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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Dietary epicatechnin and quercetin in cardiovascular health and disease
Dower, J.I. - \ 2016
Wageningen University. Promotor(en): Daan Kromhout; Marianne Geleijnse, co-promotor(en): Peter Hollman. - Wageningen : Wageningen University - ISBN 9789462577862 - 164 p.
cardiovascular disorders - cardiovascular diseases - epicatechin - quercetin - epidemiological surveys - genome analysis - chocolate - hart- en vaatstoornissen - hart- en vaatziekten - epicatechine - quercetine - epidemiologische onderzoeken - genoomanalyse - chocolade

Epidemiological studies showed that the consumption of flavonoid-rich foods such as cocoa and tea is associated with a lower risk of cardiovascular disease (CVD). Randomised controlled trials (RCTs) showed that cocoa and tea improved markers of cardiometabolic health including blood pressure, endothelial function, insulin resistance, arterial stiffness and inflammation.

Cocoa is particularly rich in the flavan-3-ol epicatechin and tea is the main dietary source of epicatechin and of the major flavonol quercetin. However, evidence on the individual roles of epicatechin and quercetin in the health effects of cocoa and tea is still scarce. Therefore, we estimated the strength of the association between epicatechin intake and CVD mortality in a prospective cohort study. Furthermore, we also investigated the effects of epicatechin and quercetin on markers of cardiometabolic health and gene expression, by means of two RCTs.

In Chapter 2, the association between epicatechin intake and CVD mortality was studied using data from the Zutphen Elderly Study, a cohort of 744 elderly Dutch men. During 25 years of follow-up, 329 men died from CVD and 148 from coronary heart disease (CHD). Results from this study showed that men in the highest tertile of epicatechin intake had a 38% lower risk of CHD mortality compared to men in the lowest tertile. For men with prevalent CVD, the risk of CVD mortality was 46% lower for men in the highest tertile of intake, compared to men in the lowest tertile. This is the first epidemiological study to have investigated the association between epicatechin intake and CVD mortality. Hence, more and larger cohort studies are required to confirm this association, possibly with a focus on populations with a high risk of CVD.

In Chapter 3, the chronic effects of pure epicatechin and quercetin on markers of cardiometabolic health were investigated by means of a RCT. Thirty-seven apparently healthy men and women aged 40–80 years consumed (-)-epicatechin (100 mg/d), quercetin-3-glucoside (160 mg/d), or placebo capsules for 4 weeks, in random order. Markers of cardiometabolic health were measured before and after each 4-week intervention. The results of this study showed that epicatechin improved insulin resistance and had a borderline significant effect on endothelial function. This suggests that epicatechin contributes to the cardioprotective effects of cocoa and tea, however, larger long-term RCTs are required to confirm these effects. Pure quercetin supplementation did not affect any of these markers of cardiometabolic health.

Using data from the same study, we investigated the effects of supplementation of pure epicatechin and quercetin on a comprehensive set of biomarkers of endothelial dysfunction and inflammation (Chapter 4). With the exception of sE-selectin (a biomarker of endothelial dysfunction), epicatechin supplementation did not beneficially influence any of the biomarkers, suggesting a lack of evidence for a role of epicatechin in inflammation. Quercetin also lowered sE-selectin as well as the inflammatory biomarker IL-1β and the overall z-score for inflammation. This suggests that quercetin may contribute to the cardioprotective effects of tea by reducing inflammation and possibly by improving endothelial function.

In the same study, the effects of pure epicatechin supplementation on whole genome gene expression profiles of circulating immune cells were also assessed (Chapter 5). Pure epicatechin supplementation modestly reduced gene expression related to inflammation signalling routes in circulating immune cells – routes which are known to play a role in cardiovascular health. However, there was no evidence that epicatechin affected pathways related to insulin resistance or endothelial function.

To directly compare the acute effects of pure epicatechin and epicatechin from dark chocolate on vascular function, we carried out an acute RCT in 20 apparently healthy men aged 40-80 years (Chapter 6). On three separate occasions, subjects consumed: 1) 70g dark chocolate (150 mg epicatechin) with two placebo capsules; 2) two pure epicatechin capsules (100 mg epicatechin) with 75g white chocolate and 3) two placebo capsules with 75g white chocolate (0 mg epicatechin). Endothelial function and arterial stiffness were measured before and two hours after each intervention. To determine epicatechin bioavailability, epicatechin metabolites were measured in blood samples taken at repeated intervals over a period of 8 hours. There was no significant difference in improvement in endothelial function or arterial stiffness between pure epicatechin and dark chocolate. There was also no difference in bioavailability of pure epicatechin and epicatechin from dark chocolate, when standardised per 100 mg of epicatechin. This suggests that epicatechin may contribute to the vascular effects of cocoa and that the bioavailability of pure epicatechin and epicatechin from dark chocolate is similar.

In the general discussion, the main findings of this thesis were first summarised. Methodological considerations related to cohort studies, such as the assessment of flavonoid intake and the possibility of residual confounding were also discussed. Issues related to the relevance of cardiometabolic markers in RCTs and the effect of cocoa flavan-3-ol bioavailability were addressed. Finally, suggestions for future research were put forward.

In conclusion, the results of this thesis suggest that epicatechin contributes to the cardioprotective effects of cocoa and tea. Epicatechin intake was inversely related to CHD mortality in elderly men, and to CVD mortality in men with prevalent CVD. The cardioprotective effects of epicatechin are likely mediated through improvements in insulin resistance and possibly endothelial function. In contrast, quercetin is unlikely to play a major role in the cardioprotective effects of tea. Results for quercetin from cohort studies are inconclusive, and based on the results of our chronic RCT, quercetin did not affect vascular function or insulin resistance, but may help to lower inflammation. Evidence of the role that individual flavonoids play in the aetiology of CVD is still limited. More studies with pure flavonoids are required to elucidate their role.

