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A framework for quantifying net benefits of alternative prognostic models
Rapsomaniki, E. ; White, I.R. ; Wood, A.M. ; Thompson, S.G. ; Feskens, E.J.M. ; Kromhout, D. - \ 2012
Statistics in Medicine 31 (2012)2. - ISSN 0277-6715 - p. 114 - 130.
coronary heart-disease - cardiovascular-disease - risk score - predictive ability - roc curve - reclassification - statins - cohort - metaanalysis - validation
New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks
Antioxidative properties of flavonoids
Bowedes, T.C.F. ; Luttikhold, J. ; Stijn, M.F.M. van; Visser, M. ; Norren, K. van; Vermeulen, M.A.R. ; Leeuwen, P.A.M. - \ 2011
Current Organic Chemistry 15 (2011)15. - ISSN 1385-2728 - p. 2616 - 2626.
spontaneously hypertensive-rats - myocardial ischemia-reperfusion - low-density-lipoprotein - nf-kappa-b - prevents endothelial dysfunction - reduces blood-pressure - coronary heart-disease - green tea polyphenol - dietary polyphenols - in-vivo
Evidence accumulates that a family of plant compounds, known as flavonoids, can prevent or slow down the progression of cardiovascular diseases, cancer, inflammatory and neurodegenerative diseases. Flavonoids are considered beneficial, this is often attributed to their powerful antioxidant properties. In this role, certain types of flavonoids are considered to be far more powerful than the two most common antioxidants, vitamin C and vitamin E, at preventing cellular damage brought on by free radicals. Interestingly, flavonoids exert those activities not only through direct radical scavenging, but also through regulating nitric oxide, and chelating metals. In addition, flavonoids are thought to facilitate/promote other important biological processes, resulting in modulation of enzymes, a decrease in leukocyte immobilization, inhibition of cell proliferation and angiogenesis, and effects on signaling pathways. The results of in vitro studies have demonstrated that the antioxidative property of flavonoids is unambiguous; however it is still not supported by strong consistent evidence in vivo. Therefore, the antioxidant theory as a mechanism of action of flavonoids is controversial. As a result, flavonoids are hypothesized to exert their activities partly through cell signaling pathways. This review intends to acquaint the reader with different pathways in which flavonoids function or might function. Furthermore, we will provide insight into the beneficial health effects of these substances
Changes in Alcohol Consumption and Subsequent Risk of Type 2 Diabetes in Men
Joosten, M.M. ; Chiuve, S.E. ; Mukamal, K.J. ; Hu, F.B. ; Hendriks, H.F.J. ; Rimm, E.B. - \ 2011
Diabetes 60 (2011)1. - ISSN 0012-1797 - p. 74 - 79.
food frequency questionnaire - coronary heart-disease - middle-aged women - myocardial-infarction - insulin sensitivity - cardiovascular-disease - postmenopausal women - drinking patterns - life-style - red wine
Objective -The objective of this study was to investigate the association of four-year changes in alcohol consumption with subsequent risk of type 2 diabetes. Research Design and Methods - We prospectively examined 38,031 men from the Health Professionals Follow-up Study free of diagnosed diabetes or cancer in 1990. Alcohol consumption was reported on food frequency questionnaires and updated every four years. Results - A total of 1905 cases of type 2 diabetes occurred during 428,497 person-years of follow-up. A 7.5 g/day (~half a glass) increase in alcohol consumption over four years was associated with lower diabetes risk among initial nondrinkers (multivariable hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.60-1.00) and drinkers initially consuming
Apple and peach consumption habits across European countries
Konopacka, D. ; Jesionkowska, K. ; Kruczynska, D. ; Schoorl, F.W. - \ 2010
Appetite 55 (2010)3. - ISSN 0195-6663 - p. 478 - 483.
