Staff Publications

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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Direct comparison of metabolic health effects of the flavonoids quercetin, hesperetin, epicatechin, apigenin and anthocyanins in high-fat-diet-fed mice
Hoek-van den Hil, E.F. ; Schothorst, E.M. van; Stelt, I. van der; Swarts, J.J.M. ; Vliet, M.A. van; Amolo, T. ; Vervoort, J.J.M. ; Venema, D.P. ; Hollman, P.C.H. ; Rietjens, I.M.C.M. ; Keijer, J. - \ 2015
Genes & Nutrition 10 (2015)4. - ISSN 1555-8932 - 13 p.
cardiovascular-disease - mediterranean diet - c57bl/6j mice - obese mice - bioavailability - polyphenols - inflammation - metaanalysis - cholesterol - prevention
Dietary flavonoid intake is associated with reduced risk of cardiovascular diseases, possibly by affecting metabolic health. The relative potency of different flavonoids in causing beneficial effects on energy and lipid metabolism has not been investigated. Effects of quercetin, hesperetin, epicatechin, apigenin and anthocyanins in mice fed a high-fat diet (HF) for 12 weeks were compared, relative to normal-fat diet. HF-induced body weight gain was significantly lowered by all flavonoids (17–29 %), but most by quercetin. Quercetin significantly lowered HF-induced hepatic lipid accumulation (71 %). Mesenteric adipose tissue weight and serum leptin levels were significantly lowered by quercetin, hesperetin and anthocyanins. Adipocyte cell size and adipose tissue inflammation were not affected. The effect on body weight and composition could not be explained by individual significant effects on energy intake, energy expenditure or activity. Lipid metabolism was not changed as measured by indirect calorimetry or expression of known lipid metabolic genes in liver and white adipose tissue. Hepatic expression of Cyp2b9 was strongly downregulated by all flavonoids. In conclusion, all flavonoids lowered parameters of HF-induced adiposity, with quercetin being most effective.
Health Gain by Salt Reduction in Europe: A Modelling Study
Hendriksen, M.A.H. ; Raaij, J.M.A. van; Geleijnse, J.M. ; Breda, J. ; Boshuizen, H.C. - \ 2015
PLoS One 10 (2015)3. - ISSN 1932-6203
dietary-sodium intake - h urinary sodium - cardiovascular-disease - cost-effectiveness - blood-pressure - heart-failure - adults - prevention - risk - interventions
Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goal, it would reduce the prevalence of stroke from 10.1% in Finland to 23.1% in Poland. Ischemic heart disease would decrease by 6.6% in Finland to 15.5% in Poland. The number of postponed deaths would be 102,100 (0.9%) in France, and 191,300 (2.3%) in Poland. A reduction of salt intake to 5 grams per day is expected to substantially reduce the burden of cardiovascular disease and mortality in several European countries.
Low 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 levels are independently associated with macroalbuminuria, but not with retinopathy and macrovascular disease in type 1 diabetes: the EURODIAB prospective complications study
Engelen, L. ; Schalkwijk, C.G. ; Eussen, S.J.P.M. ; Scheijen, J.L.J.M. ; Soedamah-Muthu, S.S. ; Chaturvedi, N. ; Fuller, J.H. ; Stehouwer, C.D. - \ 2015
Cardiovascular Diabetology 14 (2015). - ISSN 1475-2840 - 9 p.
glomerular-filtration-rate - vitamin-d deficiency - microvascular complications - cardiovascular-disease - risk-factors - 1,25-dihydroxyvitamin d-3 - endothelial function - mortality - markers - determinants
Background Low circulating levels of total vitamin D [25(OH)D] and 25(OH)D3 have been associated with vascular complications in few studies on individuals with type 1 diabetes. However, these measures are affected by UV light exposure. Circulating 25(OH)D2, however, solely represents dietary intake of vitamin D2, but its association with complications of diabetes is currently unknown. We investigated the associations between 25(OH)D2 and 25(OH)D3 and the prevalence of albuminuria, retinopathy and cardiovascular disease (CVD) in individuals with type 1 diabetes. Methods We measured circulating 25(OH)D2 and 25(OH)D3 in 532 individuals (40¿±¿10 years old, 51 % men) with type 1 diabetes who participated in the EURODIAB Prospective Complications Study. Cross-sectional associations of 25(OH)D2 and 25(OH)D3 with albuminuria, retinopathy and CVD were assessed with multiple logistic regression analyses adjusted for age, sex, season, BMI, smoking, HbA1c, total-HDL-cholesterol-ratio, systolic blood pressure, antihypertensive medication, eGFR, physical activity, alcohol intake, albuminuria, retinopathy and CVD, as appropriate. Results Fully adjusted models revealed that 1 nmol/L higher 25(OH)D2 and 10 nmol/L higher 25(OH)D3 were associated with lower prevalence of macroalbuminuria with ORs (95 % CI) of 0.56 (0.43;0.74) and 0.82 (0.72;0.94), respectively. These vitamin D species were not independently associated with microalbuminuria, non-proliferative and proliferative retinopathy or CVD. Conclusions In individuals with type 1 diabetes, both higher 25(OH)D2 and 25(OH)D3 are associated with a lower prevalence of macroalbuminuria, but not of retinopathy and CVD. Prospective studies are needed to further examine the associations between 25(OH)D2 and 25(OH)D3 and the development of microvascular complications and CVD in type 1 diabetes.
Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women’s Health
Schoenaker, D.A.J.M. ; Soedamah-Muthu, S.S. ; Callaway, L.K. ; Mishra, G.D. - \ 2015
American Journal of Clinical Nutrition 102 (2015)1. - ISSN 0002-9165 - p. 94 - 101.
coronary-heart-disease - cardiovascular-disease - mediterranean diet - gestational hypertension - preeclampsia - metaanalysis - consumption - cohort - supplementation - prevention
Background: Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. Objective: We investigated associations between prepregnancy dietary patterns and risk of HDPs. Design: We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors. Results: During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81). Conclusions: In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.
Socio-economic status and ethnicity are independently associated with dietary patterns: the HELIUS-Dietary Patterns study
Dekker, L.H. ; Nicolau, M. ; Dam, R.M. van; Vries, J.H.M. de - \ 2015
Food and Nutrition Research 59 (2015). - ISSN 1654-661X - 12 p.
cardiovascular-disease - food-consumption - british adults - united-states - random sample - risk-factors - life-style - health - netherlands - europe
Background: Differences in dietary patterns between ethnic groups have often been observed. These differences may partially be a reflection of differences in socio-economic status (SES) or may be the result of differences in the direction and strength of the association between SES and diet. Objective: We aimed to examine ethnic differences in dietary patterns and the role of socio-economic indicators on dietary patterns within a multi-ethnic population. Design: Cross-sectional multi-ethnic population-based study. Setting: Amsterdam, the Netherlands. Subjects: Principal component analysis was used to identify dietary patterns among Dutch (n1,254), South Asian Surinamese (n425), and African Surinamese (n784) participants. Levels of education and occupation were used to indicate SES. Linear regression analysis was used to examine the association between ethnicity and dietary pattern scores first and then between socio-economic indicators and dietary patterns within and between ethnic groups. Results: ‘Noodle/rice dishes and white meat’, ‘red meat, snacks, and sweets’ and ‘vegetables, fruit and nuts’ patterns were identified. Compared to the Dutch origin participants, Surinamese more closely adhered to the ‘noodle/rice dishes and white meat’ pattern which was characterized by foods consumed in a ‘traditional Surinamese diet’. Closer adherence to the other two patterns was observed among Dutch compared to Surinamese origin participants. Ethnic differences in dietary patterns persisted within strata of education and occupation. Surinamese showed greater adherence to a ‘traditional’ pattern independent of SES. Among Dutch participants, a clear socio-economic gradient in all dietary patterns was observed. Such a gradient was only present among Surinamese dietary oatterns to the ‘vegetables, fruit and nuts’ pattern. Conclusions: We found a selective change in the adherence to dietary patterns among Surinamese origin participants, presumably a move towards more vegetables and fruits with higher SES but continued fidelity to the traditional diet.
Effects of the pure flavonoids epicatechin and quercetin on vascular function and cardiometabolic health: a randomized double-blind, placebo-controlled, crossover trial
Dower, J.I. ; Geleijnse, J.M. ; Gijsbers, L. ; Zock, P.L. ; Kromhout, D. ; Hollman, P.C.H. - \ 2015
American Journal of Clinical Nutrition 101 (2015)5. - ISSN 0002-9165 - p. 914 - 921.