Dietary protein, blood pressure and mortality : the value of repeated measurements
Tielemans, S.M.A.J. - \ 2016
Wageningen University. Promotor(en): Marianne Geleijnse; Daan Kromhout, co-promotor(en): Hendriek Boshuizen. - Wageningen : Wageningen University - ISBN 9789462577916 - 169 p.
cardiovascular diseases - blood pressure - dietary protein - mortality - cardiovascular disorders - hypertension - urea - meta-analysis - antihypertensive agents - plant protein - animal protein - hart- en vaatziekten - bloeddruk - voedingseiwit - mortaliteit - hart- en vaatstoornissen - hypertensie - ureum - meta-analyse - antihypertensiva - plantaardig eiwit - dierlijk eiwit

Cardiovascular diseases (CVD) are the main cause of death worldwide. In 2012, about 17.5 million people died from CVD, accounting for 30% of all deaths. High blood pressure (BP) is a major cardiovascular risk factor, which was responsible for 10.4 million deaths in 2013. Diet and lifestyle play an important role in the etiology of hypertension. Maintenance of a desirable body weight, physical activity, and low intake of alcohol and salt are well-known measures to avoid high BP. Whether dietary protein, or more specifically plant and animal protein, could contribute to maintaining a healthy BP is less clear. The association between BP and CVD mortality has been extensively investigated. BP in prospective studies can be analyzed using different approaches, such as single BP (measured at one moment in time), single BP adjusted for regression dilution, average BP, and trajectories of BP. It is not yet clear which of these approaches is to be preferred for CVD risk prediction.

This thesis is centered on BP as a major cardiovascular risk factor. In the first part (Chapter 2, 3 and 4), the relation of dietary protein intake with BP level and change was examined. In the second part (Chapter 5 and 6), various approaches for analyzing repeated BP measurements were compared in relation to CVD and all‑cause mortality risk. The final chapter discusses the main findings and their implications.

Chapter 2 describes the association of 24-h urinary urea excretion, as a biomarker of total protein intake, with 9-year incidence of hypertension. We analyzed data of ~4000 men and women aged 28–75 years, who participated in the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, a prospective cohort study. BP was measured four times during 1997–2009 and participants were followed for hypertension incidence, defined as BP ≥140/90mmHg or use of antihypertensive medication. Urea excretion was assessed in two consecutive 24-h urine collections at baseline and approximately 4 years later, from which total protein intake was estimated. Protein intake based on 24-h urinary urea excretion was not associated with incident hypertension.

Chapter 3 presents findings for long-term total, animal and plant protein intake in relation to 5‑year BP change. Analyses were based on 702 observations of 272 men who participated in the Zutphen Elderly Study. Participants did not use antihypertensive medication and were initially free of CVD. Physical and dietary examinations were performed in 1985, 1990, 1995, and 2000. BP was measured twice at each examination and protein intake was assessed using the cross-check dietary history method. The upper tertiles of plant protein intake were associated with a mean 5‑year change in systolic BP of ‑2.9 mmHg (95% CI: ‑5.6, ‑0.2), compared with the bottom tertile. Total and animal protein intake was not associated with BP.

Chapter 4 describes a meta‑analysis of 12 observational studies and 17 randomized controlled trials (RCTs) of dietary protein, including animal and plant protein, in relation to BP. Protein intake in prospective cohort studies was not associated with incident hypertension. For RCTs that used carbohydrate as a control treatment, the pooled BP effect was ‑2.1 mmHg systolic (95% CI: ‑2.9, ‑1.4) for a weighted mean contrast in protein intake of 41 grams per day. There was no differential effect of animal and plant protein on BP.

Chapter 5 describes repeated BP measures and their association with CVD and all‑cause mortality and life years lost in two prospective and nearly extinct cohorts of middle-aged men, the Minnesota Business and Professional Men Study (n=261) and the Zutphen Study (n=632). BP was measured annually during 1947–1957 in Minnesota and 1960–1970 in Zutphen. After 10 years of BP measurements, men were followed until death on average 20 years later. Each 25-mmHg increase in average SBP was associated with a 49% to 72% greater CVD mortality risk, 34% to 46% greater all-cause mortality risk and 3 to 4 life years lost. Four systolic BP trajectories were identified, in which mean systolic BP increased by 5 to 49 mmHg in Minnesota and 5 to 20 mmHg in Zutphen between age 50 and 60. In Zutphen, a 2-times greater CVD and all-cause mortality risk and 4 life years lost were observed when comparing trajectories. In Minnesota, associations were twice as strong. BP trajectories were the strongest predictors of CVD mortality and life years lost in Minnesota men, whereas in Zutphen men, the average BP was superior to other measures.

Chapter 6 presents findings for average BP and BP trajectories in relation to CVD and all-cause mortality, taking into account antihypertensive medication. A total of 762 participants aged ≥50 years of the Rancho Bernardo Study were examined five times from 1984 to 2002 and monitored for cause‑specific mortality from 2002 to 2013. Each 20‑mmHg increment in average systolic BP was associated with 35% greater CVD mortality and 25% greater all-cause mortality risk. We identified four trajectories for systolic BP for which BP increases ranged from 5 to 12 mmHg between age 60 and 70. In individuals who belonged to the higher trajectories, 2‑3 times greater CVD mortality and 1.5-times greater all-cause mortality risks were observed, compared to those who belonged to the lowest trajectory. Long-term systolic BP trajectories and average systolic BP were both significant predictors of CVD and all-cause mortality. The associations were not modified by antihypertensive medication.

As described in Chapter 7, various approaches were used to study the relation between protein intake and BP. Findings from individual studies and a meta-analysis suggest that dietary protein per se does not affect BP within the range of intake generally consumed in the Netherlands. Replacing carbohydrates by protein, however, has a beneficial effect on BP.

Moreover, this thesis showed that BP trajectories are not superior to average BP in predicting CVD and all-cause mortality. A few repeated BP measurements, e.g. three or four, are likely to be sufficient for obtaining a reliable average BP and had a similar predictive value for mortality compared to BP trajectories. Therefore, average BP can be considered the most practical tool for estimating mortality risk.

Phytosterols and blood lipid risk factors for cardiovascular disease
Ras, R.T. - \ 2014
Wageningen University. Promotor(en): Frans Kok, co-promotor(en): Marianne Geleijnse; P.L. Zock. - Wageningen : Wageningen University - ISBN 9789462571006 - 234
hart- en vaatziekten - hart- en vaatstoornissen - phytosterolen - sterolen - bloedvetten - risicofactoren - cholesterol - cardiovascular diseases - cardiovascular disorders - phytosterols - sterols - blood lipids - risk factors

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Lifestyle improvements including dietary changes are important for CVD prevention. This thesis aimed to advance insights in the role of phytosterols, lipid-like compounds present in foods or plant origin, in the management of blood lipid risk factors for CVD. Phytosterols include plant sterols and their saturated form, plant stanols. These compounds resemble cholesterol in both structure and function, but cannot be produced by the human body. The intake of phytosterols occurs through plant-based foods and/or enriched foods like margarine.

