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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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Lifestyle factors and mortality risk in individuals with diabetes mellitus: are the associations different from those in individuals without diabetes?
Sluik, D. ; Boeing, H. ; Li, K. ; Fons Johnsen, N. ; Tjonneland, A. ; Arriola, L. ; Barricarte, A. ; Masala, G. ; Grioni, S. ; Tumino, R. ; Ricceri, F. ; Matiello, A. ; Spijkerman, A.M.W. ; A, D.L. van der; Sluijs, I. van der - \ 2014
Diabetologia 57 (2014)1. - ISSN 0012-186X - p. 63 - 72.
food frequency questionnaire - american-heart-association - cardiovascular-disease - multiple imputation - relative validity - physical-activity - clinical-research - missing data - dietary-fat - cancer
Aims/hypothesis Thus far, it is unclear whether lifestyle recommendations for people with diabetes should be different from those for the general public. We investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes. Methods Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Joint Cox proportional hazard regression models of people with and without diabetes were built for the following lifestyle factors in relation to overall mortality risk: BMI, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking. Likelihood ratio tests for heterogeneity assessed statistical differences in regression coefficients. Results Multivariable adjusted mortality risk among individuals with diabetes compared with those without was increased, with an HR of 1.62 (95% CI 1.51, 1.75). Intake of fruit, legumes, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk. These associations were significantly different in magnitude from those in diabetes-free individuals, but directions were similar. No differences between people with and without diabetes were detected for the other lifestyle factors. Conclusions/interpretation Diabetes status did not substantially influence the associations between lifestyle and mortality risk. People with diabetes may benefit more from a healthy diet, but the directions of association were similar. Thus, our study suggests that lifestyle advice with respect to mortality for patients with diabetes should not differ from recommendations for the general population.
All-cause mortality risk of metabolically healthy abdominal obese individuals: The EPIC-MORGEN study
A, D.L. van der; Nooyens, A.J.C. ; Duijnhoven, F.J.B. van; Verschuren, M.W.W. ; Boer, J.M. - \ 2014
Obesity 22 (2014)2. - ISSN 1930-7381 - p. 557 - 564.
physical-activity questionnaire - food frequency questionnaire - relative validity - cardiovascular-disease - mho individuals - cohort profile - weight-loss - women - prevalence - men
Objective It appears that a certain proportion of obese individuals have a normal metabolic profile despite having excess weight. Whether these so-called “metabolically healthy” obese express lower disease and mortality risks than “metabolically unhealthy” obese is still unclear. The mortality risk of “metabolically healthy” abdominal obese (MHAO) individuals was investigated. Design and Methods Prospective cohort study (EPIC-MORGEN) among 22,654 individuals aged 20-59 years followed for an average of 13.4 years (SD 2.3). MHAO was assessed at baseline (1993-1997) and defined as abdominal obesity (waist circumference =102 cm/=88 cm (men/women)) with normal glucose, blood pressure, and plasma lipids. All-cause mortality risks adjusted for age and sex were estimated using Cox proportional hazards models. Results Individuals who were “metabolically healthy” nonabdominal obese (MHNAO) comprised the reference group. As compared to MHNAO, mortality risk for MHAO was around 40% higher (Hazard ratio (HR) 1.43; 95% confidence interval (CI): 1.00-2.04) and of the same magnitude as that for “metabolically unhealthy” nonabdominal obese (MUNAO) (HR 1.31; 95% CI: 1.08-1.59). The HR for MUAO was 1.99 (95% CI: 1.62-2.43). Conclusions Mortality risk of MHAO individuals was significantly higher than that of MHNAO individuals and lower than, but not statistically significantly different from, that of MUAO individuals.
Estimating the mediating effect of different biomarkers on the relation of alcohol consumption with the risk of type 2 diabetes
Beulens, J.W.J. ; Schouw, Y.T. van der; Moons, K.G.M. ; Boshuizen, H.C. ; A, D.L. van der; Groenwold, R.H.H. - \ 2013
Annals of Epidemiology 23 (2013)4. - ISSN 1047-2797 - p. 193 - 197.
coronary-heart-disease - food frequency questionnaire - high-density-lipoprotein - myocardial-infarction - postmenopausal women - insulin sensitivity - epic-nl - moderate - metaanalysis - validity
Purpose Moderate alcohol consumption is associated with a reduced type 2 diabetes risk, but the biomarkers that explain this relation are unknown. The most commonly used method to estimate the proportion explained by a biomarker is the difference method. However, influence of alcohol–biomarker interaction on its results is unclear. G-estimation method is proposed to accurately assess proportion explained, but how this method compares with the difference method is unknown. Methods In a case–cohort study of 2498 controls and 919 incident diabetes cases, we estimated the proportion explained by different biomarkers on the relation between alcohol consumption and diabetes using the difference method and sequential G-estimation method. Results Using the difference method, high-density lipoprotein cholesterol explained the relation between alcohol and diabetes by 78% (95% confidence interval [CI], 41–243), whereas high-sensitivity C-reactive protein (-7.5%; -36.4 to 1.8) or blood pressure (-6.9; -26.3 to -0.6) did not explain the relation. Interaction between alcohol and liver enzymes led to bias in proportion explained with different outcomes for different levels of liver enzymes. G-estimation method showed comparable results, but proportions explained were lower. Conclusions The relation between alcohol consumption and diabetes may be largely explained by increased high-density lipoprotein cholesterol but not by other biomarkers. Ignoring exposure–mediator interactions may result in bias. The difference and G-estimation methods provide similar results.
