role of dietary patterns in the pathogenesis of cardiovascular disease.
... Interestingly, both telomere length and cardiovascular risk can be modified by diet [11][12][13][14]. A healthy diet containing high consumption of fruits, vegetables, and whole grains is anti-inflammatory and antioxidative, besides lower severe oxidative stress and DNA damage [15,16]. Lian and collaborators [12] have shown that longer LTL was associated with lower risk of hypertension only in those who consume higher levels of vegetables. ...
... In contrast, some dietary factors such as antioxidants, vitamin intake and healthy lifestyle were reported to decrease rates of LTL shortening [10]. These factors can improve inflammation, lower ROS, reduce DNA damage, and increase telomerase activity [15,16,38]. On the other hand, the high consumption of red meat and processed meat lead to increased oxidative stress [17][18][19], which can induce DNA damage and may have an impact on the telomere length [20,21]. ...
Telomere length is considered to be a biomarker of biological aging and age-related disease. There are few studies that have evaluated the association between telomere length and diet, and none of them have evaluated the impact of a vegetarian diet on telomere length and its correlation with cardiovascular biomarkers in apparently healthy subjects. Therefore, our objectives were to evaluate leukocyte telomere length (LTL) in vegetarians and omnivorous subjects and its association with classical cardiovascular risk biomarkers. From the total of 745 participants initially recruited, 44 omnivorous and 44 vegetarian men apparently healthy were selected for this study and LTL was measured in 39 omnivorous and 41 vegetarians by Real-Time Quantitative PCR reaction. Although telomere length was not different between omnivorous and vegetarians, we found a strong negative correlation between LTL and IMT (intima-media thickness) in omnivorous, but not in vegetarian group. In addition, omnivorous who were classified with short telomere length had higher carotid IMT compared to vegetarians. Our data suggest that telomere length can be a marker of subclinical atherosclerosis in the omnivorous group.
... The results of this study and that of Cassidy et al. reported that whole and refined grains were associated with longer TL (A. . Consumption of whole grains and plant foods due to the present of complex carbohydrates was related to the reduction of blood lipids, obesity, diabetes, cardiovascular disease and enhance the systemic inflammation (Lopez-Garcia et al., 2004;Poppitt et al., 2002). Thus, grains as a useful component in a healthy diet with vegetables, fruits, and smaller amounts of dairy and meat have beneficial health effects on the entire community and improve TL. ...
... In Nettleton et al.'s study, western pattern with higher consumption of fats and processed meat was associated with shorter TL (Nettleton et al., 2008). In Lopez et al.'s study, western pattern with high consumption of processed meats, sweets, chips, and refined grains was associated with increased inflammatory markers (Lopez-Garcia et al., 2004). During 10 years follow-up of the samples by Lee et al. using FFQ, it was observed that prudent pattern with high intake of whole grains, seafood, legumes, vegetables, and seaweed was associated with longer TL and western pattern with high consumption of refined grains, processed meat, and beverages was associated with a shorter TL . ...
Telomeres contain TTAGGG repetitive sequences and are located at the end of human chromosomes. Telomere dysfunction is associated with some age-related and chronic diseases, but its relationship with foods, dietary patterns, and occupational class in the young male population is not yet known. In this cross-sectional study, 300 healthy men, residents of Tehran, aged 25-40 years were enrolled from January to December 2016. We employed a cross-sectional study of 300 healthy people, residents of Tehran, aged 25-40 years. A food frequency questionnaire was used to obtain food intakes of all participants and converted into actual food intake (g/day). The principal components analysis was used to determine dietary patterns and other demographic characteristics. Leukocyte telomere length (TL) was measured by quantitative real-time polymerase chain reaction (PCR) to measure number of telomere repeat copy number (T) to the relative number of 36B4 copies (S) (T/S ratio). T/S in office-workers, waste recyclers, and other workers were 1.22 ± 0.4, 1.08 ± 0.3, and 1.094 ± 0.34, respectively. The results of multivariate linear regression adjusted for age, body mass index (BMI), and smoking were showed that whole grains (β = 0.02; p = .05), refined grains, fruits and vegetables, fish and dairy products were associated with an increase in log-T/S, but consumption of nuts and seeds (β = -0.00072; p = .06), meats (β = -0.00043; p = .9), produced meats (β = -0.00238; p = .03), oils and solid fats (β = -0.00146; p = .03) had a negative relationship with log-T/S in all studied occupational classes. A positive relationship was reported between the healthy (β = 0.017; p = .2) and traditional dietary pattern (β = 0.012; p = .4) with log-T/S, but western pattern identified negative relationship (β = -0.004; p = .7). Adherence to a healthy (with consumption whole grains, refined grains, dairy, and cereals) and then traditional pattern with increased consumption of fruits, vegetables and whole grains, fish and dairy products are necessary to prevent TL destruction in all studied occupational classes.
... The findings of Nurses' Health Studies and Health Professionals Follow-up Study suggested that prudent dietary pattern with higher fruits, vegetables, legumes, fish, poultry, and whole grains have a reverse association with markers of inflammation (CRP), endothelial dysfunction (E-selectin), insulin, and homocysteine concentrations. [56][57][58] Moreover, Nettleton et al in the Multi-Ethnic Study of Atherosclerosis (MESA), using factor analysis on an ethnically diverse population, recognized four dietary patterns that were comparable with prudent and western diet patterns in other populations. The identified dietary patterns were positively associated with serum CRP, homocysteine and sICAM-1 levels. ...
Purpose:
The aim of this study was to investigate the association between dietary inflammatory index (DII) and metabolic syndrome (MetS) and its components using data of Ravansar non-communicable diseases (RaNCD) cohort study.
Patients and methods:
The present cross-sectional study was performed using the information of 6538 participants in the RaNCD study in Iran. A validated 125-item food frequency questionnaire (FFQ) was used to acquire DII scores. MetS was defined based on national cholesterol education program-adult treatment panel III (NCEP-ATP III) criteria. The association between DII and MetS and its components was investigated by the logistic regression model using STATA software.
Results:
A significant association was found between DII and MetS (OR trend: 1.08, 95% CI: 1.01-1.15, P =0.017), triglyceride (TG) (OR trend: 1.06, 95% CI: 1.00-1.12, P=0.030), fasting blood glucose (FBG) (OR trend: 1.10, 95% CI: 1.01-1.20, P=0.018) and high density lipoprotein cholesterol (HDL-C) (OR trend: 1.07, 95% CI: 1.02-1.12, P= 0.005) after adjustment for all covariates. Also, there was a significant relationship between DII score and waist circumference (WC) (OR trend: 1.07, 95% CI: 1.01-1.14, P=0.016).
Conclusion:
Higher DII score (a pro-inflammatory diet) had a significant association with the risk of MetS and its components, even after adjustment for different potential confounding factors including socio-demographic data and lifestyle habits. However, further longitudinal investigations with more dietary parameters are needed to elucidate the role of the pro-inflammatory diet in the etiology of MetS.
... Many environmental factors have been known to elicit the chronic elevation of CRP independently of genetic factors. These environmental insults include infections, tissue injury, pollutions (Peters et al., 2001), social economic status (SES) (Nazmi and Victora, 2007;Brummett et al., 2013), dietary content ( Fung et al., 2001;King et al., 2003) and pattern ( Lopez-Garcia et al., 2004), stress, unhealthy lifestyles, and physical activities (Ford, 2002). These factors can driver chronic non-communicable inflammations ( Mega et al., 2015). ...
Obesity is characterized by low-grade chronic inflammation. As an acute-phase reactant to inflammation and infection, C-reactive protein (CRP) has been found to be the strongest factor associated with obesity. Here we show that chronic elevation of human CRP at baseline level causes the obesity. The obesity phenotype is confirmed by whole-body magnetic resonance imaging (MRI), in which the total fat mass is 6- to 9- fold higher in the CRP rats than the control rats. Univariate linear regression analysis showed different growth rates between the CRP rats and the control rats, and that the difference appears around 11 weeks old, indicating that they developed adult-onset obesity. We also found that chronic elevation of CRP can prime molecular changes broadly in the innate immune system, energy expenditure systems, thyroid hormones, apolipoproteins, and gut flora. Our data established a causal role of CRP elevation in the development of adult-onset obesity.
... The vegetable dietary pattern in our study had similar characteristics of high intake in the healthy/prudent dietary patterns that were most reproducible in Japanese [26][27][28] and other ethnicities [29][30][31]. Japanese and Mediterranean diets have similar features of customarily eating seafood, vegetables, and fruits, and instead of nuts that are commonly eaten in Western countries, soybean and soy products are popular among the Japanese [13,32]. ...
: Cardiometabolic risks were increasing in Fukushima residents after the Great East Japan Earthquake. We examined the association between dietary patterns and cardiometabolic risks in those aged ≥16 years. Dietary patterns were derived by principal component analysis for participants who underwent at least one diet assessment using a short-form food frequency questionnaire during 2011–2013 and a health checkup in 2014 and 2015 (n = 15,409 and 14,999, respectively). In 2014, the adjusted prevalence ratio (PR) and 95% confidence interval (CI) in the highest versus lowest quartile of accumulative mean scores were 0.97 (0.96–0.99) for overweight/obesity, 0.96 (0.95–0.97) for total cholesterol (TC) ≥220 mg/dL, 0.96 (0.95–0.98) for low-density lipoprotein cholesterol (LDL-C) ≥140 mg/dL, and 0.97 (0.96–0.99) for triglycerides ≥150 mg/dL for a vegetable diet and 1.03 (1.01–1.04) for TC ≥220 mg/dL and 1.02 (1.01–1.04) for LDL-C ≥140 mg/dL for a juice/milk diet. In 2015, we found consistently significant associations for the vegetable and juice/milk diets, and the PR and 95% CI were 0.99 (0.98–1.00) for HDL-C <40 mg/dL for a meat diet. The continuous promotion of the vegetable pattern diet is necessary to reduce cardiometabolic risks, particularly dyslipidemia, in Japan.
... For example, it remains unclear why the consumption of processed meats increases risk of CAD and type II diabetes to a greater degree than their unprocessed equivalents, which are otherwise identical in macronutrient content (57-59). Likewise, the mechanisms connecting processed food consumption with systemic inflammatory markers in cross-sectional studies are poorly defined (2,60,61). The present findings suggest that many processed foods, particularly those based on minced meats, may contain a higher PAMP content than their fresh or unchopped equivalents, due to historical overgrowth of proteobacteria (7). ...
Background: The mechanisms connecting dietary intake of processed foods with systemic inflammatory markers and cardiovascular risk remain poorly defined. We sought to compare the abundance of pro-inflammatory stimulants of innate immune receptors in processed foods with those produced by the murine ileal and caecal microbiota, and to explore the impact of their ingestion on systemic inflammation and lipid metabolism in vivo.Methods and results: Calibrated receptor-dependent reporter assays revealed that many processed foods, particularly those based on minced meats, contain pro-inflammatory stimulants of Toll-like receptor (TLR)-2 and TLR4 at concentrations which greatly exceed those produced by the endogenous murine ileal microbiota. Chronic dietary supplementation with these stimulants, at concentrations relevant to those measured in the Western diet, promoted hepatic inflammation and reduced several markers of reverse cholesterol transport (RCT) in mice. Hepatocytes were found to be insensitive to TLR2- and TLR4-stimulants directly, but their secretion of functional cholesterol acceptors was impaired by interleukin (IL)-1β released by TLR-responsive hepatic macrophages. Hepatic macrophage priming by high-fat diet enhanced the impairment of RCT by ingested endotoxin, and this was reversed by macrophage depletion via clodronate liposome treatment, or genetic deficiency in the IL-1 receptor.Conclusion: These findings reveal an unexpected mechanism connecting processed food consumption with cardiovascular risk factors, and introduce the food microbiota as a potential target for therapeutic regulation of lipid metabolism.
... Chronic inflammation in auto-inflammatory diseases and diet-induced metabolic syndrome is also an important etiological factor for the development of cancer (142,145). Hence it is not surprising that red meat consumption and the "Western diet" have often been associated with increased circulating markers of inflammation in human population studies (146). Cell surface glycosylation is heavily altered in cancer cells, as seen in malignant tissue that incorporate Neu5Gc (62, 64, 147). ...