coronary heart-disease - antioxidant capacity - vegetable consumption - phenolic-compounds - dietary catechins - cancer - fruit - nutrition - risk - nectarine
The aim of this study was to gain information concerning apple and peach consumption frequency within different European countries in relation to age and gender. The survey was a part of a complex experiment with the aim of evaluating consumers’ preferences towards new varieties, and the data is based on the self-reported declarations of respondents, male and female, between 15 and 70 years old. 4271 consumers from 7 European countries were invited to supply information about their apple consumption habits, whereas 499 respondents from 5 countries answered questions relating to frequency of peach and nectarine consumption. In both, the apple and the peach surveys, data analysis of declared intake showed significant differences between nationalities. The highest apple consumption was in Poland, where over 55% declared a consumption of more than 5 apples per week. In comparison, Italian consumers most often indicated eating 3–5 apples per week (39.3%). The lowest apple consumption was in the Netherlands and Spain. In the case of peaches, the highest consumption was indicated in France where 48% of respondents declared a peach consumption of 3–5 per week with 40% eating more than 5 fruits per week. The lowest peach intake was declared in Germany. Irrespective of country women were shown to eat more apples that men. Furthermore, the group of older people (61–70 years) consume apples more often than the adult group (36–60), while within the youngest group of consumers (16–35) eating apples was not at all popular. As with apples females declared a higher peach consumption, and again significantly lower fruit consumption by the youngest group (16–35) was indicated. Although the availability of fruit at the market remains a prime factor in determining apple and peach consumption, our survey confirmed the trends of declining this popular fruit intake by the younger generation, as well as the persistent tendency of lower frequency of fruit consumption among men than women
Effect of a High Intake of Conjugated Linoleic Acid on Lipoprotein Levels in Healthy Human Subjects
Wanders, A.J. ; Brouwer, I.A. ; Siebelink, E. ; Katan, M.B. - \ 2010
PLoS One 5 (2010)2. - ISSN 1932-6203 - 7 p.
trans-fatty-acids - coronary heart-disease - middle-aged men - body-composition - cardiovascular-disease - lipid-metabolism - hdl cholesterol - blood-lipids - high-density - supplementation
Background -Trans fatty acids are produced either by industrial hydrogenation or by biohydrogenation in the rumens of cows and sheep. Industrial trans fatty acids lower high-density lipoprotein (HDL) cholesterol, raise low-density lipoprotein (LDL) cholesterol, and increase the risk of coronary heart disease. The effects of trans fatty acids from ruminants are less clear. We investigated the effect on blood lipids of cis-9, trans-11 conjugated linoleic acid (CLA), a trans fatty acid largely restricted to ruminant fats. Methodology/Principal Findings - Sixty-one healthy women and men were sequentially fed each of three diets for three weeks, in random order, for a total of nine weeks. Diets were identical except for 7% of energy (approximately 20 g/day), which was provided either by oleic acid, by industrial trans fatty acids, or by a mixture of 80% cis-9, trans-11 and 20% trans-10, cis-12 CLA. After the oleic acid diet, mean (± SD) serum LDL cholesterol was 2.68±0.62 mmol/L compared to 3.00±0.66 mmol/L after industrial trans fatty acids (p
Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study
Geleijnse, J.M. ; Witteman, J.C.M. ; Stijnen, T. ; Kloos, M.W. ; Hofman, A. ; Grobbee, D.E. - \ 2007
European Journal of Epidemiology 22 (2007)11. - ISSN 0393-2990 - p. 763 - 770.
coronary heart-disease - blood-pressure - dietary potassium - national-health - urinary sodium - salt intake - stroke - cohort - women - men
Background Dietary electrolytes influence blood pressure, but their effect on clinical outcomes remains to be established. We examined sodium and potassium intake in relation to cardiovascular disease (CVD) and mortality in an unselected older population. Methods A case¿cohort analysis was performed in the Rotterdam Study among subjects aged 55 years and over, who were followed for 5 years. Baseline urinary samples were analyzed for sodium and potassium in 795 subjects who died, 206 with an incident myocardial infarction and 181 subjects with an incident stroke, and in 1,448 randomly selected subjects. For potassium, dietary data were additionally obtained by food-frequency questionnaire for 78% of the cohort. Results There was no consistent association of urinary sodium, potassium, or sodium/potassium ratio with CVD and all-cause mortality over the range of intakes observed in this population. Dietary potassium estimated by food frequency questionnaire, however, was associated with a lower risk of all-cause mortality in subjects initially free of CVD and hypertension (RR = 0.71 per standard deviation increase; 95% confidence interval: 0.51¿1.00). We observed a significant positive association between urinary sodium/potassium ratio and all-cause mortality, but only in overweight subjects who were initially free of CVD and hypertension (RR = 1.19 (1.02¿1.39) per unit). Conclusion The effect of sodium and potassium intake on CVD morbidity and mortality in Western societies remains to be established.