Adherence to the WHO's Healthy Diet Indicator and Overall Cancer Risk in the EPIC-NL Cohort
Berentzen, N.E. ; Beulens, J.W. ; Hoevenaar-Blom, M.P. ; Kampman, E. ; Bueno-de-Mesquita, H.B. ; Romaguera-Bosch, D. ; Peeters, P.H.M. ; May, A.M. - \ 2013
PLoS One 8 (2013)8. - ISSN 1932-6203
major chronic disease - food frequency questionnaire - guidelines-for-americans - colorectal-cancer - physical-activity - dairy-products - relative validity - prevention - quality - netherlands
Background: A healthy dietary pattern defined by international recommendations of the World Health Organisation (WHO) has been shown to reduce overall mortality risk. It is unknown whether this healthy dietary pattern is associated with overall cancer incidence. Design: In total 35,355 men and women within the Dutch European Prospective Investigation into Cancer and Nutrition-cohort were followed for cancer occurrence. Diet was assessed through a validated food-frequency questionnaire. We computed a dietary score for all participants based on the seven WHO dietary guidelines for the prevention of chronic diseases (Healthy Diet Indicator (HDI)). We used the existing HDI score based on the 1990 WHO guidelines, and adapted it to meet with the 2002 WHO guidelines. Multivariate-adjusted Cox proportional hazards analysis was used to examine the association between adherence to the HDI and subsequent overall cancer risk. Results: A number of 3,007 new cancers were identified during a mean follow-up of 12.7 years. Adherence to the HDI was not associated with a reduced overall cancer risk. The hazard ratio (HR) of overall cancer associated with a one-point increment of the HDI was 0.96 (95% CI 0.89-1.03) in men, and 1.00 (95% CI 0.96-1.04) in women. Adherence to the HDI was not associated with smoking-related cancer ((HR men: 0.94 (95% CI 0.84-1.04); HR women: 1.00 (95% CI 0.94-1.07)), or alcohol-related cancer ((HR men: 1.02 (95% CI 0.87-1.20); HR women: 1.03 (95% CI 0.98-1.08)). Conclusions: Greater adherence to the WHO's Healthy Diet Indicator, a dietary pattern for prevention of chronic diseases, was not associated with reduced overall, smoking-related or alcohol-related cancer risk in men or women.
Alcohol consumption before and after breast cancer diagnosis: associations with survival from breast cancer, cardiovascular disease, and other causes
Newcomb, P.A. ; Kampman, E. ; Trentham-Dietz, A. ; Egan, K.M. ; Titus, L.J. ; Baron, J.A. ; Hampton, J.M. ; Passarelli, M.N. ; Willett, W.C. - \ 2013
Journal of Clinical Oncology 31 (2013)16. - ISSN 0732-183X - p. 1939 - 1946.
food frequency questionnaire - progesterone-receptor status - hormone replacement therapy - national death index - womens health - risk-factors - postmenopausal women - mammographic density - prognostic-factors - physical-activity
Purpose Alcohol intake is associated with increased risk of breast cancer. In contrast, the relation between alcohol consumption and breast cancer survival is less clear. Patients and Methods We assessed pre- and postdiagnostic alcohol intake in a cohort of 22,890 women with incident invasive breast cancer who were residents of Wisconsin, Massachusetts, or New Hampshire and diagnosed from 198 to 200 at ages 20 to 79 years. All women reported on prediagnostic intake; a subsample of 4,881 reported on postdiagnostic intake. Results During a median follow-up of 11.3 years from diagnosis, 7,780 deaths occurred, including 3,484 resulting from breast cancer. Hazard ratios (HR) and 95% CIs were estimated. Based on a quadratic analysis, moderate alcohol consumption before diagnosis was modestly associated with disease-specific survival (compared with nondrinkers, HR = 0.93 [95% CI, 0.85 to 1.02], 0.85 [95% CI, 0.75 to 0.95], 0.88 [95% CI, 0.75 to 1.02], and 0.89 [95% CI, 0.77 to 1.04] for two or more, three to six, seven to nine, and = 10 drinks/wk, respectively). Alcohol consumption after diagnosis was not associated with disease-specific survival (compared with nondrinkers, HR = 0.88 [95% CI, 0.61 to 1.27], 0.80 [95% CI, 0.49 to 1.32], 1.01 [95% CI, 0.55 to 1.87], and 0.83 [95% CI, 0.45 to 1.54] for two or more, three to six, seven to nine, and = 10 drinks/wk, respectively). Results did not vary by beverage type. Women consuming moderate levels of alcohol, either before or after diagnosis, experienced better cardiovascular and overall survival than nondrinkers. Conclusion Overall alcohol consumption before diagnosis was not associated with disease-specific survival, but we found a suggestion favoring moderate consumption. There was no evidence for an association with postdiagnosis alcohol intake and breast cancer survival. This study, however, does provide support for a benefit of limited alcohol intake for cardiovascular and overall survival in women with breast cancer.
