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Staff Publications

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

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

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

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    The UroLife study: protocol for a Dutch prospective cohort on lifestyle habits in relation to non-muscle-invasive bladder cancer prognosis and health-related quality of life
    Goeij, Liesbeth de; Westhoff, Ellen ; Witjes, J.A. ; Aben, Katja K. ; Kampman, Ellen ; Kiemeney, Lambertus Alm ; Vrieling, Alina - \ 2019
    BMJ Open 9 (2019)10. - ISSN 2044-6055 - p. e030396 - e030396.
    biomarkers - bladder cancer - cohort - diet - lifestyle - prognosis - quality of life - recurrence - study protocol

    INTRODUCTION: Patients with non-muscle-invasive bladder cancer (NMIBC) have a good survival but are at high risk for tumour recurrence and disease progression. It is important to identify lifestyle habits that may reduce the risk of recurrence and progression and improve health-related quality of life (HRQOL). This paper describes the rationale and design of the UroLife study. The main aim of this study is to evaluate whether lifestyle habits are related to prognosis and HRQOL in patients with NMIBC. METHODS AND ANALYSIS: The UroLife study is a multicentre prospective cohort study among more than 1100 newly diagnosed patients with NMIBC recruited from 22 hospitals in the Netherlands. At 6 weeks and 3, 15 and 51 months after diagnosis, participants fill out a general questionnaire, and questionnaires about their lifestyle habits and HRQOL. At 3, 15 and 51 months after diagnosis, information about fluid intake and micturition is collected with a 4-day diary. At 3 and 15 months after diagnosis, patients donate blood samples for DNA extraction and (dietary) biomarker analysis. Tumour samples are collected from all patients with T1 disease to assess molecular subtypes. Information about disease characteristics and therapy for the primary tumour and subsequent recurrences is collected from the medical records by the Netherlands Cancer Registry. Statistical analyses will be adjusted for age, gender, tumour characteristics and other known confounders. ETHICS AND DISSEMINATION: The study protocol has been approved by the Committee for Human Research region Arnhem-Nijmegen (CMO 2013-494). Patients who agree to participate in the study provide written informed consent. The findings from our study will be disseminated through peer-reviewed scientific journals and presentations at (inter)national scientific meetings. Patients will be informed about the progress and results of this study through biannual newsletters and through the website of the study and of the bladder cancer patient association.

    Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women’s Health
    Schoenaker, D.A.J.M. ; Soedamah-Muthu, S.S. ; Callaway, L.K. ; Mishra, G.D. - \ 2015
    American Journal of Clinical Nutrition 102 (2015)1. - ISSN 0002-9165 - p. 94 - 101.
    coronary-heart-disease - cardiovascular-disease - mediterranean diet - gestational hypertension - preeclampsia - metaanalysis - consumption - cohort - supplementation - prevention
    Background: Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. Objective: We investigated associations between prepregnancy dietary patterns and risk of HDPs. Design: We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors. Results: During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81). Conclusions: In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.
    Dairy products and the risk of stroke and coronary heart disease: the Rotterdam Study
    Praagman, J. ; Franco, O.H. ; Ikram, M.A. ; Soedamah-Muthu, S.S. ; Engberink, M.F. ; Rooij, F.J.A. van; Hofman, A. ; Geleijnse, J.M. - \ 2015
    European Journal of Nutrition 54 (2015)6. - ISSN 1436-6207 - p. 981 - 990.
