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Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

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Dietary patterns and mental health after myocardial infarction
Rius-Ottenheim, Nathaly ; Kromhout, Daan ; Sijtsma, Femke P.C. ; Geleijnse, Johanna M. ; Giltay, Erik J. - \ 2017
PLoS ONE 12 (2017)10. - ISSN 1932-6203
Background: Diet has been associated with better mental health in general populations, but less is known on this association in patients with a history of coronary heart disease. The objective of this study is to examine the cross-sectional associations between dietary patterns and mental health in elderly patients with a history of myocardial infarction. Methods: Data were drawn from the final assessment of the Alpha Omega cohort that monitored patients with a history of myocardial infarction (age range 60–80 years). 2171 patients with complete data for diet and mental health were included in this study. Diet was assessed with the 203-item Food Frequency Questionnaire, and subsequently categorized into two scores: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). Depressive symptoms, assessed with the Geriatric Depression Scale (GDS-15), and dispositional optimism, assessed with the 4-item questionnaire (4Q), were cross-sectionally analyzed in relation to dietary patterns using linear regression analysis. Results: Patients were on average 72.2 years old and 79.5% were male. The DHNaFS score was associated with less depressive symptoms and higher dispositional optimism (β = -0.108; P<0.001; and β = 0.074; P<0.001), whereas no associations were found with the DUNaFS score. Particularly, consumption of vegetables, fruits, whole grains, fish, and low fat-dairy were associated with less depressive symptoms and higher optimism. Similar associations were found when analyzing the association between average DHNaFS score over the preceding 41 months with depression β = -0.085; P<0.001) and higher dispositional optimism (β = 0.084; P<0.001). Conclusions: A healthy dietary pattern, in particular a higher consumption of vegetables, fruit, whole grains, fish and low-fat dairy, was associated with less depressive symptoms and higher optimism. However, given the cross-sectional nature of our analyses, our findings may also be explained by more optimistic participants making healthier food choices. Therefore, future prospective or interventions studies are needed to establish the direction of causality of this association. Trial registration: ClinicalTrials.gov NCT03192410.
Healthy eating and survival among elderly men with and without cardiovascularmetabolic diseases
Sijtsma, F.P.C. ; Soedamah-Muthu, S.S. ; Hoon, Sabine de; Jacobs, D.R. ; Kromhout, D. - \ 2015
Nutrition, Metabolism & Cardiovascular Diseases 25 (2015)12. - ISSN 0939-4753 - p. 1117 - 1124.
Background and aims
The strength of the associations of dietary scores with cardiovascular disease (CVD) and all-cause mortality in elderly vary considerably between a priori scores. To assess whether healthy eating lowers the risk of CVD and all-cause mortality among elderly men.

Methods and results
The Zutphen Elderly Study (age 65–84 years) was divided into men with (n = 210) and without (n = 616) cardiovascular-metabolic diseases at baseline in 1985. Diet was assessed with the cross-check dietary history method. We created the “Dutch Healthy Nutrient and Food Score” (DHNaFS) and the “Dutch Undesirable Nutrient and Food Score” (DUNaFS). Associations of the scores with CVD and all-cause mortality were assessed using multivariable Cox regression models. Associations of scores with life years gained used general linear models.

During a median follow-up of 10.6 years (IQR 5.8–15.9) 806 participants died, of whom 359 from CVD. In all men, diet scores did not predict death. Among men with cardiovascular-metabolic diseases, DHNaFS was associated with lower CVD (HR: 0.57; 95% CI: 0.35–0.93) and all-cause mortality risk (HR: 0.64; 95% CI: 0.44–0.94) comparing the highest vs. the lowest score tertiles. Men with cardiovascular-metabolic diseases in the highest vs. the lowest tertile of the DHNaFS lived approximately 2.5 years longer. The DHNaFS was not associated with CVD and all-cause mortality in men without cardiovascular-metabolic diseases. The DUNaFS was not associated with any of the outcomes.

Conclusion
A high quality diet was associated with a 40% lower mortality risk and 2.5 years longer life expectancy in elderly men with, but not without, cardiovascular-metabolic diseases.

Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment
Sijtsma, F.P.C. ; Soedamah-Muthu, S.S. ; Goede, J. de; Oude Griep, L.M. ; Geleijnse, J.M. ; Kromhout, D. - \ 2015
American Journal of Clinical Nutrition 102 (2015)6. - ISSN 0002-9165 - p. 1527 - 1533.
Background: Little is known about dietary scores and mortality
risk in cardiac patients who are well treated with drugs with attendant
relatively low risk of cardiovascular diseases (CVDs).
Objective: We assessed whether healthy eating lowers the risk of
CVD and all-cause mortality in cardiac patients.
Design: We included 4307 patients from the Alpha Omega Trial aged
60–80 y with a clinically diagnosed myocardial infarction and monitored
mortality for 10 y. Diet was assessed at baseline (2002–2006)
with a validated 203-item food-frequency questionnaire. We created 2
dietary scores on the basis of nonoverlapping sets of foods: the Dutch
Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable
Nutrient and Food Score (DUNaFS). The associations of both
dietary scores with CVD and all-cause mortality were assessed by
using multivariable-adjusted Cox regression models.
Results: The median time after myocardial infarction at baseline was
3.7 y (IQR: 1.7–6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3–
7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost
to follow-up. A substantially higher average amount of DHNaFS foods
(w1750 g/d) than DUNaFS foods (w650 g/d) was consumed. Almost
all patients received drug treatment: 86% used statins, 90% used antihypertensive
medication, and 98% used antithrombotic medication. Patients
in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55,
0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower
all-cause mortality risk than did patients in the first quintile. The
DUNaFS was unrelated to both CVD and all-cause mortality.
Conclusion: Beyond state-of-the-art drug treatment, healthy eating
was associated with a lower risk of CVD and all-cause mortality in
cardiac patients. This trial was registered at clinicaltrials.gov as
NCT00127452. Am J Clin Nutr doi: 10.3945/ajcn.115.112276.
Hartpillen maken gezond eten niet overbodig
Ramaker, R. ; Sijtsma, F.P.C. - \ 2015
Resource: weekblad voor Wageningen UR 10 (2015)7. - ISSN 1874-3625 - p. 9 - 9.
hartziekten - patiënten - gezondheidsvoedsel - dieetadvisering - voeding en gezondheid - overleving - heart diseases - patients - health foods - diet counseling - nutrition and health - survival
Hartpatiënten hebben een kleinere kans te overlijden naarmate ze gezonder eten, zelfs als ze de beste medicijnencocktail krijgen. Dat stelt Femke Sijtsma in haar proefschrift. Deze uitkomsten laten volgens Sijtsma zien dat gezonde voeding een verschil blijft maken, ook naast de beste zorg met bijvoorbeeld bloeddrukverlagers, cholesterolverlagers en antistollingsmiddelen.
Dietary patterns, biomarkers of atherosclerosis, cardiovascular and all-cause mortality
Sijtsma, F.P.C. - \ 2015
Wageningen University. Promotor(en): Daan Kromhout; D.R. Jacobs, co-promotor(en): Sabita Soedamah-Muthu. - Wageningen : Wageningen University - ISBN 9789462575493 - 207
dieet - hart- en vaatziekten - atherosclerose - prognostische merkers - ziektemerkers - mortaliteit - classificatiesystemen - epidemiologie - longitudinaal onderzoek - diet - cardiovascular diseases - atherosclerosis - prognostic markers - disease markers - mortality - classification systems - epidemiology - longitudinal studies

Summary belonging to the thesis entitled ‘Dietary patterns, biomarkers of atherosclerosis, cardiovascular and all-cause mortality’

The long history of epidemiologic studies on diet and cardiovascular disease (CVD) has traditionally relied on analysis of specific nutrients or foods. Dietary patterns are multiple dietary components operationalized as a single exposure; they reflect the entire diet. In general, two methods are used to define dietary patterns: 1) theoretically, or a priori, defined dietary scores and 2) empirically, or a posteriori, derived dietary patterns. A priori dietary scores were developed to assess diet quality based on adherence to dietary patterns or recommendations. An example of an ‘a posteriori’ approach is factor analysis (e.g. principal components analysis (PCA)). Factor analysis reduces data into patterns based upon intercorrelations between nutrients or foods. The aim of this thesis was to create, examine and compare several dietary patterns and indices and assess these in relation to both early stage markers of CVD (markers of endothelial function and oxidative stress) and to mortality from CVD and all-causes.

In chapter 2 we described the creation of the A Priori Diet Quality Score, representing overall diet quality in the Coronary Artery Risk Development in Young Adults (CARDIA) study. The CARDIA study included 5115 black and white men and women, aged 18-30 at baseline (1985-86). Diet was assessed diet at baseline, year 7(1992-93) and 20 (2005-06) examinations. The A Priori Diet Quality Score summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. In 2652 participants with 3 diet assessments, the mean (±SD) A Priori Diet Quality Score increased from 64.1± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was primarily attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age matched time trend), decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. Consumption of positively rated food groups tended to increase and negatively rated food groups tended to decrease, and were similar in direction across demographic groups.