Dietary amino acids and the risk of hypertension in a Dutch older population: the Rotterdam Study
Altorf-van der Kuil, W. ; Engberink, M.F. ; Neve, M. De; Rooij, F.J.A. van; Hofman, M.K. ; Veer, P. van 't; Witteman, J.C.M. ; Franco, O.H. ; Geleijnse, J.M. - \ 2013
American Journal of Clinical Nutrition 97 (2013)2. - ISSN 0002-9165 - p. 403 - 410.
food frequency questionnaire - blood-pressure - arginine intake - protein-intake - disease - trial - men - supplementation - association - intermap
Background: Inverse associations between dietary protein and hypertension have been reported, which may be attributed to specific amino acids. Objective: We examined whether the intake of glutamic acid, arginine, cysteine, lysine, or tyrosine was associated with blood pressure (BP) levels (n = 3086) and incident hypertension (n = 1810) in the Rotterdam Study. Design: We calculated BP levels in quartiles of amino acid intake as a percentage of total protein intake (% of protein) with adjustment for age, sex, BMI, smoking, alcohol intake, education, and dietary factors. Subsequently, we used Cox proportional models that included the same confounders to evaluate the associations between specific amino acid intake and hypertension incidence. Results: Glutamic acid contributed most to protein intake (21% of protein), whereas lysine provided 7%, arginine 5%, tyrosine 4%, and cysteine 1.5%. A higher intake of tyrosine (~0.3% of protein) was significantly related to a 2.4 mm Hg lower systolic BP (P-trend = 0.05) but not to diastolic BP (P = 0.35). The other amino acids were not significantly associated with BP levels in a cross-sectional analysis. During 6 y of follow-up (7292 person-years), 873 cases of hypertension developed. None of the amino acids were significantly associated with incident hypertension (HR: 0.81–1.18; P-trend > 0.2). Conclusion: Our data do not suggest a major role for glutamic acid, arginine, lysine, tyrosine, or cysteine intake (as % of of protein intake) in determining population BP or risk of hypertension.
Dairy Intake and Coronary Heart Disease or Stroke – a population-based cohort study in the Netherlands
Dalmeijer, G.W. ; Struijk, E.A. ; Schouw, Y.T. van der; Soedamah-Muthu, S.S. ; Verschuren, W.M.M. ; Geleijnse, J.M. - \ 2013
International Journal of Cardiology 167 (2013)3. - ISSN 0167-5273 - p. 925 - 929.
food frequency questionnaire - blood-pressure - cardiovascular-disease - relative validity - risk - fat - reproducibility - metaanalysis - menaquinone - consumption
AIM: This study aimed to investigate the relationship between total dairy intake and dairy subtypes (high-fat dairy, low-fat dairy, milk and milk products, cheese and fermented dairy) with incident coronary heart disease (CHD) and stroke. METHODS: EPIC-NL is a prospective cohort study among 33,625 Dutch men and women. At baseline (1993-1997), dairy intake was measured with a validated food frequency questionnaire (FFQ). The incidence of both fatal and non-fatal CHD and stroke was obtained by linkage to the national registers. RESULTS: During 13years follow-up, 1648 cases of CHD and 531 cases of stroke were documented. Total dairy intake was not significantly associated with risk of CHD (hazard ratio per standard deviation (SD) increase=0.99; 95%-CI: 0.94-1.05) or stroke (0.95; 0.85-1.05) adjusted for lifestyle and dietary factors. None of the dairy subtypes was to CHD, while only fermented dairy tended to be associated (p=0.07) with a lower risk of stroke (0.92; 0.83-1.01). Hypertension appeared to modify the association of total and low-fat dairy with CHD (p interaction
Dietary supplement use is not associated with recurrence of colorectal adenomas : a prospective cohort study
Heine-Bröring, R.C. ; Winkels, R.M. ; Botma, A. ; Wahab, P.J. ; Tan, A.C.I.T.L. ; Nagengast, F.M. ; Witteman, B.J.M. ; Kampman, E. - \ 2013
International Journal of Cancer 132 (2013)3. - ISSN 0020-7136 - p. 666 - 675.