The description of “serum sickness” more than a century ago in humans transfused with animal sera eventually led to identification of a class of human antibodies directed against glycans terminating in the common mammalian sialic acid N-Glycolylneuraminic acid (Neu5Gc), hereafter called “Neu5Gc-glycans.” The detection of such glycans in malignant and fetal human tissues initially raised the possibility that it was an oncofetal antigen. However, “serum sickness” antibodies were also noted in various human disease states. These findings spurred further research on Neu5Gc, and the discovery that it is not synthesized in the human body due to a human-lineage specific genetic mutation in the enzyme CMAH. However, with more sensitive techniques Neu5Gc-glycans were detected in smaller quantities on certain human cell types, particularly epithelia and endothelia. The likely explanation is metabolic incorporation of Neu5Gc from dietary sources, especially red meat of mammalian origin. This incorporated Neu5Gc on glycans appears to be the first example of a “xeno-autoantigen,” against which varying levels of “xeno-autoantibodies” are present in all humans. The resulting chronic inflammation or “xenosialitis” may have important implications in human health and disease, especially in conditions known to be aggravated by consumption of red meat. In this review, we will cover the early history of the discovery of “serum sickness” antibodies, the subsequent recognition that they were partly directed against Neu5Gc-glycans, the discovery of the genetic defect eliminating Neu5Gc production in humans, and the later recognition that this was not an oncofetal antigen but the first example of a “xeno-autoantigen.” Further, we will present comments about implications for disease risks associated with red meat consumption such as cancer and atherosclerosis. We will also mention the potential utility of these anti-Neu5Gc-glycan antibodies in cancer immunotherapy and provide some suggestions and perspectives for the future. Other reviews in this special issue cover many other aspects of this unusual pathological process, for which there appears to be no other described precedent.
... There are several studies revealing that diet quality has a positive effect on many diseases such as depression, anxiety, and general mental disorders ( Sánchez-Villegas et al. 2009Sánchez-Villegas et al. , 2012. In a study with a large sample, while the levels of interleukin-6 (IL-6) and C reactive protein (CRP), which are inflammatory markers, were low in individuals with high consumption of vegetables, fruits, whole grains, fish, and legumes, they were high in those with high consumption of processed meat and grains, and other processed foods (Lopez- Garcia et al. 2004). In another study, it was found that individuals with a Western diet had higher levels of CRP than those with a Mediterranean diet ( Fung et al. 2001). ...
The aim of this study is to investigate the relationship between dietary inflammatory index (DII) and depression. The study was carried out with 134 female university students staying in dormitory. The data were collected using questionnaire form. The questionnaire contains socio-demographic information, physical activity, anthropometric measurements, depression scale, and the 3-day food intake record. The DII score was calculated based on the food intake record form. It was found that 56 of the participants did not have any depression symptoms. The participants‘ mean DII scores were 0.76 ± 0.59 and they were found to have a pro-inflammatory dietary pattern. The third-tertile depression score was 56.3 ± 8.6, which was statistically higher than the others (p < 0.05). Upon modeling, a significant association between high DII scores and increased odds of incidence DepS was observed (odds ratio (OR) = 2.90; 95% CI = 1.51–5.98). Finally there is a need to conduct cohort studies to identify DII scores of the individuals in our country, investigate the relationship between these scores and depression, and establish a cause and effect relationship.
... Additionally, a randomized controlled clinical trial suggested that probiotics and prebiotics as functional food reduced inflammatory markers such as CRP in patients with type 2 diabetes [52,53]. The prudent pattern-characterized by high consumption of dietary fiber and antioxidants-was also correlated with a decreased level of CRP and risk of CVD [54]. The vege-seafood and cereal-dairy dietary patterns were associated with lower inflammatory marker levels, suggesting that these dietary patterns might reduce the risk of inflammation-related chronic diseases [55]. ...
This study examined the correlation of dietary patterns with components of metabolic syndrome (MetS) and inflammation among middle-aged and older adults with MetS in Taiwan. This cross-sectional study used data from the Mei Jau International Health Management Institution in Taiwan between 2004 and 2013. A total of 26,016 subjects aged 35 years and above were selected for analysis. MetS was defined according to the International Diabetes Federation. Three dietary patterns were identified by principal component analysis. High intake of a meat–instant food dietary pattern (rich in animal protein, saturated fat, sweets, sodium, and food additives) was positively associated with components of MetS and C-reactive protein (CRP), while high intake of a vege–seafood dietary pattern (rich in dietary fiber, vitamins, minerals, and unsaturated fat) or a cereal–dairy dietary pattern (rich in dietary fiber, antioxidants, phytochemicals, complex carbohydrate, prebiotics, and probiotics) was inversely associated with components of MetS and CRP. Our findings suggested that intake of a vege–seafood dietary pattern or a cereal–dairy dietary pattern decreased the risk of developing MetS and inflammation among middle-aged and older adults with MetS.
Background:
Gynecological malignancies represent a major cause of death in women and are often treated with platinum-based regimens. Patients undergoing chemotherapy suffer from alterations in nutritional status which may worsen gastrointestinal (GI) toxicities, quality of life and affect the overall prognosis. Indeed, assuring a good nutritional status and limiting toxicities during treatment are still major goals for clinicians.
Aim:
To assess the role of Mediterranean Diet (MD) in reducing GI toxicities in patients with gynecological cancers treated with platinum-based regimens.
Methods:
We conducted an observational study on 22 patients with gynecological tumors treated with a platinum-based chemotherapy at Candiolo Cancer Institute FPO/IRCCS between January 2018 and June 2018. The food and frequency (FFQ) and the Patient-Reported Outcomes Common Terminology Criteria For Adverse Events (PRO-CTCAE) questionnaires were administered at baseline and at every Day 1 of each cycle. To evaluate the differences in GI toxicities the study population was divided in two groups according to the currently validated Mediterranean Diet Serving Score (MDSS) at baseline.
Results:
Patients with high MDSS reported a trend toward lower GI toxicities according to PRO-CTCAE at each timepoint (first evaluation: P = 0.7; second: P = 0.52; third: P = 0.01). In particular, difference in nausea frequency and gravity (P < 0.001), stomach pain frequency and gravity (P = 0.01 and P = 0.02), abdomen bloating frequency and gravity (P = 0.02 and P = 0.03), and interference with daily activities (P = 0.02) were highly statistically significant at the end of treatment. More than 60% of patients changed their food habits during chemotherapy mainly because of GI toxicities. A higher reduction of food intake, both in terms of caloric (P = 0.29) and of single nutrients emerged in the group experiencing higher toxicity.
Conclusion:
Our results show that adherence to MD possibly reduces GI toxicity and prevents nutritional status impairment during chemotherapy treatment. Bigger studies are needed to confirm our results.
Ziel:
Parodontale Erkrankungen scheinen durch Ernährung beeinflusst zu werden. Ziel der klinischen, randomisierten und kontrollierten Studie war es, die Ergebnisse der Pilotstudie (Woelber et al. 2016) zum Einfluss einer mundgesundheitsoptimierten (MGO)-Ernährung auf parodontale Parameter bei einem größeren Probandenkollektiv zu überprüfen. Zusätzlich wurde die Diagnostik um serologische Parameter (CRP, TNFα, IL-6, IL-1ß, Adiponektin, Vitamin D und Fettsäureprofil) erweitert.
Methoden:
Dreißig Patienten wurden randomisiert und nach Plaquewerten stratifiziert in Experimentalgruppe und Kontrollgruppe aufgeteilt. Die Studie erstreckte sich über acht Wochen. Während des Studienzeitraums durften die Probanden keine Interdentalraumhygiene betreiben. In den ersten zwei Wochen ernährten sich beide Gruppen nach einer gewohnten westlichen Ernährungsweise. Nach einer zweiwöchigen Umstellungsphase stellte die Experimentalgruppe ihre Ernährung für vier Wochen auf eine mundgesundheitsoptimierte Ernährung um. Diese beinhaltete einen weitestgehenden Verzicht einfacher und prozessierter Kohlenhydrate, gesättigter Fett- und Transfettsäuren sowie eine vermehrte Einnahme von nitrathaltigem Gemüse, Omega-3-Fettsäuren, Ballaststoffen, Antioxidantien, pflanzlichem Vitamin C und Vitamin D. Die Kontrollgruppe behielt über die gesamte Studiendauer die westliche Ernährungsweise bei. Während Plaque- und Gingiva-Index mit Ausnahme der Umstellungsphase wöchentlich erhoben wurden, erfolgte die Messung des Parodontalstatus (Sondierungstiefen mit einer drucksensitiven Sonde, Bluten auf Sondieren, Rezessionen) und die serologische Diagnostik nach Woche 2 und Woche 8. Die Messungen wurden verblindet durchgeführt.
Ergebnisse:
Die Ergebnisse zeigten, dass bei gleicher Abnahme der Plaquewerte (PI: ∆Exp. und ∆Kontrolle: -17,2%) sich die gingivale Entzündung in der Experimentalgruppe signifikant stärker reduzierte (GI: ∆Exp. vs. ∆Kontrolle: -40,8% vs. -19,6%, p=0,0275). Bei den restlichen parodontalen Parametern (ST, BOP, PISA) konnten ebenfalls positive Veränderungen gezeigt werden, jedoch nur teilweise statistisch signifikant. Darüber hinaus zeigte die Experimentalgruppe einen signifikant höheren Anstieg der Vitamin-D-Werte und einen signifikanten Gewichtsverlust. Bezüglich der serologischen Entzündungsmarker konnten keine signifikanten Ergebnisse beobachtet werden.
Fazit:
Unter Berücksichtigung der Studienlimitationen konnten die Ergebnisse der Pilotstudie bestätigt werden. Die MGO-Ernährung kann gingivale Entzündungen in einem klinisch relevanten Bereich signifikant reduzieren und zudem Gewicht reduzieren, während serologische Entzündungsmarker während dieser Studiendauer nicht betroffen zu sein scheinen.
Alzheimer’s disease (AD) is a neurodegenerative dementia that affects nearly 50 million people worldwide and is a major source of morbidity, mortality, and healthcare expenditure. While there have been many attempts to develop disease-modifying therapies for late-onset AD, none have so far shown efficacy in humans. However, the long latency between the initial neuronal changes and onset of symptoms, the ability to identify patients at risk based on family history and genetic markers, and the emergence of AD biomarkers for preclinical disease suggests that early risk-reducing interventions may be able to decrease the incidence of, delay or prevent AD. In this review, we discuss six mechanisms—dysregulation of glucose metabolism, inflammation, oxidative stress, trophic factor release, amyloid burden, and calcium toxicity—involved in AD pathogenesis that offer promising targets for risk-reducing interventions. In addition, we offer a blueprint for a multi-modality AD risk reduction program that can be clinically implemented with the current state of knowledge. Focused risk reduction aimed at particular pathological factors may transform AD to a preventable disorder in select cases.
The authors hypothesize that thrombosis causes both the complications of atherosclerosis as well as the underlying lesion, the atherosclerotic plaque, which develops from the organization of mural thrombi. These form in areas of slow blood flow, which develop because of flow separation created by changing vascular geometry and elevated blood viscosity. Many phenomena typically ascribed to inflammation or “chronic oxidative stress”, such as the development of fatty streaks, “endothelial dysfunction,” “vulnerable plaques,” and the association of mild elevations of C-reactive protein and cytokines with atherothrombosis are better explained by hemorheologic and hemodynamic abnormalities, particularly elevated blood viscosity. Elevated blood viscosity decreases the perfusion of skeletal muscle, leading to myocyte expression of the myokine IL-6, decreased glucose uptake, insulin resistance, hyperglycemia, and metabolic syndrome. The hyperfibrinogenemia and hypergammaglobulinemia present in true inflammatory diseases foster atherothrombosis by increasing blood viscosity.
Diet plays an important role in the development of colorectal cancer. Emerging data have implicated the gut microbiota in colorectal cancer. Diet is a major determinant for the gut microbial structure and function. Therefore, it has been hypothesized that alterations in gut microbes and their metabolites may contribute to the influence of diet on the development of colorectal cancer. We review several major dietary factors that have been linked to gut microbiota and colorectal cancer, including major dietary patterns, fiber, red meat and sulfur, and obesity. Most of the epidemiologic evidence derives from cross-sectional or short-term, highly controlled feeding studies that are limited in size. Therefore, high-quality large-scale prospective studies with dietary data collected over the life course and comprehensive gut microbial composition and function assessed well prior to neoplastic occurrence are critically needed to identify microbiome-based interventions that may complement or optimize current diet-based strategies for colorectal cancer prevention and management.
Background:
Several observational studies have shown association between diet quality and depression, but few studies have explored the interrelationship between these variables.
Objective:
The aim of this study was to assess the interrelationship between diet quality and depressive symptoms in elderly.
Design:
Cross-sectional study.
Setting:
Population based.