In chapter 3 we used the ‘A Priori Diet Quality Score’ and two dietary patterns derived using principal components analysis (PCA) the ‘Fruit and Vegetables’ dietary pattern and the ‘Meat’ dietary pattern in the CARDIA study. We studied prospective associations of the ‘A Priori Diet Quality Score’, the ‘Fruit and Vegetables’ dietary pattern and the ‘Meat’ dietary pattern with cellular adhesion molecules (CAMs). The ‘Fruit and Vegetables’ dietary pattern was characterized by high intakes of fruit, vegetables, and whole grains and the ‘Meat’ dietary pattern by high intakes of red meat, refined grain, and butter. The ‘A Priori Diet Quality Score’ was related to all CAMs. The ‘Fruit and Vegetables’ dietary pattern was related to E-selectin and sICAM-1 but not to P-selectin and VCAM. The ‘Meat’ dietary pattern was related to all CAMs except VCAM. Strongest associations were for the ‘Meat’ dietary pattern with E-selectin (effect size 28% of an SD (+3.9/13.7 ng/mL)) and P-selectin (effect size 37% of an SD (+4.1/11.2 ng/mL)) and the ‘A Priori Diet Quality Score’ with sICAM-1 (effect size 34% of an SD (-15.1/44.7 ng/mL)) and VCAM (effect size of 26% of an SD (-45.1/170.3 ng/mL)).

Chapter 4 described prospective associations of the A Priori Diet Quality Score, ‘Fruit and Vegetables’ dietary pattern and ‘Meat’ dietary pattern and a plasma biomarker of lipid peroxidation, F2-isoprostanes also in the CARDIA study. We estimated associations between each dietary pattern and plasma F2-isoprostanes cross-sectionally (at year 20, n=2736) and prospectively (year 0/7 average diet and year 15/20 average F2-isoprostanes, n=2718). In the cross-sectional analysis, the A Priori Diet Quality Score and the ‘Fruit and Vegetables’ dietary pattern were inversely, and the ‘Meat’ dietary pattern was positively, associated with F2-isoprostanes (all p values <0.001). These associations were also statistically significant in prospective analysis.

In chapter 5 we described a food classification system derived from the Food-based Dietary Guidelines in the Netherlands that can be used to systematically and objectively classify foods in relation to their effects on health. Classification criteria for each food group were developed based on presumed positive, neutral or negative effects on chronic diseases of five nutrients: four that likely increase (saturated fatty acids, mono-trans unsaturated fatty acids, sodium, and added sugar) and one that likely decreases (dietary fiber) the risk of chronic diseases. This classification system also provided a framework to create food-based dietary scores for epidemiologic research on diet and chronic disease relationships.

Chapter 6 describes the creation of two dietary scores the ‘Dutch Healthy Nutrient and Food Score’ and the ‘Dutch Undesirable Nutrient and Food Score’ based on the food classification system described in chapter 5 in the Alpha Omega Trial. The Alpha Omega Trial is a randomized controlled trial; however the current analyses were done from an observational prospective cohort perspective (with adjustment for intervention groups). We included 4307 cardiac patients aged 60-80 years and monitored mortality for 10 years. Patients in the highest quintile of the ‘Dutch Healthy Nutrient and Food Score’ had 30% (HR 0.70; 95% CI 0.55-0.91) lower CVD and 32% (HR 0.68; 95%CI 0.47-0.99) lower all-cause mortality risk compared to patients in the first quintile. The ‘Dutch Undesirable Nutrient and Food Score’ was unrelated to both CVD and all-cause mortality.

In Chapter 7 we also created a ‘Dutch Healthy Nutrient and Food Score’ and a ‘Dutch Undesirable Nutrient and Food Score’ in the Zutphen Elderly Study. We assessed the association of these scores with 25 year CVD and all-cause mortality and life-years gained. We divided the men (age 65-84 years) into those with (n=210) and without (n=616) cardiovascular-metabolic diseases at baseline in 1985. During a median follow-up of 10.6 years (IQR 5.8-15.9) 806 participants died, of whom 359 from CVD. Diet scores did not predict death in all men. Among men with cardiovascular-metabolic diseases, ‘Dutch Healthy Nutrient and Food Score’ was associated with lower CVD (HR: 0.57; 95%CI: 0.35-0.93) and all-cause mortality risk (HR: 0.64; 95% CI: 0.44-0.94) comparing highest vs. lowest tertiles of the score. Men with cardiovascular-metabolic diseases in the highest vs. lowest tertile of the ‘Dutch Healthy Nutrient and Food Score’ lived 2.5 year longer. The ‘Dutch Healthy Nutrient and Food Score’ was not associated with CVD and all-cause mortality in men without cardiovascular-metabolic diseases. The ‘Dutch Undesirable Nutrient and Food Score’ was not associated with any of the outcomes.