    dietary-protein sources - cardiovascular-disease - consumption - population - women - cohort - food - metaanalysis - definitions - death
    Purpose We examined whether consumption of total dairy and dairy subgroups was related to incident stroke and coronary heart disease (CHD) in a general older Dutch population. Methods The study involved 4,235 participants of the Rotterdam Study aged 55 and over who were free of cardiovascular disease (CVD) and diabetes at baseline (1990–1993). Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) for the intake of total dairy and dairy subgroups in relation to incident CVD events. Results Median intake of total dairy was 397 g/day, which mainly comprised low-fat dairy products (median intake of 247 g/day). During a median follow-up time of 17.3 years, 564 strokes (182 fatal) and 567 CHD events (350 fatal) occurred. Total dairy, milk, low-fat dairy, and fermented dairy were not significantly related to incident stroke or fatal stroke (p > 0.2 for upper vs. lower intake categories). High-fat dairy was significantly inversely related to fatal stroke (HR of 0.88 per 100 g/day; 95 % CI 0.79, 0.99), but not to incident stroke (HR of 0.96 per 100 g/day; 95 % CI 0.90, 1.02). Total dairy or dairy subgroups were not significantly related to incident CHD or fatal CHD (HRs between 0.98 and 1.05 per 100 g/day, all p > 0.35). Conclusions In this long-term follow-up study of older Dutch subjects, total dairy consumption or the intake of specific dairy products was not related to the occurrence of CVD events. The observed inverse association between high-fat dairy and fatal stroke warrants confirmation in other studies.
    Development of the HELIUS food frequency questionnaires ethnic-specific questionnaires to assess the diet of a multiethnic population in The Netherlands
    Beukers, M.H. ; Dekker, L.H. ; Boer, E.J. de; Perenboom, C.W.M. ; Meijboom, S. ; Nicolaou, M. ; Vries, J.H.M. de; Brants, H.A.M. - \ 2015
    European Journal of Clinical Nutrition 69 (2015). - ISSN 0954-3007 - p. 579 - 584.
    risk-factors - cardiovascular-disease - health - prevalence - europe - immigrants - chinese - cohort
    Objectives: Ethnic minorities are often not included in studies of diet and health because of a lack of validated instruments to assess their habitual diets. Given the increased ethnic diversity in many high-income countries, insight into the diets of ethnic minorities is needed for the development of nutritional policies and interventions. In this paper, we describe the development of ethnic-specific food frequency questionnaires (FFQs) to study the diets of Surinamese (African and South Asian), Turkish, Moroccan and ethnic Dutch residents of The Netherlands. Methods: An existing Dutch FFQ was adapted and formed the basis for three new FFQs. Information on food intake was obtained from single 24¿h recalls. Food items were selected according to their percentage contribution to and variance in absolute nutrient intake of the respective ethnic groups. A nutrient database for each FFQ was constructed, consisting of data from the Dutch Food Composition table; data on ethnic foods were based on new chemical analyses and available international data. Results: We developed four ethnic-specific FFQs using a standardised approach that included ~200 food items each and that covered more than 90% of the intake of the main nutrients of interest. Conclusions: The developed FFQs will enable standardised and comparable assessment of the diet of five different ethnic groups and provide insight into the role of diet in differences in health between ethnic groups. The methodology described in this paper and the choices made during the development phase may be useful in developing similar FFQs in other settings.
    Glycemic control and all-cause mortality risk in type 1 diabetes patients: the EURODIAB prospective complications study
    Schoenaker, D.A.J.M. ; Simon, D. ; Chaturvedi, N. ; Fuller, J.H. ; Soedamah-Muthu, S.S. - \ 2014
    Journal of Clinical Endocrinology and Metabolism 99 (2014)3. - ISSN 0021-972X - p. 800 - 807.
    vascular complications - cardiovascular-disease - severe hypoglycemia - hba(1c) - trials - cohort - accord - rates - death - a1c
    Context: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA1c) and all-cause mortality in patients with type 1 diabetes mellitus. Design, Setting, and Patients: A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15–60 years enrolled in the EURODIAB Prospective Complications Study. Outcome Measure: Possible nonlinearity of the association between HbA1c and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA1c 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. Results: HbA1c was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA1c compared with the reference (median HbA1c: 8.1%) following a U-shaped association [P overall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Conclusions: Results from our study in type 1 diabetes patients suggest that target HbA1c below a certain threshold may not be appropriate in this population. We recognize that these low HbA1c levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA1c will need further study.