Participants:
1,378 elderly in the city of Pelotas, Brazil.
Measurements:
The diet quality was assessed by a short food frequency questionnaire and the prevalence of depressive symptoms was estimated by the abbreviated Brazilian version of the Geriatric Depression Scale (GDS). The association between diet quality and depressive symptoms was assessed using logistic regression.
Results:
The prevalence of depressive symptoms was 15.3%. Elderly with low-quality diet were more likely to experience depressive symptoms, and the association was almost twice higher in males than in females (men OR = 3.8, 95% CI 1.4, 10.6; women OR = 2.1, 95% CI: 1.4, 3.3). On the other hand, depressive elderly had higher odds of consuming a low-quality diet (OR 2.4, 95% CI: 1.7, 3.8).
Limitations:
Self-reported data and cross-sectional design limit our conclusions.
Conclusions:
The choice of a low-quality diet was associated to a higher risk of depressive symptoms in elderly, and vice-versa. These results highlight the importance of encouraging the choice of healthy food habits, especially in depressed elderly, in order to promote healthy aging.
Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE–angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy.
Dietary pattern analysis is a useful tool to study the importance of food components in the context of a diet and how they relate to health and disease. The association between dietary patterns and fractures is at present uncertain. We aimed to study associations between dietary patterns and risk of hip fracture in the Swedish Mammography Cohort, including 56,736 women (median baseline age 52 years). Diet data was collected in food frequency questionnaires at two investigations and dietary patterns were defined by principal component analysis using 31 food groups. Information on hip fractures was collected from the Swedish National Patient Register. Multivariable adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated in Cox proportional hazards regression analysis. The two patterns identified—the healthy and Western/convenience dietary patterns—were time-updated and analysed. During a median follow-up time of 25.5 years, 4997 women experienced a hip fracture. Hip fracture rate was 31% lower in the highest compared to the lowest quartile of the healthy dietary pattern [HR (95% CI) 0.69 (0.64; 0.75)]. In contrast, women in the highest compared to the lowest quartile of the Western/convenience dietary pattern had a 50% higher [HR (95% CI) 1.50 (1.38; 1.62)] hip fracture rate. Further, in each stratum of a Western/convenience dietary pattern a higher adherence to a healthy dietary pattern was associated with less hip fractures. The present results suggest that a varied healthy diet may be beneficial for the prevention of fragility fractures in women.
Electronic supplementary material
The online version of this article (doi:10.1007/s10654-017-0267-6) contains supplementary material, which is available to authorized users.
Scope:
Classification of subjects into dietary patterns generally relies on self-reporting dietary data which are prone to error. The aim of the present study was to develop a model for objective classification of people into dietary patterns based on metabolomic data.
Methods and results:
Dietary and urinary metabolomic data from the National Adult Nutrition Survey (NANS) was used in the analysis (n = 567). Two-step cluster analysis was applied to the urinary data to identify clusters. The subsequent model was used in an independent cohort to classify people into dietary patterns. Two distinct dietary patterns were identified. Cluster 1 was characterized by significantly higher intakes of breakfast cereals, low fat and skimmed milks, potatoes, fruit and fish, fish dishes (p < 0.05) representing a "healthy" cluster. Cluster 2 had significantly higher intakes of chips/processed potatoes, meat products, savory snacks and high-energy beverages (p < 0.05) representing an "unhealthy cluster". Classification was supported by significant differences in nutrient status (p < 0.05). Validation in an independent group revealed that 94% of subjects were correctly classified.
Conclusion:
The model developed was capable of classifying individuals into dietary patterns based on metabolomics data. Future applications of this approach could be developed for rapid and objective assignment of subjects into dietary patterns. This article is protected by copyright. All rights reserved.
Objective Inflammation is a normal biologic process needed for normal immune, vascular, and endothelial response, but chronic inflammation can be caused from chronic infection and unhealthy lifestyle patterns, such as diet. The dietary inflammatory index was developed to investigate the inflammatory potential of the diet based on the overall inflammatory properties of dietary components. The index classifies an individual’s diet on a continuum from maximally anti-inflammatory to maximally pro-inflammatory. A majority of the dietary inflammatory index studies has been examined among middle-aged population, and to date, no dietary inflammatory index has been determined in college students. Furthermore, the association between dietary inflammatory index and commonly used diet quality indices, such as healthy eating index, glycemic index (GI), and glycemic load (GL) is not known in college students. It was hypothesized that the lower dietary inflammatory index scores (the more anti-inflammatory) are related
Background:
Dietary guidelines are a key tool in the public health quiver. Single nutrients have been linked to cardiovascular diseases, but existing metrics do not capture the overall effect of diet on inflammatory diseases. The aim of this study was to examine the association between dietary inflammatory potential and cardiovascular diseases risk factors (CVD-RFs) in a nationally-representative sample of non-institutionalized US adults using data from the continuous National Health and Nutrition Examination Survey (NHANES) (2007-2012).
Methods and results:
A sample of 7880 non-institutionalized US adults aged ≥20years provided data on dietary habits and CVD-RFs (obesity; diabetes mellitus; hypertension; hypercholesterolemia). The total number of CVD-RFs was summed for each individual to create a CVD-RF morbidity index (range 0-4) as the outcome variable, used both as ordinal and dichotomous (no CVD-RFs versus at least one CVD-RF) variables. The association between the Dietary Inflammatory Index (DII) and at least one CVD-RF was dose-dependent, with participants in the 3rd and 4th quartile of DII (i.e., more pro-inflammatory dietary habits) being 1.37 (95%CI=1.11-1.68) and 1.50 (95%CI=1.19-1.90) times more likely, respectively, to have at least one CVD-RF, as compared to participants in the 1st quartile of DII scores. Similar results were obtained for the ordinal logistic regression using the CVD-RF morbidity index as the outcome.
Conclusions:
Among US adults aged ≥20years, pro-inflammatory dietary patterns, as assessed by the DII, were associated with increased odds for CVD-RFs. Dietary guidelines aimed at lowering the DII may reduce the CVD-RF burden in US adults.
Although some studies have reported potential associations of dietary patterns with depression risk, a consistent perspective hasn’t been estimated to date. Therefore, we conducted this meta-analysis to evaluate the relation between dietary patterns and the risk of depression. A literature research was conducted searching MEDLINE and EMBASE databases up to September 2016. In total, 21 studies from ten countries met the inclusion criteria and were included in the present meta-analysis. A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression.A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression. The results of this meta-analysis suggest that healthy pattern may decrease the risk of depression, whereas western-style may increase the risk of depression. However, more randomized controlled trails and cohort studies are urgently required to confirm this findings.
BackgroundA healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. Methods
Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9–20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. ResultsThe percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). Conclusions
We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. Trial registrationClinicalTrials.gov database, NCT01001689. https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1.
Breast cancer remains the most commonly diagnosed cancer in women. Whereas some epidemiological studies generally support the role of diet in breast cancer prevention, conflicting evidence exists, making it challenging to provide a definitive answer on these risks that can be effectively translated to clinical practice and public health recommendations.
Objective:
Serum high-sensitivity CRP is a marker of inflammation and an independent predictor of chronic diseases. However, the effect of diet on serum hs-CRP is unclear. The aim of this study was to investigate the relationship between dietary macronutrient intake and serum hs-CRP.
Design and methods:
We recruited 9778 adults, aged 35-65years as part of the MASHAD study. Dietary intake was determined using 24-hour dietary recall and several biochemical parameters including serum hs-CRP were measured. Analysis of covariance was used for assessment of crude and energy-adjusted nutrients across quartiles of serum hs-CRP. To find the association of dietary nutrients intake and serum hs-CRP level, we used logistic regression in different model.
Results:
Unadjusted and adjusted multivariate analyses indicate that there was a significant positive association between dietary protein and sodium intake and serum hs-CRP concentrations. There was also a positive association with dietary fat and cholesterol and serum hs-CRP in the adjusted models. There was a significant inverse association between dietary carbohydrate and fiber consumption and serum hs-CRP in both crude and adjusted models.
Conclusion:
We have found a significant positive association between the dietary intake of fat, protein, cholesterol and sodium and hs-CRP level, and an inverse correlation between dietary carbohydrate and fiber and serum hs-CRP in a large representative Iranian population.
Trends in biliary tract cancer incidence rates have increased in Shanghai, China. These trends have coincided with economic and developmental growth, as well as a shift in dietary patterns to a more Westernized diet. To examine the effect of dietary changes on incident disease, we evaluated associations between diet and biliary tract cancers amongst men and women from a population-based case-control study in Shanghai, China. Biliary tract cancer cases were recruited from 42 collaborating hospitals in urban Shanghai, and population-based controls were randomly selected from the Shanghai Household Registry. Food frequency questionnaire data were available for 225 gallbladder, 190 extrahepatic bile duct, and 68 ampulla of Vater cancer cases. A total of 39 food groups were created and examined for associations with biliary tract cancer. Interestingly, only four food groups demonstrated a suggested association with gallbladder, extrahepatic bile duct, or ampulla of Vater cancers. The allium food group, consisting of onions, garlic, and shallots showed an inverse association with gallbladder cancer (OR: 0.81, 95% CI: 0.68–0.97). Similar trends were seen in the food group containing seaweed and kelp (OR: 0.79, 95% CI: 0.67–0.96). In contrast, both preserved vegetables and salted meats food groups showed positive associations with gallbladder cancer (OR:1.27, 95% CI: 1.06–1.52; OR: 1.18, 95% CI: 1.02–1.37, respectively). Each of these four food groups showed similar trends for extrahepatic bile duct and ampulla of Vater cancers. The results of our analysis suggest intake of foods with greater anti-inflammatory properties may play a role in decreasing the risk of biliary tract cancers. Future studies should be done to better understand effects of cultural changes on diet, and to further examine the impact diet and inflammation have on biliary tract cancer incidence.
Purpose of Review
A significant body of evidence suggests that poor dietary intake is associated with reduced cognitive function. However, few studies have examined this relation in poor urban settings. Our brief review suggests that (a) higher overall diet quality may play a particularly important role in cognitive function among the poorest and (b) greater vitamin E intake is related to better cognitive performance, at least in part, via fewer depressive symptoms.
Recent Findings
The broader recent literature strongly suggests the beneficial role of diet for learning and memory, and potentially synergistic influences on other cognitive domains. However, adherence to healthful diet among urban poor may be limited by factors such as cost and access. Here, we propose several potential moderators and mediators of diet–cognition relations among urban poor.
Summary
Future studies should focus on the complex interplay among factors that influence the role of diet in cognitive function among poor, urban-dwelling persons.
Background & aims:
Dietary fiber is implicated as a risk factor for diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident diverticulitis.
Methods:
We performed a prospective cohort study of 46,295 men who were free of diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary endpoint was incident diverticulitis.
Results:
During 894,468 person years of follow-up, we identified 1063 incident cases of diverticulitis. After adjustment for other risk factors, men in the highest quintile of western dietary pattern score had a multivariate hazard ratio (HR) of 1.55 (95% CI, 1.20-1.99) for diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of diverticulitis (multivariate HR 0.74; 95% CI, 0.60-0.91). The association between dietary patterns and diverticulitis was predominantly attributable to intake of fiber and red meat.
Conclusions:
In a prospective cohort study of 46,295 men, a western dietary pattern was associated with increased risk of diverticulitis, whereas a prudent pattern was associated with decreased risk. These data may guide dietary interventions for the prevention of diverticulitis.
Most studies linking maternal diet with offspring adiposity have focused on single nutrients or foods, but a dietary pattern approach is more representative of the overall diet. We thus aimed to investigate the relations between maternal dietary patterns and offspring adiposity in a multi-ethnic Asian mother–offspring cohort in Singapore. We derived maternal dietary patterns using maternal dietary intake information at 26–28 weeks of gestation, of which associations with offspring body mass index (BMI), abdominal circumference (AC), subscapular skinfold (SS), and triceps skinfold (TS) were assessed using longitudinal data analysis (linear mixed effects (LME)) and multiple linear regression at ages 0, 3, 6, 9, 12, 15, 18, 24, 36, 48, and 54 months. Three dietary patterns were derived: (1) vegetables-fruit-and-white rice (VFR); (2) seafood-and-noodles (SfN); and (3) pasta-cheese-and-bread (PCB). In the LME model adjusting for potential confounders, each standard deviation (SD) increase in maternal VFR pattern score was associated with 0.09 mm lower offspring TS. Individual time-point analysis additionally revealed that higher VFR score was generally associated with lower postnatal offspring BMI z-score, TS, SS, and sum of skinfolds (SS + TS) at ages 18 months and older. Maternal adherence to a dietary pattern characterized by higher intakes of fruit and vegetables and lower intakes of fast food was associated with lower offspring adiposity.