In Chapter 8 we summarized the main findings of this thesis and reflected on some methodological considerations. First, we discussed the different approaches to derive dietary scores and patterns and the advantages and disadvantages of these methods. Second, we reflected on important aspects for creating a priori dietary scores and on further research. Finally, the general conclusions and implications were presented.

From the results presented in this thesis we conclude that adherence to a healthy diet is inversely associated with early stage markers of CVD (markers of endothelial function and oxidative stress), CVD and all-cause mortality. In summary, a healthy diet consists of plenty of vegetables and fruit, legumes, whole grains, nuts and seeds, moderate intake of fish/poultry/lean meats and low fat dairy, and limited intake of processed meats, refined grains, sugar sweetened beverages, ready meals and snacks. However, this thesis also showed that a high quality dietary pattern can be achieved in several different ways, and may differ among populations.

Diet quality and markers of endothelial function: The CARDIA study
Sijtsma, F.P.C. ; Meyer, K.A. ; Steffen, L.M. ; Horn, L. van; Shikany, J.M. ; Odegaard, A.O. ; Gross, M.D. ; Kromhout, D. ; Jacobs, D.R. - \ 2014
Nutrition, Metabolism & Cardiovascular Diseases 24 (2014)6. - ISSN 0939-4753 - p. 632 - 638.
cardiovascular-disease risk - plasma-concentrations - atherosclerosis mesa - young-adults - inflammation - patterns - dysfunction - biomarkers - men
Background and aim: Dietary patterns are associated cross-sectionally with cellular adhesion molecules (CAMs). We studied prospective associations of three dietary patterns with CAMs. Methods and results: In the Coronary Artery Risk Development in Young Adults (CARDIA) study, diet was assessed at years 0 (1985-86) and 7 (1992-93) examinations. Four circulating CAMs (E-selectin, P-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), and vascular cellular adhesion molecule (VCAM)) were assayed at years 7 and 15 (2000-01). We created one index score "A Priori Diet Quality Score" and derived dietary patterns using principal components analysis (PCA). Multivariable linear regression models predicted year 15 CAMs from averaged (year 0/7) dietary patterns. The A Priori Diet Quality Score rated 46 food groups beneficial, neutral or adverse based on hypothesized health effects. We derived two PCA dietary patterns: "fruit and vegetables (FV)" (high intakes of fruit, vegetables, and whole grains) and "meat" (high intakes of red meat, refined grain, and butter). All dietary patterns were related to E-selectin and sICAM-1. P-selectin was not related to the FV dietary pattern. VCAM was only related to the A Priori Diet Quality Score. Strongest associations were for the meat dietary pattern with E-selectin (effect size 28% of an SD (+3.9/13.7 ng/mL)) and P-selectin (effect size 37% of an SD (+4.1/11.2 ng/mL)) and the A Priori Diet Quality Score with sICAM-1 (effect size 34% of an SD (-15.1/44.7 ng/mL)) and VCAM (effect size of 26% of an SD (-45.1/170.3 ng/mL)). Conclusion: This prospective analysis suggests that dietary patterns are associated with CAMs. (C) 2014 Elsevier B. V. All rights reserved.
Abstract P106: Classification of Foods - An Example from the Netherlands
Sijtsma, F.P.C. ; Werkman, A. ; Soedamah-Muthu, S.S. ; Breedveld, Boudewijn C. ; Jacobs, D.R. ; Kromhout, D. - \ 2013
The stability of dietary patterns derived applying reduced rank regression: the Zutphen Elderly Study
Jankovic, N. ; Feskens, E.J.M. ; Soedamah-Muthu, S.S. ; Sijtsma, F.P.C. ; Kampman, E. ; Boshuizen, H.C. ; Groot, C.P.G.M. de; Kromhout, D. ; Streppel, M.T. - \ 2012
Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study
Sijtsma, F.P.C. ; Meyer, K.A. ; Steffen, L.M. ; Shikany, J.M. ; Horn, L. van; Harnack, L.J. ; Kromhout, D. ; Jacobs, D.R. - \ 2012
American Journal of Clinical Nutrition 95 (2012)3. - ISSN 0002-9165 - p. 580 - 586.
cardiovascular-disease risk - atherosclerosis mesa - patterns - cardia - health - adolescence - population - energy - cohort - men
Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985–2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18–30 y at year 0 (1985–1986)] assessed diet at examinations at study years 0, 7 (1992–1993), and 20 (2005–2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups. Results: In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups. Conclusions: The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist.
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