    Plasma and dietary carotenoids and vitamines A,C and E and the risk of colon and rectal cancer in the European prospective investigation into cancer and nutrition
    Leenders, M. ; Leufkens, A.M. ; Siersema, P.D. ; Duijnhoven, F.J.B. van; Vrieling, A. ; Hulshof, P.J.M. - \ 2014
    International Journal of Cancer 135 (2014)12. - ISSN 0020-7136 - p. 2930 - 2939.
    serum alpha-tocopherol - colorectal-cancer - oxidative stress - physical-activity - epic project - antioxidants - retinol - health - cohort - biomarkers
    Carotenoids and vitamins A, C and E are possibly associated with a reduced colorectal cancer (CRC) risk through antioxidative properties. The association of prediagnostic plasma concentrations and dietary consumption of carotenoids and vitamins A, C and E with the risk of colon and rectal cancer was examined in this case-control study, nested within the European Prospective Investigation into Cancer and Nutrition study. Plasma concentrations of carotenoids (alpha- and beta-carotene, canthaxanthin, beta-cryptoxanthin, lutein, lycopene, zeaxanthin) and vitamins A (retinol), C and E (alpha-, beta- and gamma-and delta-tocopherol) and dietary consumption of beta-carotene and vitamins A, C and E were determined in 898 colon cancer cases, 501 rectal cancer cases and 1,399 matched controls. Multivariable conditional logistic regression models were performed to estimate incidence rate ratios (IRR) and corresponding 95% confidence intervals (CIs). An association was observed between higher prediagnostic plasma retinol concentration and a lower risk of colon cancer (IRR for highest quartile = 0.63, 95% CI: 0.46, 0.87, p for trend = 0.01), most notably proximal colon cancer (IRR for highest quartile = 0.46, 95% CI: 0.27, 0.77, p for trend = 0.01). Additionally, inverse associations for dietary beta-carotene and dietary vitamins C and E with (distal) colon cancer were observed. Although other associations were suggested, there seems little evidence for a role of these selected compounds in preventing CRC through their antioxidative properties.
    Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States
    Jankovic, N. ; Geelen, A. ; Streppel, M.T. ; Groot, C.P.G.M. de; Kampman, E. ; Feskens, E.J.M. ; Trichopoulou, A. ; Bueno-de Mesquita, H.B. ; Franco, O.H. - \ 2014
    American Journal of Epidemiology 180 (2014)10. - ISSN 0002-9262 - p. 978 - 988.
    cardiovascular-disease - epic project - design - prevention - cohort - risk - determinants - rationale - quality - scores
    The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988–2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States.
    A metabolic profile is associated with the risk of incident coronary heart disease
    Vaarhorst, A. ; Verhoeven, A. ; Weller, C.M. ; Bohringer, S. ; Brandt, P.A. van den; Greevenbroek, M.M. ; Merry, A.H. ; Verschuren, W.M.M. ; Boer, J.M.A. ; Feskens, E.J.M. ; Heijmans, B.T. ; Slagboom, P.E. - \ 2014
    American Heart Journal 168 (2014)1. - ISSN 0002-8703 - p. 45 - 52.e7.
    artery-disease - cardiovascular events - population - prediction - plasma - phosphatidylcholine - metabonomics - netherlands - mortality - cohort
    Background Metabolomics, defined as the comprehensive identification and quantification of low-molecular-weight metabolites to be found in a biological sample, has been put forward as a potential tool for classifying individuals according to their risk of coronary heart disease (CHD). Here, we investigated whether a single-point blood measurement of the metabolome is associated with and predictive for the risk of CHD.
    Dietary intakes of individual flavanols and flavonols are inversely associated with incident type 2 diabetes in European populations
    Zamora-Ros, R. ; Forouhi, N.G. ; Sharp, S.J. ; Gonzalez, C.A. ; Buijsse, B. ; Schouw, Y.T. van der; Boeing, H. ; Feskens, E.J.M. ; Woudenbergh, G.J. van - \ 2014
    The Journal of Nutrition 144 (2014)3. - ISSN 0022-3166 - p. 335 - 343.
