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Fasting Imparts a Switch to Alternative Daily Pathways in Liver and Muscle.
Kinouchi K, Magnan C, Ceglia N, Liu Y, Cervantes M, Pastore N, Huynh T, Ballabio A, Baldi P, Masri S, Sassone-Corsi P.
Cell Rep. 2018 Dec 18;25(12):3299-3314.e6. doi: 10.1016/j.celrep.2018.11.077.
PMID: 30566858
Abstract
The circadian clock operates as intrinsic time-keeping machinery to preserve homeostasis in response to the changing environment. While food is a known zeitgeber for clocks in peripheral tissues, it remains unclear how lack of food influences clock function. We demonstrate that the transcriptional response to fasting operates through molecular mechanisms that are distinct from time-restricted feeding regimens. First, fasting affects core clock genes and proteins, resulting in blunted rhythmicity of BMAL1 and REV-ERBα both in liver and skeletal muscle. Second, fasting induces a switch in temporal gene expression through dedicated fasting-sensitive transcription factors such as GR, CREB, FOXO, TFEB, and PPARs. Third, the rhythmic genomic response to fasting is sustainable by prolonged fasting and reversible by refeeding. Thus, fasting imposes specialized dynamics of transcriptional coordination between the clock and nutrient-sensitive pathways, thereby achieving a switch to fasting-specific temporal gene regulation.
KEYWORDS:
RNA-seq; circadian; clock; fasting; liver; metabolism; muscle; rhythm; transcriptome

Nuts and Cardio-Metabolic Disease: A Review of Meta-Analyses.
Kim Y, Keogh J, Clifton PM.
Nutrients. 2018 Dec 6;10(12). pii: E1935. doi: 10.3390/nu10121935. Review.
PMID: 30563231
https://www.mdpi.com/2072-6643/10/12/1935/htm
Abstract
OBJECTIVES:
Accumulating epidemiological and intervention evidence suggest that nut consumption is associated with reduced incidence of some cardiometabolic diseases. However, to date no review of meta-analyses of epidemiological and intervention studies has evaluated the effects of nut consumption on cardiometabolic disease. Design/Results: Electronic searches for meta-analyses of epidemiological and intervention studies were undertaken in PubMed®/MEDLINE®. Meta-analyses of prospective studies show that nut consumption appears to be associated with reduced all-cause mortality by 19⁻20% (n = 6), cardiovascular disease (CVD) incidence (19%; n = 3) and mortality (25%; n = 3), coronary heart disease (CHD) incidence (20⁻34%; n = 2) and mortality (27⁻30%; n = 2) and stroke incidence (10⁻11%; n = 7) and mortality (18%; n = 2). No association between nut consumption and the risk of type 2 diabetes mellitus (T2DM) was observed in meta-analyses of prospective studies, whereas a decrease in fasting blood glucose ranging from 0.08 to 0.15 mmol/L was observed in 3 meta-analyses of intervention studies. In the interventions, nut consumption also had favorable effects on total cholesterol (0.021 to 0.28 mmol/L reduction from 8 meta-analyses of interventions) and low-density lipoprotein cholesterol (0.017 to 0.26 mmol/L reduction from 8 meta-analyses of interventions) and endothelial function (0.79 to 1.03% increase in flow-mediated dilation from 4 meta-analyses of interventions). Nut consumption did not significantly affect body weight. Nut consumption had no effect on inflammatory markers in intervention studies. The effect on blood pressure was inconsistent. A higher nut consumption was associated with a lower incidence of hypertension in prospective studies, while nut consumption did not improve blood pressure in intervention studies.
CONCLUSIONS:
Nut consumption appeared to be associated with lower all-cause mortality and CVD and CHD mortality. There was no association between nut consumption and the incidence of T2DM although fasting blood glucose is decreased in intervention studies. In intervention studies nuts lower total cholesterol and low-density lipoprotein cholesterol (LDL-C).
KEYWORDS:
cardiovascular disease; meta-analyses; nuts; type 2 diabetes

Serum Beta Carotene and Overall and Cause-Specific Mortality.
Huang J, Weinstein SJ, Yu K, Männistö S, Albanes D.
Circ Res. 2018 Dec 7;123(12):1339-1349. doi: 10.1161/CIRCRESAHA.118.313409.
PMID: 30566060
https://sci-hub.tw/10.1161/CIRCRESAHA.118.313409
Abstract
RATIONALE:
Although the health effects of beta carotene have been studied extensively, a systematic examination of serum concentrations and long-term mortality, including cardiovascular disease mortality, has not been reported.
OBJECTIVE:
Explore whether serum beta carotene is associated with overall and cause-specific mortality and to elucidate the strength and dose-response of the association.
METHODS AND RESULTS:
We conducted a prospective serological analysis of 29 103 men in the ATBC study (Alpha-Tocopherol, Beta-Carotene Cancer Prevention). During 31 years of follow-up, 23 796 deaths occurred, including deaths because of cardiovascular disease (9869), cancer (7692), respiratory disease (2161), diabetes mellitus (119), injuries and accidents (1255), and other causes (2700). Serum beta carotene was assayed using high-performance liquid chromatography. Adjusting for major risk factors measured, men with higher serum beta carotene had significantly lower all-cause mortality (hazard ratios=0.81, 0.71, 0.69, and 0.64 for quintile 2 (Q2)-Q5 versus Q1, respectively; Ptrend<0.0001). Serum beta carotene was significantly associated with risk of death from cardiovascular disease, heart disease, stroke, cancer, respiratory disease, diabetes mellitus, injuries and accidents, and other causes (Q5 versus Q1, hazard ratio=0.21-0.73, all Ptrend<0.0001). The all-cause mortality association was not materially impacted by adjustment for fruit and vegetable consumption (albeit, estimated with some measurement error) and was generally similar across subgroups of smoking intensity, alcohol consumption, trial supplementation, and duration of follow-up, but was significantly modified by age, years of smoking, and body mass index, with stronger inverse associations among men who were younger, smoked fewer years, and had a lower body mass index (all Pinteraction≤0.0025).
CONCLUSIONS:
This study provides evidence that higher beta carotene biochemical status is associated with lower overall, cardiovascular disease, heart disease, stroke, cancer, and other causes of mortality. The dose-response associations over a 30-year period were not attenuated by adjustment for other important risk factors and support greater fruit and vegetable consumption as a means to increase beta carotene status and promote longevity.
KEYWORDS:
beta carotene; cardiovascular diseases; epidemiology; mortality; multivariate analysis; primary prevention

Dietary pattern and incidence of chronic kidney disease among adults: a population-based study.
Asghari G, Momenan M, Yuzbashian E, Mirmiran P, Azizi F.
Nutr Metab (Lond). 2018 Dec 17;15:88. doi: 10.1186/s12986-018-0322-7. eCollection 2018.
PMID: 30564279
https://nutritionandmetabolism.biomedcentral.com/track/pdf/10.1186/s12986-018-0322-7
Abstract
BACKGROUND & AIMS:
Although dietary patterns have been linked to chronic diseases such as cardiovascular disease, sparse data are available for a relationship between dietary patterns and incident chronic kidney disease (CKD) in West Asian populations. The aim of this study was to evaluate the association of population-based dietary pattern with the risk of incident CKD after 6.1 years of follow-up.
METHODS:
At baseline, habitual dietary intakes of 1630 participants of the Tehran Lipid and Glucose Study (TLGS) who were free of CKD was assessed by a valid and reliable food-frequency questionnaire. The following three major dietary patterns were identified using a principal components analysis: Lacto-vegetarian dietary pattern, traditional Iranian dietary pattern, and high fat, high sugar dietary pattern. Estimated glomerular filtration rate (eGFR) was calculated, using the Modification of Diet in Renal Disease (MDRD) Study equation and CKD was defined as eGFR < 60 mL/min/1.73m2. Odds ratio (OR) using multivariable logistic regression was calculated for the association of incident CKD with the extracted dietary patterns.
RESULTS:
After adjusting for age, sex, smoking, total energy intake, physical activity, body mass index, diabetes, and hypertension the OR for participants in the highest compared with those in the lowest tertile of the lacto-vegetarian dietary pattern was 0.57 (95% confidence interval [CI]: 0.41 to 0.80, P-trend = 0.002). In contrast, the high fat, high sugar dietary pattern was positively associated with the incidence of CKD (OR for the third tertile compared with first tertile: 1.46; 95% CI: 1.03-2.09; P-trend = 0.036). Traditional Iranian dietary pattern was not associated with incident CKD.
CONCLUSION:
The high fat, high sugar dietary pattern was associated with significantly increased (46%) odds of incident CKD, whereas a lacto-vegetarian dietary pattern may be protective against the occurrence of CKD by 43%.
KEYWORDS:
Diet quality; Dietary pattern; Glomerular filtration rate; Western dietary pattern

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Dietary factors associated with the development of physical frailty in community-dwelling older adults.
Otsuka R, Tange C, Tomida M, Nishita Y, Kato Y, Yuki A, Ando F, Shimokata H, Arai H.
J Nutr Health Aging. 2019;23(1):89-95. doi: 10.1007/s12603-018-1124-3.
PMID: 30569075
https://sci-hub.tw/10.1007/s12603-018-1124-3
Abstract
OBJECTIVES:
Nutrition plays an important role in the development of frailty, and the present study examined the association between energy, macronutrient, and food intake and the development of physical frailty.
DESIGN:
Prospective cohort study.
SETTING:
The National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA), a community-based study.
PARTICIPANTS:
Participants included 166 men and 117 women aged 65-86 years without frailty components at baseline who participated in both the sixth (2008-2010) and seventh (2010-2012) waves of the NILS-LSA.
MEASUREMENTS:
Physical frailty was assessed using the modified criteria established by the Cardiovascular Health Study (2001). All participants were classified as "robust (number of frailty components: 0)," "prefrail (1-2)," or "frail (3-5)." Energy, macronutrient, and food intake was calculated based on 3-day dietary records during the sixth wave. Associations between dietary intake per day and the development of frailty 2 years later (from robust at the sixth wave to prefrail/frail at the seventh wave) were examined using multiple logistic regression analysis after adjusting for sex, baseline age, and other covariables.
RESULTS:
Among the participants included, 36% were classified as prefrail/frail 2 years later. Higher energy [1 standard deviation (SD), odds ratio (95% confidence interval): 362 kcal, 0.68 (0.49-0.94)], protein [16 g, 0.72 (0.53-0.97)], and fat [15 g, 0.69 (0.52-0.92)] intake was negatively associated with frailty development. Higher meat [38 g, 0.68 (0.51-0.92)] and dairy [114 g, 0.73 (0.55-0.96)] intake was negatively associated with frailty development. Higher energy intake was negatively associated with the development of weakness (low grip strength) and low activity, while higher protein intake was negatively associated with the development of low activity.
CONCLUSION:
Increased consumption of meat and dairy products may provide sufficient protein and fat necessary for achieving higher energy intake, thereby effectively preventing physical frailty among older Japanese individuals.