homeostasis model assessment - reduces blood-pressure - flavanol-rich cocoa - insulin-resistance - dark chocolate - cardiovascular-disease - hypertensive subjects - endothelial function - plasma epicatechin - catechin contents
BACKGROUND: Prospective cohort studies showed inverse associations between the intake of flavonoid-rich foods (cocoa and tea) and cardiovascular disease (CVD). Intervention studies showed protective effects on intermediate markers of CVD. This may be due to the protective effects of the flavonoids epicatechin (in cocoa and tea) and quercetin (in tea). OBJECTIVE: We investigated the effects of supplementation of pure epicatechin and quercetin on vascular function and cardiometabolic health. DESIGN: Thirty-seven apparently healthy men and women aged 40-80 y with a systolic blood pressure (BP) between 125 and 160 mm Hg at screening were enrolled in a randomized, double-blind, placebo-controlled, crossover trial. CVD risk factors were measured before and after 4 wk of daily flavonoid supplementation. Participants received (-)-epicatechin (100 mg/d), quercetin-3-glucoside (160 mg/d), or placebo capsules for 4 wk in random order. The primary outcome was the change in flow-mediated dilation from pre- to postintervention. Secondary outcomes included other markers of CVD risk and vascular function. RESULTS: Epicatechin supplementation did not change flow-mediated dilation significantly (1.1% absolute; 95% CI: -0.1%, 2.3%; P = 0.07). Epicatechin supplementation improved fasting plasma insulin (¿ insulin: -1.46 mU/L; 95% CI: -2.74, -0.18 mU/L; P = 0.03) and insulin resistance (¿ homeostasis model assessment of insulin resistance: -0.38; 95% CI: -0.74, -0.01; P = 0.04) and had no effect on fasting plasma glucose. Epicatechin did not change BP (office BP and 24-h ambulatory BP), arterial stiffness, nitric oxide, endothelin 1, or blood lipid profile. Quercetin-3-glucoside supplementation had no effect on flow-mediated dilation, insulin resistance, or other CVD risk factors. CONCLUSIONS: Our results suggest that epicatechin may in part contribute to the cardioprotective effects of cocoa and tea by improving insulin resistance. It is unlikely that quercetin plays an important role in the cardioprotective effects of tea. This study was registered at as NCT01691404.
Effect of cheese consumption on blood lipids: a systematic review and meta-analysisi of randomized controlled trials
Goede, J. de; Geleijnse, J.M. ; Ding, E.L. ; Soedamah-Muthu, S.S. - \ 2015
Nutrition Reviews 73 (2015)5. - ISSN 0029-6643 - p. 259 - 275.
coronary-heart-disease - low-density-lipoprotein - fecal fat excretion - cardiovascular-disease - serum-cholesterol - normolipidemic volunteers - clinical-trials - dietary-intake - dairy foods - milk-fat
Context: Cheese may affect lipids and lipoproteins differently than other high-fat dairy foods. Objective: The present systematic review and meta-analysis was performed to evaluate randomized controlled trials that examined the effect of cheese consumption compared with another food product on blood lipids and lipoproteins. Data Sources: A systematic literature search of the MEDLINE, Embase, Scopus, CAB Abstracts, the Cochrane Controlled Trials Register, and the website was performed. Study Selection: A total of 12 randomized controlled trials (RCTs) were identified that examined the effect of cheese consumption on blood lipids and lipoproteins in healthy adults. Data Extraction: A meta-analysis of 5 RCTs that compared the effects of hard cheese and butter, both of which had a similar ratio of polyunsaturated fatty acids to saturated fatty acids (P/S ratio), was performed. Data Synthesis: Compared with butter intake, cheese intake (weighted mean difference: 145.0 g/d) reduced low-density lipoprotein cholesterol (LDL-C) by 6.5% (-0.22 mmol/l; 95%CI: -0.29 to -0.14) and high-density lipoprotein cholesterol (HDL-C) by 3.9% (-0.05 mmol/l; 95%CI: -0.09 to -0.02) but had no effect on triglycerides. Compared with intake of tofu or fat-modified cheese, cheese intake increased total cholesterol or LDL-C, as was expected on the basis of the P/S ratio of the diets. There was insufficient data to compare intake of cheese with intake of other foods. Conclusion: Despite the similar P/S ratios of hard cheese and butter, consumption of hard cheese lowers LDL-C and HDL-C when compared with consumption of butter. Whether these findings can be attributed to calcium, specific types of saturated fatty acids, or the food matrix of cheese warrants further research.
Adapting an effective lifestyle intervention towards individuals with low socioeconomic status of different ethnic origins: the design of the MetSLIM study
Teuscher, D. ; Bukman, A.J. ; Meershoek, A. ; Renes, R.J. ; Feskens, E.J.M. ; Baak, M.A. van - \ 2015
BMC Public Health 15 (2015). - ISSN 1471-2458 - 10 p.
tolerance maastricht slim - to-height ratio - glucose-tolerance - risk-factors - cardiovascular-disease - physical-activity - health-promotion - screening tool - implementation - prevalence
Background People with low socioeconomic status (SES) and some ethnic minorities are often underrepresented in lifestyle programmes. Therefore, a lifestyle programme was developed especially targeting these groups. Developing this lifestyle programme and designing an intervention study to test the effectiveness of this programme was an informative process in which several obstacles were encountered and choices had to be made. Study protocols, however, rarely describe these obstacles encountered in the protocol design process, and it is not always clear why researchers made certain choices. Therefore, the aim of this article is to describe both the final MetSLIM study protocol and the considerations and choices made in designing this study protocol. Methods/Design The developed MetSLIM study has a quasi-experimental design, targeting 30- to 70-year-old adults with an elevated waist circumference, living in deprived neighbourhoods, of Dutch, Turkish or Moroccan descent. The intervention group participates in a 12-month lifestyle programme consisting of individual dietary advice, four group sessions and weekly sports lessons. The control group receives written information about a healthy lifestyle and one group session provided by a dietician. The study contains an elaborate effect, process and economic evaluation. Outcome measures are, among other things, change in waist circumference and the other components of the metabolic syndrome. Discussion Matching the preferences of the target group, such as their preferred setting, has implications for the entire study protocol. The process evaluation of the MetSLIM study will provide insight into the consequences of the choices made in the MetSLIM study protocol in terms of reach, acceptability and delivery of the programme, and the effect and economic evaluation will provide insight into the (cost)effectiveness of the lifestyle programme in order to reduce waist circumference among individuals with low SES of different ethnic origins.