food frequency questionnaire - health interview survey - vitamin-d - united-states - life-style - folic-acid - antioxidant vitamins - relative validity - clinical-trial - cancer risk
Diet and lifestyle influence colorectal adenoma recurrence. The role of dietary supplement use in colorectal adenoma recurrence remains controversial. In this prospective cohort study, we examined the association between dietary supplement use, total colorectal adenoma recurrence and advanced adenoma recurrence. Colorectal adenoma cases (n = 565) from a former case–control study, recruited between 1995 and 2002, were prospectively followed until 2008. Adenomas with a diameter of =1 cm and/or (tubulo)villous histology and/or with high grade dysplasia and/or =3 adenomas detected at the same colonic examination were considered advanced adenomas. Hazard ratios (HRs) and 95% confidence intervals (CIs) for dietary supplement users (use of any supplement during the past year) compared to nonusers and colorectal adenoma recurrence were calculated using stratified Cox proportional hazard models for counting processes and were adjusted for age, sex, educational level and number of colonoscopies during follow-up. Robust sandwich covariance estimation was used to adjust for the within subject correlation. A number of 165 out of 565 adenoma patients had at least one colorectal adenoma recurrence during a median person-time of 5.4 years and of these, 37 patients had at least one advanced adenoma. One-third of the total study population (n = 203) used a dietary supplement. Compared to no use, dietary supplement use was neither statistically significantly associated with total colorectal adenoma recurrence (HR = 1.03; 95% CI 0.79–1.34) nor with recurrent advanced adenomas (HR = 1.59; 95% CI 0.88–2.87). This prospective cohort study did not suggest an association between dietary supplement use and colorectal adenoma recurrence
N-6 and n-3 fatty acid cholesteryl esters in relation to incident stroke in a Dutch adult population: A nested case-control study
Goede, J. de; Verschuren, W.M.M. ; Boer, J.M.A. ; Kromhout, D. ; Geleijnse, J.M. - \ 2013
Nutrition, Metabolism & Cardiovascular Diseases 23 (2013)8. - ISSN 0939-4753 - p. 737 - 743.
food frequency questionnaire - alpha-linolenic acid - cardiovascular-disease - dietary-intake - erythrocyte-membranes - adipose-tissue - fish intake - humans - risk - biomarkers
Background and aims - There are few prospective studies on fatty acid status in relation to incident stroke, with inconsistent results. We assessed the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with the risk of total stroke and stroke subtypes in Dutch adults. Methods and results - We conducted a nested case–control study using data from a population-based cohort study in adults aged 20–65 years. Blood sampling and data collection took place during 1993–1997 and subjects were followed for 8–13 years. We identified 179 incident cases of stroke and 179 randomly selected controls, matched on age, gender, and enrollment date. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated per standard deviation (SD) increase of PUFA in cholesteryl esters using multivariable conditional logistic regression. Cases comprised 93 ischemic, 50 hemorrhagic, and 36 unspecified strokes. The n-6 PUFA linoleic acid and arachidonic acid contributed ~55% and ~6.5% respectively to total plasma fatty acids, whereas the n-3 PUFA alpha-linolenic acid contributed ~0.5% and eicosapentaenoic acid plus docosahexaenoic acid (EPA-DHA) ~1.3%. After adjustment for confounders, n-6 and n-3 PUFA were not associated with incident total stroke or stroke subtypes. The OR (95% CI) for total stroke was 0.95 (0.74–1.23) per SD increase in linoleic acid and 1.02 (0.80–1.30) per SD increase in arachidonic acid. ORs (95% CI) for total stroke were 0.94 (0.72–1.21) for alpha-linolenic acid and 1.16 (0.94–1.45) for EPA-DHA. Conclusion - In the present study, plasma n-6 or n-3 fatty acids were not related to incident stroke or stroke subtypes.
Mediterranean Style Diet and 12-Year Incidence of Cardiovascular Diseases: The Epic-NL Cohort Stusy
Hoevenaar-Blom, M.P. ; Nooyens, A.J.C. ; Kromhout, D. ; Spijkerman, A.M.W. ; Beulens, W.J. ; Schouw, Y.T. van der; Bueno-de-Mesquita4, B. ; Verschuren, W.M.M. - \ 2012
PLoS One 7 (2012)9. - ISSN 1932-6203 - 7 p.
coronary-heart-disease - physical-activity questionnaire - food frequency questionnaire - venous thromboembolism - relative validity - myocardial-infarction - risk-factors - 7 countries - survival - health
Background: A recent meta-analysis showed that a Mediterranean style diet may protect against cardiovascular diseases (CVD). Studies on disease-specific associations are limited. We evaluated the Mediterranean Diet Score (MDS) in relation to incidence of total and specific CVDs. Methods: The EPIC-NL Study is a cohort of 40,011 men and women aged 20-70 years, examined between 1993 and 1997, with 10-15 years of follow-up. Diet was assessed with a validated food frequency questionnaire and the MDS was based on the daily intakes of vegetables, fruits, legumes and nuts, grains, fish, fatty acids, meat, dairy, and alcohol. Cardiovascular morbidity and mortality were ascertained through linkage with national registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) adjusted for age, sex, cohort, smoking, physical activity, total energy intake, and educational level. Results: In 34,708 participants free of CVD at baseline, 4881 CVD events occurred, and 487 persons died from CVD. A two unit increment in MDS (range 0-9) was inversely associated with fatal CVD (HR: 0.78; 95% CI: 0.69-0.88), total CVD (HR: 0.95 (0.91-0.98)), myocardial infarction (HR: 0.86 (0.79-0.93)), stroke (HR: 0.88 (0.78-1.00)), and pulmonary embolism (HR: 0.74 (0.59-0.92)). The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease. Conclusion: Better adherence to a Mediterranean style diet was more strongly associated with fatal CVD than with total CVD. Disease specific associations were strongest for incident myocardial infarction, stroke and pulmonary embolism.