Body Composition Changes and 10-Year Mortality Risk in Older Brazilian Adults: Analysis of Prospective Data from the SABE Study.
de Almeida Roediger M, de Fátima Nunes Marucci M, Quintiliano Scarpelli Dourado DA, de Oliveira C, Licio Ferreira Santos J, de Oliveira Duarte YA.
J Nutr Health Aging. 2019;23(1):51-59. doi: 10.1007/s12603-018-1118-1.
PMID: 30569068
Abstract
INTRODUCTION:
Aging related alterations in body composition are associated with higher all-cause mortality risk.
OBJECTIVE:
To examine the associations between 10-year mortality risk with both BMI and body composition, as well as to establish whether these relationships are modified by age and gender, using data from community-dwelling older Brazilian adults.
METHODS:
We used data from two waves i.e., 2000 and 2010 of the SABE (Health, Well-being, and Aging) study conducted in São Paulo, Brazil, involving a probabilistic sample of community-dwelling older adults aged 60 years and older. The variables of the study were: mortality (in 10-year follow-up period), body mass index (BMI), body composition (waist circumference, waist hip ratio, triceps skinfold thickness, mid-upper arm circumference, calf circumference, and arm muscle area) and covariables (sociodemographic characteristics, life style, self-reported health conditions, number of chronic diseases, Mini mental state exam, and Geriatric depression scale). Poisson regression estimates with STATA statistical software were used for statistical analyses, considering all p-values < 0.05.
RESULTS:
Over the 10-year follow-up period, there were 769 deaths (40.2%). The mortality rate was 61.0 for men and 111.8 for the ≥80 age group. In the fully adjusted model, statistically significant hazard ratios were found for low muscle mass (IRR: 1.33), underweight (IRR: 1.29), and low fat mass (IRR: 1.31) with mortality. Men in extreme BMI categories (underweight - IRR: 1.47; obesity I - IRR: 1.66; and obesity II - IRR: 1.91) and women with low muscle and low fat mass were significantly associated with mortality risk. In the ≥80 age group it was observed that low muscle mass (IRR: 168.7), inadequate body reserves (IRR: 1.63), low fat mass (IRR: 140.7), and underweight (IRR: 142.9) were associated with mortality risk. Waist circumference demonstrated protection for mortality in the high-risk categorization for the ≥80 age group.
CONCLUSION:
Our results showed that underweight, low fat mass, and low muscle mass were associated with mortality risk, presenting different roles considering gender and age in older Brazilian adults over a 10-year follow-up period.
KEYWORDS:
Aging; body composition; community-dwelling; mortality

The neutrophil-to-lymphocyte ratio is associated with mortality in the general population: The Rotterdam Study.
Fest J, Ruiter TR, Groot Koerkamp B, Rizopoulos D, Ikram MA, van Eijck CHJ, Stricker BH.
Eur J Epidemiol. 2018 Dec 19. doi: 10.1007/s10654-018-0472-y. [Epub ahead of print]
PMID: 30569368
https://sci-hub.tw/https://link.springer.com/article/10.1007/s10654-018-0472-y
Abstract
Inflammation is a risk factor for morbidity and mortality in the elderly. The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that integrates the information of the leukocyte differentials into one variable. We aimed to assess whether the NLR is a risk indicator for overall and cause-specific mortality in the general population. We analyzed data (2002-2014) from the Rotterdam Study, a long-standing, population-based, prospective cohort study in a community-dwelling ageing population. The association between the NLR and time to all-cause mortality was assessed with Cox proportional hazard models. We additionally assessed cardiovascular, cancer and other mortality. The multivariable analyses were adjusted for age, gender, socio-economic status (SES), smoking status, body mass index, type 2 diabetes, and history of cancer and cardiovascular disease (CVD). Data of 8715 individuals were included. The mean age was 65.9 years (SD 10.5) and the majority were women (57.1%). The NLR was higher in men, higher age categories, smokers and among individuals with lower SES, prevalent diabetes, or a history of cancer or CVD. During the 11.7 years follow-up period, 1641 individuals died. Survival among individuals in the 3rd, 4th, and 5th quintile of the NLR was significantly poorer than that of those in the 1st quintile (P < 0.001). In the multivariable analysis, NLR levels were independently and significantly associated with an increased risk of all-cause mortality (HR 1.64; 95% CI 1.44-1.86), cardiovascular mortality (HR 1.92; 95% CI 1.49-2.48), and other mortality (HR 1.86; 95% CI 1.54-2.24). No significant association was found for cancer mortality (HR 1.20; 95% CI 0.95-1.51). The NLR is a strong and independent risk indicator for mortality in the elderly population. Its clinical value needs to be established in further studies.
KEYWORDS:
Low-grade inflammation; Mortality; Neutrophil-to-lymphocyte ratio

Lifestyle and neurocognition in older adults with cognitive impairments: A randomized trial.
Blumenthal JA, Smith PJ, Mabe S, Hinderliter A, Lin PH, Liao L, Welsh-Bohmer KA, Browndyke JN, Kraus WE, Doraiswamy PM, Burke JR, Sherwood A.
Neurology. 2018 Dec 19. pii: 10.1212/WNL.0000000000006784. doi: 10.1212/WNL.0000000000006784. [Epub ahead of print]
PMID: 30568005
Abstract
OBJECTIVE:
To determine the independent and additive effects of aerobic exercise (AE) and the Dietary Approaches to Stop Hypertension (DASH) diet on executive functioning in adults with cognitive impairments with no dementia (CIND) and risk factors for cardiovascular disease (CVD).
METHODS:
A 2-by-2 factorial (exercise/no exercise and DASH diet/no DASH diet) randomized clinical trial was conducted in 160 sedentary men and women (age >55 years) with CIND and CVD risk factors. Participants were randomly assigned to 6 months of AE, DASH diet nutritional counseling, a combination of both AE and DASH, or health education (HE). The primary endpoint was a prespecified composite measure of executive function; secondary outcomes included measures of language/verbal fluency, memory, and ratings on the modified Clinical Dementia Rating Scale.
RESULTS:
Participants who engaged in AE (d = 0.32, p = 0.046) but not those who consumed the DASH diet (d = 0.30, p = 0.059) demonstrated significant improvements in the executive function domain. The largest improvements were observed for participants randomized to the combined AE and DASH diet group (d = 0.40, p = 0.012) compared to those receiving HE. Greater aerobic fitness (b = 2.3, p = 0.049), reduced CVD risk (b = 2.6, p = 0.042), and reduced sodium intake (b = 0.18, p = 0.024) were associated with improvements in executive function. There were no significant improvements in the memory or language/verbal fluency domains.
CONCLUSIONS:
These preliminary findings show that AE promotes improved executive functioning in adults at risk for cognitive decline.
CLASSIFICATION OF EVIDENCE:
This study provides Class I evidence that for adults with CIND, AE but not the DASH diet significantly improves executive functioning.

Risk of hypertension among different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies.
Mirzababaei A, Mozaffari H, Shab-Bidar S, Milajerdi A, Djafarian K.
J Hum Hypertens. 2018 Dec 19. doi: 10.1038/s41371-018-0146-y. [Epub ahead of print] Review.
PMID: 30568291
Abstract
We performed a meta-analysis to assess the association of body mass index (BMI) and metabolic status with the risk of incident hypertension. Relevant studies were identified by searching comprehensive search via PubMed and Scopus search engines up to May 2018 and were analyzed using a random-effects model. Eight prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference group. Pooled relative risks (RRs) and their 95% confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity. Overall, among 79090 participants, the risk of hypertension in metabolically unhealthy obese (MUHO) and metabolically healthy obese phenotypes (MHO) increased compared with the reference group (pooled effect size = 1.95, 95%CI: 1.87-2.04, P < 0.001 vs pooled effect size: 1.54, 95%CI: 1.48-1.61, P < 0.001, respectively). Also, a significant positive association between metabolically unhealthy normal weight (MUHNW) phenotype and the risk of hypertension was observed (pooled effect size = 1.48, 95%CI: 1.41-1.55, P < 0.001). Metabolically unhealthy overweight (MUHOW) and metabolically healthy overweight (MHOW) phenotypes had greater risk of hypertension compared with the MHNW phenotype (pooled effect size = 1.50, 95%CI: 1.13-1.71, P < 0.001 and pooled effect size = 1.18, 95%CI: 1.11-1.27, P < 0.001). This meta-analysis revealed that individuals with metabolic abnormality had a higher risk for hypertension and also suggests that MHOW/ MHO are not a benign condition. We are refuting the notion that overweight and obesity without metabolic abnormalities are benign conditions in all population.

Does dietary intake of selenium protect against cancer? A systematic review and meta-analysis of population-based prospective studies.
Kuria A, Fang X, Li M, Han H, He J, Aaseth JO, Cao Y.
Crit Rev Food Sci Nutr. 2018 Dec 20:1-11. doi: 10.1080/10408398.2018.1548427. [Epub ahead of print]
PMID: 30570346
https://sci-hub.tw/10.1080/10408398.2018.1548427
Abstract
Current evidence on selenium and its effects on cancer is conflicting. This study aimed at assessing the association between dietary intake of selenium and incidence of cancers by performing systematic review and meta-analysis of population-based prospective studies. We systematically searched for articles in Medline (Ovid), Embase, Web of Science (Thomson Reuters), China National Knowledge Infrastructure, Wanfang Database and VIP Chinese Scientific Journals. Analysis was performed in Stata version 14.2. Of the 2,564 articles obtained from the databases, 39 met our inclusion criteria, 37 were included in the final analysis. Selenium at recommended daily allowance levels of ≥55 μg/day decreased the risk of cancer [relative risk (RR) = 0.94, 95% confidence interval (CI): 0.90-0.98]. A protective effect was found in men at levels ≥55 μg/day (RR = 0.97, 95% CI: 0.94-0.99). Extra selenium intake from supplements was protective at levels ≥55 μg/day (RR = 0.89, 95% CI: 0.82-0.97). There was an inverse relationship (p value = 0.020) between selenium intake and overall cancer risk after adjusting for age, body mass index, and smoking but there was no evidence of nonlinear relationship (p value = 0.261). The findings in this study suggest that selenium is protective against cancer however the effects vary with different cancers.
KEYWORDS:
Nutrition; cancer; diet; incidence; meta-analysis; population; prospective study; selenium; systematic review