Dairy products and the risk of stroke and coronary heart disease: the Rotterdam Study
Praagman, J. ; Franco, O.H. ; Ikram, M.A. ; Soedamah-Muthu, S.S. ; Engberink, M.F. ; Rooij, F.J.A. van; Hofman, A. ; Geleijnse, J.M. - \ 2015
European Journal of Nutrition 54 (2015)6. - ISSN 1436-6207 - p. 981 - 990.
dietary-protein sources - cardiovascular-disease - consumption - population - women - cohort - food - metaanalysis - definitions - death
Purpose We examined whether consumption of total dairy and dairy subgroups was related to incident stroke and coronary heart disease (CHD) in a general older Dutch population. Methods The study involved 4,235 participants of the Rotterdam Study aged 55 and over who were free of cardiovascular disease (CVD) and diabetes at baseline (1990–1993). Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) for the intake of total dairy and dairy subgroups in relation to incident CVD events. Results Median intake of total dairy was 397 g/day, which mainly comprised low-fat dairy products (median intake of 247 g/day). During a median follow-up time of 17.3 years, 564 strokes (182 fatal) and 567 CHD events (350 fatal) occurred. Total dairy, milk, low-fat dairy, and fermented dairy were not significantly related to incident stroke or fatal stroke (p > 0.2 for upper vs. lower intake categories). High-fat dairy was significantly inversely related to fatal stroke (HR of 0.88 per 100 g/day; 95 % CI 0.79, 0.99), but not to incident stroke (HR of 0.96 per 100 g/day; 95 % CI 0.90, 1.02). Total dairy or dairy subgroups were not significantly related to incident CHD or fatal CHD (HRs between 0.98 and 1.05 per 100 g/day, all p > 0.35). Conclusions In this long-term follow-up study of older Dutch subjects, total dairy consumption or the intake of specific dairy products was not related to the occurrence of CVD events. The observed inverse association between high-fat dairy and fatal stroke warrants confirmation in other studies.
Development of the HELIUS food frequency questionnaires ethnic-specific questionnaires to assess the diet of a multiethnic population in The Netherlands
Beukers, M.H. ; Dekker, L.H. ; Boer, E.J. de; Perenboom, C.W.M. ; Meijboom, S. ; Nicolaou, M. ; Vries, J.H.M. de; Brants, H.A.M. - \ 2015
European Journal of Clinical Nutrition 69 (2015). - ISSN 0954-3007 - p. 579 - 584.
risk-factors - cardiovascular-disease - health - prevalence - europe - immigrants - chinese - cohort
Objectives: Ethnic minorities are often not included in studies of diet and health because of a lack of validated instruments to assess their habitual diets. Given the increased ethnic diversity in many high-income countries, insight into the diets of ethnic minorities is needed for the development of nutritional policies and interventions. In this paper, we describe the development of ethnic-specific food frequency questionnaires (FFQs) to study the diets of Surinamese (African and South Asian), Turkish, Moroccan and ethnic Dutch residents of The Netherlands. Methods: An existing Dutch FFQ was adapted and formed the basis for three new FFQs. Information on food intake was obtained from single 24¿h recalls. Food items were selected according to their percentage contribution to and variance in absolute nutrient intake of the respective ethnic groups. A nutrient database for each FFQ was constructed, consisting of data from the Dutch Food Composition table; data on ethnic foods were based on new chemical analyses and available international data. Results: We developed four ethnic-specific FFQs using a standardised approach that included ~200 food items each and that covered more than 90% of the intake of the main nutrients of interest. Conclusions: The developed FFQs will enable standardised and comparable assessment of the diet of five different ethnic groups and provide insight into the role of diet in differences in health between ethnic groups. The methodology described in this paper and the choices made during the development phase may be useful in developing similar FFQs in other settings.