    epic-interact - food sources - nutrition - cancer - polyphenols - risk - women - humans - cohort - tea
    Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)–InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend <0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile: 0.81; 95% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% CI: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D
    Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study
    Streppel, M.T. ; Sluik, D. ; Yperen, J. van; Geelen, A. ; Hofman, A. ; Franco, O.H. ; Witteman, J.C.M. ; Feskens, E.J.M. - \ 2014
    European Journal of Clinical Nutrition 68 (2014). - ISSN 0954-3007 - p. 741 - 747.
    nutritional quality index - physical-activity - dietary pattern - elderly-people - women - risk - questionnaire - validation - cohort
    Background/Objectives: The nutrient-rich food (NRF) index assesses nutrient quality of individual food items by ranking them according to their nutrient composition. The index reflects the nutrient density of the overall diet. We examined the associations between the NRF9.3 index—a score on the basis of nine beneficial nutrients (protein, fiber, vitamins and minerals) and three nutrients to limit (saturated fat, sugar and sodium)—incidence of cardiovascular disease (CVD) events and all-cause mortality. Subjects/Methods: A total of 4969 persons aged 55 and older from the Rotterdam Study, a prospective cohort study in the Netherlands, were studied. First, all foods were scored on the basis of their nutrient composition, resulting in an NRF9.3 score on food item level. Subsequently, they were converted into individual weighted scores on the basis of the amount of calories of each food item consumed by the subjects and the total energy intake. The hazard ratios (HRs) of the NRF9.3 index score were adjusted for age, gender, body mass index, smoking history, doctor-prescribed diet, alcohol consumption and education. Results: Food groups that contributed most to the NRF9.3 index score were vegetables, milk and milk products, fruit, bread and potatoes. A high NRF9.3 index score was inversely associated with all-cause mortality (HR Q4 versus Q1: 0.84 (95% confidence interval: 0.74, 0.96)). Associations were stronger in women than in men. The NRF9.3 index score was not associated with incidence of CVD. Conclusion: Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival
    Smoking and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition
    Rohrmann, S. ; Linseisen, J. ; Allen, N. ; Bueno-de-Mesquita, H.B. ; Johnsen, N.F. ; Tjonneland, A. ; Overvad, K. ; Kaaks, R. ; Teucher, B. ; Boeing, H. ; Pischon, T. ; Lagiou, P. ; Trichopoulou, A. ; Trichopoulos, D. ; Palli, D. ; Krogh, V. ; Tunnino, R. ; Ricceri, F. ; Suarez, M.V.A. ; Agudo, A. ; Sanchez, M.J. ; Chirlaque, M.D. ; Barricarte, A. ; Larranaga, N. ; Boshuizen, H.C. ; Kranen, H.J. ; Stettin, P. ; Johansson, M. ; Bjartell, A. ; Ulmert, D. ; Khaw, K.T. ; Wareham, N.J. ; Ferrari, P. ; Romieux, I. ; Gunter, M.J.R. ; Riboli, E. ; Key, T.J. - \ 2013
    British Journal of Cancer 108 (2013)3. - ISSN 0007-0920 - p. 708 - 714.
    cigarette-smoking - follow-up - health-professionals - prospective us - tobacco use - cohort - men - recurrence - association - mortality
    Background: Smoking is not associated with prostate cancer incidence in most studies, but associations between smoking and fatal prostate cancer have been reported. Methods: During 1992 and 2000, lifestyle information was assessed via questionnaires and personal interview in a cohort of 145112 European men. Until 2009, 4623 incident cases of prostate cancer were identified, including 1517 cases of low-grade, 396 cases of high grade, 1516 cases of localised, 808 cases of advanced disease, and 432 fatal cases. Multivariable Cox proportional hazards regression models were used to examine the association of smoking status, smoking intensity, and smoking duration with the risk of incident and fatal prostate cancer. Results: Compared with never smokers, current smokers had a reduced risk of prostate cancer (RR = 0.90, 95% CI: 0.83-0.97), which was statistically significant for localised and low-grade disease, but not for advanced or high-grade disease. In contrast, heavy smokers (25+ cigarettes per day) and men who had smoked for a long time (40+ years) had a higher risk of prostate cancer death (RR = 1.81, 95% CI: 1.11-2.93; RR = 1.38, 95% CI: 1.01-1.87, respectively). Conclusion: The observation of an increased prostate cancer mortality among heavy smokers confirms the results of previous prospective studies.