Elevated blood low-density lipoprotein cholesterol (LDL-C) is a major risk factor for CVD, especially for coronary heart disease (CHD) resulting from atherosclerosis. We studied the dose-response relationship between dietary phytosterols and blood LDL-C in two meta-analyses (Chapters 2 and 3). A meta-analysis of 81 randomized controlled trials (Chapter 2) demonstrated a non-linear, continuous dose-response relationship for the LDL-C-lowering effect of phytosterols. Based on this dose-response curve, it may be predicted that phytosterols at a dose of 2 g/d lower LDL-C by 0.35 mmol/L or 9%. The dose-response curve reached a plateau at phytosterol doses of ~3 g/d, above which there is limited additional LDL-C-lowering effect. In another meta-analysis of 124 randomized controlled trials (Chapter 3), we showed that plant sterols and plant stanols up to ~3 g/d are equally effective in lowering LDL-C by a maximum of 12%. No conclusions could be drawn for phytosterol doses exceeding 4 g/d because of the limited number of studies.

Elevated blood triglycerides (TGs) may also be involved in the onset of CVD, although its role is less established than for LDL-C. The effect of plant sterols on blood TG concentrations was assessed in a meta-analysis of individual subject data from 12 randomized controlled trials (Chapter 4). We showed that plant sterols, at a dose of ~2 g/d, modestly reduce TG concentrations by on average 0.12 mmol/L or 6%. The TG-lowering effect of plant sterols was larger in subjects with higher initial TG concentrations. Our double-blind, placebo-controlled, randomized trial with 332 subjects (Chapter 5) showed more pronounced TG-lowering effects of 9-16% when plant sterols (2.5 g/d) were combined with low doses of omega-3 fish fatty acids (0.9 to 1.8 g/d).

Dietary phytosterols are, after initial absorption by intestinal cells, actively excreted back into the intestinal lumen. Nevertheless, small amounts reach the circulation. We assessed the effect of plant sterol intake on blood plant sterol concentrations in a meta-analysis of 41 randomized controlled trials (Chapter 6). The intake of plant sterols, at a dose of ~1.6 g/d, increased blood sitosterol concentrations by on average 2 μmol/L (31%) and campesterol concentrations by 5 μmol/L (37%). At the same time, total cholesterol and LDL-C concentrations were reduced by on average 0.36 mmol/L (6%) and 0.33 mmol/L (9%), respectively. After supplemental intake, plant sterol concentrations remained below 1% of total sterols circulating in the blood.

Whether phytosterols, due to their LDL-C-lowering properties, affect the risk of CVD events is at present unknown. The relation between phytosterol intake from natural sources (e.g. vegetables, cereals, nuts) and CVD risk in the population was examined in a large prospective cohort of 35,597 Dutch men and women with 12 years of follow-up (Chapter 7). The intake of phytosterols from natural sources (~300 mg/d) was not related to risk of CVD (total of 3,047 events) with a relative risk ranging from 0.90 to 0.99 across quintiles of phytosterol intake. Also, no association with incident CHD and myocardial infarction were found. In a cross-sectional analysis using baseline data of this cohort, phytosterol intake was associated with lower blood LDL-C in men (-0.18 mmol/L per 50 mg/d; 95% CI: -0.29; -0.08) but not in women (-0.03 mmol/L; 95% CI: -0.08; 0.03).

Most randomized trials with enriched foods have tested phytosterol doses between 1.5 and 2.4 g/d. In practice, however, users of such foods consume much lower amounts (~1 g/d), which is about 3 times higher than obtained from a regular Western diet. Individuals who consume diets with emphasis on plant-based foods (e.g. vegetarians) may reach phytosterol intakes between 0.5 and 1 g/d. Health authorities recommend various types of diets for CVD prevention, almost all rich in plant-based foods and, consequently, relatively rich in phytosterols.

In conclusion, a high intake of phytosterols with enriched foods was shown to lower LDL-C in a dose-dependent manner. Furthermore, a high intake of plant sterols with enriched foods modestly lowered TG concentrations and increased plasma plant sterol concentrations. A low intake of naturally occurring phytosterols in the general population did not show a clear association with CVD risk. Based on these findings, the intake of phytosterols may be considered in the management of hypercholesterolemia. Whether a high intake of phytosterols can play a role in CVD prevention in the population at large remains to be established.