Non-linear associations between serum 25-OH vitamin D and indices of arterial stiffness and arteriosclerosis in an older population
Dijk, S.C. van; Sohl, E. ; Oudshoorn, C. ; Enneman, A.W. ; Ham, A.C. ; Swart, K.M.A. ; Wijngaarden, J.P. van; Brouwer, E.M. ; Zwaluw, N.L. van der; Uitterlinden, A.G. ; Groot, C.P.G.M. de; Dhonukshe-Rutten, R.A.M. ; Lips, P. ; Schoor, N.M. van; Blom, H.J. ; Geleijnse, J.M. ; Feskens, E.J.M. - \ 2015
Age and Ageing 44 (2015)1. - ISSN 0002-0729 - p. 136 - 142.
nutrition examination survey - 3rd national-health - cardiovascular-disease - blood-pressure - d deficiency - risk - 25-hydroxyvitamin-d - hypertension - mortality - system
Background: several studies have been pointing towards a non-linear relationship between serum 25(OH)D and cardiovascular disease. Next to vitamin D deficiency, also higher levels of 25(OH)D have been reported to be associated with increased cardiovascular risk. We aimed to investigate the nature of the relationship between serum 25(OH)D and measures of arterial stiffness and arteriosclerosis in an elderly population. Design: cross-sectional. Setting/subjects: a subgroup of the B-PROOF study was included to determine associations between serum 25(OH)D and arterial stiffness and atherosclerosis (n = 567, 57% male, age 72.6 ± 5.6 years, mean serum 25(OH)D 54.6 ± 24.1 nmol/l). Methods: carotid intima media thickness (IMT) was assessed using ultrasonography and pulse wave velocity (PWV) was determined with applanation tonometry. Associations were tested using multivariable restricted cubic spline functions and stratified linear regression analysis. Results: the associations between serum 25(OH)D and carotid IMT or PWV were non-linear. Spline functions demonstrated a difference between 25(OH)D deficient and sufficient individuals. In serum 25(OH)D sufficient participants (=50 nmol/l; n = 287), a positive association with IMT and serum 25(OH)D was present (ß 1.24; 95%CI [0.002; 2.473]). PWV levels were slightly lower in vitamin D deficient individuals, but the association with 25(OH)D was not significant. Conclusion: our study demonstrates that associations of serum 25(OH)D and PWV and IMT in an elderly population are not linear. In particular from serum 25(OH)D levels of 50 nmol/l and up, there is a slight increase of IMT with increasing 25(OH)D levels.
The cross-sectional association between uric acid and atherosclerosis and the role of low-grade inflammation: the CODAM study
Wijnands, J.M.A. ; Boonen, A. ; Dagnelie, P.C. ; Greevenbroek, M.M.J. van; Kallen, C.J.H. van der; Ferreira, I. ; Schalkwijk, C.G. ; Feskens, E.J.M. ; Stehouwer, C.D.A. ; Linden, S. van der; Arts, I.C.W. - \ 2014
RHEUMATOLOGY 53 (2014)11. - ISSN 1462-0324 - p. 2053 - 2062.
peripheral arterial-disease - c-reactive protein - type-2 diabetes-mellitus - nitric-oxide production - metabolic syndrome - carotid atherosclerosis - cardiovascular-disease - hypertensive patients - risk-factor - subclinical atherosclerosis
Objectives. The aims of this study were to investigate (i) associations between uric acid and prevalent cardiovascular disease (CVD), ankle-arm blood pressure index (AAIx) and carotid intima-media thickness (CIMT) in the total population and in predefined subgroups according to glucose metabolism status and (ii) the extent to which these associations are explained by low-grade inflammation. Methods. Cross-sectional analyses were conducted among 530 individuals [60.6% men, mean age 58.9 years (S. D. 6.9), 52.6% normal glucose metabolism (NGM)] at increased risk of CVD from the Cohort of Diabetes and Atherosclerosis Maastricht study. A low-grade inflammation score was computed by averaging the z-scores of eight inflammation markers [CRP, TNF-alpha, IL-6, IL-8, serum amyloid A, intercellular adhesion molecule 1 (ICAM-1), ceruloplasmin and haptoglobin]. Results. After adjustment for traditional CVD risk factors, plasma uric acid (per S. D. of 81 mu mol/l) was associated with CVD in individuals with NGM [odds ratio (OR) = 1.66, 95% CI 1.06, 2.58] but not with disturbed glucose metabolism (DGM) (OR = 0.81, 95% CI 0.55, 1.19, P interaction = 0.165). Uric acid was associated with CIMT in the total population (beta = 0.024, 95% CI 0.007, 0.042) and slightly more strongly in individuals with NGM (beta = 0.030, 95% CI 0.006, 0.054) than DGM (beta = 0.018, 95% CI -0.009, 0.044, P interaction = 0.443). There was no association between uric acid and AAIx in any group (P interaction = 0.058). Uric acid was associated with low-grade inflammation in the total population (beta = 0.074, 95% CI 0.013, 0.134, P interaction = 0.737). Adding low-grade inflammation to the models did not attenuate any of the associations. Conclusion. The associations for uric acid with CIMT, and with CVD in NGM only, were not explained by low-grade inflammation. A difference in the strength of the associations between individuals with NGM and DGM was suggested.
The Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) project-design, population and data harmonization of a large-scale, international study
Boffetta, P. ; Bobak, M. ; Borsch-Supan, A. ; Brenner, H. ; Eriksson, S. ; Grodstein, F. ; Jansen, E. ; Jenab, M. ; Juerges, H. ; Kampman, E. ; Kee, F. ; Kuulasmaa, K. ; Park, Y. ; Tjonneland, A. ; Duijn, C. van; Wilsgaard, T. ; Wolk, A. ; Trichopoulos, D. ; Bamia, C. ; Trichopoulou, A. - \ 2014
European Journal of Epidemiology 29 (2014)12. - ISSN 0393-2990 - p. 929 - 936.
osteoporotic fractures - cardiovascular-disease - life-style - epidemiology - mortality - women - diet - consumption - disability - cancer
There is a public health demand to prevent health conditions which lead to increased morbidity and mortality among the rapidly-increasing elderly population. Data for the incidence of such conditions exist in cohort studies worldwide, which, however, differ in various aspects. The Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) project aims at harmonizing data from existing major longitudinal studies for the elderly whilst focussing on cardiovascular diseases, diabetes mellitus, cancer, fractures and cognitive impairment in order to estimate their prevalence, incidence and cause-specific mortality, and identify lifestyle, socioeconomic, and genetic determinants and biomarkers for the incidence of and mortality from these conditions. A survey instrument assessing ageing-related conditions of the elderly will be also developed. Fourteen cohort studies participate in CHANCES with 683,228 elderly (and 150,210 deaths), from 23 European and three non-European countries. So far, 287 variables on health conditions and a variety of exposures, including biomarkers and genetic data have been harmonized. Different research hypotheses are investigated with meta-analyses. The results which will be produced can help international organizations, governments and policy-makers to better understand the broader implications and consequences of ageing and thus make informed decisions.
Relationship of coagulation and fibrinolytic variables with arterial structure and function in Africans
Pieters, M. ; Boshuizen, H.C. ; Lange, Z. de; Schutte, A.E. ; Schutte, R. ; Greeff, M. ; Ariens, R.A.S. - \ 2014
Thrombosis Research 134 (2014)1. - ISSN 0049-3848 - p. 78 - 83.
tissue-plasminogen-activator - individual participant metaanalysis - ischemic-heart-disease - cardiovascular-disease - myocardial-infarction - plasma-fibrinogen - edinburgh artery - risk-factors - inflammatory markers - hemostatic factors
Introduction: Although both coagulation and fibrinolysis are associated with cardiovascular disease (CVD) the underlying nature and pathways of many of these associations are still unclear. Our aim was to determine which of the current or 5-year prior levels of total fibrinogen, fibrinogen gamma', plasminogen activator inhibitor-1 (PAI-1(act)) and global fibrinolytic potential were the stronger determinant of arterial structure and function. Materials and methods: This prospective study consisted of 2010 Africans over the age of 35 years with 5-year follow-up data available for 1288 participants. Cardiovascular measurements included arterial stiffness, blood pressure and carotid intima media thickness. Results: Fibrinogen gamma' showed stronger associations with blood pressure than total fibrinogen also in the presence of other CVD risk factors. PAI-1(act) was positively associated with blood pressure both cross-sectionally and prospectively, with the longitudinal association being the stronger determinant, also after adjustment for known CVD risk factors. Clot lysis time (CLT) was positively associated, both prospectively and crosssectionally, with intima media thickness and negatively with markers of arterial stiffness but not after adjustment for known CVD risk factors. Conclusions: Fibrinogen gamma' was more strongly associated with CVD function than total fibrinogen. PAI-1(act) was significantly associated with blood pressure with changes in PAI-1 levels preceding changes in blood pressure. Different mechanisms may be at play determining arterial wall stiffness/thickening and blood pressure as observed from the opposing associations with PAI-1act and CLT. CLT was not independently related to cardiovascular measures as its associations were weakened in the presence of other known CVD risk factors. (C) 2014 Elsevier Ltd. All rights reserved.
LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies
Ras, R.T. ; Geleijnse, J.M. ; Trautwein, E.A. - \ 2014
British Journal of Nutrition 112 (2014)2. - ISSN 0007-1145 - p. 214 - 219.
placebo-controlled trials - serum-lipids - cardiovascular-disease - enriched margarines - efficacy - consumption - management - spreads - safety - diet
Phytosterols (PS, comprising plant sterols and plant stanols) have been proven to lower LDL-cholesterol concentrations. The dose-response relationship for this effect has been evaluated in several meta-analyses by calculating averages for different dose ranges or by applying continuous dose-response functions. Both approaches have advantages and disadvantages. So far, the calculation of averages for different dose ranges has not been done for plant sterols and stanols separately. The objective of the present meta-analysis was to investigate the combined and separate effects of plant sterols and stanols when classified into different dose ranges. Studies were searched and selected based on predefined criteria. Relevant data were extracted. Average LDL-cholesterol effects were calculated when studies were categorised by dose, according to random-effects models while using the variance as weighing factor. This was done for plant sterols and stanols combined and separately. In total, 124 studies (201 strata) were included. Plant sterols and stanols were administered in 129 and fifty-nine strata, respectively; the remaining used a mix of both. The average PS dose was 2.1 (range 0.2-9.0) g/d. PS intakes of 0.6-3.3 g/d were found to gradually reduce LDL-cholesterol concentrations by, on average, 6-12%. When plant sterols and stanols were analysed separately, clear and comparable dose-response relationships were observed. Studies carried out with PS doses exceeding 4 g/d were not pooled, as these were scarce and scattered across a wide range of doses. In conclusion, the LDL-cholesterol-lowering effect of both plant sterols and stanols continues to increase up to intakes of approximately 3 g/d to an average effect of 12 %.
Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study
Boers, I. ; Muskiet, F.A.J. ; Berkelaar, E. ; Schut, E. ; Penders, R. ; Hoenderdos, K. ; Jong, M.C. de; Wichers, H.J. - \ 2014
Lipids in Health and Disease 13 (2014). - ISSN 1476-511X - 13 p.
obese postmenopausal women - mediterranean-like diet - ischemic-heart-disease - hunter-gatherer - cardiovascular-disease - life-style - macronutrient - 21st-century - metaanalysis - individuals
Background The main goal of this randomized controlled single-blinded pilot study was to study whether, independent of weight loss, a Palaeolithic-type diet alters characteristics of the metabolic syndrome. Next we searched for outcome variables that might become favourably influenced by a Paleolithic-type diet and may provide new insights in the pathophysiological mechanisms underlying the metabolic syndrome. In addition, more information on feasibility and designing an innovative dietary research program on the basis of a Palaeolithic-type diet was obtained. Methods Thirty-four subjects, with at least two characteristics of the metabolic syndrome, were randomized to a two weeks Palaeolithic-type diet (n¿=¿18) or an isoenergetic healthy reference diet, based on the guidelines of the Dutch Health Council (n¿=¿14). Thirty-two subjects completed the study. Measures were taken to keep bodyweight stable. As primary outcomes oral glucose tolerance and characteristics of the metabolic syndrome (abdominal circumference, blood pressure, glucose, lipids) were measured. Secondary outcomes were intestinal permeability, inflammation and salivary cortisol. Data were collected at baseline and after the intervention. Results Subjects were 53.5 (SD9.7) year old men (n¿=¿9) and women (n¿=¿25) with mean BMI of 31.8 (SD5.7) kg/m2. The Palaeolithic-type diet resulted in lower systolic blood pressure (-9.1 mmHg; P¿=¿0.015), diastolic blood pressure (-5.2 mmHg; P¿=¿0.038), total cholesterol (-0.52 mmol/l; P¿=¿0.037), triglycerides (-0.89 mmol/l; P¿=¿0.001) and higher HDL-cholesterol (+0.15 mmol/l; P¿=¿0.013), compared to reference. The number of characteristics of the metabolic syndrome decreased with 1.07 (P¿=¿0.010) upon the Palaeolithic-type diet, compared to reference. Despite efforts to keep bodyweight stable, it decreased in the Palaeolithic group compared to reference (-1.32 kg; P¿=¿0.012). However, favourable effects remained after post-hoc adjustments for this unintended weight loss. No changes were observed for intestinal permeability, inflammation and salivary cortisol. Conclusions We conclude that consuming a Palaeolithic-type diet for two weeks improved several cardiovascular risk factors compared to a healthy reference diet in subjects with the metabolic syndrome.
Predicting major outcomes in type 1 diabetes: a model development and validation study
Soedamah-Muthu, S.S. ; Vergouwe, Y. ; Costacou, T. ; Miller, R.G. ; Zgibor, J. ; Chaturvedi, N. ; Snell-Bergeon, J.K. ; Maahs, D.M. ; Rewers, M. ; Forsblom, C. ; Harjutsalo, V. ; Groop, P.H. ; Fuller, J.H. ; Moons, K.G.M. ; Orchard, T.J. - \ 2014
Diabetologia 57 (2014)11. - ISSN 0012-186X - p. 2304 - 2314.