Ruminant production has been an essential part of human activities worldwide since ancient times. The expected increase in world population and per capita income, with an increase in the amount and prevalence of animal products in human diet, urbanisation, with a concentration of population in urban areas and an increase in losses in the supply chain, and the growing concern over the environmental impact of animal farming require a long-term global strategy for a more intensive and sustainable ruminant production. Therefore, solutions to increase the supply of high-quality products of ruminant origin, without harming human health, animal welfare, and environment, should consider the following interconnected issues discussed in this review: (a) effects of meat, milk and dairy products consumption on human health, focussing on the imbalance caused by their insufficient consumption, and the alleged increased incidence of certain diseases due to their consumption; (b) importance of the sustainable intensification of ruminant production systems (e.g. better feed conversion and higher production output per unit of input introduced into the farming system); (c) environmental impact of ruminant production; (d) improvement of animal performance by improving animal welfare; (e) adaptation of ruminants to climate change; (f) sustainable ruminant feeding (e.g. precision feeding techniques, optimisation of grazing systems, and use of unconventional feeds); (g) challenges posed by production intensification to animal breeding and conservation of animal biodiversity; and (h) strategies to increase ruminant production in developing countries, thus achieving food security in vast areas of the planet affected by fast growth of human population.
Investigating protective and risk factors that influence mental health in young people is a high priority. While previous cross‐sectional studies have reported associations between diet and mental health among adolescents, few prospective studies exist. The aim of this study was to examine prospective relationships between dietary patterns and mental health among adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study. Self‐report questionnaires were used to assess indicators of mental health (Youth Self‐Report externalizing/internalizing T‐scores) and Western and Healthy dietary patterns (identified using factor analysis) at 14 (2003–2005) and 17 years (2006–2008). Multivariate linear and logistic regression were used to assess relationships between dietary patterns and mental health. Complete data were available for 746 adolescents. In females only, the Western dietary pattern z–score at 14 years was positively associated with greater externalizing behaviors at 17 years (β = 1.91; 95% CI: 0.04, 3.78) and a greater odds of having clinically concerning externalizing behaviors at 17 years (OR = 1.90; 95% CI: 1.06, 3.41). No other statistically significant associations were observed. Overall our findings only lend partial support to a link between diet and mental health. We found it to be specific to females consuming a Western dietary pattern and to externalizing behaviors. Future research on dietary patterns and mental health needs to consider possible sex differences and distinguish between different mental health outcomes as well as between healthy and unhealthy dietary patterns.
Background
Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited.Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison. Methods
Study period: January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6–0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1–3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS. ResultsPatients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (<37 weeks: on-diet singletons 77.4 %; controls: 71.4 %). The incidence of other adverse pregnancy related outcomes was non-significantly lower in on-diet patients (early preterm delivery: on diet: 32.3 % vs controls 35.7 %; birth-weight = <1.500 g: on diet: 9.7 % vs controls 23.8 %). None of the singletons in the on-diet series died, while two perinatal deaths occurred among the controls (p = 0.505).The incidence of small for gestational age (SGA <10th centile) and/or extremely preterm babies (<28th week) was significantly lower in singletons from on-diet mothers than in controls (on diet: 12.9 % vs controls: 33.3 %; p: 0.04 (Fisher)). Conclusion
Moderate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.
Introduction. The population of the world is aging. In 2010, an estimated 524 million people were aged 65 years or older presenting eight percent of the global population. By 2050, this number is expected to nearly triple to approximately 1.5 billion, 16 percent of the world’s population. Although people are living longer, the quality of their lives are often compromised due to ill-health.
Areas covered. Of the conditions which compromise health as we age, obesity is at the forefront. Over half of the global older population were overweight or obese in 2010, significantly increasing the risk of a range of metabolic diseases. Although, it is well recognised excessive calorie intake is a fundamental driver of adipose tissue dysfunction, the relationship between obesity; intrinsic aging; and fat metabolism is less understood. In this review we discuss the intersection between obesity, aging and the factors which contribute to the dysregulation of whole-body fat metabolism.
Expert Commentary. Being obese disrupts an array of physiological systems and there is significant crosstalk among these. Moreover it is imperative to acknowledge the contribution intrinsic aging makes to the dysregulation of these systems and the onset of disease.
Proinflammatory conditions, including acute and chronic infections, have been associated with an increased risk of stroke. The risk of stroke is increased by both the acute and chronic phases of a wide spectrum of proinflammatory conditions, suggesting that the association is related to activation of the inflammatory response rather than the condition itself. Different inflammatory mechanisms probably influence the risk of different stroke subtypes. This hypothesis is supported by observations that high levels of various immune system markers and acute phase reactants in otherwise healthy individuals have also been associated with ischaemic stroke subtypes. C-reactive protein, IL-6 and lipoprotein-associated phospholipase A2 are some of the inflammatory markers that have been associated with stroke risk and prognosis. Multiple epidemiological studies have demonstrated that these markers are associated with the risk of stroke, but the value of these markers in a clinical setting has not yet been proven. Further research is needed to determine whether immune system modulators can lower the risk of stroke in individuals with elevated concentrations of inflammatory markers. Here, we review the association between infection, systemic inflammation, and ischaemic stroke, and discuss the currently recommended preventive methods to decrease the risk of stroke associated with systemic inflammation.
Interactions between dietary patterns and 2 β-adrenergic receptor (ADRβ) gene polymorphisms (ADRβ2 Gln27Glu and ADRβ3 Trp64Arg) were examined with regard to the effects on serum triglyceride levels. The cross-sectional study comprised 1720 men and women (aged 35-69 years) enrolled in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. Genotyping was conducted using a multiplex polymerase chain reaction-based invader assay. We used 46 items from a validated short food frequency questionnaire and examined major dietary patterns by factor analysis. We identified four dietary patterns: healthy, Western, seafood and bread patterns. There was no significant association between any dietary pattern and serum triglyceride levels. After a separate genotype-based analysis, significant interactions between ADRβ3 Trp64Arg genotype and the bread pattern (p for interaction = 0.01) were associated with serum triglyceride levels; specifically, after adjusting for confounding factors, Arg allele carriers with the bread pattern had lower serum triglycerides (p for trend = 0.01). However, the Trp/Trp homozygous subjects with the bread pattern showed no association with serum triglycerides (p for trend = 0.55). Interactions between other dietary patterns and ADRβ polymorphisms were not significant for serum triglyceride levels. Our findings suggest that ADRβ3 polymorphism modifies the effects of the bread pattern on triglyceride levels.
Hematologic malignancies include a diverse group of lymphomas and leukemias that arise in cells of the immune and lymphatic systems. In general, genetic errors of normal processes of lymphocyte maturation and activation are believed to be central to lymphomagenesis, suggesting that factors that influence the host immune milieu in a manner that favors the survival and proliferation of transformed lymphocytes are likely to also contribute to their etiology. The following chapter discusses the epidemiology of three broad categories of hematologic malignancies grouped according to common risk factors and biology: Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma. Each category includes multiple distinct cancers, and in some instances, also clinically relevant molecular subtypes, for which emerging evidence suggests some commonality but also some heterogeneity of etiology. This complexity makes it difficult to capture the unique epidemiology of each type of tumor comprehensively. In the following chapter, we will focus instead on the most common types of hematologic cancer to provide an overview of the epidemiology of these diseases and report the most consistently reported risk factor associations for each cancer subtype.
Design:
PubMed, Science Direct, The Cochrane Library and Google Scholar databases were electronically searched for all relevant studies, up to November 2015. Among the 17 included studies, 3 and 10 of them were regarding the effect of dietary patterns and various food groups on TL, respectively. Also, in 4 studies, both dietary patterns and different food groups were assessed in relation to TL. Mediterranean dietary pattern was related to longer TL in 3 studies. Five studies indicated beneficial effect of fruits or vegetables on TL. In 7 studies, a reverse association between TL and intake of cereals, processed meat, and fats and oils was reported. Our systematic review supports the health benefits of adherence to Mediterranean diet on TL. Except for the fruits and vegetables, which showed positive association with TL, results were inconsistent for other dietary factors. Also, certain food categories including processed meat, cereals and sugar-sweetened beverages may be associated with shorter TLs. However, additional epidemiological evidence and clinical trials should be considered in future research in order to develop firm conclusions in this regard.European Journal of Clinical Nutrition advance online publication, 17 August 2016; doi:10.1038/ejcn.2016.149.
Background:
There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention. Evidence is lacking for effective dietary patterns for kidney disease prevention.
Study design:
Prospective cohort study.
Setting & participants:
Atherosclerosis Risk in Communities (ARIC) Study participants with baseline estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m(2) (N=14,882).
Predictor:
The Dietary Approaches to Stop Hypertension (DASH) diet score was calculated based on self-reported dietary intake of red and processed meat, sweetened beverages, sodium, fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy products, averaged over 2 visits.
Outcomes:
Cases were ascertained based on the development of eGFRs<60mL/min/1.73m(2) accompanied by ≥25% eGFR decline from baseline, an International Classification of Diseases, Ninth/Tenth Revision code for a kidney disease-related hospitalization or death, or end-stage renal disease from baseline through 2012.
Results:
3,720 participants developed kidney disease during a median follow-up of 23 years. Participants with a DASH diet score in the lowest tertile were 16% more likely to develop kidney disease than those with the highest score tertile (HR, 1.16; 95% CI, 1.07-1.26; P for trend < 0.001), after adjusting for sociodemographics, smoking status, physical activity, total caloric intake, baseline eGFR, overweight/obese status, diabetes status, hypertension status, systolic blood pressure, and antihypertensive medication use. Of the individual components of the DASH diet score, high red and processed meat intake was adversely associated with kidney disease and high nuts, legumes, and low-fat dairy products intake was associated with reduced risk for kidney disease.
Limitations:
Potential measurement error due to self-reported dietary intake and lack of data for albuminuria.
Conclusions:
Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics, established kidney risk factors, and baseline kidney function. Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention.
Alpha-linolenic acid (ALA) is an essential fatty acid and the substrate for the synthesis of longer-chain, more unsaturated ω-3 fatty acids, eicosapentaenoic acid (EPA), docosapentaenoic acid and docosahexaenoic acid (DHA). EPA and DHA are associated with human health benefits. The primary source of EPA and DHA is seafood. There is a need for sustainable sources of biologically active ω-3 fatty acids. Certain plants contain high concentrations of ALA and stearidonic acid (SDA). Here we review the literature on the metabolism of ALA and SDA in humans, the impact of increased ALA and SDA consumption on concentrations of EPA and DHA in blood and cell lipid pools, and the extent to which ALA and SDA might have health benefits. Although it is generally considered that humans have limited capacity for conversion of ALA to EPA and DHA, sex differences in conversion to DHA have been identified. If conversion of ALA to EPA and DHA is limited, then ALA may have a smaller health benefit than EPA and DHA. SDA is more readily converted to EPA and appears to offer better potential for health improvement than ALA. However, conversion of both ALA and SDA to DHA is limited in most humans.
Background:
Increased nut consumption has been associated with reduced risk of cardiovascular disease and type 2 diabetes, as well as a healthy lipid profile. However, the associations between nut consumption and inflammatory biomarkers are unclear.
Objective:
We investigated habitual nut consumption in relation to inflammatory biomarkers in 2 large cohorts of US men and women.
Design:
We analyzed cross-sectional data from 5013 participants in the Nurses' Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) who were free of diabetes. Nut intake, defined as intake of peanuts and other nuts, was estimated from food-frequency questionnaires, and cumulative averages from 1986 and 1990 in the NHS and from 1990 and 1994 in the HPFS were used. Plasma biomarkers were collected in 1989-1990 in the NHS and 1993-1995 in the HPFS. Multivariate linear regression was used to assess the associations of nut consumption with fasting plasma C-reactive protein (CRP, n = 4941), interleukin 6 (IL-6, n = 2859), and tumor necrosis factor receptor 2 (TNFR2, n = 2905).
Results:
A greater intake of nuts was associated with lower amounts of a subset of inflammatory biomarkers, after adjusting for demographic, medical, dietary, and lifestyle variables. The relative concentrations (ratios) and 95% CIs comparing subjects with nut intake of ≥5 times/wk and those in the categories of never or almost never were as follows: CRP: 0.80 (0.69, 0.90), P-trend = 0.0003; and IL-6: 0.86 (0.77, 0.97), P-trend = 0.006. These associations remained significant after further adjustment for body mass index. No significant association was observed with TNFR2. Substituting 3 servings of nuts/wk for 3 servings of red meat, processed meat, eggs, or refined grains/wk was associated with significantly lower CRP (all P < 0.0001) and IL-6 (P ranges from 0.001 to 0.017).