Adherence to the Dietary Approaches to Stop Hypertension Dietary Pattern and Risk of Abdominal Aortic Aneurysm: Results From the ARIC Study.
Haring B, Selvin E, He X, Coresh J, Steffen LM, Folsom AR, Tang W, Rebholz CM.
J Am Heart Assoc. 2018 Nov 6;7(21):e009340. doi: 10.1161/JAHA.118.009340.
PMID: 30571386
https://www.ahajournals.org/doi/pdf/10.1161/JAHA.118.009340
Abstract
Background The role of a healthy dietary pattern in the prevention of abdominal aortic aneurysms ( AAA ) is unknown. We aimed to evaluate the relationship between adherence to a Dietary Approaches To Stop Hypertension-style dietary pattern and the risk of incident AAA s. Methods and Results Dietary intake was assessed via a 66-item food frequency questionnaire at baseline (1987-1989) and at visit 3 (1993-1995) in 13 496 participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study without clinical AAA (mean age, 54 years). A dietary scoring index based on food times was constructed to assess self-reported adherence to a dietary approaches to stop hypertension-style dietary pattern. Participants were followed for incident clinical AAA s using hospital discharge diagnoses, Medicare inpatient and outpatient diagnoses, or death certificates through December 31, 2011. Cox proportional hazards models with covariate adjustment were used to estimate hazard ratios with 95% confidence intervals. During a median follow-up of 23 years, there were 517 incident AAA cases. Individuals with a Dietary Approaches To Stop Hypertension-style diet score in the highest quintile had a 40% lower risk of hospitalization for AAA than those in the lowest quintile (hazard ratioQ5 vs Q1: 0.60; 95% confidence intervals: 0.44, 0.83; Ptrend=0.002). In detailed analyses, higher consumption of fruits, vegetables, whole grains, low-fat dairy, and nuts and legumes was related to a lower risk for AAA . Conclusions Greater adherence to a Dietary Approaches To Stop Hypertension-style dietary pattern was associated with lower risk for AAA. Higher consumption of fruits, vegetables, whole grains, low-fat dairy as well as nuts and legumes may help to decrease the burden of AAAs.
KEYWORDS:
Dietary Approaches to Stop Hypertension; aneurysm; diet

APOE and the Association of Fatty Acids With the Risk of Stroke, Coronary Heart Disease, and Mortality.
Satizabal CL, Samieri C, Davis-Plourde KL, Voetsch B, Aparicio HJ, Pase MP, Romero JR, Helmer C, Vasan RS, Kase CS, Debette S, Beiser AS, Seshadri S.
Stroke. 2018 Dec;49(12):2822-2829. doi: 10.1161/STROKEAHA.118.022132.
PMID: 30571417
Abstract
Background and Purpose- The role of dietary fat on cardiovascular health and mortality remains under debate. Because the APOE is central to the transport and metabolism of lipids, we examined associations between plasma fatty acids and the risk of stroke, coronary heart disease, and mortality by APOE-ε4 genotype. Methods- We included 943 FHS (Framingham Heart Study) and 1406 3C (Three-City) Bordeaux Study participants. Plasma docosahexaenoic, linoleic, arachidonic, and palmitic fatty acids were measured at baseline by gas chromatography. All-cause stroke, ischemic stroke, coronary heart disease, and all-cause mortality events were identified prospectively using standardized protocols. Each cohort used Cox models to separately relate fatty acid levels to the risk of developing each event during ≤10 years of follow-up adjusting for potential confounders and stratifying by APOE genotype (ε4 carriers versus noncarriers). We then meta-analyzed summary statistics using random-effects models. Results- On average, participants had a mean age of 74 years, 61% were women, and 21% (n=483) were APOE-ε4 carriers. Meta-analysis results showed that, only among APOE-ε4 carriers, every SD unit increase in linoleic acid was associated with a reduced risk of all-cause stroke (hazard ratio {HR}, 0.54 [95% CI, 0.38-0.78]), ischemic stroke (HR, 0.48 [95% CI, 0.33-0.71]), and all-cause mortality (HR, 0.70 [95% CI, 0.57-0.85]). In contrast, every SD unit increase in palmitic acid was related to an increased risk of all-cause stroke (HR, 1.58 [95% CI, 1.16-2.17]), ischemic stroke (HR, 1.76 [95% CI, 1.26-2.45]), and coronary heart disease (HR, 1.48 [95% CI, 1.09-2.01]), also in APOE-ε4 carriers only. Results for docosahexaenoic acid and arachidonic acid were heterogeneous between cohorts. Conclusions- These exploratory results suggest that APOE-ε4 carriers may be more susceptible to the beneficial or adverse impact of fatty acids on cardiovascular disease and mortality. In this subgroup, higher linoleic acid was protective for stroke and mortality, whereas palmitic acid was a risk factor for stroke and coronary heart disease. The mechanisms underlying these novel findings warrant further investigation.
KEYWORDS:
apolipoproteins E; cardiovascular diseases; humans; lipids; mortality

Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial.
Shah B, Newman JD, Woolf K, Ganguzza L, Guo Y, Allen N, Zhong J, Fisher EA, Slater J.
J Am Heart Assoc. 2018 Dec 4;7(23):e011367. doi: 10.1161/JAHA.118.011367.
PMID: 30571591
Abstract
Background Dietary interventions may play a role in secondary cardiovascular prevention. hsCRP (High-sensitivity C-reactive protein) is a marker of risk for major adverse cardiovascular outcomes in coronary artery disease. Methods and Results The open-label, blinded end-point, EVADE CAD (Effects of a Vegan Versus the American Heart Association-Recommended Diet in Coronary Artery Disease) trial randomized participants (n=100) with coronary artery disease to 8 weeks of a vegan or American Heart Association-recommended diet with provision of groceries, tools to measure dietary intake, and dietary counseling. The primary end point was high-sensitivity C-reactive protein. A linear regression model compared end points after 8 weeks of a vegan versus American Heart Association diet and adjusted for baseline concentration of the end point. Significance levels for the primary and secondary end points were set at 0.05 and 0.0015, respectively. A vegan diet resulted in a significant 32% lower high-sensitivity C-reactive protein (β, 0.68, 95% confidence interval [0.49-0.94]; P=0.02) when compared with the American Heart Association diet. Results were consistent after adjustment for age, race, baseline waist circumference, diabetes mellitus, and prior myocardial infarction (adjusted β, 0.67 [0.47-0.94], P=0.02). The degree of reduction in body mass index and waist circumference did not significantly differ between the 2 diet groups (adjusted β, 0.99 [0.97-1.00], P=0.10; and adjusted β, 1.00 [0.98-1.01], P=0.66, respectively). There were also no significant differences in markers of glycemic control between the 2 diet groups. There was a nonsignificant 13% reduction in low-density lipoprotein cholesterol with the vegan diet when compared with the American Heart Association diet (adjusted β, 0.87 [0.78-0.97], P=0.01). There were no significant differences in other lipid parameters. Conclusions In patients with coronary artery disease on guideline-directed medical therapy, a vegan diet may be considered to lower high-sensitivity C-reactive protein as a risk marker of adverse outcomes.
KEYWORDS:
C‐reactive protein; diet; inflammation

Fresh fruit intake in pregnancy and association with gestational diabetes mellitus: A prospective cohort study.
Zhou X, Chen R, Zhong C, Wu J, Li X, Li Q, Cui W, Yi N, Xiao M, Yin H, Xiong G, Han W, Hao L, Yang X, Yang N.
Nutrition. 2018 Oct 24;60:129-135. doi: 10.1016/j.nut.2018.09.022. [Epub ahead of print]
PMID: 30572275
Abstract
OBJECTIVE:
Fresh fruit intake has been found to be associated with risk of gestational diabetes mellitus (GDM); however, the evidence is limited and the findings are inconsistent. We aimed to assess the association of fresh fruit intake by fruit subgroups based on their glycemic index (GI) and glycemic load (GL) values and GDM incidence in Chinese pregnant women.
METHODS:
We included 3300 eligible women from the Tongji Maternal and Child Health Cohort. Dietary intakes were assessed by using a validated semiquantitative food frequency questionnaire. GDM was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test. In the adjusted logistic regression model, odds ratios and 95% confidence intervals for GDM were computed for the highest compared with lowest quintiles of fruit intake.
RESULTS:
GDM occurred in 378 (11.5%) of 3300 pregnant women. The average fresh fruit consumption was 381.7 g/d. The adjusted odds ratios (95% confidence intervals) for GDM from the lowest to highest quintile of whole fruit consumption were 1.00 (referent), 0.80 (0.56, 1.12), 0.74 (0.52, 1.05), 0.63 (0.44, 0.92), and 0.41 (0.27, 0.62), respectively; Ptrend < 0.001. Higher overall midpregnancy fresh fruit consumption was associated with lower plasma 1-h OGTT glucose and 2-h OGTT glucose levels (all P < 0.05). In addition, the stratified analysis results indicated that greater consumption of low and high GI fruits and low GL fruits were both associated with a lower risk of GDM but not high GL fruits.
CONCLUSIONS:
Our findings suggested an inverse association of fresh fruit intake with the risk of GDM in Chinese pregnant women. In women with GDM risk, low GI and GL fresh fruit consumption should be privileged versus those with high GI and GL.
KEYWORDS:
Fresh fruit; Gestational diabetes mellitus; Glycemic index; Glycemic load; Plasma glucose

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Associations of Calcium, Vitamin D, and Dairy Product Intakes with Colorectal Cancer Risk among Older Women: The Iowa Women's Health Study.
Um CY, Prizment A, Hong CP, Lazovich D, Bostick RM.
Nutr Cancer. 2018 Dec 20:1-10. doi: 10.1080/01635581.2018.1539188. [Epub ahead of print]
PMID: 30572720
https://sci-hub.tw/10.1080/01635581.2018.1539188
Abstract
Calcium and, to a lesser extent, dairy products are consistently modestly inversely associated with colorectal cancer (CRC). Dairy products may contain components other than calcium and fat, such as insulin-like growth factor-1, that may affect CRC risk. In the prospective Iowa Women's Health Study, calcium, dairy product, and vitamin D intakes were assessed using a semiquantitative food frequency questionnaire. To investigate dairy products independent of their calcium components, we estimated residuals from linear regression models of their associations with dietary calcium. Of the 35,221 55-69-year-old cancer-free women at baseline in 1986, 1,731 developed CRC during follow-up through 2012. For those in the highest relative to the lowest intake quintiles, the adjusted hazards ratios and 95% confidence intervals from multivariable Cox proportional hazards regression models for overall and distal CRC were 0.81 (0.67-0.98; Ptrend = 0.004) and 0.59 (0.44-0.80; Ptrend = 0.003), respectively, for total calcium; and 0.79 (0.66-0.94; Ptrend = 0.01) and 0.69 (0.53-0.90; Ptrend = 0.003) for total dairy products, respectively. The various dairy product residuals were not associated with CRC. These results support that, among women, calcium and dairy products may be inversely associated with CRC-perhaps primarily distal CRC-but suggest that the non-calcium, non-fat component of dairy products may not be associated with CRC.