Dairy products and colorectal cancer risk : a systematic review and meta-analysis of cohort studies
Aune, D. ; Lau, R. ; Chan, D.S.M. ; Vieira, R. ; Greenwood, D.C. ; Kampman, E. ; Norat, T. - \ 2012
Annals of Oncology 23 (2012)1. - ISSN 0923-7534 - p. 37 - 45.
vitamin-d intake - epithelial-cell proliferation - food frequency questionnaire - japan collaborative cohort - dose-response data - colon-cancer - dietary calcium - womens health - milk consumption - united-states
Background: Previous studies of the association between intake of dairy products and colorectal cancer risk have indicated an inverse association with milk, however, the evidence for cheese or other dairy products is inconsistent. Methods: We conducted a systematic review and meta-analysis to clarify the shape of the dose–response relationship between dairy products and colorectal cancer risk. We searched the PubMed database for prospective studies published up to May 2010. Summary relative risks (RRs) were estimated using a random effects model. Results: Nineteen cohort studies were included. The summary RR was 0.83 (95% CI [confidence interval]: 0.78–0.88, I2 = 25%) per 400 g/day of total dairy products, 0.91 (95% CI: 0.85–0.94, I2 = 0%) per 200 g/day of milk intake and 0.96 (95% CI: 0.83–1.12, I2 = 28%) per 50 g/day of cheese. Inverse associations were observed in both men and women but were restricted to colon cancer. There was evidence of a nonlinear association between milk and total dairy products and colorectal cancer risk, P <0.001, and the inverse associations appeared to be the strongest at the higher range of intake. Conclusion: This meta-analysis shows that milk and total dairy products, but not cheese or other dairy products, are associated with a reduction in colorectal cancer risk
Magnesium intake and colorectal tumor risk : a case-control study and meta-analysis
Wark, P.A. ; Lau, R. ; Norat, T. ; Kampman, E. - \ 2012
American Journal of Clinical Nutrition 96 (2012)3. - ISSN 0002-9165 - p. 622 - 631.
food frequency questionnaire - large-bowel carcinogenesis - colon-cancer - united-states - double-blind - nondiabetic subjects - insulin sensitivity - prospective cohort - relative validity - randomized-trial
Background: Dietary magnesium might be related to colorectal tumor risk through the pivotal roles of magnesium in cellular metabolism, insulin resistance, and systemic inflammation. Objective: We evaluated the hypothesis of whether higher dietary magnesium intake is associated with reduced colorectal tumor risk. Design: A case-control study on colorectal adenomas (768 cases; 709 polyp-free control subjects) and a meta-analysis of colorectal adenomas (3 case-control studies) and carcinomas (6 prospective cohort studies) were conducted. Dietary magnesium was estimated from food-frequency questionnaires in the case-control study and most studies in the meta-analyses. Data analysis comprised multiple logistic regression analysis (case-control study) and fixed- and random-effects meta-analyses. Results: The case-control study showed a nonsignificant inverse association between dietary magnesium intake and risk of colorectal adenomas (OR for every 100-mg/d increase: 0.81; 95% CI: 0.62, 1.06). However, inverse associations were observed only in subjects with BMI (in kg/m2) =25, in subjects aged =55 y, and for advanced adenomas. Associations did not vary by the calcium-to-magnesium intake ratio. In the meta-analysis, every 100-mg/d increase in magnesium intake was associated with 13% lower risk of colorectal adenomas (OR: 0.87; 95% CI: 0.75, 1.00) and 12% lower risk of colorectal cancer (RR: 0.88; 95% CI: 0.81, 0.97). Conclusions: Our findings support the hypothesis that higher intakes of dietary magnesium are associated with lower risk of colorectal tumors. The consumption of magnesium-rich foods may be a new avenue to explore further in the search for cancer-prevention strategies
Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis
Cooper, A.J. ; Forouhi, N.G. ; Ye, Z. ; Buijsse, B. ; Feskens, E.J.M. - \ 2012
European Journal of Clinical Nutrition 66 (2012). - ISSN 0954-3007 - p. 1082 - 1092.