Conclusion:
Frequent nut consumption was associated with a healthy profile of inflammatory biomarkers.
Background:
Considering both diet and energy expenditures possess some influence on weight status, research into dietary determinants of obesity is challenging but essential to rational planning of well-organized interventions to avoid obesity.
Objectives:
This study aimed to determine whether dietary factors were predictive of overweight and obesity in adolescents in the Iranian population.
Patients and methods:
A total of 840 students, ages 15 - 17, from six schools were enrolled in this cross-sectional study. A diet-patterns approach often has been used to describe the eating patterns in adolescents. Height, weight, and waist circumference anthropometric indices, physical activity, waist hip ratio, and BMI measurements were determined. Daily dietary data and weighed food records were collected in 2010 and 2011. Abdominal obesity was defined according to world health organization guidelines, and the relationship between dietary predictor variables and the measures of adiposity were determined by using linear regression. Usual dietary intakes were assessed in an experimental study of Esfahani students.
Results:
In total, 38.5% of girls and 32.2% of boys had a Western dietary pattern as the more prevalent pattern. The diet quality of adolescents with the lowest score on each dietary pattern was compared with those recording the highest scores. Those with the Western dietary pattern score were less likely to exercise and had a higher prevalence of general obesity. Adolescents in the greater quartile of the Mediterranean dietary patterns had the lowest odds of being overweight (OR 0.50, 95%; CI 0.27 - 0.73) and obese (OR 0.48, 95%; CI 0.15 - 0.80) than those in the lower quartile, whereas those in the greater quartile of the Western dietary pattern had the highest odds of being overweight (OR 1.69, 95%; CI 1.10 - 2.04) and obese (OR 1.44, 95% CI 1.05 - 1.84). Higher consumption of a Western dietary pattern and a salty dietary pattern were associated significantly with obesity (P < 0.05). Intake of a Western dietary pattern and a salty-sweet dietary pattern were associated positively with measures of adiposity, namely body mass index and waist circumference.
Conclusions:
This study showed significant associations between the seven dietary patterns and overweight and obesity among adolescents. Using dietary patterns within adolescents can provide important information on dietary consumption, and this approach is clearer and much easier to follow.
Background
Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of disability-adjusted life years in developed countries. This study derived a dietary pattern using an a priori method and additionally derived dietary patterns using a posteriori methods, and assessed the relationship with CVD risk factors in Taiwanese middle-aged and elderly adults.
Methods
Cross-sectional analyses of 62,965 subjects aged 40 years and above from the Mei Jau (MJ) database collected between 2003 and 2012 in Taiwan. Diet was assessed using a 22 item semi-quantitative food frequency questionnaire. Using this information, three dietary patterns were generated. The a priori diet was labeled the Taiwanese dietary pattern and was derived using hypothesized effect of 22 food groups, while two a posteriori dietary patterns, “vegi-fruits” and “meat-processed”, were derived using principal component analysis. The association between dietary patterns and a range of CVD risk factors (i.e. blood lipids, blood glucose and C-reactive protein) was evaluated using linear regression.
Results
The results showed that high intake (Q5, quintile 5) of Taiwanese diet was negatively associated with CVD risk factors at (p < 0.001, model 3), but not with triacylglycerol. In addition, high intake of vegi-fruit dietary pattern (Q5) was negatively associated with CVD risk factors (p < 0.001), but not with high-density lipoprotein, while high consumption of meat-processed dietary pattern (Q5) was positively associated with CVD risk factors (p < 0.001), but negatively related with triacylglycerol in Q3 level and no association with C-reactive protein.
Conclusion
A negative association was observed between Taiwanese or vegi-fruit dietary patterns and CVD risk factors, while a positive association was found between meat-processed dietary pattern and CVD risk factors. The findings suggested that a diet rich in vegetables and fruits has a beneficial effect in the management of CVD risk factors.
Background:
Diet and inflammation have been suggested to be important risk factors for multiple sclerosis (MS).
Objectives:
In this study, we examined the ability of the dietary inflammatory index (DII) to predict MS in a case-control study conducted in Iran.
Methods:
This study included 68 MS cases and 140 controls hospitalized for acute non-neoplastic diseases. The DII was computed based on dietary intake assessed by a previously validated food frequency questionnaire. Logistic regression models were used to estimate ORs adjusted for age, energy, sex, body mass index, season of birth, rubella history, history of routine exercise before MS, smoking and history of consumption of cow's milk in the first 2 years of life.
Results:
Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of MS, with the DII being used both as a continuous variable (ORcontinuous 1.66; 95% CI 1.19-2.31; 1 unit increase corresponding to ≈15% of its range in the current study) and a categorical variable (ORDII (>1.43 vs.≤1.43) 2.68; 95% CI 1.15-6.26).
Conclusions:
These results indicate that a pro-inflammatory diet is associated with increased risk of MS.
Background:
Knowledge on specific biological pathways mediating disease occurrence (e.g., inflammation) may be utilized to construct hypotheses-driven dietary patterns that take advantage of current evidence on disease-related hypotheses and the statistical methods of a posteriori patterns.
Objective:
We developed and validated an empirical dietary inflammatory index (EDII) based on food groups.
Methods:
We entered 39 pre-defined food groups in reduced rank regression models followed by stepwise linear regression analyses in the Nurses' Health Study (NHS, n = 5230) to identify a dietary pattern most predictive of 3 plasma inflammatory markers: interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor α receptor 2 (TNFαR2). We evaluated the construct validity of the EDII in 2 independent samples from NHS-II (n = 1002) and Health Professionals Follow-up Study (HPFS, n = 2632) using multivariable-adjusted linear regression models to examine how well the EDII predicted concentrations of IL-6, CRP, TNFαR2, adiponectin, and an overall inflammatory marker score combining all biomarkers.
Results:
The EDII is the weighted sum of 18 food groups; 9 are anti-inflammatory and 9 proinflammatory. In NHS-II and HPFS, the EDII significantly predicted concentrations of all biomarkers. For example, the relative concentrations comparing extreme EDII quintiles in NHS-II were: adiponectin, 0.88 (95% CI, 0.80, 0.96), P-trend = 0.003; and CRP, 1.52 (95% CI, 1.18, 1.97), P-trend = 0.002. Corresponding associations in HPFS were: 0.87 (95% CI, 0.82, 0.92), P-trend < 0.0001; and 1.23 (95% CI, 1.09, 1.40), P-trend = 0.002.
Conclusion:
The EDII represents, to our knowledge, a novel, hypothesis-driven, empirically derived dietary pattern that assesses diet quality based on its inflammatory potential. Its strong construct validity in independent samples of women and men indicates its usefulness in assessing the inflammatory potential of whole diets. Additionally, the EDII may be calculated in a standardized and reproducible manner across different populations thus circumventing a major limitation of dietary patterns derived from the same study in which they are applied.
Energy intake and stored energy are positive factors in the equation of energy balance of an individual, while the rate of energy expenditure is the negative factor. Theoretically, when the weight of an individual is stable, energy intake correlates to some degree with the same total energy expenditure. If energy intake were to be significantly less than energy expenditure, then a variable weight and reduced energy availability are highly probable. A negative energy balance can affect fertility. Moreover, along with insufficient energy intake, there may be a poor intake of nutrients such as antioxidant compounds, iron, selenium, and zinc that are important for the reproductive function. The nutritional approach to fertility disorders induced by exercise and those that are diet related is complex. It starts with problem identification and definition of dietary strategies and food education specific to each athlete. This chapter discusses the nutritional approach and different strategies for preventing or correcting fertility defects associated with nutrition and exercise analyzed in Chap. 19. In addition, it will offer potential dietary and exercise guidelines to try to improve or assist in reproductive outcomes (either naturally or through assisted reproductive techniques) in people with specific reproductive pathologies.
Etiology. Type 2 diabetes (diabetes) is a disease that is preventable through the practice of a healthy lifestyle, including the consumption of a healthy, fiber-rich dietary pattern, weight loss/management, and physical activity (Textbook of natural medicine, Elsevier, Philadelphia, 2013, pp. 1320–48; Br J Clin Nutr 92:7–19, 2004; N Engl J Med 345(11):790–797, 2001; Lancet 383:1999–2007, 2014; Lancet 379(9833): 2279–90, 2012; J Hum Nutr Diet 27:251–60, 2014). Only about 5 % of the US and many other westernized populations routinely follow a diabetes preventive lifestyle or consume adequate levels of dietary fiber (fiber) (Advisory guidelines advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture, Figure D1.2:131, 2015; Dietary reference intakes: energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein and amino acids, National Academies Press, Washington, DC, 2005, pp 339–421; EFSA J 8(3):1462, 2010; J Am Diet Assoc 108:1716–31, 2008; Nutr J 13:34, 2014; Am J Med 126(12):1059–67, 2013; Am J Epidemiol 180(6):565–73, 2014; Fiber intake of the US population. What we eat in American, NHANES 2009-2010. Food Surveys Research Group, Dietary Surveys Research Group No. 12; 2014).
Psychoneuroimmunology (PNI) is a field in which researchers investigate the intersections among behavior, the nervous system, and the immune system. Its development over the past 35 years followed the realization that the immune system does not function in isolation [1, 2]. The initial focus on biological mechanisms encouraged the use of animal models to uncover pathways through which the brain and behavior affect immune activity. Once biological pathways were established, researchers started replicating similar results in humans with broad applications in areas such as infectious diseases, cardiovascular disease, autoimmunity, and cancer. Today, the transdisciplinary field of PNI continues to unravel the complex connections among behavior, immune function, and health.
Diet and lifestyle play a significant role in the development chronic diseases; however the full complexity of this relationship is not yet understood. Dietary pattern investigation, which reflects the complexity of dietary intake, has emerged as an alternative and complementary approach to examining the association between diet and chronic diseases. Literature on this association has largely focused on individual nutrients, with conflicting outcomes, but individuals consume a combination of foods from many groups that form dietary patterns. Our objective was to systematically review the current findings on the effects of dietary patterns on chronic diseases. In this review, we describe and discuss the relationships between dietary patterns, such as the Mediterranean, the Dietary Approach to Stop Hypertension, Prudent, Seventh-day Adventists, and Western, with risk of obesity, type-2 diabetes mellitus, cardiovascular diseases, asthma, and mental health problems. Evidence is increasing from both observational and clinical studies that plant-based dietary patterns, which are rich in fruits, vegetables, and whole grains, are valuable in preventing various chronic diseases, whereas a diet high in red and processed meat, refined grains and added sugar seems to increase said risk. Dietary pattern analysis might be especially valuable to the development and evaluation of food-based dietary guidelines.
Background:
The associations between long-term dietary quality and biomarkers of the brain-adipose axis have not been examined.
Objective:
We evaluated both cross-sectional and longitudinal associations between dietary quality and several biomarkers involved in the brain-adipose axis.
Methods:
In the Nurses' Health Study II, 831 women [baseline mean age: 45 y; body mass index (BMI; in kg/m(2)): 24.6] were randomly selected from women who provided 2 fasting blood samples in 1996-1999 and 2010-2011 to measure plasma concentrations of leptin, soluble leptin receptor (sOB-R), adiponectin, insulin, retinol binding protein-4 (RBP-4), interleukin-6 (IL-6), and C-reactive protein (CRP). Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI-2010) with the use of semiquantitative food-frequency questionnaires administered in 1995 and 2011. We used linear mixed models to evaluate the cross-sectional associations between dietary quality and biomarker concentrations. We also examined change in dietary quality in relation to change in biomarker concentrations.
Results:
In cross-sectional analyses that compared the highest with the lowest quintile of AHEI-2010, we observed significantly lower leptin (P-trend < 0.0001), insulin (P-trend < 0.0001), and CRP (P-trend = 0.02) and significantly higher sOB-R (P-trend < 0.0001) and adiponectin (P-trend = 0.0003). These associations, except for CRP, remained significant after adjustment for BMI. In longitudinal analyses, women in the highest quintile of AHEI-2010 score change (most improvement) had a 13% increase in leptin, compared with a 42% increase (P-trend < 0.0001) in the lowest quintile (least improvement). The corresponding multivariable-adjusted percentage changes for other biomarkers were 4% compared with -1% for sOB-R (P-trend = 0.04), 14% compared with 6% for adiponectin (P-trend = 0.02), and -11% compared with 16% for CRP (P-trend = 0.02). Adjustment for interim weight change attenuated these associations. No associations were observed for RBP-4 or IL-6.