Effect of Fish Oil on Ventricular Tachyarrhythmia and Death in Patients With Implantable Cardioverter Defibrillators: The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) Randomized Trial
Brouwer, I.A. ; Zock, P.L. ; Camm, A.J. ; Bocker, D. ; Hauer, R.N.W. ; Wever, E.F.D. ; Dullemeijer, C. ; Ronden, J.E. ; Katan, M.B. ; Lubinski, A. ; Buschler, H. ; Schouten, E.G. - \ 2006
JAMA: The Journal of the American Medical Association 295 (2006)22. - ISSN 0098-7484 - p. 2613 - 2619.
polyunsaturated fatty-acids - sudden cardiac death - serum cholesteryl esters - coronary heart-disease - dietary-intake - n-3 - prevention - risk - fibrillation - supplementation
Context Very-long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. Design, Setting, and Patients The Study on Omega-3 Fatty acids and ventricular Arrhythmia ( SOFA) was a randomized, parallel, placebo-controlled, double-blind trial conducted at 26 cardiology clinics across Europe. A total of 546 patients with implantable cardioverter-defibrillators ( ICDs) and prior documented malignant ventricular tachycardia ( VT) or ventricular fibrillation ( VF) were enrolled between October 2001 and August 2004. Patients were randomly assigned to receive 2 g/d of fish oil ( n= 273) or placebo ( n= 273) for a median period of 356 days ( range, 14-379 days). Main Outcome Measure Appropriate ICD intervention for VT or VF, or all-cause death. Results The primary end point occurred in 81 ( 30%) patients taking fish oil vs 90 ( 33%) patients taking placebo ( hazard ratio [ HR], 0.86;95% confidence interval [ CI], 0.64-1.16; P=. 33). In prespecified subgroup analyses, the HR was 0.91 ( 95% CI, 0.661.26) for fish oil vs placebo in the 411 patients who had experienced VT in the year before the study, and 0.76 ( 95% CI, 0.52-1.11) for 332 patients with prior myocardial infarctions. Conclusion Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs.
Blood pressure response to chronic intake of coffee and caffeine: a meta-analysis of randomized controlled trials
Noordzij, M. ; Uiterwaal, C.S.P.M. ; Arends, L.R. ; Kok, F.J. ; Grobbee, D.E. ; Geleijnse, J.M. - \ 2005
Journal of Hypertension 23 (2005)5. - ISSN 0263-6352 - p. 921 - 928.
type-2 diabetes-mellitus - coronary heart-disease - clinical-trials - older men - consumption - hypertension - risk - women - cholesterol - tolerance
Purpose: Coffee is a widely consumed beverage and small health effects of substances in coffee may have large public health consequences. It has been suggested that caffeine in coffee increases the risk of hypertension. We performed a meta-analysis of randomized controlled trials of coffee or caffeine and blood pressure (BP). Data identification: BP trials of coffee or caffeine published between January 1966 and January 2003 were identified through literature databases and manual serach. Study selection: A total of 16 studies with a randomized, controlled design and at least 7 days of intervention was selected, comprising 25 strata and 1010 subjects. Data extraction: Two persons independently obtained data on sample size, type and duration of intervention, changes in BP and heart rate (HR), and subjects' characteristics for each trial. Meta-analysis was performed using a random-effects model. Results: A significant rise of 2.04 mmHg [95% confidence interval (CI), 1.10-2.99] in systolic BP and 0.73 mmHg (95% CI, 0.14-1.31) in diastolic BP was found after pooling of coffee and caffeine trials. When coffee trials (n = 18, median intake: 725 ml/day) and caffeine trials (n = 7, median dose: 410 mg/day) were analysed separately, BP elevations appeared to be larger for caffeine [systolic: 4.16 mmHg (2.13-6.20); diastolic: 2.41 mmHg (0.98-3.84)] than for coffee [systolic: 1.22 mmHg (0.52-1.92) and diastolic: 0.49 mmHg (-0.06-1.04)]. Effects on HR were negligible. Conclusions: Regular caffeine intake increases BP. When ingested through coffee, however, the blood pressure effect of caffeine is small.