food frequency questionnaire - randomized controlled-trial - 10 european countries - chronic disease risk - dietary patterns - life-style - magnesium intake - beta-carotene - cancer - consumption
Fruit and vegetable intake (FVI) may reduce the risk of type 2 diabetes (T2D), but the epidemiological evidence is inconclusive. The aim of this study is to examine the prospective association of FVI with T2D and conduct an updated meta-analysis. In the European Prospective Investigation into Cancer-InterAct (EPIC-InterAct) prospective case–cohort study nested within eight European countries, a representative sample of 16¿154 participants and 12¿403 incident cases of T2D were identified from 340¿234 individuals with 3.99 million person-years of follow-up. For the meta-analysis we identified prospective studies on FVI and T2D risk by systematic searches of MEDLINE and EMBASE until April 2011. In EPIC-InterAct, estimated FVI by dietary questionnaires varied more than twofold between countries. In adjusted analyses the hazard ratio (95% confidence interval) comparing the highest with lowest quartile of reported intake was 0.90 (0.80–1.01) for FVI; 0.89 (0.76–1.04) for fruit and 0.94 (0.84–1.05) for vegetables. Among FV subtypes, only root vegetables were inversely associated with diabetes 0.87 (0.77–0.99). In meta-analysis using pooled data from five studies including EPIC-InterAct, comparing the highest with lowest category for FVI was associated with a lower relative risk of diabetes (0.93 (0.87–1.00)). Fruit or vegetables separately were not associated with diabetes. Among FV subtypes, only green leafy vegetable (GLV) intake (relative risk: 0.84 (0.74–0.94)) was inversely associated with diabetes. Subtypes of vegetables, such as root vegetables or GLVs may be beneficial for the prevention of diabetes, while total FVI may exert a weaker overall effect
Gender-specific Associations of Marine n-3 Fatty Acids and Fish Consumption with 10-year Incidence of Stroke
Goede, J. de; Verschuren, W.M.M. ; Boer, J.M.A. ; Kromhout, D. ; Geleijnse, J.M. - \ 2012
PLoS One 7 (2012)4. - ISSN 1932-6203
food frequency questionnaire - relative validity - cardiovascular-disease - risk - reproducibility - men - omega-3-fatty-acids - mortality - cohort - health
Background There is some evidence that the association of fish and marine fatty acids with stroke risk differs between men and women. We investigated the gender-specific associations of habitual intake of the marine fatty acids eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) and fish on incident stroke in a population-based study in the Netherlands. Methods We prospectively followed 20,069 men and women, aged 20–65 years, without cardiovascular diseases at baseline. Habitual diet was assessed with a validated 178-item food frequency questionnaire. Incidence of stroke was assessed through linkage with mortality and morbidity registers. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (95%CI). Results During 8–13 years of follow-up, 221 strokes occurred. In women, an inverse dose-response relation (P-trend = 0.02) was observed between EPA-DHA intake and incident stroke, with an HR of 0.49 (95% CI: 0.27–0.91) in the top quartile of EPA-DHA (median 225 mg/d) as compared to the bottom quartile (median 36 mg/d). In men, the HR (95%CI) for the top quartile of EPA-DHA intake was 0.87 (0.51–1.48) (P-trend = 0.36). Similar results were observed for fish consumption and stroke incidence. Conclusion A higher EPA-DHA and fish intake is related to a lower stroke risk in women, while for men an inverse association could not be demonstrated
Sources of dietary protein and risk of hypertension in a general Dutch population
Altorf-van der Kuil, W. ; Engberink, M.F. ; Geleijnse, J.M. ; Boer, J.M.A. ; Verschuren, W.M.M. - \ 2012
British Journal of Nutrition 108 (2012)10. - ISSN 0007-1145 - p. 1897 - 1903.
food frequency questionnaire - blood-pressure - relative validity - nutrition - chinese - cohort - women - men - reproducibility - association
Evidence suggests a small beneficial effect of dietary protein on blood pressure (BP), especially for plant protein. We examined the relationship between several types of dietary protein (total, plant, animal, dairy, meat and grain) and the risk of hypertension in a general population of 3588 Dutch adults, aged 26–65 years, who were free of hypertension at baseline. Measurements were done at baseline and after 5 and 10 years of follow-up. Hazard ratios (HR), with 95 % CI, for incident hypertension were obtained in tertiles of energy-adjusted protein, using time-dependent Cox regression models. Models were adjusted for age, sex, BMI, education, smoking, baseline systolic BP, dietary confounders and protein from other sources (if applicable). Mean BP was 118/76 mmHg at baseline. Protein intake was 85 (sd 22) g/d (approximately 15 % of energy) with 62 % originating from animal sources. The main sources of protein were dairy products (28 %), meat (24 %) and grain (19 %). During the follow-up, 1568 new cases of hypertension were identified (44 % of the participants). Energy-adjusted intake of total protein, plant protein and animal protein was not significantly associated with hypertension risk (all HR approximately 1·00, P>0·60). Protein from grain showed a significant inverse association with incident hypertension, with a HR of 0·85 (95 % CI 0·73, 1·00, Ptrend = 0·04) for the upper tertile ( = 18 g/d) v. the lower tertile ( <14 g/d), whereas dairy protein and meat protein were not associated with incident hypertension. In conclusion, higher intake of grain protein may contribute to the prevention of hypertension, which warrants confirmation in other population-based studies and randomised controlled trials.