Folate and age-related disease
Durga, J. - \ 2004
Wageningen University. Promotor(en): Frans Kok; Evert Schouten, co-promotor(en): P. Verhoef. - [S.I.] : S.n. - ISBN 9085040914
foliumzuur - voeding - homocysteïne - hart- en vaatziekten - hart- en vaatstoornissen - ouderen - volwassenen - folic acid - nutrition - homocysteine - cardiovascular diseases - cardiovascular disorders - elderly - adults
N-3 fatty acids from fish and markers of cardiac arrhythmia
Geelen, A. - \ 2004
Wageningen University. Promotor(en): M.B. Katan; Evert Schouten, co-promotor(en): P.L. Zock. - [S.I.] : S.n. - ISBN 9085040841
voedingsonderzoek bij de mens - vetzuren - vissen - hart- en vaatstoornissen - hart- en vaatziekten - human nutrition research - fatty acids - fishes - cardiovascular disorders - cardiovascular diseases
Nutrition counselling in general practice: the stages of change model
Verheijden, M.W. - \ 2004
Wageningen University. Promotor(en): Wija van Staveren. - [S.I.] : S.n. - ISBN 9085040507
medische voorzieningen - artsen - gezondheidszorg - voedingsinformatie - volksgezondheid - modellen - vaatziekten - hart- en vaatstoornissen - medical services - physicians - health care - nutrition information - public health - models - vascular diseases - cardiovascular disorders
Elucidating the mechanism behind the lipid-raising effect of cafestol
Boekschoten, M.V. - \ 2004
Wageningen University. Promotor(en): M.B. Katan, co-promotor(en): Guido Hooiveld. - [S.I.] : S.n. - ISBN 9085041139
cafestol - koffie - cholesterolmetabolisme - lipiden - hart- en vaatstoornissen - gezondheid - coffee - cholesterol metabolism - lipids - cardiovascular disorders - health
Uitval bij diverse soorten vleeskuikens door extreme temperaturen
Middelkoop, J.H. van; Harn, J. van; Wiers, W.J. - \ 2000
Praktijkonderzoek voor de Pluimveehouderij 11 (2000)2. - ISSN 0924-9087 - p. 17 - 20.
kippenziekten - pluimveehouderij - bloedsomloopstoornissen - hart- en vaatstoornissen - diergeneeskunde - kuikens - vleeskuikens - fowl diseases - poultry farming - circulatory disorders - cardiovascular disorders - veterinary science - chicks - broilers
Naar aanleiding van het eindrapport van de Stuurgroep Heroriëntatie Pluimveehouderij is onderzoek gedaan naar verschil in gevoeligheid voor hart- en circulatiestoornissen, zoals doodgroeiers, hart failure syndrome en ascites bij vleeskuikens. De onderzochte soorten vleeskuikens zijn in vergelijking met de gangbare soorten in Nederland minder sterk geselecteerd op groei en voerconversie.
Regular physical activity in old age : effect on coronary heart disease risk factors and well-being
Schuit, A.J. - \ 1997
Agricultural University. Promotor(en): Frans Kok; E.G. Schouten. - S.l. : Schuit - ISBN 9789054857112 - 163
gezondheidszorg - medische voorzieningen - sociale voorzieningen - therapie - sport - voedselhygiëne - voedingstoestand - consumptiepatronen - vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - ouderen - ouderdom - nederland - health care - medical services - social services - therapy - food hygiene - nutritional state - consumption patterns - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - elderly - old age - netherlands
<br/> <p><em><strong>Background.</strong></em> Regular physical activity is considered an important aspect of a healthy lifestyle. It may improve fitness, physical competence and may lower the risk of coronary heart disease (CHD). However, until now, data on the effects of regular exercise on CHD risk factors in elderly are limited, and there is a particular lack of data about the training effects on recently indicated risk factors, such as fibrinolytic and coagulation factors, and factors involved in the autonomic regulation of the heart.<p><em><strong>Methods</strong> .</em> We have conducted a randomised, controlled intervention study, which addressed the effect of a 6 months training programme on 'classical' and 'new' CHD risk factors and well-being in 229 (intervention: 143 and control:86) apparently healthy, free- living elderly men and women (60-80 years).<p><em><strong>Results</strong> .</em> Physical fitness (maximal exercise capacity) improved significantly in subjects of the intervention group (mean increase 14.1 Watt , 95%Cl: 10.1-18.1, +9%), compared to the controls. Among the classical CHD risk factors, only the reduction in serum triglyceride concentration in women was significant (-0.11 mmol/L, 95%Cl: -0.22-0.0, -7%). Blood pressure, high- and low density lipoprotein and total serum cholesterol concentration changed in a favourable direction, but not significantly from the control group. No effect of training on body weight and fasting insulin concentration was found. Among the new risk factors, the concentration of tissue type plasminogen activator (t-PA), a fibrinolytic factor, was significantly increased (+0.07 IU/mL, 95%Cl: 0.0-0.14,+11%) in subjects of the intervention group, while plasminogen activator inhibitor (PAI-1, inhibitor of fibrinolysis) was reduced, but not significantly different from the controls. These changes reflect an increase in fibrinolytic activity. However, fibrinogen concentration increased (+0.18 g/L 95%Cl 0.04-0.32,+6%). In addition, heart rate variability was increased and heart-rate- adjusted-QT interval was reduced in subjects of the intervention group (P&lt;0.05). Both changes probably represent increase in parasympathetic activity and a more favourable autonomic regulation of the heart. Finally, physical self-efficacy was significantly improved in the subjects of the intervention group. Symptoms of depression were reduced, but not significantly different from the controls.<p><em><strong>Conclusion</strong> .</em> Regular physical activity beneficially affected CHD risk factors, physical fitness and self-efficacy, which are important determinants of the quality of life and longevity in elderly. The magnitude of the benefits on CHD incidence remain unclear, since there is little information on the predictive value of the new risk factors in elderly. However, since elderly, in general, have advanced atherosclerosis and autonomic dysbalance, the improvements of these factors may be of particular importance in this age- group. In conclusion, our observations underline the importance of a public health policy aiming at stimulating regular physical activity in elderly people
Movement and circulation : population studies on physical activity and cardiovascular disease risk
Mensink, G.B.M. - \ 1997
Agricultural University. Promotor(en): Frans Kok; H. Hoffmeister; B.M. Bellach. - S.l. : Mensink - ISBN 9789054857426 - 149
lichamelijke activiteit - vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - sport - spel - lichamelijke opvoeding - physical activity - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - play - physical education