The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study.
DiPietro L, Jin Y, Talegawkar S, Matthews CE.
Int J Obes (Lond). 2018 Dec 21. doi: 10.1038/s41366-018-0294-8. [Epub ahead of print]
PMID: 30575803
https://sci-hub.tw/https://www.nature.com/articles/s41366-018-0294-8
Abstract
BACKGROUND/OBJECTIVES:
The purpose of this study was to determine the joint associations of weight status and physical activity with mobility disability in older men and women.
SUBJECTS/METHODS:
We analyzed prospective data from 135,220 participants in the NIH-AARP Diet and Health Study between 1995-1996 and 2004-2005.
METHODS:
Height and weight, as well as light- and moderate-to-vigorous-intensity physical activity typical of the past 10 years (h/week) were self-reported at baseline, and body mass index (BMI: kg/m2) was categorized into normal weight (BMI 18 to <25 kg/m2); overweight (BMI 25 to <30 kg/m2); and obese (BMI ≥ 30 kg/m2). Mobility was assessed by self-report at follow-up and mobility disability was defined as reporting "unable to walk" or an "easy usual walking pace (<2 mph)". Multivariable logistic regression determined the independent and joint associations of weight status and total physical activity with the odds of mobility disability.
RESULTS:
Twenty-one percent of men and 37% of women reported a mobility disability at follow-up. We observed a curvilinear dose-response association between increasing categories of weight status and mobility disability within each tertile of physical activity, with the highest odds experienced by men and women with overweight (OR = 2.45; 95%CI: 2.25, 2.67 for men and OR = 2.99; 95%CI: 2.78, 3.22 for women) and obesity (OR = 3.93; 95%CI: 3.58, 4.32 for men and OR = 5.08; 95% CI: 4.65, 5.54 for women) in combination with low physical activity. Moreover, among those reporting 7 or fewer hours/week of total physical activity, being of normal body weight did not eliminate the excess odds of mobility disability.
CONCLUSIONS:
These findings highlight the combined importance of obesity prevention and physical activity promotion to mobility in older age. Given aging demographics and the global economic burden associated with aging- and disuse-related disability, there is tremendous public health benefit to understanding how various modifiable determinants of mobility disability can interact in older age.

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Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis.
Kua CH, Mak VSL, Huey Lee SW.
J Am Med Dir Assoc. 2018 Dec 20. pii: S1525-8610(18)30606-6. doi: 10.1016/j.jamda.2018.10.026. [Epub ahead of print]
PMID: 30581126
Abstract
OBJECTIVES:
Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes.
DESIGN:
Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028).
SETTING AND PARTICIPANTS:
Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age.
MEASURES:
Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis.
RESULTS:
A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19-0.89). In subgroup analysis, medication review-directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65-0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62-0.93).
CONCLUSIONS:
Compared to other deprescribing interventions, medication review-directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review-directed deprescribing practice.
KEYWORDS:
Deprescribing; falls; mortality; nursing home; older adult; polypharmacy

Association of Physical Activity and Risk of Hepatobiliary Cancers: A Multinational Cohort Study.
Baumeister SE, Schlesinger S, Aleksandrova K, Jochem C, Jenab M, Gunter MJ, Overvad K, Tjønneland A, Boutron-Ruault MC, Carbonnel F, Fournier A, Kühn T, Kaaks R, Pischon T, Boeing H, Trichopoulou A, Bamia C, La Vecchia C, Masala G, Panico S, Fasanelli F, Tumino R, Grioni S, de Mesquita BB, Vermeulen R, May AM, Borch KB, Oyeyemi SO, Ardanaz E, Rodríguez-Barranco M, López MDC, Felez-Nobrega M, Sonestedt E, Ohlsson B, Hemmingsson O, Werner M, Perez-Cornago A, Ferrari P, Stepien M, Freisling H, Tsilidis KK, Ward H, Riboli E, Weiderpass E, Leitzmann MF.
J Hepatol. 2018 Dec 21. pii: S0168-8278(18)32633-3. doi: 10.1016/j.jhep.2018.12.014. [Epub ahead of print]
PMID: 30582978
Abstract
BACKGROUND & AIMS:
Evidence on the association between physical activity and risk of hepatobiliary cancers is inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC).
METHODS:
We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBC), and 164 non-gallbladder extrahepatic bile duct cancers (NGBC) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity, performed mediation analysis, and secondary analyses to assess robustness to confounding (e.g., due to hepatitis virus infection).
RESULTS:
In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% confidence intervals (CI) 0.38-0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (0.33-0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC.
CONCLUSIONS:
Findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity.
LAY SUMMARY:
In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption.
KEYWORDS:
Hepatobiliary cancer; Hepatocellular carcinoma; Liver cancer; Physical activity

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Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials.
Cioffi I, Evangelista A, Ponzo V, Ciccone G, Soldati L, Santarpia L, Contaldo F, Pasanisi F, Ghigo E, Bo S.
J Transl Med. 2018 Dec 24;16(1):371. doi: 10.1186/s12967-018-1748-4. Review.
PMID: 30583725
https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1748-4
https://translational-medicine.biomedcentral.com/track/pdf/10.1186/s12967-018-1748-4
Abstract
BACKGROUND:
This systematic review and meta-analysis summarized the most recent evidence on the efficacy of intermittent energy restriction (IER) versus continuous energy restriction on weight-loss, body composition, blood pressure and other cardiometabolic risk factors.
METHODS:
Randomized controlled trials were systematically searched from MEDLINE, Cochrane Library, TRIP databases, EMBASE and CINAHL until May 2018. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI).
RESULTS:
Eleven trials were included (duration range 8-24 weeks). All selected intermittent regimens provided ≤ 25% of daily energy needs on "fast" days but differed for type of regimen (5:2 or other regimens) and/or dietary instructions given on the "feed" days (ad libitum energy versus balanced energy consumption). The intermittent approach determined a comparable weight-loss (WMD: - 0.61 kg; 95% CI - 1.70 to 0.47; p = 0.87) or percent weight loss (WMD: - 0.38%, - 1.16 to 0.40; p = 0.34) when compared to the continuous approach. A slight reduction in fasting insulin concentrations was evident with IER regimens (WMD = - 0.89 µU/mL; - 1.56 to - 0.22; p = 0.009), but the clinical relevance of this result is uncertain. No between-arms differences in the other variables were found.
CONCLUSIONS:
Both intermittent and continuous energy restriction achieved a comparable effect in promoting weight-loss and metabolic improvements. Long-term trials are needed to draw definitive conclusions.
KEYWORDS:
Continuous energy restriction; Fasting glucose; Intermittent energy restriction; Triglycerides; Weight loss

Effects of Consuming Calcium-Rich Foods on the Incidence of Type 2 Diabetes Mellitus.
Jeon J, Jang J, Park K.
Nutrients. 2018 Dec 22;11(1). pii: E31. doi: 10.3390/nu11010031.
PMID: 30583546
https://www.mdpi.com/2072-6643/11/1/31/htm
Abstract
The effect of calcium consumption in the prevention of type 2 diabetes mellitus (T2DM) remains controversial, and depends on food calcium sources. This prospective study aimed to evaluate the association between calcium-rich food consumption and T2DM incidence among Korean adults. We analyzed the data of 8574 adults aged 40⁻69 years, without a history of T2DM, cardiovascular disease, and cancer at the baseline from the Korean Genome and Epidemiology Study. The consumption of calcium-rich foods was assessed using a validated semi-quantitative food frequency questionnaire. T2DM-related data were collected using biennial questionnaires, health examinations, and clinical tests. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. In the multivariate-adjusted model, yogurt intake was inversely associated with T2DM risk (HR: 0.73; 95% CI: 0.61⁻0.88 in the fourth quartile as compared to the first quartile). However, the intakes of other calcium-rich foods, including milk and anchovies, were not significantly associated with T2DM risk. Yogurt may provide protective effects against T2DM in Korean adults, owing to the beneficial effects of probiotics. Further prospective large-scale cohort studies should be conducted to validate these findings.
KEYWORDS:
Korean adults; calcium; type 2 diabetes mellitus; yogurt

Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network.
Cappuccio FP, Beer M, Strazzullo P; European Salt Action Network.
Nutr Metab Cardiovasc Dis. 2018 Dec 7. pii: S0939-4753(18)30352-1. doi: 10.1016/j.numecd.2018.11.010. [Epub ahead of print] Review.
PMID: 30583888
Abstract
The publication in the last few years of a number of prospective observational studies suggesting a J-shaped association between levels of salt (sodium) consumption and cardiovascular outcomes has opened a debate on the pertinence of population-wide salt reduction policies to reduce cardiovascular disease burden, and some have even questioned the global World Health Organization guidelines, that recommend a 30% reduction in salt consumption by 2025, aiming at an ideal target of no more than 5 g of salt consumption per day. In September 2018 the European Salt Action Network (E.S.A.N.), after appraising the quality of publications questioning the appropriateness of population salt reduction, discussed the scientific evidence and identified the pitfalls of recent data. The new evidence was deemed inadequate and, in places, biased by flawed methodology. These were identified in the biased assessment of sodium intake from spot urine and the use of the Kawasaki formula, the biased assessment of the sodium-outcome relationships in prospective observational studies using spot urine samples, the impact of reverse causality in such studies, the inadequate analytical approaches to data analysis, the lack of biological plausibility and the lack of precision in assessing long-term salt consumption, as recently demonstrated in studies using more stringent quality features in their study designs. On the basis of such appraisal, the E.S.A.N. agreed a statement confirming the support to the implementation of national and regional programmes of moderate reduction in salt intake, as recommended by the World Health Organization.
KEYWORDS:
Methodology; Policy; Population; Salt reduction; Urine collections

Legacy of the Tehran Lipid and Glucose Study: Chronic Kidney Disease.
Eftekharzadeh A, Hosseinpanah F, Valizadeh M, Barzin M, Mahdavi M, Azizi F.
Int J Endocrinol Metab. 2018 Oct 31;16(4 Suppl):e84761. doi: 10.5812/ijem.84761. eCollection 2018 Oct. Review.
PMID: 30584436
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289308/pdf/ijem-16-suppl04-84761.pdf
Abstract
CONTEXT:
Chronic kidney disease (CKD), is correlated with a substantial upsurge in mortality and morbidity worldwide. In this review, we aimed to review the 20-year-findings on CKD of the Tehran lipid and glucose study (TLGS).
EVIDENCE ACQUISITION:
We conducted a systematic review of all studies on CKD that had been performed in the context of TLGS.
RESULTS:
Age adjusted prevalence of CKD, according to estimated glomerular filtration rate (eGFR) assessed with the two abbreviated equations of the modification of diet in renal disease (MDRD) and the CKD epidemiology collaboration (CKD-EPI) were 11.3% (95% confidence interval (CI): 10.7, 12.0) and 8.5% (95% CI: 7.9, 9.1), respectively. Using MDRD equation, over a mean follow up of 9.9 years, the incidence density rates of CKD were 285.3 person years in women and 132.6 per 10000 person-years in men. Studies on the TLGS population documented that abdominal adiposity defined as waist circumference (WC) categories (P for trend < 0.02) and waist gain in men (hazard ratio (HR) = 1.7, CI: 1.3, 2.2) significantly affected CKD development. Also, CKD had a significant effect on coronary heart disease (CHD) only in participants with low body mass index (HR = 2.06; CI: 1.28, 3.31 and HR = 2.56; CI: 1.04, 6.31 in men and women, respectively). Moreover, CKD was among the strongest independent predictors of stroke (HR = 2.01, CI: 1.22, 3.33). Also, compared to diabetic patients, an abnormal ECG was more prevalent in moderate CKD (P = 0.02).
CONCLUSIONS:
Increased waist circumference and waist gain (only in men) were associated with developing CKD in the TLGS population. CKD was an independent predictor of CHD (in lean individuals) and stroke.
KEYWORDS:
Chronic Kidney Disease (CKD); Tehran Lipid and Glucose Study (TLGS)