Linoleic acid intake, plasma cholesterol and 10-year incidence of CHD in 20.000 middle-aged men and women in the Netherlands
Goede, J. de; Geleijnse, J.M. ; Boer, J.M.A. ; Kromhout, D. ; Verschuren, W.M.M. - \ 2012
British Journal of Nutrition 107 (2012)7. - ISSN 0007-1145 - p. 1070 - 1076.
coronary-heart-disease - polyunsaturated fatty-acids - food frequency questionnaire - dietary-fat - cardiovascular-disease - relative validity - physical-activity - controlled-trials - saturated fat - risk
We studied the associations of a difference in linoleic acid or carbohydrate intake with plasma cholesterol levels and risk of CHD in a prospective cohort study in the Netherlands. Data on diet (FFQ) and plasma total and HDL-cholesterol were available at baseline (1993–7) of 20 069 men and women, aged 20–65 years, who were initially free of CVD. Incidence of CHD was assessed through linkage with mortality and morbidity registers. During an average of 10 years of follow-up, 280 CHD events occurred. The intake of linoleic acid ranged from 3·6 to 8·0 % of energy (en%), whereas carbohydrate intake ranged from 47·6 to 42·5 en% across quintiles of linoleic acid intake. Linoleic acid intake was inversely associated with total cholesterol and HDL-cholesterol in women but not in men. Linoleic acid intake was not associated with the ratio of total to HDL-cholesterol. No association was observed between linoleic acid intake and CHD incidence, with hazard ratios varying between 0·83 and 1·00 (all P>0·05) compared to the bottom quintile. We conclude that a 4–5 en% difference in linoleic acid or carbohydrate intake did not translate into either a different ratio of total to HDL-cholesterol or a different CHD incidence
Fluid intake and the risk of urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition (EPIC)
Ros, M.M. ; Bueno de Mesquita, H.B. ; Büchner, F.L. ; Kampman, E. ; Duijnhoven, F.J.B. van - \ 2011
International Journal of Cancer 128 (2011)11. - ISSN 0020-7136 - p. 2695 - 2708.
food frequency questionnaire - disinfection by-products - lower urinary-tract - bladder-cancer - drinking-water - relative validity - life-style - consumption - epidemiology - coffee
Results from previous studies investigating the association between fluid intake and urothelial cell carcinomas (UCC) are inconsistent. We evaluated this association among 233,236 subjects in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had adequate baseline information on water and total fluid intake. During a mean follow-up of 9.3 years, 513 first primary UCC occurred. At recruitment, habitual fluid intake was assessed by a food frequency questionnaire. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for energy intake, smoking status, duration of smoking and lifetime intensity of smoking. When using the lowest tertile of intake as reference, total fluid intake was not associated with risk of all UCC (HR 1.12; 95%CI 0.86–1.45, p-trend = 0.42) or with risk of prognostically high-risk UCC (HR 1.28; 95%CI 0.85–1.93, p-trend = 0.27) or prognostically low-risk UCC (HR 0.93; 95%CI 0.65–1.33, p-trend = 0.74). No associations were observed between risk of UCC and intake of water, coffee, tea and herbal tea and milk and other dairy beverages. For prognostically low-risk UCC suggestions of an inverse association with alcoholic beverages and of a positive association with soft drinks were seen. Increased risks were found for all UCC and prognostically low-risk UCC with higher intake of fruit and vegetable juices. In conclusion, total usual fluid intake is not associated with UCC risk in EPIC. The relationships observed for some fluids may be due to chance, but further investigation of the role of all types of fluid is warranted.
Colours of fruit and vegetables and 10-year incidence of CHD
Oude Griep, L.M. ; Verschuren, W.M.M. ; Kromhout, D. ; Ocke, M.C. ; Geleijnse, J.M. - \ 2011
British Journal of Nutrition 106 (2011)10. - ISSN 0007-1145 - p. 1562 - 1569.