<p>The relationship of leisure-time physical activity with cardiovascular risk factors and mortality was determined using data from the German Cardiovascular Prevention Study, conducted from 1984-1991. Three nationally representative crosssectional samples, with a total of 7 689 men and 7 747 women, ages 25-69, were part of this study, originally designed to estimate the impact of community intervention on cardiovascular health. Additionally we analyzed regional cross-sectional and follow-up samples.<p>Physically active individuals were more often urbanized, more likely to have high socioeconomic status, less often smokers and had healthier eating patterns and lower body mass index. Compared with sedentary individuals, the most active quartile of men (>18 kcal/kg/week spent on conditioning activities) had significantly favorable levels of serum total cholesterol (-2.5%), HDL/total cholesterol ratio (+4.2%) and resting heart rate (-4.3%). The most active women (>12 kcal/kg/week) had significantly better HDL cholesterol (+3.7%), HDL/total cholesterol ratio (+3.9%), triglycerides (-5.1%), diastolic (-1.3%) and systolic (-1.6%) blood pressure, body mass index (-2.8%) and resting heart rate (-2.5%). With duration and intensity constant, significantly better risk factor levels were observed with increased frequency of physical activity. For active men, we observed a relative risk of 0.33 (95% CI 0.11-0.94) for cardiovascular disease mortality and of 0.67 (95% CI 0.36-1.25) for all-cause mortality (5-8 year follow-up) compared with the least actives, independent of baseline risk factor levels. The elderly (ages 50-69) showed substantial benefits from participation in light to moderate activities, such as walking and cycling, most apparent when conducted frequently (≥5 times/week). Using data from the Spandau Health Test (1827 men and 2 929 women, ages 40-80, followed from 1982-1994) we estimated an all-cause mortality relative risk of 1.7 (95% CI 1.4-2.2) for men and 1.4 (95% CI 1.1-1.8) for women for each 20 beats/min higher resting heart rate.<p>More than 40% of German adults are sedentary. We recommend them regularly, preferably daily, to conduct moderately intense activities, such as brisk walking, running, swimming or cycling, for at least 30 minutes. Elderly may prefer light activities, such as walking or gardening. An active lifestyle may substantially improve the cardiovascular risk profile of the German population. For example, if only 50% of sedentary German men, ages 40-69, would become modestly active more than 6 500 cardiovascular deaths could be prevented each year.
Coagulation factor 7 in elderly people : genetic disposition and diet
Mennen, L.I. - \ 1997
Agricultural University. Promotor(en): Frans Kok; D.E. Grobbee; E.G. Schouten. - S.l. : S.n. - ISBN 9789054857433 - 112
vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - voedselhygiëne - voedingstoestand - consumptiepatronen - genetische stoornissen - erfelijke ziekten - ouderen - ouderdom - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - food hygiene - nutritional state - consumption patterns - genetic disorders - hereditary diseases - elderly - old age
In elderly people an increase in thrombotic tendency may lead to a increase in the risk of a coronary event. Coagulation factor VII affects this thrombotic tendency and has been recognised as a risk indicator for coronary heart disease. It is not known whether the level of factor VII can be influenced at older age. From studies in young subjects it is clear that dietary fat and the R/Q353 polymorphism (alleles R and Q) are the main determinants of factor VII. We studied the relation of factor VII with diet in elderly men and women, taking the R/Q353 polymorphism into account.<p>In a cross-sectional study among 1158 elderly men and women (>55 y) factor VII coagulant activity (FVII:C) and total factor VII (FVIIt) were investigated in relation to serum-triglycerides, the R/Q353 polymorphism and the habitual diet. FVII:C was inversely associated with dietary fibre and protein and positively with saturated fat intake and serum-triglycerides. These associations were much stronger in subjects with the RR genotype compared to those carrying the Q allele; if the mean intake of dietary fibre would increase with 10 g a day, FVII:C would be expected to decrease with 7.6 % in elderly people homozygous for the R allele versus only 1.9 % decrease in those carrying the Q allele. FVIIt was inversely related to intake of dietary fibre and positively to serumtriglycerides, again the associations being stronger in subjects with the RR genotype. In a cross-over study among elderly women (>60 y, 35 RQ/QQ, 56RR) the postprandial response of activated factor VII (FVIIa) to several fat-rich (50 g) breakfasts was evaluated. The response of (FVIIa) was very similar for meals rich in palmitic acid, rich in stearic acid or rich in linoleic/linolenic acid with a ratio of 3:1 or 15:1. The increase in FVIIa ranged from 14.9 (95% CI: 10.6,19.2) IUmL after the stearic rich breakfast to 21.1 (16.6,25.6) IU/mL after the linoleic/linolenic 15:1 rich breakfasts. After the fat-free control breakfast FVIIa decreased with 8.7 (6.3,11.1) IU/mL. The mean absolute total response to the fatrich breakfasts combined was 37 IU/mL in subjects with the RR genotype and 16.1 IU/mL in subjects carrying the Q allele. Also the response relative to the fasting (FVIIa) level differed significantly between the genotype groups (RR: <strong></strong> 42%, RQ/QQ: 32%). Serumtriglycerides concentration was not associated with FVIIa.<p>In elderly people, factor VII is influenced by dietary fibre, total dietary fat and serumtriglycerides and not by fat type. The R/Q353 polymorphism strongly modifies these effects. This indicates that an increase in dietary fibre and a decrease in dietary fat intake may reduce the risk of a coronary event by reducing the level of factor VII particularly in elderly people with the RR genotype.
Dietary non-nutrients and haemostasis in humans : effects of salicylates, flavonoids and ginger
Janssen, P.L.T.M.K. - \ 1997
Agricultural University. Promotor(en): M.B. Katan; W.A. van Staveren; R.P. Mensink. - S.l. : S.n. - ISBN 9789054857037 - 70
vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - bloedsomloopstoornissen - bloedstolling - aspirine - salicylzuur - flavonen - flavonolen - flavonoïden - specerijen - kruiderijen - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - circulatory disorders - blood coagulation - aspirin - salicylic acid - flavones - flavonols - flavonoids - spices - condiments
<p>In this thesis we studied the content of acetylsalicylate and total salicylates in foods, and we studied the effects of the dietary non-nutrients salicylates and flavonoids and of certain foods on haemostatic parameters in humans.<p>Acetylsalicylic acid -aspirin- irreversibly inhibits platelet cyclo-oxygenase, leading to decreased platelet thromboxane A <sub><font size="-2">2</font></sub> production and decreased aggregation. Therefore it is effective as an anti-thrombotic drug in doses as low as 30 mg/d. Qualitative analyses by Swain <em>et al</em> suggested the presence of acetylsalicylate in foods. It was estimated that a normal mixed Western diet provides 10-200 mg/d of total salicylate and 3 mg/d of acetylsalicylate. We showed in 10 healthy subjects that 3 mg/d of acetylsalicylic acid decreased mean platelet thromboxane production by 39±8% (±sd). Thus, quantitative data on dietary acetylsalicylate deserved closer investigation. We determined acetylsalicylate and total salicylates in 30 foods using HPLC with fluorescence detection. Acetylsalicylate was lower than the detection limit (0.02 mg/kg for fresh and 0.2 mg/kg for dried products) in all foods. Total salicylates were 0-1 mg/kg in vegetables and fruits, and 3-28 mg/kg in herbs and spices. We showed that urinary excretion was a valid indicator for intake of pure (acetyl)salicylic acid (recovery 77-80%). We then studied urinary salicylate excretion in 17 subjects eating a variety of diets to estimate the content of bio-available salicylates of diets. Median excretion was 1.4 mg/24 h (range 0.8-1.6). Our data suggest that even purely vegetable diets provide less than 6 mg/d of salicylates, and no measurable acetylsalicylate. These amounts are probably too low to affect coronary heart disease risk, and worries about adverse effects of dietary salicylates on the behaviour of children may be unfounded.