Conclusion:
Improvement in dietary quality was associated with favorable profiles of several biomarkers of the brain-adipose axis in women.
Diet and inflammation have been suggested to be important risk factors for ulcerative colitis (UC). In this case-control study conducted in Iran, we examined the ability of the dietary inflammatory index (DII) to predict UC. This study included 62 UC cases and 124 controls hospitalized for acute non-neoplastic diseases. The DII was computed based on dietary intake assessed by a previously validated food frequency questionnaire. Multivariable logistic regression models were used to estimate odds ratios (ORs) and the DII was analyzed as both continuous and as tertiles. Energy was adjusted using the residual method. Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of UC, with the DII being used as both a continuous variable (ORcontinuous 1.55, 95% confidence interval (CI) 1.04-2.32; one unit increase corresponding to ≈8% of its range in the current study) and as tertiles (ORtertile3vstertile1 2.58, 95% CI 1.03-6.48, Ptrend| = |0.04). These results indicate that a pro-inflammatory diet is associated with increased risk of UC.
Although there is a cumulative evidence for the inflammation pathophysiology in schizophrenia, it has not been conclusively proven yet. One reason for this is the lack of studies that have controlled for major confounding factors such as obesity, smoking, antipsychotic use, and stress. The studies in which the major confounding factors were controlled were done in subjects in acute relapse and in treatment-resistant schizophrenia. To date, no studies have been done in stable outpatients with schizophrenia controlling for major confounding factors. Data on cerebrospinal fluid cytokines in large sample independent of confounding factors are also lacking. The efficacy signal from anti-inflammatory medications in schizophrenia has been modest. In this study, the inconsistent and nonvalidated cytokine findings independent of the confounding factors are discussed.
The analysis of dietary patterns emerged recently as a possible approach to examining diet-disease relation. We analysed the risk of all-cause and cardiovascular mortality associated with dietary patterns in men and women, while taking a number of potential confounding variables into account. Data were from a prospective cohort study with follow-up of total and cause-specific mortality. A random sample of 3698 men and 3618 women aged 30-70 years and living in Copenhagen County, Denmark, were followed from 1982 to 1998 (median 15 years). Three dietary patterns were identified from a twenty-eight item food frequency questionnaire, collected at baseline: (1) a predefined healthy food index, which reflected daily intakes of fruits, vegetables and wholemeal bread, (2) a prudent and (3) a Western dietary pattern derived by principal component analysis. The prudent pattern was positively associated with frequent intake of wholemeal bread, fruits and vegetables, whereas the Western was characterized by frequent intakes of meat products, potatoes, white bread, butter and lard. Among participants with complete information on all variables, 398 men and 231 women died during follow-up. The healthy food index was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling for confounding variables. The Western pattern was not significantly associated with mortality. This study partly supports the assumption that overall dietary patterns can predict mortality, and that the dietary pattern associated with the lowest risk is the one which is in accordance with the current recommendations for a prudent diet.
Inflammation is hypothesized to play a role in development of type 2 diabetes mellitus (DM); however, clinical data addressing this issue are limited.
To determine whether elevated levels of the inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) are associated with development of type 2 DM in healthy middle-aged women.
Prospective, nested case-control study.
The Women's Health Study, an ongoing US primary prevention, randomized clinical trial initiated in 1992.
From a nationwide cohort of 27 628 women free of diagnosed DM, cardiovascular disease, and cancer at baseline, 188 women who developed diagnosed DM over a 4-year follow-up period were defined as cases and matched by age and fasting status with 362 disease-free controls.
Incidence of confirmed clinically diagnosed type 2 DM by baseline levels of IL-6 and CRP.
Baseline levels of IL-6 (P<.001) and CRP (P<.001) were significantly higher among cases than among controls. The relative risks of future DM for women in the highest vs lowest quartile of these inflammatory markers were 7.5 for IL-6 (95% confidence interval [CI], 3.7-15.4) and 15.7 for CRP (95% CI, 6.5-37.9). Positive associations persisted after adjustment for body mass index, family history of diabetes, smoking, exercise, use of alcohol, and hormone replacement therapy; multivariate relative risks for the highest vs lowest quartiles were 2.3 for IL-6 (95% CI, 0.9-5.6; P for trend =.07) and 4.2 for CRP (95% CI, 1.5-12.0; P for trend =.001). Similar results were observed in analyses limited to women with a baseline hemoglobin A(1c) of 6.0% or less and after adjustment for fasting insulin level.
Elevated levels of CRP and IL-6 predict the development of type 2 DM. These data support a possible role for inflammation in diabetogenesis.
To study the relation of fibrinogen and C-reactive protein (CRP) to various measures of body fat and body fat distribution and to investigate whether these relations were explained by differences in insulin sensitivity.
Cross-sectional analysis of the IRAS (Insulin Resistance Atherosclerosis Study), a large (n=1559) tri-ethnic population (non-Hispanic whites, African-Americans and Mexican-Americans) across different states of glucose tolerance.
Glucose tolerance (oral glucose tolerance test), insulin sensitivity (frequently sampled intravenous glucose tolerance test and minimal model analysis), assessment of body fat mass and distribution (weight, girths, bioelectrical impedance), subclinical atherosclerosis (B-mode ultrasonography of carotid artery intima-media thickness, IMT), CRP (highly sensitive immunoassay), fibrinogen (standard assay).
Both CRP and fibrinogen were related to all measures of body fat. Strong correlations (correlation coefficient r > or = 0.35) were found between CRP and body mass index (BMI), waist circumference and adipose body mass, respectively. The associations were consistent in non-diabetic and type-2 diabetic subjects, were generally stronger in women, and were only moderately attenuated by the prevailing insulin sensitivity (S(I)). In a multivariate linear regression model waist circumference explained 14.5% of the variability of circulating CRP levels (P=0.0001), BMI 0.4% (P=0.0067), and S(I) 1.7% (P=0.0001). Common carotid artery IMT was related to CRP and fibrinogen in men, but not in women, and was attenuated after adjusting for BMI or waist.
Our findings show that measures of body fat are strongly associated with circulating levels of CRP and fibrinogen. These associations were not explained by lower S(I) in obese subjects. Chronic, subclinical inflammation may be one pathophysiological mechanism explaining the increased risk of atherosclerotic disease associated with adiposity.
Atherosclerosis, formerly considered a bland lipid storage disease, actually involves an ongoing inflammatory response. Recent advances in basic science have established a fundamental role for inflammation in mediating all stages of this disease from initiation through progression and, ultimately, the thrombotic complications of atherosclerosis. These new findings provide important links between risk factors and the mechanisms of atherogenesis. Clinical studies have shown that this emerging biology of inflammation in atherosclerosis applies directly to human patients. Elevation in markers of inflammation predicts outcomes of patients with acute coronary syndromes, independently of myocardial damage. In addition, low-grade chronic inflammation, as indicated by levels of the inflammatory marker C-reactive protein, prospectively defines risk of atherosclerotic complications, thus adding to prognostic information provided by traditional risk factors. Moreover, certain treatments that reduce coronary risk also limit inflammation. In the case of lipid lowering with statins, this anti-inflammatory effect does not appear to correlate with reduction in low-density lipoprotein levels. These new insights into inflammation in atherosclerosis not only increase our understanding of this disease, but also have practical clinical applications in risk stratification and targeting of therapy for this scourge of growing worldwide importance.
The advanced lesions of atherosclerosis represent the culmination of a specialized form of chronic inflammation followed by a fibroproliferative process that takes place within the intima of the affected artery. Proliferation of smooth muscle cells and generation of connective tissue occur. Proliferation results from interactions between arterial smooth muscle, monocyte-derived macrophages, T lymphocytes, and endothelium. The initial lesion of atherosclerosis, the fatty streak, begins as an accumulation of monocytederived macrophages and T lymphocytes, which adhere and migrate into the intima of the affected artery. Smooth muscle cells, which are present in the intima or which migrate into the intima from the media, then replicate. Monocyte-derived macrophages and T cells also replicate during lesion formation and progression due to the production of cytokines and growth-regulatory molecules. These molecules determine whether there is proliferation and lesion progression or inhibition of proliferation and lesion regression. Several growthregulatory molecules may play critical roles in this process, including platelet-derived growth factor (PGDF), transforming growth factor beta, fibroblast growth factor, heparinbinding epidermal growth factor-like growth factor, and others. PDGF may be one of the principal components in this process because protein containing the PDGF B-chain has been demonstrated within activated lesion macrophages during every phase of atherogenesis. The presence of this growth factor and its receptors on lesion smooth muscle cells creates opportunities for smooth muscle chemotaxis and replication. Smooth muscle proliferation depends upon a series of complex signals based upon cellular interactions in the local microenvironment of the artery. The intracellular signalling pathways for mitogenesis versus chemotaxis are being investigated for smooth muscle. The roles of the cytokines and growth-regulatory peptides involved in these cellular interactions represent critical points of departure for intervention and the development of new diagnostic methods. In addition, magnetic resonance imaging has been developed to demonstrate the fine structure of lesions of atherosclerosis in peripheral arteries not subject to cardiac motion. This noninvasive methodology holds great promise for the future of these approaches.
The aim of this study was to evaluate the reproducibility and validity of a 61-item semiquantitative food frequency questionnaire used in a large prospective study among women. This form was administered twice to 173 participants at an interval of approximately one year (1980-1981), and four one-week diet records for each subject were collected during that period. Intraclass correlation coefficients for nutrient intakes estimated by the one-week diet records (range = 0.41 for total vitamin A without supplements to 0.79 for vitamin B6 with supplements) were similar to those computed from the questionnaire (range = 0.49 for total vitamin A without supplements to 0.71 for sucrose), indicating that these methods were generally comparable with respect to reproducibility. With the exception of sucrose and total carbohydrate, nutrient intakes from the diet records tended to correlate more strongly with those computed from the questionnaire after adjustment for total caloric intake. Correlation coefficients between the mean calorie-adjusted intakes from the four one-week diet records and those from the questionnaire completed after the diet records ranged from 0.36 for vitamin A without supplements to 0.75 for vitamin C with supplements. Overall, 48% of subjects in the lowest quintile of calorie-adjusted intake computed from the diet records were also in the lowest questionnaire quintile, and 74% were in the lowest one of two questionnaire quintiles. Similarly, 49% of those in the highest diet record quintile were also in the highest questionnaire quintile, and 77% were in the highest one or two questionnaire quintiles. These data indicate that a simple self-administered dietary questionnaire can provide useful information about individual nutrient intakes over a one-year period.
We investigated whether dietary patterns were associated with cardiovascular risk factors in 518 elderly men (70-89 years), using data from the 30-year follow-up survey of the Zutphen Study.
Dietary intake was estimated by cross-check dietary history. We used cluster analysis to aggregate individuals into four groups, characterized by high alcohol intake, high meat consumption, healthy dietary pattern, and high intake of refined sugars.
In the alcohol cluster socioeconomic status was higher (P < 0.05) than in the meat cluster. High density lipoprotein (HDL)-cholesterol was 0.15-0.23 mmol/l higher (P < 0.05) in the alcohol cluster compared to the other clusters. Furthermore, in the meat cluster HDL-cholesterol was 0.08 mmol/l higher than in the refined sugars cluster (P < 0.05). Total serum cholesterol was 0.26 mmol/l higher in the meat cluster compared to the healthy diet cluster (95% CI: -0.17, 0.69). The prevalence of hypertension was almost 10% higher in alcohol cluster compared to the other three clusters (95% CI: -3, 23). The percentage of non-smokers was highest in the healthy diet cluster. These results were irrespective of potential confounders, such as age, body mass index, socioeconomic status, smoking, and being on a prescribed diet.
The effects of moderate alcohol intake on cardiovascular risk factors are confirmed in elderly men. Furthermore, a healthy diet is associated with more favourable levels of cardiovascular risk factors at old age.
The reproducibility and validity of self-administered questionnaires on physical activity and inactivity were examined in a random (representative) sample of the Nurses' Health Study II cohort and a random sample of African-American women in that cohort.
Repeat questionnaires were administered 2 years apart. Past-week activity recalls and 7-day activity diaries were the referent methods; these instruments were sent to participants four times over a 1-year period.
