Category Archive for: ‘Diet’
A healthful diet and lifestyle is related to low CVD risk
A Mediterranean style diet, a high level of physical activity, not smoking and moderate alcohol consumption were all associated with low 10-year risk of CHD and CVD in the European HALE project. A very low risk of these diseases was observed in elderly men who had four compared to those who had none or one healthful diet and lifestyle factor. We estimate that among elderly men who did not adhere to a low-risk lifestyle pattern, 64% of deaths due to CHD and 61% due to CVD might have been prevented based on the observed risk differences.
Among elderly men, the more healthful factors of diet and lifestyle the lower the CVD mortality observed. More than 60% of CVD mortality was associated with lack of adherence to the low-risk pattern. This finding implies that even at advanced ages those who follow a Mediterranean style diet and maintain a healthful lifestyle are less likely to die from CVD.
Flavan-3-ol intake related to CHD but not to stroke
An average intake of monomeric flavan-3-ols of 124 mg/d, compared to an average intake of 25 mg/d, was associated with a 51% lower 10-year CHD mortality in the Zutphen Elderly Study. Tea is a rich source of both flavan-3-ols and flavonols. Therefore we analyzed also the intake of tea, flavan-3-ols not from tea and flavonols not from tea in relation to fatal CHD. Tea and flavan-3-ols not from tea were inversely related to fatal CHD but flavonols from other sources than tea were not associated. These results suggest that a high intake of flavan-3-ols is related to a low risk of fatal CHD independent of flavonols. In contrast, flavan-3-ols intake was not associated with 10-year stroke incidence.
Measuring flavan-3-ols (catechins)
Flavan-3-ols are a subclass of flavonoids, an extended class of chemically related compounds ubiquitously present in plant foods. Evidence from controlled experiments in people shows that one of the flavan-3-ols, epicatechin, has favorable effects on endothelial function, blood pressure and insulin resistance. The richest sources of flavan-3-ols are tea, apples and chocolate (cocoa).
Omega-3 fatty acids associated with lower risk of depressive symptoms
A cross-sectional analysis of the Zutphen Elderly Study showed that men with an average daily intake of the fish fatty acids EPA-DHA (407 mg per day), followed for 10 years, had a 54% lower risk of depressive symptoms compared to those with an average daily intake of 21 mg/d. An explanation for this association might be that low levels of EPA-DHA are associated with low levels of neurotransmitters and with markers of inflammation and endothelial dysfunction.
B-vitamins not related to depressive symptoms
Major depression is associated with with lower blood levels of B-vitamins. The B-vitamins folate, vitamin B6 and B12 are involved in the production of neurotransmitters and low levels are associated with depression. However, in a cross-sectional analysis the intake of B-vitamins was not related to depressive symptoms in the Zutphen Elderly Study.
Fish consumption related to lower cognitive decline.
In the Zutphen Elderly Study fish consumers had significantly less cognitive decline after 5 years than non-users. Similar results were obtained for the intake of the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).
Fish consumption related to lower cognitive decline
In the Zutphen Elderly Study fish consumers had less cognitive decline than non-users after 3 years of follow-up. However, this association was not statistically significant. After extending the follow-up period to 5 years this association became statistically significant.
Moderate intake fatty acids EPA-DHA associated with lower cognitive decline
An average difference in consumption of 380 mg of EPA-DHA per day was associated with a significant difference in cognitive decline after 5 years of follow-up. These results suggest that a moderate intake of EPA-DHA may postpone cognitive decline.
Coffee may promote cognitive function in contrast to alcohol and smoking
In elderly men of the FINE study, moderate coffee drinking was associated with less cognitive decline, while alcohol consumption and tobacco-smoking were not related to cognition.
Coffee associated with less cognitive decline
The least cognitive decline was observed for elderly men who consumed 3 cups of coffee/day. It was 4 times less than the decline among non-consumers. The association between coffee consumption and cognitive decline over a 10-year period was investigated in the FINE study. In Finland, 90% of the elderly men drank coffee, while 95% did so in The Netherlands and 50% in Italy.
Alcohol and smoking not related to cognitive decline
Alcohol consumption was not related to cognitive decline in men without CVD or diabetes at entry. About 80% of the elderly men in Zutphen used alcohol while only 5% drank as many as 3 drinks per day. There was also no association between cigarette smoking and cognitive decline in men without CVD or diabetes at entry. In Zutphen, only 23% of men aged 70-89 smoked cigarettes.