Polyphenols and disease risk in epidemiologic studies 1-4
Arts, I.C.W. ; Hollman, P.C.H. - \ 2005
American Journal of Clinical Nutrition 81 (2005)suppl.. - ISSN 0002-9165 - p. 317S - 325S.
coronary heart-disease - breast-cancer risk - potentially anticarcinogenic flavonoids - cardiovascular-disease - postmenopausal women - phytoestrogen intake - dietary flavonoids - united-states - male smokers - antioxidant flavonols
Plant polyphenols, a large group of natural antioxidants, are serious candidates in explanations of the protective effects of vegetables and fruits against cancer and cardiovascular diseases. Epidemiologic studies are useful for evaluation of the human health effects of long-term exposure to physiologic concentrations of polyphenols, but reliable data on polyphenol contents of foods are still scarce. The aim of this review is to summarize available epidemiologic data on the health effects of polyphenols, focusing on the flavonoid subclasses of flavonols, flavones, and catechins and on lignans. Data obtained to date suggest beneficial effects of both flavonoids and lignans on cardiovascular diseases but not on cancer, with the possible exception of lung cancer. There is a need for more research on stroke and lung diseases such as asthma and chronic obstructive pulmonary disease. Most studies to date have included only flavonols and flavones. With data becoming available for other polyphenols, these compounds should be included in future studies. Careful design of prospective studies is important to offset some of the major drawbacks of epidemiologic studies, including residual confounding (by smoking and other dietary factors) and exposure assessment.
Physical activity and stroke: a meta-analysis of observational data
Wendel-Vos, G.C.W. ; Schuit, A.J. ; Feskens, E.J.M. ; Boshuizen, H.C. ; Verschuren, W.M.M. ; Saris, W.H.M. ; Kromhout, D. - \ 2004
International Journal of Epidemiology 33 (2004)4. - ISSN 0300-5771 - p. 787 - 798.
coronary heart-disease - middle-aged men - risk-factors - follow-up - cardiovascular-diseases - cerebrovascular-disease - global burden - reduced risk - mortality - women
Background Based on studies published so far, the protective effect of physical activity on stroke remains controversial. Specifically, there is a lack of insight into the sources of heterogeneity between studies. Methods Meta-analysis of observational studies was used to quantify the relationship between physical activity and stroke and to explore sources of heterogeneity. In total, 31 relevant publications were included. Risk estimates and study characteristics were extracted from original studies and converted to a standard format for use in a central database. Results Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48¿0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78¿0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60¿0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43¿0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71¿0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57¿0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69¿0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33¿0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75¿0.90). Conclusions Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction
Bioavailability and antioxidant effects of olive oil phenols in humans: a review
Vissers, M.N. ; Katan, M.B. ; Zock, P.L. - \ 2004
European Journal of Clinical Nutrition 58 (2004)6. - ISSN 0954-3007 - p. 955 - 965.
low-density-lipoprotein - coronary heart-disease - in-vitro oxidation - virgin olive - oleic-acid - dietary oils - lipid-peroxidation - ldl oxidation - fatty-acids - rat plasma
Objective: We reviewed the bioavailability and antioxidant effects of phenols from extra virgin olive oil. Search strategy: We searched the MEDLINE database for the years 1966 - 2002. To review the bioavailability of olive oil phenols, we selected animal and human studies that studied the absorption, metabolism, and urinary excretion of olive oil phenols. We also estimated the intake of the various phenols in the Mediterranean area. To review the antioxidant effects of olive oil phenols, we included human and animal studies on the effect of olive oil phenols on markers of oxidative processes in the body. We excluded studies without a proper control treatment and studies in which the antioxidant effects of phenols could not be disentangled from those of the fatty acid composition of olive oil. Results: Bioavailability studies in humans show that the absorption of olive oil phenols is probably larger than 55 - 66 mol%, and that at least 5% is excreted in urine as tyrosol and hydroxytyrosol. Animal studies suggest that phenol-rich olive oil lowers oxidisability of ex vivo low-density lipoprotein (LDL) particles or lowers markers in urine of oxidative processes in the body. In five out of seven human studies, however, these effects of phenols were not found. There are no data on the phenol concentrations in plasma that are attainable by intake of olive oil. We estimated that 50 g of olive oil per day provides about 2 mg or similar to13 mumol of hydroxytyrosol-equivalents per day, and that the plasma concentration of olive oil phenols with antioxidant potential resulting from such an intake can be at most 0.06 mumol/l. This is much lower than the minimum concentrations of these phenols ( 50 - 100 mmol) required to show antioxidant activity in vitro. Conclusion: Although phenols from olive oil seem to be well absorbed, the content of olive oil phenols with antioxidant potential in the Mediterranean diet is probably too low to produce a measurable effect on LDL oxidisability or other oxidation markers in humans. The available evidence does not suggest that consumption of phenols in the amounts provided by dietary olive oil will protect LDL against oxidative modification to any important extent.
Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects
Elbers, J.M.H. ; Giltay, E.J. ; Teerlink, T. ; Scheffer, P.G. ; Asscheman, H. ; Seidell, J.C. ; Gooren, L.J.G. - \ 2003
Clinical Endocrinology 58 (2003)5. - ISSN 0300-0664 - p. 562 - 571.
coronary heart-disease - estrogen replacement therapy - lipoprotein particle-size - human postheparin plasma - male-female differences - body-fat distribution - postmenopausal women - cardiovascular-disease - hepatic lipase - risk-factors
objective Sex differences are found in most components of the insulin resistance syndrome and the associated cardiovascular risk profile. These differences are attributed to sex-specific sex steroid profiles, but the effects of sex steroids on the individual components of the insulin resistance syndrome remain incompletely understood. design Prospective, intervention study. subjects In 37 young (age range 16¿36 years), nonobese [body mass index (BMI) <29], transsexual subjects, effects of ethinyl oestradiol (100 µg/day) + cyproterone acetate (100 mg/day) administration were evaluated in 20 male-to-female transsexuals and of testosterone-ester administration [250 mg intramuscularly (i.m.)/2 weeks] in 17 female-to-male transsexuals. measurements We studied lipid spectrum, postheparin hepatic lipase (HL) and lipoprotein lipase (LPL) activity, blood pressure, glucose utilization (by euglycaemic hyperinsulinaemic clamp), and fat areas (by magnetic resonance imaging) at baseline and during 1-year cross-sex hormone administration. results Oestrogens + antiandrogens increased high-density lipoprotein (HDL)-cholesterol and decreased LDL-cholesterol, and HL activity, which are considered beneficial. But this combination also increased triglycerides, blood pressure, subcutaneous fat and visceral fat, and decreased the LDL-particle size, LPL activity and insulin sensitivity, which are all considered detrimental. Testosterone reduced HDL-cholesterol and the LDL-particle size, and increased triglycerides and HL activity. An android fat distribution was induced (i.e. decreased subcutaneous and increased visceral fat). Blood pressure, total and LDL-cholesterol, LPL activity and insulin sensitivity were mainly unaffected. conclusions The effects of cross-sex hormone treatment ¿ in the dosages used in this study ¿ in healthy, nonobese, young transsexual subjects do not show unequivocally that female sex steroids, given in large amounts to male subjects, have beneficial effects on cardiovascular profile and that high dose testosterone administration to female subjects is detrimental with respect to cardiovascular risk.
Myocardial infarction risk in relation to zinc concentration in toenails
Martin-Moreno, J.M. ; Gorgojo, L. ; Riemersma, R.A. ; Gomez-Aracena, J. ; Kark, J.D. ; Guillen, J. ; Jimenez, J. ; Ringstad, J.J. ; Fernandez-Crehuet, J. ; Bode, P. ; Kok, F.J. - \ 2003
British Journal of Nutrition 89 (2003)5. - ISSN 0007-1145 - p. 673 - 678.
coronary heart-disease - trace-elements - cardiovascular-disease - serum copper - magnesium - calcium - nutrition - selenium - tissue - cancer
Zn is an essential mineral. The role of Zn in atherosclerosis is not clear. Epidemiological studies, which have reported contradictory results, are limited by the use of serum Zn levels as a marker of intake. We assessed the association of toenail Zn, which integrates dietary Zn intake over 3 to 12 months, with the risk of a first myocardial infarction. Toenail Zn concentrations were determined by neutron activation analysis in the European multi-centre case–control study on antioxidants, myocardial infarction and breast cancer. This multi-centre case–control study included 684 cases and 724 controls from eight European countries and Israel. Toenail Zn levels of controls (adjusted for age and study centre) were positively associated with age, a-tocopherol and Se, but not with additional dietary variables or with classical risk factors for CHD. Average toenail Zn was 106·0 mg/kg in cases (95 % CI 103·1, 108·9) and 107·5 mg/kg in controls (95 % CI 104·5, 110·7). After controlling for cardiovascular risk factors and for centre, the adjusted odds ratios of myocardial infarction for quintiles 2–5 of toenail Zn with respect to the first quintile were 0·97 (95 % CI 0·59, 1·58), 1·15 (95 % CI 0·72, 1·85), 0·91 (95 % CI 0·56, 1·50), and 0·85 (95 % CI 0·52, 1·39). The P for trend was 0·45. In conclusion toenail Zn levels (reflecting long-term dietary intake) were not significantly associated with acute myocardial infarction.