    Early life factors and adult mammographic density
    Lokate, M. ; Duijnhoven, F.J.B. van; Berg, S.W. van den; Peeters, P.H. ; Gils, C.H. van - \ 2013
    Cancer Causes and Control 24 (2013)10. - ISSN 0957-5243 - p. 1771 - 1778.
    breast-cancer risk - reported birth-weight - perinatal characteristics - parenchymal patterns - women - metaanalysis - cohort - etiology - validity - stem
    Purpose Early life factors have shown to be related to breast cancer risk. The pathophysiological link could be mammographic density, a strong risk factor for breast cancer. Mammary gland development already starts in utero and early life factors might affect the number of mammary cells at risk. In this study, we investigated the association between early life factors and mammographic density in adulthood. Methods The study was conducted within 2,588, mainly postmenopausal women of the Prospect-European Prospective Investigation into Cancer and Nutrition cohort. This ongoing study recruited breast cancer screening participants who filled out extensive questionnaires. Information on the early life factors birth weight, gestational age, maternal and paternal age, multiple births, birth rank, exposure to parental smoking, and leg length as a proxy for growth at childhood was obtained using questionnaires. Generalized linear models and linear regression models were used to study the relation between early life factors and mammographic density. Analyses were adjusted for potential confounders. Results Women who had an older mother (p = 0.06) or father (p = 0.002) at birth tended to have a higher mammographic density. Furthermore, greater leg length seemed to be related to higher mammographic density, although not statistically significantly (p = 0.16). After adjustment for confounders, none of the early life factors showed any statistically significant relationship with mammographic density in adulthood. Conclusion Although we cannot exclude small effects that go undetected due to measurement error in recall of early life factors, the results suggest that mammographic density is not a major pathway in any observed relationship between these early life events and breast cancer risk.
    The Association between dietary flavonoid and lignan intakes and incident type 2 diabetes in European populations
    Zamora-Ros, R. ; Forouhi, N.G. ; Buijsse, B. ; Schouw, Y.T. van der; Boeing, H. ; Feskens, E.J.M. - \ 2013
    Diabetes Care 36 (2013)12. - ISSN 0149-5992 - p. 3961 - 3970.
    insulin sensitivity - risk-factors - food sources - life-style - us men - nutrition - cancer - women - cohort - polyphenols
    OBJECTIVE To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations. RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study included 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants from among 340,234 participants with 3.99 million person-years of follow-up in eight European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the Phenol-Explorer, the U.K. Food Standards Agency, and the U.S. Department of Agriculture databases. Hazard ratios (HRs) from country-specific Prentice-weighted Cox regression models were pooled using random-effects meta-analysis. RESULTS In multivariable models, a trend for an inverse association between total flavonoid intake and type 2 diabetes was observed (HR for the highest vs. the lowest quintile, 0.90 [95% CI 0.77–1.04]; P value trend = 0.040), but not with lignans (HR 0.88 [95% CI 0.72–1.07]; P value trend = 0.119). Among flavonoid subclasses, flavonols (HR 0.81 [95% CI 0.69–0.95]; P value trend = 0.020) and flavanols (HR 0.82 [95% CI 0.68–0.99]; P value trend = 0.012), including flavan-3-ol monomers (HR 0.73 [95% CI 0.57–0.93]; P value trend = 0.029), were associated with a significantly reduced hazard of diabetes. CONCLUSIONS Prospective findings in this large European cohort demonstrate inverse associations between flavonoids, particularly flavanols and flavonols, and incident type 2 diabetes. This suggests a potential protective role of eating a diet rich in flavonoids, a dietary pattern based on plant-based foods, in the prevention of type 2 diabetes
    Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct
    Romaguera, D. ; Norat, T. ; Wark, P.A. ; Vergnaud, A.C. ; Schulze, M.B. ; Woudenbergh, G.J. van; Beulens, J.W.J. ; Feskens, E.J.M. ; The InterAct Consortium, A. - \ 2013
    Diabetologia 56 (2013)7. - ISSN 0012-186X - p. 1520 - 1530.