coronary-heart-disease - food frequency questionnaire - los-angeles-atherosclerosis - cardiovascular-disease - relative validity - flavonoid intake - postmenopausal women - physicians health - alpha-carotene - vitamin-c
The colours of the edible part of fruit and vegetables indicate the presence of specific micronutrients and phytochemicals. The extent to which fruit and vegetable colour groups contribute to CHD protection is unknown. We therefore examined the associations between fruit and vegetables of different colours and their subgroups and 10-year CHD incidence. We used data from a prospective population-based cohort including 20 069 men and women aged 20–65 years who were enrolled between 1993 and 1997. Participants were free of CVD at baseline and completed a validated 178-item FFQ. Hazard ratios (HR) for the association between green, orange/yellow, red/purple, white fruit and vegetables and their subgroups with CHD were calculated using multivariable Cox proportional hazards models. During 10 years of follow-up, 245 incident cases of CHD were documented. For each 25 g/d increase in the intake of the sum of all four colours of fruit and vegetables, a borderline significant association with incident CHD was found (HR 0·98; 95 % CI 0·97, 1·01). No clear associations were found for the colour groups separately. However, each 25 g/d increase in the intake of deep orange fruit and vegetables was inversely associated with CHD (HR 0·74; 95 % CI 0·55, 1·00). Carrots, their largest contributor (60 %), were associated with a 32 % lower risk of CHD (HR 0·68; 95 % CI 0·48, 0·98). In conclusion, though no clear associations were found for the four colour groups with CHD, a higher intake of deep orange fruit and vegetables and especially carrots may protect against CHD
Colors of Fruit and Vegetables and 10-Year Incidence of Stroke
Oude Griep, L.M. ; Verschuren, W.M.M. ; Kromhout, D. ; Ocké, M.C. ; Geleijnse, J.M. - \ 2011
Stroke 42 (2011). - ISSN 0039-2499 - p. 3190 - 3195.
food frequency questionnaire - relative validity - cardiovascular-disease - flavonoid intake - ischemic-stroke - blood-pressure - dietary fiber - risk - women - metaanalysis
Background and Purpose—The color of the edible portion of fruits and vegetables reflects the presence of pigmented bioactive compounds, (eg, carotenoids, anthocyanidins, and flavonoids). Which fruit and vegetable color groups contribute most to the beneficial association of fruit and vegetables with stroke incidence is unknown. Therefore, we examined associations between consumption of fruit and vegetable color groups with 10-year stroke incidence. Methods—This was a prospective, population-based cohort study, including 20 069 men and women age 20 to 65 years and free of cardiovascular diseases at baseline. Participants completed a validated, 178-item food frequency questionnaire. Hazard ratios (HR) were calculated for stroke incidence using multivariate Cox proportional hazards models adjusting for age, sex, lifestyle, and dietary factors. Results—During 10 years of follow-up, 233 incident cases of stroke were documented. Fruits and vegetables were classified into 4 color groups. Medians of green, orange/yellow, red/purple, and white fruit and vegetable consumption were 62, 87, 57, and 118 g/d, respectively. Green, orange/yellow, and red/purple fruits and vegetables were not related to incident stroke. Higher intake of white fruits and vegetables was inversely associated with incident stroke (Q4, >171 g/d, versus Q1, =78 g/d; HR, 0.48; 95% CI, 0.29–0.77). Each 25-g/d increase in white fruit and vegetable consumption was associated with a 9% lower risk of stroke (HR, 0.91; 95% CI, 0.85–0.97). Apples and pears were the most commonly consumed white fruit and vegetables (55%).
Alpha-Linolenic Acid Intake and 10-Year Incidence of Coronary Heart Disease and Stroke in 20,000 Middle-Aged Men and Women in The Netherlands
Goede, J. de; Verschuren, W.M.M. ; Boer, J.M.A. ; Kromhout, D. ; Geleijnse, J.M. - \ 2011
PLoS One 6 (2011)3. - ISSN 1932-6203 - 8 p.
polyunsaturated fatty-acids - food frequency questionnaire - cardiovascular risk - relative validity - dietary-intake - united-states - cohort - reproducibility - fish - metaanalysis
Background - Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3 polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is not yet clear. We examined the associations of ALA intake with 10-year incidence of coronary heart disease (CHD) and stroke in the Netherlands. Methods - Data were collected from a general population of 20,069 generally healthy men and women, aged 20 to 65 years. Habitual diet was assessed at baseline (1993–1997) with a validated 178-item food frequency questionnaire. Incidences of CHD and stroke were assessed through linkage with mortality and morbidity registers. Hazard ratios (HR) were calculated with multivariable Cox proportional hazards models, adjusted for age, gender, lifestyle, and dietary factors. Results - During 8–13 years of follow-up, we observed 280 incident CHD events (19% fatal) and 221 strokes (4% fatal). Intakes of energy-adjusted ALA in quintiles ranged from less than 1.0 g/d in the bottom quintile (Q1) to more than 1.9 g/d in the top quintile (Q5). ALA intake was not associated with incident CHD, with HRs varying between 0.89 and 1.01 (all p>0.05) in Q2–Q5 compared with the bottom quintile of ALA intake. For incident stroke, however, participants in Q2–Q5 had a 35–50% lower risk compared with the reference group. HRs were 0.65 (0.43–0.97), 0.49 (0.31–0.76), 0.53 (0.34–0.83), and 0.65 (0.41–1.04) for Q2–Q5 respectively. Conclusion - In this general Dutch population, ALA intake was not associated with incident CHD. The data suggested that a low intake of ALA may be a risk factor for incident stroke. These results warrant confirmation in other population-based studies and in trials
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