Dietary quality, lifestyle factors and healthy ageing in Europe: the SENECA study
Haveman-Nies, A. ; Groot, C.P.G.M. de; Staveren, W.A. van - \ 2003
Age and Ageing 32 (2003). - ISSN 0002-0729 - p. 427 - 434.
self-rated health - coronary heart-disease - 20 year mortality - physical-activity - elderly people - alcohol-consumption - smoking cessation - older europeans - risk factor - men
Objective: to identify dietary and lifestyle factors that contribute to healthy ageing. Subjects: for the analyses, data of the longitudinal SENECA study were used. The study population consisted of 1091 men and 1109 women aged 70-75 years from Belgium, France, Denmark, Italy, The Netherlands, Portugal, Spain, Switzerland, and Poland. Methods: this European study started with baseline measurements in 1988-1989 and lasted until 30 April 1999. The study includes data on diet, lifestyle and health. The study population is followed for 10 years, and measurements were performed in 1988/1989 (baseline), 1993, and 1999. The relationships of the three lifestyle factors diet, physical activity, and smoking habits to survival and maintenance of health at old age were investigated. Finally it is discussed whether the relationships of healthy lifestyle habits to survival and health contribute to healthy ageing. Results: the unhealthy lifestyle habits smoking, having a low-quality diet, and being physically inactive were singly related to an increased mortality risk (hazard ratios ranged from 1.2 to 2.1). In addition, inactive and smoking persons had an increased risk for a decline in health status as compared with active and non-smoking people. The net effect of a healthy lifestyle on the process of healthy ageing is likely to go together with a compressed cumulative morbidity. Conclusions: a healthy lifestyle at older ages is positively related to a reduced mortality risk and to a delay in the deterioration in health status. This postponement of the onset of major morbidity is likely to go together with a compressed cumulative morbidity. Therefore, health promotion at older ages can contribute to healthy ageing.
Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials
Mensink, R.P. ; Zock, P.L. ; Kester, A.D.M. ; Katan, M.B. - \ 2003
American Journal of Clinical Nutrition 77 (2003). - ISSN 0002-9165 - p. 1146 - 1155.
coronary heart-disease - density-lipoprotein-cholesterol - healthy-young men - hydrogenated soybean oil - plasma-lipids - trans-fatty - palmitic acid - stearic-acid - sunflower oil - normolipidemic men
Background: The effects of dietary fats on the risk of coronary artery disease (CAD) have traditionally been estimated from their effects on LDL cholesterol. Fats, however, also affect HDL cholesterol, and the ratio of total to HDL cholesterol is a more specific marker of CAD than is LDL cholesterol. Objective: The objective was to evaluate the effects of individual fatty acids on the ratis of total to HDL cholesterol and on serum lipoproteins. Design: We performed a meta-analysis of 60 selected trials and calculated the effects of the amount and type of fat on total:HDL cholesterol and on other lipids. Results: The ratio did not change if carbohydrates replaced saturated fatty acids, but it decreased if cis unsaturated fatty acids replaced saturated fatty acids. The effect on total: HDL cholesterol of replacing trans fatty acids with a mix of carbohydrates and cis unsaturated fatty acids was almost twice as large as that of replacing saturated fatty acids. Lauric acid greatly increased total cholesterol, but much of its effect was on HDL cholesterol. Consequently, oils rich in lauric acid decreased the ratio of total to HDL cholesterol. Myristic and palmitic acids had little effect on the ratio, and stearic acid reduced the ratio slightly. Replacing fats with carbohydrates increased fasting triacylglycerol concentrations. Conclusions: The effects of dietary fats on total:HDL cholesterol may differ markedly from their effects on LDL. The effects of fats on these risk markers should not in themselves be considered to reflect changes in risk but should be confirmed by prospective observational studies or clinical trials. By that standard, risk is reduced most effectively when trans fatty acids and saturated fatty acids are replaced with cis unsaturated fatty acids. The effects of carbohydrates and of lauric acid-rich fats on CAD risk remain uncertain.