Low alcohol intake associated with low all-cause mortality and better survival
Among regular consumers of alcoholic beverages in the Zutphen Study, average alcohol intake increased from 8 g/d in 1960 to 18 g/d in 1985 and then decreased to 13 g/d in 2000. All-cause mortality during 40 years of follow-up was 25% lower in men who drank less than 20 g alcohol per day and on average 6 g/d compared to non-drinkers. Men average aged 50 with a long-term regular alcohol intake of 20 g/d or less, had a 2.3 years longer life expectancy than those who did not use alcohol.
Wine drinkers had the best life expectancy
The life expectancy of wine drinkers (average age 50, average alcohol intake 2 g/d) was 4.7 years longer compared to those who did not use alcohol. For those who consumed on average 8 g/d alcohol as beer or spirits the difference in life expectancy from non-alcohol drinkers was 2.2 years.
Healthy diet associated with low all-cause mortality
A Healthy Diet Indicator (HDI) score was calculated based on the 1990 Guidelines of WHO on prevention of chronic diseases for men aged 50-70 from Finland, The Netherlands and Italy. The 20-year all-cause mortality was 13% lower in the group with the highest compared to the lowest HDI.
Mediterranean diet related to low all-cause mortality
In the HALE project the Mediterranean Diet Score (MDS) was associated with a 18% lower and the Mediterranean Adequacy Index (MAI) with a 17% lower 10-year all-cause mortality. The MDS and the MAI were both based on foods characteristic of the traditional Mediterranean diet in the 1960s. Within these dietary patterns, grains, fruit and fish were most strongly and inversely related to all-cause mortality.
All three scores indicated that a healthy dietary pattern is associated with a lower all-cause mortality.
The lignan MAT might be inversely related to CHD
The median total lignan intake in elderly men in Zutphen was 977 microgram/d. The intake of the lignan MAT (matairesinol) was significantly inversely related to 15-year fatal CHD – in contrast to the total lignan intake which was unrelated. The inverse association between MAT and CHD mortality could be due to an associated factor such as wine consumption.
How to measure lignans
Lignans are diphenolic compounds present in plant foods (and not to be confused with lignin, one of the dietary fibers). We studied the lignans LARI (lariciresinol), PINO (pinoresinol), SECO (secoisolariciresionol) and MAT. These molecules are converted to enterolignans by the intestinal microflora and possess estrogen-like activities.
We developed a method to measure the four lignans in foods and beverages. The most abundant lignan sources are flaxseed and sesame seeds. In the Zutphen Elderly Study most of the lignans came from tea, vegetables, bread, coffee, fruit and wine.
A Mediterranean style diet was consistently associated with lower cardiovascular risk
Adhering to a Mediterranean style diet was associated with a 39% lower coronary mortality risk and a 29% lower cardiovascular mortality risk in middle-aged and elderly European men and women in the HALE project. The Mediterranean diet score we used was based on eight basic food groups: bread, legumes, vegetables, fruit, fish, fats, dairy products and meats. A high intake of bread, legumes, vegetables, fruit and fats rich in unsaturated fatty acids, a moderate intake of fish and a low intake of dairy and meat was characteristic of a Mediterranean diet.
Measuring habitual diets
The HALE project dealt with European elderly men and women participating in the FINE and the SENECA Studies. They were 70-90 years old at baseline and were followed for 10 years. In both studies the dietary history was recorded as the measure of habitual food consumption.
CVD Main topics
A high saturated fat intake, a low flavonoid intake and smoking are associated with high CHD mortality rates
Three factors combined – saturated fat, flavonoids and smoking – account for 90% of the differences in 25-year CHD mortality rates among the 16 cohorts in the Seven Countries Study. In univariable models average saturated fat intake at baseline was strongly associated with CHD mortality, while average flavonoid intake was inversely related. The prevalence of smoking at baseline was not related to CHD mortality rates. However, multivariable modeling showed that saturated fat and smoking were positively and that flavonoid intake was inversely related to CHD mortality rates.
Interpretation of the results
Based on mechanistic studies confirming these associations we conclude that saturated fat increases the cholesterol rich LDL-lipoprotein fraction and the risk of atherosclerosis. Smoking promotes LDL oxidation that might be offset by the strong antioxidant effects of flavonoids. Trials showed that replacing saturated with polyunsaturated fat reduces CHD risk. Prospective cohort studies found that stopping smoking and a high intake of flavonoids are associated with a lowered CHD risk. These results found at the population level in the Seven Countries Study are thus in agreement with those obtained in experimental and prospective cohort studies, strenghtening the interpretation of cause and prevention.