<p>Others found that dietary flavonoids were associated with a reduced risk of coronary heart disease and stroke. This might be due to effects on haemostasis, because flavonoids have been reported to inhibit platelet aggregation <em>in vitro</em> . We found that concentrations of 2.5 μM of the flavone apigenin inhibited collagen- and ADP-induced platelet aggregation <em>in vitro</em> by about 26%, whereas the flavonols quercetin and quercetin-3-glucoside had no effect. No effects were found on platelet aggregation, thromboxane production, or other haemostatic parameters in 18 healthy subjects after they had consumed large amounts of quercetin- (onions) and apigenin-rich (parsley) foods daily for 7 d each. We conclude that claims for anti-aggregatory effects of flavonoids are based on the <em>in vitro</em> use of concentrations that cannot be attained <em>in vivo</em> . <em></em> Our findings suggest that it is unlikely that reported effects of dietary flavonoids on coronary vascular disease risk are mediated through platelet aggregation or cyclo-oxygenase activity. Possible effects on known risk indicators for coronary heart disease from the coagulation cascade or the fibrinolytic system should be examined in a larger study.<p>It has been claimed that ginger consumption exerts an anti-thrombotic effect by inhibiting platelet thromboxane production. We, however, found no effects on platelet thromboxane production in a placebo-controlled cross-over study in 18 healthy subjects after consumption of raw (-1±9%, mean±sd) or cooked ginger (1±8%).<p>We conclude that contents of (acetyl)salicylate in foods are too low to affect disease risk. We could not confirm the putative anti-thrombotic effect of ginger, onions and parsley on haemostatic parameters in humans.
Absorptie- en dispositiekinetiek van quercetine- glycosiden bij de mens
Hollman, P.C.H. ; Leeuwen, S.D. van; Gaag, M.S. van der; Mengelers, M.J.B. ; Trijp, J.M.P. van; Vries, J.H.M. de; Katan, M.B. - \ 1996
Voeding 57 (1996)3. - ISSN 0042-7926 - p. 28 - 28.
bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - chemische analyse - chemische samenstelling - chlorofyl - ziektepreventie - flavonen - flavonoïden - voedingsmiddelen - isoprenoïden - metabolisme - planten - porfyrinen - preventie - preventieve geneeskunde - quercetine - steroïden - vaatziekten - blood disorders - cardiovascular diseases - cardiovascular disorders - chemical analysis - chemical composition - chlorophyll - disease prevention - flavones - flavonoids - foods - isoprenoids - metabolism - plants - porphyrins - prevention - preventive medicine - quercetin - steroids - vascular diseases
Homocysteine, B-vitamins and cardiovascular disease : epidemiologic evidence
Verhoef, P. - \ 1996
Agricultural University. Promotor(en): Frans Kok; M.J. Stampfer. - S.l. : Verhoef - ISBN 9789054855002 - 167
cystine - cysteïne - methionine - aminozuren - chemie - nicotinamide - vitamine b complex - riboflavine - pantoteenzuur - choline - myo-inositol - vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - epidemieën - epidemiologie - cysteine - amino acids - chemistry - vitamin b complex - riboflavin - pantothenic acid - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - epidemics - epidemiology
<strong><em>Background</em></strong> Cardiovascular disease constitutes a major public health problem in the Netherlands and other Western countries. Elevated plasma homocysteine has attracted growing interest as a "new" risk factor for cardiovascular disease. Homocysteine is formed from the essential amino acid methionine. Defective Homocysteine, metabolism may lead to elevation of plasma total homocysteine (tHcy). Genetic enzyme deficiencies or inadequate intake of vitamins B <sub><font size="-2">6</font></sub> , B <sub><font size="-2">12</font></sub> , and folate, all important cofactors in homocysteine metabolism, may result in elevation of tHcy. Accumulation of tHcy can possibly promote atherosclerotic or thrombotic processes.<p><em><strong>Methods</strong></em> The epidemiologic studies presented in the thesis, aimed to find additional evidence for the hypothesis that elevated plasma tHcy is an independent risk factor for cardiovascular disease. We addressed various disease endpoints, with data of prospective and retrospective studies, from Dutch, European, and US populations. The role of the B-vitamins and of a genetic enzyme defect, predisposing to high tHcy levels, were studied.<p><em><strong>Results</strong></em> Overall, in line with other findings, most of our studies showed that elevated tHcy is an independent risk factor for cardiovascular disease. Results indicated that the risk increased with rising levels of tHcy, with no threshold effect. The estimated average % increase in risk for 5 μmol/L (about 1 SD) increase in fasting tHcy varied between 20% and 60% in the various studies. In a large European case-control study, we found that elevated tHcy was a strong risk factor in women, both in pre- and postmenopausal women.<p>Folate concentrations in plasma or expressed per haematocrit, and dietary folate were found to be important determinants of plasma tHcy in several studies. In one of our studies, in concordance with findings of others, tHcy reached its nadir at a folate intake of 400 μg/day. Furthermore, we observed that homozygosity for a mutation in 5,10-methylenetetrahydrofolate reductase, in combination with low folate status, predisposed to particularly high tHcy levels, and may thereby increase risk of cardiovascular disease.<p><strong><em>Conclusions & implications</em></strong> Dietary folate intake of a large segment of the general population is lower than 400 μg/day, and tHcy may be generally increased. Several studies have already shown that elevated tHcy can be normalized by supplementation with folate, even at a dose of 650 μg/day. Thus, increased folate intake seems an important way to decrease tHcy in populations, thereby possibly reducing incidence of cardiovascular disease. Large-scale prevention trials are warranted to demonstrate the efficacy of tHcy-lowering, and the minimal folate intake required. At this moment, based on the available epidemiologic evidence, it is advisable to increase consumption of fruits and vegetables in the general population. Results from prevention trials will indicate whether additional measures, such as fortification of food or supplementation are justified as well.
Prospective studies on coronary heart disease in the elderly : the role of classical and new risk factors
Weijenberg, M.P. - \ 1996
Agricultural University. Promotor(en): Daan Kromhout; Edith Feskens. - S.l. : Weijenberg - ISBN 9789090092096 - 161
vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - epidemieën - epidemiologie - ouderen - ouderdom - nederland - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - epidemics - epidemiology - elderly - old age - netherlands