The 2-year test-retest correlation for activity was 0.59 for the representative sample (n = 147) and 0.39 for the African-American sample (n = 84). Correlations between activity reported on recalls and that reported on questionnaire were 0.79 and 0.83 for the representative and African-American samples, respectively. Correlations between activity reported in diaries and that reported on questionnaire were 0.62 and 0.59, respectively. Test-retest coefficients for inactivity were 0.52 and 0.55, respectively. Correlations between inactivity reported in diaries and that reported on questionnaire were 0.41 and 0.44, respectively.
The simple, short questionnaires on activity and inactivity used in the Nurses' Health Study II are reasonably valid measures for epidemiological research.
Recruitment of circulating leukocytes at sites of atherosclerosis is mediated through a family of adhesion molecules. The function of circulating forms of these adhesion molecules remains unknown, but their levels may serve as molecular markers of subclinical coronary heart disease (CHD).
To determine the ability of circulating vascular cell adhesion molecule-1 (VCAM-1), endothelial-leukocyte adhesion molecule-1 (E-selectin), and intercellular adhesion molecule-1 (ICAM-1) to serve as molecular markers of atherosclerosis and predictors of incident CHD, we studied 204 patients with incident CHD, 272 patients with carotid artery atherosclerosis (CAA), and 316 control subjects from the large, biracial Atherosclerosis Risk In Communities (ARIC) study. Levels of VCAM-1 were not significantly different among the patients with incident CHD, those with CAA, and control subjects. Higher levels of E-selectin and ICAM-1 were observed for the patients with CHD (means [ng/mL]: E-selectin, 38.4; ICAM-1, 288.7) and those with CAA (E-selectin, 41.5; ICAM-1, 283.6) compared with the control subjects (E-selectin, 32.8; ICAM-1, 244.2), but the distributions were not notably different between the patients with CHD and CAA. Results of logistic regression analyses indicated that the relationship of ICAM-1 and E-selectin with CHD and CAA was independent of other known CHD risk factors and was most pronounced in the highest quartile. The odds of CHD and CAA were 5.53 (95% CI, 2.51-12.21) and 2.64 (95% CI, 1.40-5.01), respectively, for those with levels of ICAM-1 in the highest quartile compared with those in the lowest quartile. Odds of CAA were 2.03 (95% CI, 1.14-3.62) for those with levels of E-selectin in the highest quartile compared with those in the lowest quartile.
These data indicate that plasma levels of ICAM-1 and E-selectin may serve as molecular markers for atherosclerosis and the development of CHD.
The intercellular adhesion molecule ICAM-1 mediates adhesion and transmigration of leucocytes to the vascular endothelial wall, a step proposed to be critical in the initiation and progression of atherosclerosis. Whether concentrations of soluble ICAM-1 (sICAM-1) are raised in apparently healthy individuals who later suffer acute myocardial infarction is unknown.
We obtained baseline plasma samples from a prospective cohort of 14,916 healthy men enrolled in the Physicians' Health Study. With a nested case-control design, we measured sICAM-1 concentrations for 474 participants who developed a first myocardial infarction, and 474 controls (participants who remained healthy throughout the 9-year follow-up). Cases were matched to controls according to age and smoking status at the time of myocardial infarction.
We found a significant association between increasing concentration of sICAM-1 and risk of future myocardial infarction (p = 0.003), especially among participants with baseline sICAM-1 concentrations in the highest quartile (> 260 ng/mL; relative risk 1.6 [95% Cl 1.1-2.4], p = 0.02). This association was present overall as well as among non-smokers, and persisted after control for lipid and non-lipid risk factors. In multivariate analyses, the risk of future myocardial infarction was 80% higher for participants with baseline sICAM-1 concentrations in the highest quartile (relative risk 1.8 [1.1-2.8], p = 0.02). Similar risk estimates were seen among non-smokers. We found slight but significant correlations between sICAM-1 and fibrinogen, high-density-lipoprotein cholesterol, homocysteine, triglycerides, tissue-type plasminogen-activator antigen, and C-relative protein, but adjustment for these altered the risk little. The risk of myocardial infarction associated with raised concentrations of sICAM-1 seemed to increase with length of follow-up.
Our data support the hypothesis that cellular mediators of inflammation have a role in atherogenesis and provide a clinical basis to consider antiadhesion therapies as a novel means of cardiovascular disease prevention.
Recently, the analysis of dietary patterns has emerged as a possible approach to examining diet-disease relations.
We examined the reproducibility and validity of dietary patterns defined by factor analysis using dietary data collected with a food-frequency questionnaire (FFQ).
We enrolled a subsample of men (n = 127) from the Health Professionals Follow-up Study in a diet-validation study in 1986. A 131-item FFQ was administered twice, 1 y apart, and two 1-wk diet records and blood samples were collected during this 1-y interval.
Using factor analysis, we identified 2 major eating patterns, which were qualitatively similar across the 2 FFQs and the diet records. The first factor, the prudent dietary pattern, was characterized by a high intake of vegetables, fruit, legumes, whole grains, and fish and other seafood, whereas the second factor, the Western pattern, was characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains. The reliability correlations for the factor scores between the 2 FFQs were 0.70 for the prudent pattern and 0.67 for the Western pattern. The correlations (corrected for week-to-week variation in diet records) between the 2 FFQs and diet records ranged from 0.45 to 0.74 for the 2 patterns. In addition, the correlations between the factor scores and nutrient intakes and plasma concentrations of biomarkers were in the expected direction.
These data indicate reasonable reproducibility and validity of the major dietary patterns defined by factor analysis with data from an FFQ.
C-reactive protein, a hepatic acute phase protein largely regulated by circulating levels of interleukin-6, predicts coronary heart disease incidence in healthy subjects. We have shown that subcutaneous adipose tissue secretes interleukin-6 in vivo. In this study we have sought associations of levels of C-reactive protein and interleukin-6 with measures of obesity and of chronic infection as their putative determinants. We have also related levels of C-reactive protein and interleukin-6 to markers of the insulin resistance syndrome and of endothelial dysfunction. We performed a cross-sectional study in 107 nondiabetic subjects: (1) Levels of C-reactive protein, and concentrations of the proinflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, were related to all measures of obesity, but titers of antibodies to Helicobacter pylori were only weakly and those of Chlamydia pneumoniae and cytomegalovirus were not significantly correlated with levels of these molecules. Levels of C-reactive protein were significantly related to those of interleukin-6 (r=0.37, P<0.0005) and tumor necrosis factor-alpha (r=0.46, P<0.0001). (2) Concentrations of C-reactive protein were related to insulin resistance as calculated from the homoeostasis model assessment model, blood pressure, HDL, and triglyceride, and to markers of endothelial dysfunction (plasma levels of von Willebrand factor, tissue plasminogen activator, and cellular fibronectin). A mean standard deviation score of levels of acute phase markers correlated closely with a similar score of insulin resistance syndrome variables (r=0.59, P<0.00005), this relationship being weakened only marginally by removing measures of obesity from the insulin resistance score (r=0.53, P<0.00005). These data suggest that adipose tissue is an important determinant of a low level, chronic inflammatory state as reflected by levels of interleukin-6, tumor necrosis factor-alpha, and C-reactive protein, and that infection with H pylori, C pneumoniae, and cytomegalovirus is not. Moreover, our data support the concept that such a low-level, chronic inflammatory state may induce insulin resistance and endothelial dysfunction and thus link the latter phenomena with obesity and cardiovascular disease.
In the Seven Countries Study, associations between the intake of food-groups and 25-year mortality from coronary heart disease (CHD, defined as sudden coronary death or fatal myocardial infarction) were investigated. Baseline surveys were carried out between 1958 and 1964. A number of individual characteristics were measured in 12,763 middle-aged men belonging to 16 cohorts in seven countries (USA, Finland, The Netherlands, Italy, former Yugoslavia, Greece and Japan). Dietary information was collected in sub-samples using the weighed record method. Vital status of all participants was verified at regular intervals during 25 years of follow-up and the underlying cause of death was adjudicated. Eighteen different food-groups and combinations were considered for comparison among cohorts. Large differences in food-group consumption were seen, with high consumption of dairy products in Northern Europe, meat in the USA, vegetables, legumes, fish, and wine in Southern Europe, and cereals, soy products, and fish in Japan. Population death rates from CHD showed large differences, ranging from 268 per 1000 in East Finland to 25 per 1000 in Crete, Greece. Animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = -0.822), oils (R = -0.571), and alcohol (R = -0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = -0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates. Multivariate stepwise analysis selected butter, lard + margarine and meat as significant predictors and produced an R2 of 0.922. These findings were confirmed by factor analysis. These cross-cultural analyses are consistent with the hypothesis that dietary patterns are important determinants of differences in population CHD death rates, and confirm the opposite effects on apparent risk of animal and vegetable foods.
Since inflammation is believed to have a role in the pathogenesis of cardiovascular events, measurement of markers of inflammation has been proposed as a method to improve the prediction of the risk of these events.
We conducted a prospective, nested case-control study among 28,263 apparently healthy postmenopausal women over a mean follow-up period of three years to assess the risk of cardiovascular events associated with base-line levels of markers of inflammation. The markers included high-sensitivity C-reactive protein (hs-CRP), serum amyloid A, interleukin-6, and soluble intercellular adhesion molecule type 1 (sICAM-1). We also studied homocysteine and a variety of lipid and lipoprotein measurements. Cardiovascular events were defined as death from coronary heart disease, nonfatal myocardial infarction or stroke, or the need for coronary-revascularization procedures.
Of the 12 markers measured, hs-CRP was the strongest univariate predictor of the risk of cardiovascular events; the relative risk of events for women in the highest as compared with the lowest quartile for this marker was 4.4 (95 percent confidence interval, 2.2 to 8.9). Other markers significantly associated with the risk of cardiovascular events were serum amyloid A (relative risk for the highest as compared with the lowest quartile, 3.0), sICAM-1 (2.6), interleukin-6 (2.2), homocysteine (2.0), total cholesterol (2.4), LDL cholesterol (2.4), apolipoprotein B-100 (3.4), HDL cholesterol (0.3), and the ratio of total cholesterol to HDL cholesterol (3.4). Prediction models that incorporated markers of inflammation in addition to lipids were significantly better at predicting risk than models based on lipid levels alone (P<0.001). The levels of hs-CRP and serum amyloid A were significant predictors of risk even in the subgroup of women with LDL cholesterol levels below 130 mg per deciliter (3.4 mmol per liter), the target for primary prevention established by the National Cholesterol Education Program. In multivariate analyses, the only plasma markers that independently predicted risk were hs-CRP (relative risk for the highest as compared with the lowest quartile, 1.5; 95 percent confidence interval, 1.1 to 2.1) and the ratio of total cholesterol to HDL cholesterol (relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.9).
The addition of the measurement of C-reactive protein to screening based on lipid levels may provide an improved method of identifying persons at risk for cardiovascular events.
Previous epidemiological studies have demonstrated relationships between individual nutrients and glucose intolerance and type 2 diabetes, but the association with the overall pattern of dietary intake has not previously been described. In order to characterize this association, 802 subjects aged 40-65 years were randomly selected from a population-based sampling frame and underwent a 75 g oral glucose-tolerance test. Principal component analysis was used to identify four dietary patterns explaining 31.7% of the dietary variation in the study cohort. These dietary patterns were associated with other lifestyle factors including socio-economic group, smoking, alcohol intake and physical activity. Component 1 was characterized by a healthy balanced diet with a frequent intake of raw and salad vegetables, fruits in both summer and winter, fish, pasta and rice and low intake of fried foods, sausages, fried fish, and potatoes. This component was negatively correlated with central obesity, fasting plasma glucose, 120 min non-esterified fatty acid and triacylglycerol, and positively correlated with HDL-cholesterol. It therefore appears to be protective for the metabolic syndrome. Component 1 was negatively associated with the risk of having undiagnosed diabetes, and this association was independent of age, sex, smoking and obesity. The findings support the hypothesis that dietary patterns are associated with other lifestyle factors and with glucose intolerance and other features of the metabolic syndrome. The results provide further evidence for the recommendation of a healthy balanced diet as one of the main components of chronic disease prevention.
Previous studies on diet and coronary heart disease (CHD) focused primarily on individual nutrients or foods.
We examined whether overall dietary patterns derived from a food-frequency questionnaire (FFQ) predict risk of CHD in men.
This was a prospective cohort study of 44875 men aged 40-75 y without diagnosed cardiovascular disease or cancer at baseline in 1986.