    weight-gain - metabolic syndrome - body-weight - risk - project - obesity - cancer - cohort - dietary - women
    Aims/hypothesis Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults. Methods We established a case–cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case–cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence. Results In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence. Conclusions/interpretation This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults
    Twenty-four hour urinary urea excretion and 9-year risk of hypertension: the PREVEND study
    Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Baak, M.A. van; Engberink, M.F. ; Brink, E.J. ; Jong, P.E. ; Gansevoort, R.T. ; Bakker, S.J.A. - \ 2013
    Journal of Hypertension 31 (2013)8. - ISSN 0263-6352 - p. 1564 - 1569.
    blood-pressure - protein-intake - association - nutrients - nitrogen - cohort - trial - life - men
    OBJECTIVES:: It is not yet clear whether dietary protein could help maintaining a healthy blood pressure (BP). We investigated the association between total protein intake, estimated from 24-h urinary urea excretion, and incident hypertension in Dutch men and women. METHODS:: We analyzed data of 3997 men and women (aged 28-75 years) who participated in the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, a prospective cohort study. 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 using the Maroni method. Participants were followed for 9 years for hypertension incidence, defined as BP at least 140/90¿mmHg or initiation of antihypertensive medication. Hazard ratios (HR) were obtained in sex-specific quintiles of protein intake using time-dependent Cox regression, adjusted for age, sex, BMI, smoking, alcohol use, and 24-h urinary excretions of sodium and potassium. RESULTS:: Baseline BP was on average 119/70¿mmHg and 976 participants developed hypertension during follow-up. Mean protein intake (in g/kg ideal body weight) was 1.18¿±¿0.26 for men and 1.12¿±¿0.25 for women. Estimated protein intake was nonlinearly inversely associated with incident hypertension in the fully adjusted model, with nonsignificant HR of 0.77, 0.75, 0.82, and 0.83 in consecutive quintiles compared with the lowest quintile (P-trend: 0.52). CONCLUSION:: Protein intake, as assessed by urinary urea excretion, was not significantly associated with 9-year hypertension incidence in Dutch men and women.
    N-6 and N-3 Fatty Acid Cholesteryl Esters in Relation to Fatal CHD in a Dutch Adult Population: A Nested Case-Control Study and Meta-Analysis
    Goede, J. de; Verschuren, W.M.M. ; Boer, J.M.A. ; Verberne, L.D.M. ; Kromhout, D. ; Geleijnse, J.M. - \ 2013
    PLoS ONE 8 (2013)5. - ISSN 1932-6203 - 9 p.
    coronary-heart-disease - alpha-linolenic acid - cardiovascular-disease - dietary-intake - erythrocyte-membranes - adipose-tissue - humans - risk - biomarkers - cohort
    Background: Dietary polyunsaturated fatty acids (PUFA) are inversely related to coronary heart disease (CHD) in epidemiological studies. We examined the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with fatal CHD in a nested case-control study. Additionally, we performed a dose-response meta-analysis of similar prospective studies on cholesteryl ester PUFA. Methods: We used data from two population-based cohort studies in Dutch adults aged 20-65y. Blood and data collection took place from 1987-1997 and subjects were followed for 8-19y. We identified 279 incident cases of fatal CHD and randomly selected 279 controls, matched on age, gender, and enrollment date. Odds ratios (OR) were calculated per standard deviation (SD) increase of cholesteryl ester PUFA. Results: After adjustment for confounders, the OR (95% CI) for fatal CHD per SD increase in plasma linoleic acid was 0.89 (0.74-1.06). Additional adjustment for plasma total cholesterol and systolic blood pressure attenuated this association (OR:0.95; 95% CI: 0.78-1.15). Arachidonic acid was not associated with fatal CHD (OR per SD:1.11; 95% CI: 0.92-1.35). The ORs (95% CI) for fatal CHD for an SD increase in n-3 PUFA were 0.92 (0.74-1.15) for alpha-linolenic acid and 1.06 (0.88-1.27) for EPA-DHA. In the meta-analysis, a 5% higher linoleic acid level was associated with a 9% lower risk (relative risk: 0.91; 95% CI: 0.84-0.98) of CHD. The other fatty acids were not associated with CHD. Conclusion: In this Dutch population, n-6 and n-3 PUFA in cholesteryl esters were not significantly related to fatal CHD. Our data, together with findings from previous prospective studies, support that linoleic acid in plasma cholesteryl is inversely associated with CHD.
    Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with risk op type 2 diabetes in eight European countries
    Sluijs, I. van der; Beulens, J.W.J. ; Schouw, Y.T. van der; Buckland, G. ; Kuijsten, A. ; Schulze, M.B. ; Amiano, P. ; Ardanaz, E. ; Balkau, B. ; Boeing, H. ; Gavrila, D. ; Feskens, E.J.M. - \ 2013
    The Journal of Nutrition 143 (2013)1. - ISSN 0022-3166 - p. 93 - 99.
    fiber intake - energy-intake - life-style - nutrition - cancer - women - mellitus - cohort - prevention - disease
    The association of glycemic index (GI) and glycemic load (GL) with the risk of type 2 diabetes remains unclear. We investigated associations of dietary GI, GL, and digestible carbohydrate with incident type 2 diabetes. We performed a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition Study, including a random subcohort (n = 16,835) and incident type 2 diabetes cases (n = 12,403). The median follow-up time was 12 y. Baseline dietary intakes were assessed using country-specific dietary questionnaires. Country-specific HR were calculated and pooled using random effects meta-analysis. Dietary GI, GL, and digestible carbohydrate in the subcohort were (mean +/- SD) 56 +/- 4, 127 +/- 23, and 226 +/- 36 g/d, respectively. After adjustment for confounders, GI and GL were not associated with incident diabetes [HR highest vs. lowest quartile (HRQ4) for GI: 1.05 (95% CI = 0.96, 1.16); HRQ4 for GL: 1.07 (95% CI = 0.95, 1.20)]. Digestible carbohydrate intake was not associated with incident diabetes [HRQ4: 0.98(95% CI = 0.86, 1.10)]. In additional analyses, we found that discrepancies in the GI value assignment to foods possibly explain differences in GI associations with diabetes within the same study population. In conclusion, an expansion of the GI tables and systematic GI value assignment to foods may be needed to improve the validity of GI values derived in such studies, after which GI associations may need reevaluation. Our study shows that digestible carbohydrate intake is not associated with diabetes risk and suggests that diabetes risk with high-GI and -GL diets may be more modest than initial studies suggested. J. Nutr. 143: 93-99, 2013.
    Mediterranean dietary pattern and prevalence and incidence of depressive symptoms in mid-aged women: results from a large community-based prospective study
    Rienks, J. ; Dobson, A. ; Mishra, G.D. - \ 2013
    European Journal of Clinical Nutrition 67 (2013). - ISSN 0954-3007 - p. 75 - 82.
    mood disorders - short-form - fast-food - ces-d - association - cohort - health - risk - australia - validity
    BACKGROUND/OBJECTIVES: To investigate the association between dietary patterns and prevalence and incidence 3 years later of depressive symptoms using data from the mid-aged cohort in the Australian Longitudinal Study on Women’s Health. SUBJECTS/METHODS: Participants (aged 50–55 years) completed a food frequency questionnaire in 2001. Depressive symptoms were measured in 2001 and 2004 using the validated 10-item Centre for Epidemiologic Studies Depression scale. Multiple logistic regression was used for cross-sectional analysis (8369 women) and longitudinal analysis (7588) to assess the associations between dietary patterns and prevalence of depressive symptoms, and then for longitudinal analysis (6060) on their associations with the incidence of depressive symptoms in 2004, while adjusting for sociodemographic and lifestyle factors. RESULTS: Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the Mediterranean-style diet had a cross-sectional association with lower prevalence of depressive symptoms in 2001, adjusted odds ratio 0.82 (95% confidence interval 0.77–0.88); and longitudinally with lower incidence of depressive symptoms in 2004, adjusted odds ratio 0.83 (0.75–0.91). None of the associations found for other dietary patterns remained statistically significant after adjustment for confounders. A dose–response relationship was found cross-sectionally when women were grouped according to quintiles of Mediterranean-style diet (P-value for trend o0.001). CONCLUSIONS: Consumption of a ‘Mediterranean-style’ dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms. These findings suggest that dietary patterns have a potential role in the prevention and management of depressive symptoms.