In this thesis associations between biological risk factors and the occurrence of coronary heart disease in elderly persons are described. The focus is on classical (i.e. total and high density lipoprotein cholesterol and blood pressure) and some new (i.e. homocysteine, white blood cell count and serum albumin) biological risk factors. The studies are based on two Dutch cohorts. One is a cohort of 292 men and women, aged 64 to 87 years in 1971, from a general practice in Rotterdam, with a mortality follow-up of 17 years. The other is the Dutch cohort of the Seven Countries Study which consists of 939 men aged 64 to 84 years in 1985 from the town of Zutphen. The morbidity and mortality follow- up embraced five years.<p>In general, the classical risk factors were important predictors of coronary heart disease occurrence in elderly people. Systolic blood pressure was a strong independent long-term predictor of coronary heart disease mortality in elderly women, but the long-term association was less clear in elderly men. Total cholesterol was also significantly associated with long-term mortality from coronary heart disease in elderly women, but in men the association tended to be inverted <em>U</em> -shaped, i.e. men with cholesterol levels in the median tertile of the cholesterol distribution had a higher risk than those with levels in the first and third tertile. Regarding the Zutphen study, the short-term associations with incidence of coronary heart disease were usually weaker than with mortality from the disease. Elevated systolic and diastolic blood pressure, and especially isolated systolic hypertension, were important short-term predictors of sudden cardiac death in elderly men. For mortality from coronary heart disease, which was not additionally recorded as sudden, <em>U</em> -shaped associations with systolic and diastolic blood pressure levels were observed, i.e. men with the lowest blood pressure levels and those with the highest blood pressure levels and using antihypertensive medication had the highest risk. Serum total cholesterol was related to short-term coronary heart disease mortality in elderly men. For incidence of the disease, an association was only observed in a subgroup of the population with serum albumin levels below the median. High density lipoprotein cholesterol was not predictive of mortality from coronary heart disease, but there appeared to be an association with the incidence of the disease.<p>Concerning the new risk factors, serum homocysteine appeared to be associated with mortality from coronary heart disease in elderly men in the first one-and-a-half years of follow-up only. A strong association with mortality from cerebrovascular disease was observed in normotensive men. In addition, an association with an increased risk of cognitive impairment was suggested. Both white blood cell count and serum albumin were important predictors of coronary heart disease independent of the classical risk factors for coronary heart disease. The association with serum albumin could only partly be explained by baseline health status indicators.<p>The experience obtained from the studies described in this thesis has made clear that elderly people are a heterogenous group with respect to risk factor levels as well as coronary heart disease risk. It would therefore be desirable to have a measure of susceptibility for coronary heart disease to identify elderly people who are at increased risk of the disease. Our studies suggest that white blood cell count and serum albumin, routine clinical blood chemistry values, may be useful in this respect in addition to the classical risk factors. Future studies should aim at assessing the effectiveness of a multifactorial approach of risk factor management on coronary heart disease and all-cause mortality as well as on quality of life in older men and women.
Dietary fatty acids and risk factors for coronary heart disease : controlled studies in healthy volunteers
Zock, P.L. - \ 1995
Agricultural University. Promotor(en): J.G.A.J. Hautvast; M.B. Katan. - S.l. : Zock - ISBN 9789054853282 - 190
vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - vetzuren - voedselhygiëne - bloedvetten - lipoproteïnen - plantaardige vetten - plantaardige oliën - voeding - cholesterol - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - fatty acids - food hygiene - blood lipids - lipoproteins - plant fats - plant oils - nutrition
<p>High levels of LDL cholesterol, blood pressure and Lp(a), and low levels of HDL cholesterol increase the risk for coronary heart disease (CHD). This thesis describes the effects of dietary fatty acids on these risk factors. In each of three trials we fed diets with tailored fatty acid composition to about 60 healthy men and women. Each diet within a trial was supplied to every volunteer for 3 weeks.<p>In the <strong><em>first study</em></strong><em></em> we compared the effects of monounsaturated <em>trans</em> fatty acids with those of linoleic acid, the fatty acid from which <em>trans</em> fatty acids are formed upon partial hydrogenation, and with those of stearic acid, a product of complete hydrogenation of linoleic acid. Relative to linoleic acid, both <em>trans</em> fatty acids and stearic acid raised LDL and lowered HDL cholesterol. Thus, partial as well as complete hydrogenation of linoleic acid produces fatty acids that unfavorably affect serum lipids relative to linoleic acid itself. <em>Trans</em> fatty acids and stearic acid did not influence blood pressure, but <em>trans</em> fatty acids modestly raised Lp(a).<p>The <em><strong>second study</strong></em> addressed the relative cholesterol-raising potentials of two specific saturates, myristic and palmitic acid. Relative to oleic acid, myristic acid was about 1.5 times as cholesterol-raising a's palmitic acid, due to increases in both LDL and HDL cholesterol. The differences between myristic and palmitic acid were statistically significant. However, both saturates caused high LDL cholesterol levels and raise the LDL to HDL cholesterol ratio.<p>In the <em><strong>third study</strong></em> we examined the effect of the positional distribution of fatty acids within dietary triglycerides. Two diets had identical total fatty acid composition, but a major contrast in fatty acid configuration. Total, LDL, and HDL cholesterol levels were the same on both diets. The position of the dietary fatty acids was partly reflected in fasting plasma lipids, but the fatty acid configuration had no important effect on lipoprotein levels.<p>In conclusion, monounsaturated <em>trans</em> fatty acids and the saturates myristic and palmitic acid have adverse effects on the serum lipoprotein risk profile for CHID. People at high risk for CHD should replace the hard fats in their diets by carbohydrates or unsaturated oils.
Epidemiology of stroke : the role of blood pressure, alcohol and diet
Keli, S.O. - \ 1995
Agricultural University. Promotor(en): Daan Kromhout; Edith Feskens. - S.l. : Keli - ISBN 9789054854173 - 91
hersenziekten - vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - bloeddruk - alcoholische dranken - voedselhygiëne - voedingstoestand - consumptiepatronen - preventieve geneeskunde - ziektepreventie - preventie - epidemieën - epidemiologie - nederland - nederlandse antillen - brain diseases - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - blood pressure - alcoholic beverages - food hygiene - nutritional state - consumption patterns - preventive medicine - disease prevention - prevention - epidemics - epidemiology - netherlands - netherlands antilles