Nutrition and Cardio-Metabolic Risk Factors: Findings from 20 Years of the Tehran Lipid and Glucose Study.
Hosseini-Esfahani F, Hosseinpour-Niazi S, Asghari G, Bahadoran Z, Moslehi N, Golzarand M, Ejtahed HS, Mirmiran P, Azizi F.
Int J Endocrinol Metab. 2018 Oct 13;16(4 Suppl):e84772. doi: 10.5812/ijem.84772. eCollection 2018 Oct. Review.
PMID: 30584439
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289298/pdf/ijem-16-suppl04-84772.pdf
Abstract
CONTEXT:
Genetic and environmental factors contribute to the incidence of metabolic syndrome (MetS). This study aimed to review all findings of studies conducted in framework of the Tehran lipid and glucose study (TLGS) regarding the association of dietary factors with cardio-metabolic risk factors.
EVIDENCE ACQUISITION:
All English-language studies were searched using PubMed and Scopus databases from 2000 to 2017. Finally, 105 relevant papers were included in this review.
RESULTS:
Whole grains, legumes, nuts and healthy dietary patterns (DPs) reduced risk of MetS, while white rice, salty/sweet snacks increased this. The western DP had a significant interaction with APOC3, APOA1 and MC4R polymorphisms in relation to MetS. After 6.5 years of follow-up, odds of reaching menarche ≤ 12 years was significantly higher in girls with higher intakes of milk, calcium, magnesium, and phosphorous. Among children and adolescents, higher adherence to the dietary approaches to stop hypertension (DASH)-style diet decreased the risk of abdominal obesity, whereas increased adherence to the western DP could contribute to general and abdominal obesity. A three-year follow-up of adult participants showed that higher intakes of phytochemical-rich foods were inversely related to development of insulin resistance. Higher adherence to the healthy DPs was associated with the reduced risk of hyperlipidemia and hypertention. Nutrition interventions postponed rise in the prevalence of MetS. The DASH diet resulted in weight reduction compared to control diet.
CONCLUSIONS:
Higher adherence to healthy food choices was associated with reduced odds of MetS, abdominal obesity, dyslipidemia and hypertension. The western DP accentuated the association of polymorphisms with MetS.
KEYWORDS:
Cardiovascular Risk Factors; Diet; Metabolic Syndrome; Nutrients; Tehran Lipid and Glucose Study

Nutrition and Diabetes, Cardiovascular and Chronic Kidney Diseases: Findings from 20 Years of the Tehran Lipid and Glucose Study.
Hosseini-Esfahani F, Moslehi N, Asghari G, Hosseinpour-Niazi S, Bahadoran Z, Yuzbashian E, Mirmiran P, Azizi F.
Int J Endocrinol Metab. 2018 Oct 31;16(4 Suppl):e84791. doi: 10.5812/ijem.84791. eCollection 2018 Oct. Review.
PMID: 30584447
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289313/pdf/ijem-16-suppl04-84791.pdf
Abstract
CONTEXT:
The high prevalence of chronic diseases can be prevented or managed by specific changes in lifestyle patterns of individuals of which dietary factors is emphasized. The objective of this study was to review all findings of the Tehran Lipid and Glucose Study regarding validity and reliability of food frequency questionnaire (FFQ), evaluating dietary quality and association of dietary factors in relation to diabetes, dysglycemia, cardiovascular (CVD) and chronic kidney disease (CKD).
EVIDENCE ACQUISITION:
Related documents were searched through PubMed and Scopus databases, in English language from 2000 to 2017. Finally, 52 relevant documents were eligible for inclusion in this review.
RESULTS:
The FFQ proved to be an acceptable tool for assessing nutrient and food group intakes and rank individuals accurately according to the levels of their dietary intakes. After 8 years of follow-up, the western dietary pattern (DP) was fairly stable but there was instability of traditional Iranian DP. DPs of over two-thirds of Tehranian populations were not in accordance with the dietary recommendations. Higher dietary scores of variety and healthy DPs were also associated with reduced odds of dysglycemia. The main dietary factor related to increased risk of CVD in our population was western DP. Patterns of amino acid intakes may contribute to the development of CVD. Higher intakes of several micronutrients and macronutrients, DPs and some vegetables decrease the risk of CKD. In conclusion DPs of most Tehranian adults need improvement.
CONCLUSIONS:
This review showed that higher adherence to healthy food choices was associated with reduced odds of dysglycemia and CVD. Dietary sources of renal-protective nutrients should be encouraged among the general population.
KEYWORDS:
Chronic Kidney Disease; Diabetes, Cardiovascular Disease; Diet, Nutrients; Tehran Lipid and Glucose Study

Dietary glycaemic index and cognitive function: prospective associations in adults of the 1946 British birth cohort.
Philippou E, Pot GK, Heraclides A, Richards M, Bendayan R.
Public Health Nutr. 2018 Dec 26:1-10. doi: 10.1017/S136898001800352X. [Epub ahead of print]
PMID: 30585572
Abstract
OBJECTIVE:
Evidence suggests that the rate of glucose release following consumption of carbohydrate-containing foods, defined as the glycaemic index (GI), is inversely associated with cognitive function. To date, most of the evidence stems from either single-meal studies or highly heterogeneous cohort studies. We aimed to study the prospective associations of diet GI at age 53 years with outcomes of verbal memory and letter search tests at age 69 years and rate of decline between 53 and 69 years.
DESIGN:
Longitudinal population-based birth cohort study.
SETTING:
MRC National Survey for Health and Development.ParticipantsCohort members (n 1252).
RESULTS:
Using multivariable linear and logistic regression, adjusted for potential confounders, associations of higher-GI diet with lower verbal memory, lower letter search speed and lower number of hits in a letter search test were attenuated after adjustments for cognitive ability at age 15 years, educational attainment, further training and occupational social class. No association was observed between diet GI at 53 years and letter search accuracy or speed-accuracy trade-off at 69 years, or between diet GI at 53 years and rate of decline between 53 and 69 years in any cognitive measure.
CONCLUSIONS:
Diet GI does not appear to predict cognitive function or decline, which was mainly explained by childhood cognitive ability, education and occupational social class. Our findings confirm the need for further research on the association between diet and cognition from a life-course perspective.
KEYWORDS:
Aged; Carbohydrates; Glucose release; National Survey of Health and Development; Prospective study

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Carrying the T Allele of the SNP rs574344, an eQTL of GSTM1, Contributes to Longevity in the Han Chinese Population.
Zhang Y, Zhang S, Yan D, Pan H, Liu B, Li T, Wang X, Cai W, Wang B.
Genet Test Mol Biomarkers. 2018 Dec 27. doi: 10.1089/gtmb.2018.0178. [Epub ahead of print]
PMID: 30589570
Abstract
BACKGROUND:
There has been recent recognition that the GSTM1 gene is associated with successful aging and longevity. It has been hypothesized that individuals with a GSTM1 deletion are at a greater risk for developing a plethora of diseases. This study was carried out to investigate the association between the rs574344 single nucleotide polymorphism, an expression quantitative trait locus of GSTM1, and longevity in the Han Chinese population.
MATERIALS AND METHODS:
We performed a case-control study that comprised 526 long-lived subjects (>97 years of age) and 783 younger subjects (aged 19-80 years) from the general population who served as controls. Identification of the genotypes of rs574344 was accomplished by combining polymerase chain reaction with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.
RESULTS:
The long-lived study population, when compared with the controls, showed a significantly higher frequency of the T/T genotype and the T allele of rs574344. We determined that the T/T genotype is associated with a longer lifespan (OR = 5.972, 95% CI 1.798-19.833, p = 0.001, for all genders; p = 0.006 adjusted by gender). We also observed a significant difference (p < 0.05) in the distribution of alleles and genotypes in both the male group (TT vs. TA, OR = 1.043, 95% CI 1.022-1.067, p = 0.043) and the female group (TT vs. TA, OR = 3.592, 95% CI 0.982-13.147, p = 0.039) Conclusion: We found significant associations between both the T allele and the T/T genotype of rs574344 with longevity in the Han Chinese population.
KEYWORDS:
; Chinese; SNP; eQTL; longevity
https://en.wikipedia.org/wiki/Glutathione_S-transferase_Mu_1

Association between added sugar intake and mortality is nonlinear and dependent on sugar source in 2 Swedish population-based prospective cohorts.
Ramne S, Alves Dias J, González-Padilla E, Olsson K, Lindahl B, Engström G, Ericson U, Johansson I, Sonestedt E.
Am J Clin Nutr. 2018 Dec 26. doi: 10.1093/ajcn/nqy268. [Epub ahead of print]
PMID: 30590448
Abstract
BACKGROUND:
Although sugar consumption has been associated with several risk factors for cardiometabolic diseases, evidence for harmful long-term effects is lacking. In addition, most studies have focused on sugar-sweetened beverages (SSBs), not sugar per se.
OBJECTIVE:
The aim of this study was to examine the associations between added and free sugar intake, intake of different sugar sources, and mortality risk.
METHODS:
Two prospective population-based cohorts were examined: the Malmö Diet and Cancer Study (MDCS; n = 24,272), which collected dietary data by combining a food diary, interview, and food-frequency questionnaire (FFQ), and the Northern Swedish Health and Disease Study (NSHDS; n = 24,475), which assessed diet with an FFQ. Sugar intakes defined as both added and free sugar and different sugar sources were examined. The associations with mortality were examined using a multivariable Cox proportional hazards regression.
RESULTS:
Higher sugar consumption was associated with a less favorable lifestyle in general. The lowest mortality risk was found with added sugar intakes between 7.5% and 10% of energy (E%) intake in both cohorts. Intakes >20E% were associated with a 30% increased mortality risk, but increased risks were also found at intakes <5E% [23% in the MDCS and 9% (nonsignificant) in the NSHDS]. Similar U-shaped associations were found for both cardiovascular and cancer mortality in the MDCS. By separately analyzing the different sugar sources, the intake of SSBs was positively associated with mortality, whereas the intake of treats was inversely associated.
CONCLUSIONS:
Our findings indicate that a high sugar intake is associated with an increased mortality risk. However, the risk is also increased among low sugar consumers, although they have a more favorable lifestyle in general. In addition, the associations are dependent on the type of sugar source.

