Category Archive for: ‘Foods’
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.
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.
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
An ancient believe was that chocolate strengthens the heart
As early as the 18th century chocolate was believed to ‘strengthen the heart’. In 1999 we found that chocolate is a rich source of flavan-3-ols (catechins), a subclass of flavonoids. The flavan-3-ols in chocolate are a component of cocoa.
Cocoa associated with lower CVD mortality
The Zutphen Elderly Study found that a high intake of cocoa was associated with a low risk of CVD. The median cocoa intake in the highest group was 4.2 g/d, which equals approximately 10 g of dark chocolate per day. These men had a 50% lower 15-year CVD mortality compared to those who did not use cocoa.
This association of cocoa with CVD mortality may be due to epicatechin, one of the major monomeric flavan-3-ols. Evidence from controlled experiments in people shows that epicatechin has favorable effects on endothelial function, blood pressure and insulin resistance. These risk factors might explain the inverse association between cocoa intake and fatal CHD.
Tea inversely related to coronary heart disease risk
In 1985 the average consumption of black tea in the Zutphen men was approximately 3 cups per day. Elderly men who drank more than 4 cups of tea per day had a 60% lower risk of fatal CHD after 5 years of follow-up, when compared to those who drank less than 2 cups of per day.
Higher tea consumption associated with lower stroke incidence
The average tea consumption in the period 1960-1970 was related to non-fatal and fatal stroke incidence over the next 15-years. Middle-aged men who drank on average at least 5 cups of tea per day had a 3 times lower stroke incidence than those who drank less than 2.5 cups per day.
Potentially, the effects of tea on CHD and stroke might be due to its high content of flavonoids – compounds with potential beneficial properties.
Wine associated with lower cardiovascular risk
Wine drinkers in Zutphen who at entry of the study consumed less than 20 g alcohol from wine per day – the equivalent of 2 glasses – had a 39% lower risk of coronary death and a 32% lower risk of overall cardiovascular mortality. Consumption of beer and spirits was related neither to long-term coronary or cardiovascular mortality. These results are compatible with the idea, but do not establish, that a low intake of wine may protect against CVD.
Continuous increase in wine consumption over time in Zutphen
In the Zutphen Study information on alcoholic drinks consumed was collected by questionnaire seven times between 1960 and 2000. Regular wine consumption increased from 2% of the men to 40%. Of the wine consumed, 70% was red. The percentage of beer drinkers was approximately 40% in the period 1960-1970 and fell to about 25% in the period 1985-2000. The percentage of men drinking spirits increased from 15% in 1960 to 55% in 1985 and did not change thereafter.
Many Mediterranean diets
Ancel Keys and his Italian colleague Flaminio Fidanza and their SCS colleagues were central to the modern recognition, definition, and promotion of the eating pattern they found in Italy and Greece in the 1950s and ’60s, now popularly called “The Mediterranean Diet”. Ancel Keys was the first researcher who associated the traditional Mediterranean diet with a low risk of CHD. However, the Mediterranean diet does not exist. The Mediterranean Sea borders 18 countries that differ markedly in geography, economic status, health, lifestyle and diet.
Traditional Mediterranean diets had olive oil as their principal component of fat, were high in cereal products, legumes, fruit and vegetables, moderate in fish and low in dairy and meat products. Moderate amounts of wine were taken with meals. The traditional Mediterranean diets were nutritionally adequate with a varying amounts of total fat, low in saturated fat and very low in trans fat, rich in fiber and in antioxidant vitamins or flavonoids.
Mediterranean diets in the the Seven Countries Study in the 1960s
The Seven Countries Study included four Mediterranean cohorts: Crete and Corfu in Greece, Dalmatia in Croatia and Montegiorgio in Italy. In the 1960s the Greek diet had the highest content of olive oil and was high in fruit, the Dalmatian diet was highest in fish and the Italian diet was high in vegetables. In line with their diet, these cohorts were characterized by low mortality rates from CHD.
- Keys, Ancel and Margaret. Eat well and stay well. Doubleday, 1959.
- Kromhout et al. Am J Clin Nutr 1989;49:889-94
- Fidanza Proc Nutr Soc 1991;50:519-26
CVD Main topics
Large differences in alcohol intake between Italy and The Netherlands
In the rural Italian cohorts and in Zutphen information on alcohol consumption was collected with the cross-check dietary history method among all men. In the 1960s the average alcohol intake in the rural Italian cohorts was more than 80 g/day, while less than 10 g/day in the Zutphen cohort.
Moderate alcohol use associated with low CVD risk
In rural Italian and in Zutphen men a J-shaped relation was observed between alcohol intake at entry and CHD mortality. In Italian men the lowest 15-year CHD risk was observed in the mid-range (third quintile) of alcohol intake. A 30% lower CHD risk among alcohol users compared to non-users was found throughout the range of use up to 80 g per day. Zutphen men using less than 20 g per day, compared to non-users, had 30% lower CVD mortality during 40 years of follow-up. Above 20g/day the CVD risk was greater.
These results are compatible with a protective effect of alcohol for CHD risk in Italy and CVD risk in The Netherlands in the low range of 1-20 g/day intake. The Italian data showed that the possible protective effect of alcohol on CHD keeps until very high levels of alcohol intake. Also other studies in Mediterranean areas reported a higher protective effect of alcohol than countries outside the Mediterranean. This may be due to differences in consumption pattern. Northern European men used mainly beer and spirits outside meals and men in Mediterranean areas consumed mostly wine with meals.
Eating fish associated with lower risk of fatal CHD and stroke
The Zutphen Study showed in 1985 that eating fish once or twice a week compared to eating no fish was associated with a 50% lower 20-year fatal CHD risk.
In 1994 we also found that fish consumption was inversely associated with a 50% lower incidence of non-fatal and fatal stroke.
Fatty fish compared to lean fish
The Finnish, Dutch and Italian cohorts showed that men eating fatty fish (e.g. mackerel and herring) had a 34% lower 20-year CHD mortality risk compared to those eating no fish. The consumption of lean fish, such as plaice and cod, had no comparable association with lower CHD risk.
Analysis of the dietary data repeatedly collected between 1960 and 2000 in the Zutphen Study also showed that eating fatty fish but not lean fish was inversely associated with long-term risk of sudden coronary death.
- Kromhout et al. N Engl J Med 1985;312:1205-9
- Keli et al. Stroke 1994;25:328-32
- Oomen et al. Am J Epidemiol 2000;151:999-1006
- Streppel et al. Eur Heart J 2008;29:2024-30