<p>This thesis evaluates the recent trends in stroke mortality in the Netherlands Antilles, and the role of long-term blood pressure, alcohol and diet as risk factors for stroke incidence. The official mortality statistics and population data from the Netherlands Antilles over the period 1981-1992 were used to study trends in stroke mortality. The association of long-term blood pressure, alcohol and diet were studied with data from the Zutphen Study, a longitudinal study on risk factors for chronic diseases in the Netherlands. Repeated blood pressure measurements were collected yearly between 1960 and 1970. Information on alcohol and diet was collected in 1960, 1965 and 1970 with the crosscheck dietary history method. Stroke incidence data were present for the period 1970-1985.<p>Age-adjusted stroke mortality declined over the period 1981-1986 in men and women in the Netherlands Antilles. Over the period 1987-1992 a slow down occurred in men, and in older women even an increase was observed. The average of individual repeated systolic blood pressure measurements over a period of 10 years was shown to be a better predictor of stroke incidence than single measurements. The latter understimated the stroke risk by 55%. Moderate alcohol consumption was associated with a nonsignificant 34% lower stroke risk. Consumption of one serving of fish per week was associated with a 50% lower stroke incidence compared with the consumption of less fish. Men with high intake of dietary flavonoids and men who drank their main source tea frequently had a 70% lower stroke incidence compared with men with a lower intake of flavonoids or tea. Men with high intake of beta-carotene had a 46% lower incidence of stroke, although this was not statistically significant. The effects of blood pressure, fish and flavonoids were independent from each other, and from other risk factors for stroke.<p>We conclude that the decrease in stroke mortality in the Netherlands Antilles came to a standstill, and that long-term blood pressure and diet are important predictors of stroke.
Blood cholesterol : a public health perspective
Verschuren, W.M.M. - \ 1995
Agricultural University. Promotor(en): Daan Kromhout. - S.l. : Verschuren - ISBN 9789054854234 - 169
vaatziekten - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - bloed - cholesterol - lipiden - epidemieën - epidemiologie - nederland - vascular diseases - blood disorders - cardiovascular diseases - cardiovascular disorders - blood - lipids - epidemics - epidemiology - netherlands
Changes in total cholesterol levels (TC) were studied using data from three epidemiological studies: about 30,000 men and women aged 37-43 were examined between 1974 and 1980 (CB Project), about 80,000 men aged 33-37 between 1981 and 1986 (RIFOH Project) and 42,000 men and women aged 20-59 from 1987 to 1992 (Monitoring Project on CVD Risk Factors). In men a decline in TC of 6.5% was observed between 1974 and 1992. However, the largest decrease took place between 1981 and 1986 in men in a limited age range (33-37 years), and there were indications that this decrease was not generalizable to other age groups. From 1987 to 1992, a decrease of 7% in HDL cholesterol levels (HDL-C) was observed in men, leading to an increase in the non-HDL-C/HDL-C ratio. In women, no changes in TC and HDL-C were observed.<p>Analyses of data from 36,000 men and women aged 20-59 years showed that between ages 30 and 50 about 19-38% of the gender difference in TC was explained by differences in body mass index (BMI) and cigarette smoking between men and women. After age 50, the higher TC in women compared to men was largely due to the effect of the menopause. The TC increase associated with menopause was 0.45 mmol/l in non-smokers and 0.28 mmol/l in smokers. The difference between a low-risk and a high-risk lifestyle was 0.58 mmol/I for TC and 0.38 mmol/l for HDL-C in men, and 0.40 mmol/l for TC and 0.45 mmol/l for HDL-C in women.<p>Twelve year follow-up of 50,000 men and women aged 30-54 (CB Project) showed that the adjusted relative risk for coronary heart disease (CHD) mortality for the highest compared to the lowest cholesterol quintile was 3.0 (95% CI 1.8-5.1) in men and 3.8 (95% Cl 1.1-13.1) in women. It was estimated that a TC reduction of 0.6 mmol/l was associated with a 20% lower CHD mortality. Low TC was not associated with non-cardiovascular mortality. All-cause mortality was positively related to total cholesterol, with a 60% and 46% higher risk in the highest compared to the lowest TC quintile for men and women respectively.<p>Twenty-five year follow-up of the Seven Countries Study, in which over 12,000 men aged 40-59 at baseline participated, showed that relative risks for CHD mortality were similar in different cultures, but the absolute risks were strikingly different. At a cholesterol level of about 5.4 mmol/l agestandardized CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to 15% in Northern Europe after adjustment for age, smoking and blood pressure. It was concluded that other factors, such as diet, typical for low-risk countries, modify the effect of TC on CHD mortality. In the Seven Countries Study, in non-smokers no association of TC with cancer mortality was observed, while non-cardiovascular/non-cancer mortality was elevated only at TC below 4.15 mmol/l. In smokers, cancer mortality and non-cardiovascular/non-cancer mortality were inversely associated with TC. All- cause mortality showed a J-shaped association with TC in non-smokers (lowest all-cause mortality for TC between 4.15 and 5.15 mmol/l), while all-cause mortality was unrelated to TC in smokers. Absolute mortality rates were higher in smokers than in non-smokers for all endpoints.<p>Lowering the average TC level in the population is concluded to contribute to a reduction in the burden of CHD. Low cholesterol levels are not considered an important public health concern in the Netherlands. Changes in the lipid profile should preferably be achieved by lifestyle interventions such as a diet low in saturated fat and rich in fruits and vegetables, no cigarette smoking, a desirable body mass index (less than 25 kg/m <sup><font size="-2">2</font></SUP>) and a physically active lifestyle. Such a lifestyle will not only have a favorable impact on coronary heart disease, but is also compatible with recommendations on the prevention of other chronic diseases such as diabetes and cancer.
Haemostase en het effect van voedingsvet.
Cavelaars, A.E.J.M. ; Mennen, L.I. ; Verhoef, P. ; Dekker, J.M. ; Kok, F.J. - \ 1992
Voeding 53 (1992)6. - ISSN 0042-7926 - p. 151 - 154.
bloedstolling - bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - vetten - voeding - vaatziekten - blood coagulation - blood disorders - cardiovascular diseases - cardiovascular disorders - fats - nutrition - vascular diseases
Een hoge consumptie van visolie die rijk is aan eicosapentaeenzuur, vermindert de bloedplaatjesaggregatie en daarmee het riisco op hart- en vaatziekte
Inspanning en voeding bij diabetes, hart- en vaatziekten, overgewicht
Erp-Baart, A.M.J. van; Katan, M.B. ; Kemper, H.C.G. ; Laan, J.A.M. van der; Morris, J.N. ; Nobel, E. de; Saris, W.H.M. ; Weeda, H.W.H. - \ 1985
Alphen a/d Rijn : Samsom - ISBN 9789060165461 - 115
bloedstoornissen - hart- en vaatziekten - hart- en vaatstoornissen - suikerziekte - diabetes mellitus - energiebehoeften - moeheid - voeding - obesitas - overgewicht - lichamelijke activiteit - vaatziekten - blood disorders - cardiovascular diseases - cardiovascular disorders - diabetes - energy requirements - fatigue - nutrition - obesity - overweight - physical activity - vascular diseases
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