    Factor analysis is more appropriate to identify overall dietary patterns associated with diabetes when compared with treelet transform analysis
    Schoenaker, D.A.J.M. ; Dobson, A. ; Soedamah-Muthu, S.S. ; Mishra, G.D. - \ 2013
    The Journal of Nutrition 143 (2013)3. - ISSN 0022-3166 - p. 392 - 398.
    adaptive multiscale basis - sparse unordered data - womens health - prevention - australia - validity - rotation - cohort - index
    Treelet transform (TT) is a proposed alternative to factor analysis for deriving dietary patterns. Before applying this method to nutrition data, further analyses are required to assess its validity in nutritional epidemiology. We aimed to compare dietary patterns from factor analysis and TT and their associations with diabetes incidence. Complete data were available for 7349 women (50-55 y at baseline) from the Australian Longitudinal Study on Women's Health. Exploratory factor analysis and TT were performed to obtain patterns by using dietary data collected from an FFQ. Generalized estimating equations analyses were used to examine associations between dietary patterns and diabetes incidence. Two patterns were identified by both methods: a prudent and a Western dietary pattern. Factor analysis factors are a linear combination of all food items, whereas TT factors also include items with zero loading. The Western pattern identified by factor analysis showed a significant positive association with diabetes [highest quintile: OR = 1.94 (95% CI: 1.25, 3.00); P-trend = 0.001). Both factor analysis and TT involve different assumptions and subjective decisions. TT produces clearly interpretable factors accounting for almost as much variance as factors from factor analysis. However, TT patterns include food items with zero loading and therefore do not represent overall dietary patterns. The different dietary pattern loading structures identified by both methods result in different conclusions regarding the relationship with diabetes. Results from this study indicate that factor analysis might be a more appropriate method for identifying overall dietary patterns associated with diabetes compared with TT.
    Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn study
    Aerde, M.A. van; Soedamah-Muthu, S.S. ; Geleijnse, J.M. ; Snijder, M.B. ; Nijpels, G. ; Stehouwer, C.D.A. ; Dekker, J.M. - \ 2013
    European Journal of Nutrition 52 (2013)2. - ISSN 1436-6207 - p. 609 - 616.
    coronary-heart-disease - dietary-intake - blood-pressure - calcium intake - milk drinking - reduced risk - skim milk - vitamin-d - consumption - cohort
    Purpose Existing data from prospective cohort studies on dairy consumption and cardiovascular diseases are inconsistent. Even though the association between total dairy and cardiovascular diseases has been studied before, little is known about the effect of different types of dairy products on cardiovascular diseases (CVD). The objective of this study was to examine the relationship between (type of) dairy intake and CVD mortality and all-cause mortality in a Dutch population. Methods We examined the relationship between dairy intake and CVD mortality and all-cause mortality in 1956 participants of the Hoorn Study (aged 50–75 years), free of CVD at baseline. Hazard ratios with 95 % CIs were obtained for CVD mortality and all-cause mortality per standard deviation (SD) of the mean increase in dairy intake, with adjustment for age, sex, BMI, smoking, education, total energy intake, alcohol consumption, physical activity, and dietary intakes. Results During 12.4 years of follow-up, 403 participants died, of whom 116 had a fatal CVD event. Overall dairy intake was not associated with CVD mortality or all-cause mortality. Each SD increase in high-fat dairy intake was associated with a 32 % higher risk of CVD mortality (95 % CI; 7–61 %). Conclusion In this prospective cohort study, the intake of high-fat dairy products was associated with an increased risk of CVD mortality
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