Efficacy and safety of plant stanols and sterols in the control of blood cholesterol levels
Katan, M.B. ; Grundy, S.M. ; Jones, P.J.H. ; Law, M.R. ; Miettinen, T. ; Paoletti, R. - \ 2003
Mayo Clinic Proceedings 78 (2003). - ISSN 0025-6196 - p. 965 - 978.
coronary heart-disease - sitostanol-ester-margarine - soluble antioxidant concentrations - density-lipoprotein cholesterol - mildly hypercholesterolemic population - randomized controlled-trial - plasma total-cholesterol - serum total cholesterol - e-deficient mi
Foods with plant stanol or sterol esters lower serum cholesterol levels. We summarize the deliberations of 32 experts on the efficacy and safety of sterols and stanols. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%; higher intakes added little. Efficacy is similar for sterols and stanols, but the food form may substantially affect LDL reduction. Effects are additive with diet or drug interventions: eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20%; adding sterols or stanols to statin medication is more effective than doubling the statin dose. A meta-analysis of 10 to 15 trials per vitamin showed that plasma levels of vitamins A and D are not affected by stanols or sterols. Alpha carotene, lycopene, and vitamin E levels remained stable relative to their carrier molecule, LDL. Beta carotene levels declined, but adverse health outcomes were not expected. Sterol-enriched foods increased plasma sterol levels, and workshop participants discussed whether this would increase risk, in view of the marked increase of atherosclerosis in patients with homozygous phytosterolemia. This risk is believed to be largely hypothetical, and any increase due to the small increase in plasma plant sterols may be more than offset by the decrease in plasma LDL. There are insufficient data to suggest that plant stanols or sterols either prevent or promote colon carcinogenesis. Safety of sterols and stanols is being monitored by follow-up of samples from the general population; however, the power of such studies to pick up infrequent increases in common diseases, if any exist, is limited. A trial with clinical outcomes probably would not answer remaining questions about infrequent adverse effects. Trials with surrogate end points such as intima-media thickness might corroborate the expected efficacy in reducing atherosclerosis. However, present evidence is sufficient to promote use of sterols and stanols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease.
Rationale and design of a randomised controlled clinical trial on supplemental intake of n-3 fatty acids and incidence of cardiac arrhythmia: SOFA
Brouwer, I.A. ; Zock, P.L. ; Katan, M.B. ; Hauer, R.N.W. ; Camm, A. ; Bocker, D.I. ; Terlouw, P. ; Schouten, E.G. - \ 2003
European Journal of Clinical Nutrition 57 (2003). - ISSN 0954-3007 - p. 1323 - 1330.
serum cholesteryl esters - coronary heart-disease - sudden-death - ventricular-fibrillation - myocardial-infarction - dietary-intake - fish consumption - prevention - risk - angioplasty
Background: Evidence from earlier studies indicates that intake of very long-chain n-3 polyunsaturated fatty acids (n-3 PUFA, also named omega-3 fatty acids) as present in fish oil reduces the risk of sudden death. Sudden death forms a major part of mortality from cardiovascular disease and is in most cases a direct consequence of cardiac arrhythmia. n-3 PUFA may exert their protective effect through reducing the susceptibility for cardiac arrhythmia. Objective: To investigate the effect of n-3 PUFA on the incidence of recurrent ventricular arrhythmia. This paper presents the rationale, design and methods of the Study on Omega-3 Fatty acids and ventricular Arrhythmia (SOFA) and discusses problems encountered in conducting a multicentre clinical trial on food. Design: A randomised, parallel, placebo-controlled, double blind intervention study, which obeys the guidelines for Good Clinical Practice. Setting: Multiple cardiology centres in Europe. Subjects: A total of 500 patients with an implantable cardioverter defibrillator (ICD). An ICD detects, treats and stores cardiac arrhythmic events in its memory chip. Interventions: Patients receive either 2 g/day of fish oil, containing approximately 450 mg eicosapentaenoic acid and 350 mg docosahexaenoic acid, or placebo for 12 months. Primary outcome: Spontaneous ventricular tachyarrhythmias as recorded by the ICD or all-cause mortality. Conclusion: SOFA is designed to answer the question whether intake of n-3 PUFA from fish-a regular food ingredient-can reduce the incidence of life-threatening cardiac arrhythmia. If this proves to be true, increasing the intake of n-3 PUFA could be an easy, effective and safe measure to prevent fatal arrhythmia in the general population.
Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk
Woollard, J. ; Burke, V. ; Beilin, L.J. ; Verheijden, M.W. ; Bulsara, M.K. - \ 2003
Journal of Cardiovascular Risk 10 (2003). - ISSN 1350-6277 - p. 31 - 40.
coronary heart-disease - food-frequency questionnaire - physicians - trial - hypertensives - reduction - promotion - pressure - barriers - fish
Background General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in all groups with no significant changes related to the programme. Design In a randomized controlled trial, trained nurse-counsellors delivered cognitive behavioural programmes aiming to reduce cardiovascular risk in patients with hypertension, Type 2 diabetes mellitus or coronary heart disease. Of 591 eligible patients from seven general practices in Perth, Western Australia, 212 agreed to participate and were randomized to one of three groups. In the 'Low' intervention (n = 69), monthly telephone contacts for 1 year followed one face-to-face individual counselling session; in the 'High' intervention (n = 74) individual face-to-face counselling continued over 1 year, taking place monthly, for up to 1 h; Controls (n = 69) received usual care only. Participants were assessed at baseline with follow-up 12 and 18 months later. Results Follow-up assessments were attended by 77,71 and 65% of the Control,'Low' and 'High' groups, respectively. Total fat intake fell by 9,12 and 5% in the 'High','Low' and Control groups, respectively, at 12 months and by 2, 10 and 5% at 18 months. Total serum cholesterol fell by 3, 3 and 2% in the 'High','Low' and 'Control' groups, respectively, at 12 months and by 7, 5 and 8% at 18 months. Conclusions Programmes using nurse-counsellors were not significantly more successful than usual care from general practitioners, consistent with reported benefits of lifestyle advice from primary-care physicians. J Cardiovasc Risk 10:31-40 (C) 2003 Lippincott Williams Wilkins.
Nutrition guidance in Dutch family practice: behavioral determinants of reduction of fat consumption
Verheijden, M.W. ; Veen, J.E. van der; Zadelhoff, W.M. van der; Bakx, C. van; Koelen, M.A. ; Hoogen, H.J.M. van den; Weel, C. van; Staveren, W.A. van - \ 2003
American Journal of Clinical Nutrition 77 (2003)4. - ISSN 0002-9165 - p. 1058S - 1064S.
coronary heart-disease - transtheoretical model - self-efficacy - dietary intervention - cardiovascular risk - planned behavior - randomized trial - field experiment - general-practice - saturated fat
Background: Studies have shown that the psychosocial determinants attitude, self-efficacy, subjective norm, and health threat are important in predicting intention to change fat consumption. However, the role of habit in relation to these determinants is still largely unknown. Objective: We aimed to assess whether and how habit influences intention in relation to attitude, self-efficacy, subjective norm, and health threat. Design: Cross-sectionally, we studied the self-reported psychosocial determinants and intention of 105 (52 intervention, 53 control) patients who participated in a family practice-based tailored nutrition counseling intervention study for lowering cardiovascular risk. Fat intake 15 mo before the assessment of psychosocial determinants was used as a measure of habit. We used logistic regression analyses to develop a model predicting intention to change fat consumption. Results: Our regression model explained 43% of the variance in intention. Patients who perceived higher subjective norm or more social support had a higher intention. Habit was a significant predictor of intention in interaction with self-efficacy and health threat. Attitude, health threat, age, and group membership (ie, whether patients had been in the intervention group or the control group of the intervention study) were also included in the regression model. Conclusions: The results suggest that habit in addition to subjective norm and the other more frequently investigated psychosocial determinants are important in predicting intention to change fat consumption. To achieve sustainable health improvement through nutrition education programs, these programs should therefore start focusing more on subjective norm and habit.
Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project
Slimani, N. ; Fahey, M. ; Welch, A.A. ; Wirfalt, E. ; Stripp, C. ; Bergstrom, E. ; Linseisen, J. ; Schulze, M.B. ; Bamia, C. ; Chloptsios, Y. ; Veglia, F. ; Panico, S. ; Bueno de Mesquita, B. ; Ocké, M.C. ; Brustadt, M. ; Lund, E. ; Gonzalez, C.A. ; Barcos, A. ; Berglund, G. ; Winkvist, A. ; Mulligan, A. ; Appleby, P. ; Overvad, K. ; Tjonneland, A. ; Clavel-Chapelon, F. ; Kesse, E. ; Ferrari, P. ; Staveren, W.A. van; Riboli, E. - \ 2002
Public Health Nutrition 5 (2002)6B. - ISSN 1368-9800 - p. 1311 - 1328.
coronary heart-disease - mediterranean diet - potential confounders - measurement error - nutrient intake - breast-cancer - life-style - risk - epidemiology - men
Objective: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Design and setting: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. Subjects: In total, 35 955 men and women, aged 35–74 years, participating in the EPIC nested calibration study. Results: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK ‘health-conscious’ group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. Conclusions: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.