coronary-heart-disease - eurodiab prospective complications - all-cause mortality - cardiovascular-disease - pittsburgh epidemiology - risk-factors - intensive treatment - iddm complications - metabolic syndrome - association
Aims/hypothesis Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicted these outcomes early in the disease process would help in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts. Methods Data were analysed from 1,973 participants with type 1 diabetes followed for 7 years in the EURODIAB Prospective Complications Study. Strong prognostic factors for major outcomes were combined in a Weibull regression model. The performance of the model was tested in three different prospective cohorts: the Pittsburgh Epidemiology of Diabetes Complications study (EDC, n¿=¿554), the Finnish Diabetic Nephropathy study (FinnDiane, n¿=¿2,999) and the Coronary Artery Calcification in Type 1 Diabetes study (CACTI, n¿=¿580). Major outcomes included major CHD, stroke, end-stage renal failure, amputations, blindness and all-cause death. Results A total of 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors were age, HbA1c, WHR, albumin/creatinine ratio and HDL-cholesterol level. The discriminative ability of the model was adequate, with a concordance statistic (C-statistic) of 0.74. Discrimination was similar or even better in the independent cohorts, the C-statistics being: EDC, 0.79; FinnDiane, 0.82; and CACTI, 0.73. Conclusions/interpretation Our prognostic model, which uses easily accessible clinical features can discriminate between type 1 diabetes patients who have a good or a poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials.
Glycemic control and all-cause mortality risk in type 1 diabetes patients: the EURODIAB prospective complications study
Schoenaker, D.A.J.M. ; Simon, D. ; Chaturvedi, N. ; Fuller, J.H. ; Soedamah-Muthu, S.S. - \ 2014
Journal of Clinical Endocrinology and Metabolism 99 (2014)3. - ISSN 0021-972X - p. 800 - 807.
vascular complications - cardiovascular-disease - severe hypoglycemia - hba(1c) - trials - cohort - accord - rates - death - a1c
Context: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA1c) and all-cause mortality in patients with type 1 diabetes mellitus. Design, Setting, and Patients: A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15–60 years enrolled in the EURODIAB Prospective Complications Study. Outcome Measure: Possible nonlinearity of the association between HbA1c and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA1c 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. Results: HbA1c was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA1c compared with the reference (median HbA1c: 8.1%) following a U-shaped association [P overall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Conclusions: Results from our study in type 1 diabetes patients suggest that target HbA1c below a certain threshold may not be appropriate in this population. We recognize that these low HbA1c levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA1c will need further study.
Psychological Determinants of Consumer Acceptance of Personalised Nutrition in 9 European Countries
Poinhos, R. ; Lans, I.A. van der; Rankin, A. ; Fischer, A.R.H. ; Bunting, B. ; Kuznesof, S. ; Stewart-Knox, B. ; Frewer, L.J. - \ 2014
PLoS One 9 (2014)10. - ISSN 1932-6203 - 13 p.
protection motivation theory - food-related hazards - self-efficacy - planned behavior - cardiovascular-disease - health behavior - predictive-validity - perceived control - attitude-change - fear appeals
Objective To develop a model of the psychological factors which predict people’s intention to adopt personalised nutrition. Potential determinants of adoption included perceived risk and benefit, perceived self-efficacy, internal locus of control and health commitment. Methods A questionnaire, developed from exploratory study data and the existing theoretical literature, and including validated psychological scales was administered to N = 9381 participants from 9 European countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway). Results Structural equation modelling indicated that the greater participants’ perceived benefits to be associated with personalised nutrition, the more positive their attitudes were towards personalised nutrition, and the greater their intention to adopt it. Higher levels of nutrition self-efficacy were related to more positive attitudes towards, and a greater expressed intention to adopt, personalised nutrition. Other constructs positively impacting attitudes towards personalised nutrition included more positive perceptions of the efficacy of regulatory control to protect consumers (e.g. in relation to personal data protection), higher self-reported internal health locus of control, and health commitment. Although higher perceived risk had a negative relationship with attitude and an inverse relationship with perceived benefit, its effects on attitude and intention to adopt personalised nutrition was less influential than perceived benefit. The model was stable across the different European countries, suggesting that psychological factors determining adoption of personalised nutrition have generic applicability across different European countries. Conclusion The results suggest that transparent provision of information about potential benefits, and protection of consumers’ personal data is important for adoption, delivery of public health benefits, and commercialisation of personalised nutrition.
Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States
Jankovic, N. ; Geelen, A. ; Streppel, M.T. ; Groot, C.P.G.M. de; Kampman, E. ; Feskens, E.J.M. ; Trichopoulou, A. ; Bueno-de Mesquita, H.B. ; Franco, O.H. - \ 2014
American Journal of Epidemiology 180 (2014)10. - ISSN 0002-9262 - p. 978 - 988.
cardiovascular-disease - epic project - design - prevention - cohort - risk - determinants - rationale - quality - scores
The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988–2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States.
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