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Aspirin Use and Respiratory Morbidity in COPD: a Propensity Score Matched Analysis in SPIROMICS.
Fawzy A, Putcha N, Aaron CP, Bowler RP, Comellas AP, Cooper CB, Dransfield MT, Han MK, Hoffman EA, Kanner RE, Krishnan JA, Labaki WW, Paine R 3rd, Paulin LM, Peters SP, Wise R, Barr RG, Hansel NN; SPIROMICS Investigators.
Chest. 2018 Dec 26. pii: S0012-3692(18)32887-3. doi: 10.1016/j.chest.2018.11.028. [Epub ahead of print]
PMID: 30593776
Abstract
BACKGROUND:
Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, aspirin's effect on COPD morbidity is unknown.
METHODS:
Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV1/FVC<70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring emergency department visit or hospitalization). Aspirin users were matched one-to-one with non-users based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression were used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance.
RESULTS:
Among 1,698 participants, 45% reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant-pairs. Aspirin users had lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR] 0.78, 95% Confidence Interval [CI]: 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR 0.86, 95%CI: 0.63-1.18). Aspirin use was associated with lower total St. George Respiratory Questionnaire score (β -2.2, 95%CI: -4.1, -0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score ≥2 adjusted odds ratio 0.69, 95%CI: 0.51-0.93), and COPD Assessment Test score (β -1.1; 95%CI: -1.9, -0.2) but not six-minute walk distance (β 0.7 meters; 95%CI: -14.3, 15.6).
CONCLUSIONS:
Daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding.

Dietary Sodium Reduction Reduces Albuminuria: A Cluster Randomized Trial.
Jardine MJ, Li N, Ninomiya T, Feng X, Zhang J, Shi J, Zhang Y, Zhang R, Zhang J, Hao J, Perkovic V, Heerspink HL, Wu Y, Yan LL, Neal B.
J Ren Nutr. 2018 Dec 24. pii: S1051-2276(18)30247-4. doi: 10.1053/j.jrn.2018.10.009. [Epub ahead of print]
PMID: 30591358
Abstract
OBJECTIVES:
The objective of the study was to assess the impact of sustained dietary salt reduction on albuminuria in nearly 2000 community-dwelling adults.
DESIGN AND METHODS:
The present study is a prespecified secondary analysis of the China Rural Health Initiative Salt Reduction Study cluster randomized trial undertaken in 120 villages in rural China. Villages were randomized to a sodium reduction program of education and access to reduced-sodium salt substitute or control. Urinary albumin-to-creatinine ratio (uACR) and albuminuria (uACR ≥22.1 or 31.0 mg/g for men and women, respectively) were assessed at 18 months in a stratified random sample of predominantly older individuals living in participating rural villages.
RESULTS:
A total of 2,566 participants from 119 villages provided 1,903 eligible urine samples. The sodium reduction program reduced sodium intake by an equivalent of 0.82g of salt/day (0.06-1.68 g) (322 [24-661] mg sodium/day). The mean uACR was 8.85 (8.05-9.82) mg/g (1.00 [0.91-1.11] mg/mmol) in intervention participants compared with 10.53 (9.73-11.33) mg/g (1.19 [1.10-1.28] mg/mmol) in control participants (p=0.008). The corresponding odds ratio for albuminuria was 0.67 (0.46-0.99).
CONCLUSIONS:
Dietary sodium reduction was associated with significantly lower uACR and less albuminuria after 18 months. Whether CKD progression can be slowed by dietary sodium reduction should be a global research priority. 

The impact of nutrient-based dietary patterns on cognitive decline in older adults.
Prinelli F, Fratiglioni L, Musicco M, Johansson I, Adorni F, Shakersain B, Rizzuto D, Xu W.
Clin Nutr. 2018 Dec 14. pii: S0261-5614(18)32580-9. doi: 10.1016/j.clnu.2018.12.012. [Epub ahead of print]
PMID: 30591381
https://sci-hub.tw/10.1016/j.clnu.2018.12.012
Abstract
BACKGROUND & AIMS:
The impact of nutrient patterns on cognitive decline is complex and findings are still inconclusive. We aimed to identify major nutrient patterns and to explore their association with cognitive decline over time among older adults.
METHODS:
In a population-based cohort, 2250 cognitively healthy people aged ≥60 years were identified at baseline (2001-2004), and followed-up to 9 years. Global cognitive function was tested with the Mini-Mental State Examination (MMSE) at baseline and follow-ups. Nutrients intake was assessed on the basis of food intake using a 98-semi-quantitative food frequency questionnaire at baseline, and nutrient-based patterns were identified by principal components analysis based on 30 nutrients. Mixed-effects linear regression models were used to determine their association with change in cognitive function taking into account potential confounders.
RESULTS:
Four major patterns (the plant-, animal-, dairy-derived nutrients and animal/plants-derived fats) were identified. Over the follow-up time, each one unit increment in plant- (β = 0.081, P = 0.002) and animal-derived nutrients pattern scores (β = 0.098, P < 0.001) was associated with slower decline in MMSE score. On the other hand, one-unit higher in dairy-derived nutrients pattern was related to a faster decline in global cognitive function (β = -0.064, P = 0.014). No significant association between animal/plants fats pattern and cognitive decline was observed. In stratified analyses, the association of high scores of plants- and animal-derived nutrient pattern with slower cognitive decline was stronger in APOE ε4 carriers than in ε4 non-carriers.
CONCLUSIONS:
Plant- and animal -derived nutrients are associated with preserved cognitive function, especially among the APOE ε4 carriers, whereas nutrients derived from dairy products may accelerate cognitive decline in older adults.
KEYWORDS:
Cognitive decline; Nutrient-based dietary patterns; Older adults; Population-based cohort study

Patterns of Beverages Consumed and Risk of Incident Kidney Disease.
Rebholz CM, Young BA, Katz R, Tucker KL, Carithers TC, Norwood AF, Correa A.
Clin J Am Soc Nephrol. 2018 Dec 27. pii: CJN.06380518. doi: 10.2215/CJN.06380518. [Epub ahead of print]
PMID: 30591520
Abstract
BACKGROUND AND OBJECTIVES:
Selected beverages, such as sugar-sweetened beverages, have been reported to influence kidney disease risk, although previous studies have been inconsistent. Further research is necessary to comprehensively evaluate all types of beverages in association with CKD risk to better inform dietary guidelines.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
We conducted a prospective analysis in the Jackson Heart Study, a cohort of black men and women in Jackson, Mississippi. Beverage intake was assessed using a food frequency questionnaire administered at baseline (2000-2004). Incident CKD was defined as onset of eGFR<60 ml/min per 1.73 m2 and ≥30% eGFR decline at follow-up (2009-13) relative to baseline among those with baseline eGFR ≥60 ml/min per 1.73 m2. Logistic regression was used to estimate the association between the consumption of each individual beverage, beverage patterns, and incident CKD. Beverage patterns were empirically derived using principal components analysis, in which components were created on the basis of the linear combinations of beverages consumed.
RESULTS:
Among 3003 participants, 185 (6%) developed incident CKD over a median follow-up of 8 years. At baseline, mean age was 54 (SD 12) years, 64% were women, and mean eGFR was 98 (SD 18) ml/min per 1.73 m2. After adjusting for total energy intake, age, sex, education, body mass index, smoking, physical activity, hypertension, diabetes, HDL cholesterol, LDL cholesterol, history of cardiovascular disease, and baseline eGFR, a principal components analysis-derived beverage pattern consisting of higher consumption of soda, sweetened fruit drinks, and water was associated with significantly greater odds of incident CKD (odds ratio tertile 3 versus 1 =1.61; 95% confidence interval, 1.07 to 2.41).
CONCLUSIONS:
Higher consumption of sugar-sweetened beverages was associated with an elevated risk of subsequent CKD in this community-based cohort of black Americans.
KEYWORDS:
Beverages; Body Mass Index; Cardiovascular Diseases; Cholesterol; Chronic; Energy Intake; Epidemiology and outcomes; Exercise; Fruit; HDL; LDL; Logistic Models; Nutrition Policy; Prospective; Renal Insufficiency; Sex Education; Smoking; Studies; Sugars; Sweetening Agents; Water; chronic kidney disease; diabetes mellitus; glomerular filtration; hypertension; kidney; nutrition; rate

Effects of fruit and vegetables intake in periodontal diseases: A systematic review.
Skoczek-Rubińska A, Bajerska J, Menclewicz K.
Dent Med Probl. 2018 Dec 27. doi: 10.17219/dmp/99072. [Epub ahead of print] Review.
PMID: 30592392
Abstract
Periodontal diseases affect up to 90% of the population worldwide. Deficiencies in vitamins, minerals and polyphenolic compounds, whose main sources are fruit and vegetables (F&V), may predispose to these diseases. The PICO (Patient, Intervention of interest, Comparison or Control Intervention, and Outcome) question was: What is the effect of F&V intake on the outcomes of periodontal diseases, observed in either experimental or observational studies of human populations suffering from periodontitis or gingivitis, compared to controls without intervention or healthy people. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for search strategy, selection criteria and data extraction. The searched databases included MEDLINE (PubMed), Scopus and Google Scholar. A total of 181 potentially relevant articles were identified, which were then evaluated according to pre-specified criteria relating to relevance and quality. Finally, 15 articles were selected for review. Four articles described intervention studies, 3 reported on prospective and retrospective cohort studies, and 8 concerned cross-sectional studies. A total of 10,604 people aged 15-90 years took part in the studies. On the basis of the research it can be concluded that the consumption of at least 5 servings of F&V per day may prevent the progression of periodontal diseases, especially periodontitis, and even tooth loss. Moreover, incorporation of specific F&V into the diet or, alternatively, their lyophilized forms, and nutritional education activities seem to support the standard of care therapy of gingivitis and periodontitis. However, further observational and well-designed experimental studies, with homogeneous periodontal status outcomes, are needed to confirm these findings. Furthermore, professional dietetics care for periodontal patients should become an integral component of the healthcare program.
KEYWORDS:
diet; fruit; periodontal diseases; vegetables

Equol Decreases Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
Daily JW, Ko BS, Ryuk J, Liu M, Zhang W, Park S.
J Med Food. 2018 Dec 28. doi: 10.1089/jmf.2018.4265. [Epub ahead of print]
PMID: 30592686
Abstract
Soy isoflavones may benefit some, but not all, menopausal women, and the ability of the women to produce equol may be the major determinant of effectiveness. We assessed the efficacy of soy isoflavones and equol for alleviating menopausal symptoms, especially vasomotor symptoms, in postmenopausal women who were equol producers and nonproducers by using systematic review and meta-analysis of randomized clinical trials (RCTs). We searched 12 English, Korean, and Chinese language scientific and medical databases. We selected all available RCTs that assessed the effect of equol, either equol itself or soy isoflavone in equol producers, on menopausal symptoms in peri- or postmenopausal women. The primary outcome was the effect on hot flashes. The severity of hot flashes was determined by the scores, and sensitivity and risk of bias analyses were conducted. Other outcomes of the review, but not meta-analysis, included depression and adverse events. Six studies (779 total subjects) met all criteria for the systematic review, 5 of those could be included in the meta-analysis (728 total subjects). Two studies included in the meta-analysis reported no statistically significant benefits of equol; the other three did report significant benefits of equol. Meta-analysis revealed a significant benefit of equol for lowering hot flash scores and revealed a generally low risk of bias. In conclusion, this study found that supplementing equol to equol nonproducers significantly lowered the incidence and/or severity of hot flashes in menopausal women.