During 8 y of follow-up, we documented 1089 cases of CHD (nonfatal myocardial infarction and fatal CHD). Using factor analysis, we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ. The first factor, which we labeled the "prudent pattern," was characterized by higher intake of vegetables, fruit, legumes, whole grains, fish, and poultry, whereas the second factor, the "Western pattern," was characterized by higher intake of red meat, processed meat, refined grains, sweets and dessert, French fries, and high-fat dairy products. After adjustment for age and CHD risk factors, the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0, 0. 87, 0.79, 0.75, and 0.70 (95% CI: 0.56, 0.86; P: for trend = 0.0009). In contrast, the relative risks across increasing quintiles of the Western pattern score were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17; P: for trend < 0.0001). These associations persisted in subgroup analyses according to cigarette smoking, body mass index, and parental history of myocardial infarction.
These data suggest that major dietary patterns derived from the FFQ predict risk of CHD, independent of other lifestyle variables.
Although the effects of individual foods or nutrients on the development of diseases and their risk factors have been investigated in many studies, little attention has been given to the effect of overall dietary patterns.
Our objective was to examine the associations of 2 major dietary patterns, Western and prudent, with biomarkers of obesity and cardiovascular disease (CVD) risk.
We used factor analysis to define major dietary patterns for a subsample of men (n = 466) from the Health Professionals Follow-up Study by using dietary information collected from food-frequency questionnaires (FFQs) in 1994. We calculated partial correlation coefficients between pattern scores and biomarker values adjusted for age, smoking status, energy and alcohol intake, physical activity, hours of television watching, and body mass index.
We derived 2 major dietary patterns that were generally reproducible over time. The first pattern (prudent) was characterized by higher intakes of fruit, vegetables, whole grains, and poultry. The second pattern (Western) was characterized by higher intakes of red meats, high-fat dairy products, and refined grains. Using pattern scores from 1994 and adjusting for potential confounders, we found significant positive correlations between the Western pattern and insulin, C-peptide, leptin, and homocysteine concentrations, and an inverse correlation with plasma folate concentrations. The prudent pattern was positively correlated with plasma folate and inversely correlated with insulin and homocysteine concentrations.
Major dietary patterns are predictors of plasma biomarkers of CVD and obesity risk, suggesting that the effect of overall diet on CVD risk may be mediated through these biomarkers.
The vascular endothelium is the primary site of dysfunction in many diseases, particularly cardiovascular disease. A variety of risk factors, including smoking, hypercholesterolemia, hyperhomocysteinemia, hypertension, and diabetes mellitus, adversely affect endothelial function. Emerging evidence suggests an important role of dietary factors in modulating endothelial function. In particular, n-3 fatty acids, antioxidant vitamins (especially vitamins E and C), folic acid, and L-arginine appear to have beneficial effects on vascular endothelial function, either by decreasing endothelial activation or by improving endothelium-dependent vasodilation in patients at high risk of cardiovascular disease as well as in healthy subjects. These effects may serve as one potential mechanism through which these nutrients reduce the risk of cardiovascular disease, as observed in epidemiologic studies and several clinical trials. This article reviews clinical and experimental evidence regarding the role of these nutrients in modulating endothelial function and their potential to prevent cardiovascular disease.
During the past several decades, reduction in fat intake has been the main focus of national dietary recommendations to decrease risk of coronary heart disease (CHD). Several lines of evidence. however, have indicated that types of fat have a more important role in determining risk of CHD than total amount of fat in the diet. Metabolic studies have long established that the type of fat, but not total amount of fat, predicts serum cholesterol levels. In addition, results from epidemiologic studies and controlled clinical trials have indicated that replacing saturated fat with unsaturated fat is more effective in lowering risk of CHD than simply reducing total fat consumption. Moreover, prospective cohort studies and secondary prevention trials have provided strong evidence that an increasing intake of n-3 fatty acids from fish or plant sources substantially lowers risk of cardiovascular mortality. In this article, we review evidence from epidemiologic studies and dietary intervention trials addressing the relationship between dietary fat intake and risk of CHD, with a particular emphasis on different major types of fat, n-3 fatty acids and the optimal balance between n-3 and n-6 fatty acids. We also discuss the implications of the available evidence in the context of current dietary recommendations.
Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.
The role of diet in the development of type 2 diabetes mellitus remains unsettled.
To examine the association between major dietary patterns and risk for type 2 diabetes mellitus.
Prospective cohort study.
United States.
42 504 male health professionals, 40 to 75 years of age, without diagnosed diabetes, cardiovascular disease, or cancer at baseline.
Using factor analysis based on data from food-frequency questionnaires, we identified and validated two major dietary patterns that we labeled "prudent" (characterized by higher consumption of vegetables, fruit, fish, poultry and whole grains) and "western" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts). Relative risks and 95% CIs were adjusted for potential confounders, including body mass index (BMI), physical activity, and cigarette smoking.
During 12 years of follow-up (466 508 person-years), we documented 1321 cases of type 2 diabetes. The prudent dietary pattern score was associated with a modestly lower risk for type 2 diabetes (relative risk for extreme quintiles, 0.84 [CI, 0.70 to 1.00]). In contrast, the western dietary pattern score was associated with an increased risk for type 2 diabetes (relative risk, 1.59 [CI, 1.32 to 1.93]; P < 0.001 for trend). A high score for the western dietary pattern combined with low physical activity (relative risk comparing extreme quintiles of dietary pattern score and physical activity, 1.96 [CI, 1.35 to 2.84]) or obesity (relative risk for BMI > or = 30 kg/m2 vs. <25 kg/m2, 11.2 [CI, 8.07 to 15.6]) was associated with a particularly high risk for type 2 diabetes.
Our findings suggest that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes in men.
Several studies have shown that humoral markers of inflammation and endothelial dysfunction are predictive of macrovascular events, and correlated with indirect measures of adiposity and insulin action, thus providing a possible link between obesity, insulin resistance and atherosclerosis. We examined the relationship between humoral markers of inflammation and endothelial dysfunction and direct measures of adiposity and insulin action in Pima Indians, a population with a very high prevalence of obesity and insulin resistance, but a relatively low propensity for atherosclerotic disease. Fasting plasma concentrations of the inflammatory markers C-reactive protein (CRP), secretory phospholipase A2 (sPLA2) and soluble intercellular adhesion molecule-1 (sICAM-1) and of the endothelial markers E-selectin and von Willebrand factor (vWF) were measured in 32 non-diabetic Pima Indians (18 M/14 F, age 27+/-1 years) in whom percent body fat and insulin-stimulated glucose disposal (M) were assessed by DEXA and a hyperinsulinemic clamp, respectively. CRP, sPLA2, and sICAM-1 were all positively correlated with percent body fat (r=0.71, 0.57, and 0.51, all P<0.01). E-selectin and vWF were not correlated with percent body fat, but were negatively correlated with M (r= -0.65 and -0.46, both P<0.001) and positively correlated with CRP (r=0.46, and 0.33, both P<0.05). These findings indicate that humoral markers of inflammation increase with increasing adiposity in Pima Indians whereas humoral markers of endothelial dysfunction increase primarily in proportion to the degree of insulin resistance and inflammation. Thus, obesity and insulin resistance appear to be associated with low-grade inflammation and endothelial dysfunction, respectively, even in an obesity- and diabetes-prone population with relatively low propensity for atherosclerosis.
Dietary pattern analysis, which reflects the complexity of dietary intake, has recently received considerable attention by nutritional epidemiologists. Two general approaches have been used to define these summary variables in observational studies. The so-called a posteriori approach builds on statistical exploratory methods, whereas the so-called a priori approach focuses on the construction of pattern variables that reflect hypothesis-oriented patterns based on available scientific evidence for specific diseases. Several studies, both observational and clinical, suggest that these measures of overall diet predict disease risk, and that its application might be especially valuable in the development of food-based dietary guidelines. In this review, we describe different patterning approaches and the available evidence regarding the relationships between dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease.
Blake GJ, Ridker PM (Harvard Medical School, Boston, MA, USA). Inflammatory bio-markers and cardiovascular risk prediction (Review). J Intern Med 2002; 252: 283–294.
Inflammatory processes are now recognized to play a central role in the pathogenesis of atherosclerosis and its complications. Plasma levels of several markers of inflammation have been found to be associated with future cardiovascular risk in a variety of clinical settings. These markers include cell adhesion molecules, cytokines, pro-atherogenic enzymes and C-reactive protein (CRP). Initially thought of as an inactive downstream marker of the inflammatory cascade, emerging evidence suggests that CRP may be directly involved in atherogenesis, and that arterial plaque can produce CRP, independent of traditional hepatic pathways. In addition to being a strong predictor of future cardiovascular risk amongst patients presenting with acute coronary syndromes, numerous studies have found that baseline levels of CRP are associated with risk of future myocardial infarction, stroke, peripheral vascular disease and cardiovascular death amongst apparently healthy populations. The combination of measurement of a marker of inflammation with lipid testing may improve upon risk stratification based on lipid testing alone, and intensification of programmes for exercise, weight loss, and smoking cessation is recommended for those with elevated CRP levels. Further trials are needed to confirm the potential benefits of statins amongst individuals with elevated CRP levels.
Markers of myocyte necrosis such as cardiac troponin or creatine kinase-myocardial band are invaluable tools for risk stratification among patients presenting with acute coronary syndromes (ACS). Nonetheless, many patients without any evidence of myocyte necrosis may be at high risk for recurrent ischemic events. In consideration of the important role that inflammatory processes play in determining plaque stability, recent work has focused on whether plasma markers of inflammation may help improve risk stratification. Of these markers, C-reactive protein (CRP) has been the most widely studied, and there is now robust evidence that CRP is a strong predictor of cardiovascular risk among apparently healthy individuals, patients undergoing elective revascularization procedures, and patients presenting with ACS. Moreover, even among patients with troponin-negative ACS, elevated levels of CRP are predictive of future risk. Other, more upstream markers of the inflammatory cascade, such as interleukin (IL)-6, have also been found to be predictive of recurrent vascular instability. A recent report from the second FRagmin during InStability in Coronary artery disease trial investigators suggests that elevated levels of an inflammatory marker such as IL-6 may indicate which patients may benefit most from an early invasive strategy. Other inflammatory markers currently under investigation include lipoprotein-associated phospholipase A(2), myeloperoxidase, and pregnancy-associated plasma protein A. Of all these novel markers, CRP appears to meet most of the criteria required for potential clinical application. Furthermore, the benefits of lifestyle modification and drug therapy with aspirin or statins may be most marked among those with elevated CRP levels.
PURPOSE: The aim of this article is to discuss the role of inflammation in atherosclerosis. SUMMARY: An initial chemical, mechanical or immunological insult induces endothelial dysfunction. This triggers a cascade of inflammatory reactions, in which monocytes, macrophages, T lymphocytes and vascular smooth muscle cells participate. Leukocyte adhesion molecules, cytokines, growth factors and metalloproteinases participate in all stages of atherogenesis. Almost all of the traditional risk factors for atherosclerosis are associated with and participate in the inflammatory process. Many infectious agents, mainly Chlamydia pneumoniae, have been proposed as potential triggers of the cascade. The immune system has been implicated in plaque formation, through the activation of cellular and humoral immunity against innate or microbial heat shock protein 60. Methods of detection of systemic or local plaque inflammation have been developed and research is being conducted on the potential use of anti-inflammatory and antibiotic drugs in atherosclerosis.
The Diet Quality Index Revised (DQI-R) is a dietary assessment instrument based on 10 dietary recommendations reflecting dietary guidelines and policy in the United States.
The objective of this study was to assess the reproducibility and validity of the DQI-R as measured by use of food-frequency questionnaires (FFQs).
Diet was assessed separately by two FFQs at a 1-y interval and by two 1-wk diet records. DQI-R scores were computed from each method. Venous blood specimens were collected for measurement of dietary biomarkers. Participants (n = 127) were men aged 40-75 y in a validation study of the Health Professionals Follow-up Study.
Mean DQI-R scores were 69.5 for FFQ-1, 67.2 for FFQ-2, and 62.0 for the diet records out of a possible score of 100. The reproducibility correlation for the 2 FFQ scores was 0.72. Correlations between scores for each of the 2 FFQs and diet records were 0.66 (FFQ-1) and 0.72 (FFQ-2). DQI-R scores from FFQ-2 were directly correlated with plasma biochemical measurements of alpha-carotene (r = 0.43, P < 0.0005), beta-carotene (r = 0.35, P < 0.005), lutein (r = 0.31, P <0.005), and alpha-tocopherol (r = 0.25, P < 0.05) and were inversely correlated with plasma total cholesterol (r = -0.22, P < 0.05).
These data indicate reasonable reproducibility and validity of the DQI-R as assessed by an FFQ. Future studies are needed to examine whether this index and other instruments of diet quality can reliably predict disease outcomes.
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