The association between serum testosterone and insulin resistance: a longitudinal study.
Ottarsdottir K, Nilsson AG, Hellgren M, Lindblad U, Daka B.
Endocr Connect. 2018 Dec 1;7(12):1491-1500. doi: 10.1530/EC-18-0480.
PMID: 30592706
https://ec.bioscientifica.com/view/journals/ec/7/12/EC-18-0480.xml
Abstract
The objective of this study was to investigate whether there is a bidirectional association between testosterone concentrations and insulin resistance, in a prospective population study. A random population sample of 1400 men, aged 30-74, was examined in 2002-2005 in southwestern Sweden and followed up in 2012-2014 (N = 657). After excluding subjects without information on sex hormones and insulin resistance, 1282 men were included in the baseline study. Fasting measurements of plasma glucose, insulin and hormones were performed. Insulin resistance was defined using HOMA-Ir. Mean age at baseline was 47.3 ± 11.4 years. From the follow-up survey 546 men were included, mean age 57.7 ± 11.6 years. Low concentrations of total testosterone at baseline were significantly associated with high logHOMA-Ir at follow-up in a multivariable model including age, waist-hip ratio, physical activity, alcohol intake, smoking, LDL, CRP, hypertension, diabetes and logHOMA-Ir at baseline as covariates (β = -0.096, P = 0.006). Similar results were observed for bioavailable testosterone. Men within the lowest quartile of total testosterone at baseline had significantly higher logHOMA-Ir at follow-up than other quartiles (Q1 vs Q2 P = 0.008, Q1 vs Q3 P = 0.001, Q1 vs Q4 P = 0.052). Multivariable analysis of the impact of insulin resistance at baseline on testosterone levels at follow-up revealed no significant associations regarding testosterone concentrations (β = -0.003, P = 0.928) or bioavailable testosterone (β = -0.006, P = 0.873), when adjusting for baseline concentrations of total testosterone, age, waist-hip-ratio, LDL, CRP, physical activity, alcohol intake, smoking, hypertension and diabetes. Low testosterone concentrations at baseline predicted higher insulin resistance at follow-up, but high insulin resistance at baseline could not predict low testosterone at follow-up.
KEYWORDS:
androgens; cohort studies; insulin resistance; pre-diabetes; prospective studies; sex hormones; testosterone

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A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study.
Liu Z, Kuo PL, Horvath S, Crimmins E, Ferrucci L, Levine M.
PLoS Med. 2018 Dec 31;15(12):e1002718. doi: 10.1371/journal.pmed.1002718. eCollection 2018 Dec.
PMID: 30596641
https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002718&type=printable
Abstract
BACKGROUND:
A person's rate of aging has important implications for his/her risk of death and disease; thus, quantifying aging using observable characteristics has important applications for clinical, basic, and observational research. Based on routine clinical chemistry biomarkers, we previously developed a novel aging measure, Phenotypic Age, representing the expected age within the population that corresponds to a person's estimated mortality risk. The aim of this study was to assess its applicability for differentiating risk for a variety of health outcomes within diverse subpopulations that include healthy and unhealthy groups, distinct age groups, and persons with various race/ethnic, socioeconomic, and health behavior characteristics.
METHODS AND FINDINGS:
Phenotypic Age was calculated based on a linear combination of chronological age and 9 multi-system clinical chemistry biomarkers in accordance with our previously established method. We also estimated Phenotypic Age Acceleration (PhenoAgeAccel), which represents Phenotypic Age after accounting for chronological age (i.e., whether a person appears older [positive value] or younger [negative value] than expected, physiologically). All analyses were conducted using NHANES IV (1999-2010, an independent sample from that originally used to develop the measure). Our analytic sample consisted of 11,432 adults aged 20-84 years and 185 oldest-old adults top-coded at age 85 years. We observed a total of 1,012 deaths, ascertained over 12.6 years of follow-up (based on National Death Index data through December 31, 2011). Proportional hazard models and receiver operating characteristic curves were used to evaluate all-cause and cause-specific mortality predictions. Overall, participants with more diseases had older Phenotypic Age. For instance, among young adults, those with 1 disease were 0.2 years older phenotypically than disease-free persons, and those with 2 or 3 diseases were about 0.6 years older phenotypically. After adjusting for chronological age and sex, Phenotypic Age was significantly associated with all-cause mortality and cause-specific mortality (with the exception of cerebrovascular disease mortality). Results for all-cause mortality were robust to stratifications by age, race/ethnicity, education, disease count, and health behaviors. Further, Phenotypic Age was associated with mortality among seemingly healthy participants-defined as those who reported being disease-free and who had normal BMI-as well as among oldest-old adults, even after adjustment for disease prevalence. The main limitation of this study was the lack of longitudinal data on Phenotypic Age and disease incidence.
CONCLUSIONS:
In a nationally representative US adult population, Phenotypic Age was associated with mortality even after adjusting for chronological age. Overall, this association was robust across different stratifications, particularly by age, disease count, health behaviors, and cause of death. We also observed a strong association between Phenotypic Age and the disease count an individual had. These findings suggest that this new aging measure may serve as a useful tool to facilitate identification of at-risk individuals and evaluation of the efficacy of interventions, and may also facilitate investigation into potential biological mechanisms of aging. Nevertheless, further evaluation in other cohorts is needed.

The Prognostic Value of Renal Function in Acute Pulmonary Embolism-A Multi-Centre Cohort Study.
Kostrubiec M, Pływaczewska M, Jiménez D, Lankeit M, Ciurzynski M, Konstantinides S, Pruszczyk P.
Thromb Haemost.
PMID: 30597508
Abstract
BACKGROUND:
 Haemodynamic alterations caused by acute pulmonary embolism (PE) may affect multi-organ function including kidneys. This multi-centre, multinational cohort study aimed to validate the prognostic significance of estimated glomerular filtration rate (eGFR) and its potential additive value to the current PE risk assessment algorithms.
METHODS:
 The post hoc analysis of pooled prospective cohort studies: 2,845 consecutive patients (1,424 M/1,421 F, 66 ± 17 years) with confirmed acute PE and followed up for 180 days. We tested prognostic value of pre-specified eGFR level ≤60 mL/min/1.73 m2 calculated on admission according to the Modification of Diet in Renal Disease study equation. The primary outcome was all-cause 30-day mortality; the secondary outcomes were PE-related mortality, 180-day all-cause mortality, bleeding and composite outcome (PE-related death, thrombolysis or embolectomy).
RESULTS:
 Two hundred and twenty-three patients (8%; 95% confidence interval [CI]: 7-9%) died within the first 30 days after the diagnosis. The eGFR on admission was significantly lower in non-survivors than in survivors (64 ± 34 vs. 75 ± 3 mL/min/1.73 m2, p < 0.0001). Independent predictors for a fatal outcome included: cancer, systolic blood pressure, older age, hypoxia, eGFR, heart rate and coronary artery disease. The eGFR of ≤60 mL/min/1.73 m2 independently predicted all-cause mortality (hazard ratio: 2.3; 95% CI: 1.7-3.0, p < 0.0001), PE-related outcome and clinically relevant bleedings (odds ratio: 0.90 per 10 mL/min/1.73 m2, 95% CI: 0.85-0.95, p = 0.0002). The eGFR assessment significantly improved prognostic models proposed by European guidelines with net re-classification improvement of 0.42 (p < 0.0001).
CONCLUSION:
 The eGFR of ≤60 mL/min/1.73 m2 not only independently predicted higher 30- and 180-day all-cause mortality and bleeding events, but when added to the current European Society of Cardiology risk stratification algorithm improved identification of both low- and high-risk patients. Therefore, eGFR calculation should be implemented in the risk assessment of acute PE.

Consumption of dairy product and its association with total and cause specific mortality - A population-based cohort study and meta-analysis.
Mazidi M, Mikhailidis DP, Sattar N, Howard G, Graham I, Banach M; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group.
Clin Nutr. 2018 Dec 18. pii: S0261-5614(18)32583-4. doi: 10.1016/j.clnu.2018.12.015. [Epub ahead of print]
PMID: 30595374
https://sci-hub.tw/10.1016/j.clnu.2018.12.015
Abstract
BACKGROUND:
The intake of dairy products has been thought to be associated with an increased risk of coronary heart diseases (CHD) and total mortality due to its relatively high content of saturated fat. However, reports on this association particularly among US adults are conflicting and controversial. Therefore, we used data from the 1999-2010 National Health and Nutrition Examination Surveys (NHANES) study to examine whether consumption of total dairy and dairy subgroups was associated with total and cause specific (CHD, cerebrovascular and cancer) mortality. Further we carried out a systematic review and meta-analysis of prospective studies to check for consistency with the NHANES findings.
METHODS:
In the NHANES cohort vital status through December 31, 2011 was ascertained. Cox proportional hazard regression models were used to relate baseline dairy intake with all-cause and cause-specific mortality. For the systematic review PubMed, SCOPUS, Web of Science and Google Scholar databases were searched (up to December 2017). The DerSimonian-Laird method and generic inverse variance methods were used for quantitative data synthesis.
RESULTS:
In the NHANES data set of 24,474 participants, 3520 deaths occurred during follow-up. In multivariate adjusted Cox models, total mortality risk was lower when comparing the top (Q4) with the lower (Q1) quartiles of total dairy (hazard ratio


0.98, 95% confidence interval [CI]: 0.95-0.99) and cheese (HR: 0.92, 95% CI: 0.87-0.97) consumption. Using a similar model, we have found a negative association between total dairy and milk consumption with risk of cerebrovascular mortality (HR: 0.96, 95% CI: 0.94-0.98, HR: 0.93, 95% CI: 0.91-0.96, respectively), while milk consumption was associated with increased CHD mortality (HR: 1.04, 95% CI: 1.02-1.06). The meta-analysis with 636,726 participants indicated a significant inverse association between fermented dairy products and total mortality (RR: 0.97, 95% CI: 0.96-0.99), while milk consumption was associated with higher CHD mortality (RR: 1.04, 95% CI: 1.01-1.05). These findings were robust in sensitivity analyses.
CONCLUSIONS:
Among American adults, higher total dairy consumption was associated with lower total and cerebrovascular mortality, while higher milk consumption was associated with higher risk of CHD. These findings do not support dogmatic public health advice to reduce total dairy fat consumption, although the association between milk consumption and CHD mortality requires further study.
KEYWORDS:
Dairy; Fermented dairy; Meta-analysis; Milk; Mortality; Systematic review

Association of Serum Calcium and Insulin Resistance With Hypertension Risk: A Prospective Population-Based Study.
Wu X, Han T, Gao J, Zhang Y, Zhao S, Sun R, Sun C, Niu Y, Li Y.
J Am Heart Assoc. 2019 Jan 8;8(1):e009585. doi: 10.1161/JAHA.118.009585.
PMID: 30596304
Abstract
Background The temporal sequence between serum calcium and insulin resistance (IR) and their effects on hypertension are unclear. We studied the association between serum calcium and IR, with risk of hypertension events in a longitudinal cohort conducted in China. Methods and Results Data from 8653 subjects aged 20 to 74 years with an average follow-up of 5.3 years were analyzed. Serum calcium, and fasting and 2-hour serum glucose and insulin were measured at baseline and follow-up. Cross-lagged panel and mediation analysis were used to examine the temporal relationship between serum calcium and IR and its impact on hypertension incidence. The conjoint effects of serum calcium and IR at baseline on hypertension at follow-up were observed ( P=0.029 for HOMA_IR [hepatic IR] and P=0.009 for Gutt index [peripheral IR]). The cross-lagged path coefficient (β2) from baseline serum calcium to follow-up peripheral IR were significantly greater than path coefficient (β1) from baseline peripheral insulin resistance to follow-up serum calcium (β2 =-0.354 versus β1=-0.005; P=0.027). However, no directional relationships were observed in the serum calcium↔hepatic IR analysis. The mediation effect of peripheral IR on the association of serum calcium at baseline with hypertension at follow-up was estimated at 16.4% ( P<0.001). Conclusions Our findings demonstrate that higher serum calcium levels probably precede peripheral IR, and this 1-directional relation plays a role in the development of hypertension.
KEYWORDS:
calcium; hypertension; insulin resistance

Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol.
Vincent MJ, Allen B, Palacios OM, Haber LT, Maki KC.
Am J Clin Nutr. 2018 Dec 29. doi: 10.1093/ajcn/nqy273. [Epub ahead of print]
PMID: 30596814
https://sci-hub.tw/10.1093/ajcn/nqy273
Abstract
BACKGROUND:
Elevated low-density lipoprotein (LDL) cholesterol is a major risk factor for cardiovascular disease. Dietary guidance recommends reducing saturated fatty acid, trans fatty acid, and cholesterol intakes to reduce circulating LDL cholesterol. Cholesterol intake may also affect high-density lipoprotein (HDL)-cholesterol concentrations, but its impact has not been fully quantified.
OBJECTIVES:
The aims of this study were to investigate the dose-response relation between changes in dietary cholesterol intake and changes in lipoprotein-cholesterol markers for cardiovascular disease risk and to provide a reference for clinicians on how changes in dietary cholesterol intake affect circulating cholesterol concentrations, after accounting for intakes of fatty acids.
METHODS:
We used a Bayesian approach to meta-regression analysis, which uses Markov chain Monte Carlo techniques, to assess the relation between the change in dietary cholesterol (adjusted for dietary fatty acids) and changes in LDL and HDL cholesterol based on the use of data from randomized dietary intervention trials.
RESULTS:
Fifty-five studies (2652 subjects) were included in the analysis. The nonlinear Michaelis-Menten (MM) and Hill models best described the data across the full spectrum of dietary cholesterol changes studied (0-1500 mg/d). Mean predicted changes in LDL cholesterol for an increase of 100 mg dietary cholesterol/d were 1.90, 4.46, and 4.58 mg/dL for the linear, nonlinear MM, and Hill models, respectively.
CONCLUSIONS:
The change in dietary cholesterol was positively associated with the change in LDL-cholesterol concentration. The linear and MM models indicate that the change in dietary cholesterol is modestly inversely related to the change in circulating HDL-cholesterol concentrations in men but is positively related in women. The clinical implications of HDL-cholesterol changes associated with dietary cholesterol remain uncertain.
[Supported by the American Egg Board/Egg Nutrition Center (ENC).]

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The association between olive oil consumption and primary prevention of cardiovascular diseases.
Al-Ghamdi S.
J Family Med Prim Care. 2018 Sep-Oct;7(5):859-864. doi: 10.4103/jfmpc.jfmpc_191_18.
PMID: 30598924
http://www.jfmpc.com/article.asp?issn=2249-4863;year=2018;volume=7;issue=5;spage=859;epage=864;aulast=Al-Ghamdi
http://www.jfmpc.com/temp/JFamMedPrimaryCare75859-4050539_111505.pdf
Abstract
INTRODUCTION:
American Heart Association and many other recommend Mediterranean diet for patients with cardiovascular risk. This systematic review and meta-analysis are conducted to review the effects of Mediterranean diet on the cardiovascular events as reported in randomized controlled trials (RCTs).
METHODS:
A systematic research is conducted on MEDLINE via Ovid, Embase, PubMed, Google Scholar, Web of Science, and Informit. Databases of studies conducted between 2000 and 2017 were included in the analysis. All the collected studies were screened, and at the end, seven RCTs met the inclusion criteria. All the characteristics of trails such as study design, interventions, follow-up duration, and primary and secondary outcomes were recorded. RevMan was used to evaluate risk reduction in each trial individual using forest plot and fixed effects.
RESULTS:
Four studies were included in the review, having a total of 25,195 participants. The effects of Mediterranean diet were found in cardiovascular events (627), coronary events (251), and all-cause death (887). The analysis revealed that there is a statistically significant relationship between Mediterranean diet and reduction in cardiovascular events at P = 0.02. However, other parameters did not show any statistically significant results that need further investigation.
CONCLUSION:
The individual RCT provides evidence of protective effects of the Mediterranean diet on cardiovascular events. However, the quality and quantity of data available in those trails are not reliable and limited. Therefore, the results of those trails must be cautiously interpreted.
KEYWORDS:
Cardiovascular risk; Mediterranean diet; coronary artery disease; meta-analysis; olive oil; systematic review

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Happiness and Health.
Steptoe A.
Annu Rev Public Health. 2019 Jan 2. doi: 10.1146/annurev-publhealth-040218-044150. [Epub ahead of print]
PMID: 30601719
Abstract
Research into the relationship between happiness and health is developing rapidly, exploring the possibility that impaired happiness is not only a consequence of ill-health but also a potential contributor to disease risk. Happiness encompasses several constructs, including affective well-being (feelings of joy and pleasure), eudaimonic well-being (sense of meaning and purpose in life), and evaluative well-being (life satisfaction). Happiness is generally associated with reduced mortality in prospective observational studies, albeit with several discrepant results. Confounding and reverse causation are major concerns. Associations with morbidity and disease prognosis have also been identified for a limited range of health conditions. The mechanisms potentially linking happiness with health include lifestyle factors, such as physical activity and dietary choice, and biological processes, involving neuroendocrine, inflammatory, and metabolic pathways. Interventions have yet to demonstrate substantial, sustained improvements in subjective well-being or direct impact on physical health outcomes. Nevertheless, this field shows great potential, with the promise of establishing a favorable effect on population health.

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Marine n-3 Polyunsaturated Fatty Acids and the Risk of Ischemic Stroke.
Venø SK, Bork CS, Jakobsen MU, Lundbye-Christensen S, McLennan PL, Bach FW, Overvad K, Schmidt EB.
Stroke. 2019 Jan 3:STROKEAHA118023384. doi: 10.1161/STROKEAHA.118.023384. [Epub ahead of print]
PMID: 30602356
Abstract
Background and Purpose- We hypothesized that total marine n-3 polyunsaturated fatty acids (PUFA), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the diet and in adipose tissue (biomarkers of long-term intake and endogenous exposure) were inversely associated with the risk of ischemic stroke and its subtypes. Methods- The Diet, Cancer and Health cohort consisted of 57 053 participants aged 50 to 65 years at enrolment. All participants filled in a food frequency questionnaire and had an adipose tissue biopsy taken at baseline. Information on ischemic stroke during follow-up was obtained from The Danish National Patient Register, and all cases were validated. Cases and a random sample of 3203 subjects from the whole cohort had their fatty acid composition of adipose tissue determined by gas chromatography. Results- During 13.5 years of follow-up 1879 participants developed an ischemic stroke. Adipose tissue content of EPA was inversely associated with total ischemic stroke (hazard ratio {HR}, 0.74; 95% CI, 0.62-0.88) when comparing the highest with the lowest quartile. Also, lower rates of large artery atherosclerosis were seen with higher intakes of total marine n-3 PUFA (HR, 0.69; 95% CI, 0.50-0.95), EPA (HR, 0.66; 95% CI, 0.48-0.91) and DHA (HR, 0.72; 95% CI, 0.53-0.99), and higher adipose tissue content of EPA (HR, 0.52; 95% CI, 0.36-0.76). Higher rates of cardioembolism were seen with higher intakes of total marine n-3 PUFA (HR, 2.50; 95% CI, 1.38-4.53) and DHA (HR, 2.12; 95% CI, 1.21-3.69) as well as with higher adipose tissue content of total marine n-3 PUFA (HR, 2.63; 95% CI, 1.33-5.19) and DHA (HR, 2.00; 95% CI, 1.04-3.84). The EPA content in adipose tissue was inversely associated with small-vessel occlusion (HR, 0.69; 95% CI, 0.55-0.88). Conclusions- EPA was associated with lower risks of most types of ischemic stroke, apart from cardioembolism, while inconsistent findings were observed for total marine n-3 PUFA and DHA.

KEYWORDS:
adipose tissue; docosahexaenoic acids; eicosapentaenoic acid; fatty acids

Edited by AlPater

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Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease.
Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, D'Agostino D, Friedenberg G, Ridge C, Bubes V, Giovannucci EL, Willett WC, Buring JE; VITAL Research Group.
N Engl J Med. 2019 Jan 3;380(1):33-44. doi: 10.1056/NEJMoa1809944. Epub 2018 Nov 10.
PMID: 30415629
Abstract
BACKGROUND:
It is unclear whether supplementation with vitamin D reduces the risk of cancer or cardiovascular disease, and data from randomized trials are limited.
METHODS:
We conducted a nationwide, randomized, placebo-controlled trial, with a two-by-two factorial design, of vitamin D3 (cholecalciferol) at a dose of 2000 IU per day and marine n-3 (also called omega-3) fatty acids at a dose of 1 g per day for the prevention of cancer and cardiovascular disease among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were invasive cancer of any type and major cardiovascular events (a composite of myocardial infarction, stroke, or death from cardiovascular causes). Secondary end points included site-specific cancers, death from cancer, and additional cardiovascular events. This article reports the results of the comparison of vitamin D with placebo.
RESULTS:
A total of 25,871 participants, including 5106 black participants, underwent randomization. Supplementation with vitamin D was not associated with a lower risk of either of the primary end points. During a median follow-up of 5.3 years, cancer was diagnosed in 1617 participants (793 in the vitamin D group and 824 in the placebo group; hazard ratio, 0.96; 95% confidence interval [CI], 0.88 to 1.06; P=0.47). A major cardiovascular event occurred in 805 participants (396 in the vitamin D group and 409 in the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P=0.69). In the analyses of secondary end points, the hazard ratios were as follows: for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95% CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for the expanded composite end point of major cardiovascular events plus coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myocardial infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to 1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to 1.40). In the analysis of death from any cause (978 deaths), the hazard ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or other adverse events were identified.
CONCLUSIONS:
Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo. 
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VITAL Signs for Dietary Supplementation to Prevent Cancer and Heart Disease.
Keaney JF Jr, Rosen CJ.
N Engl J Med. 2019 Jan 3;380(1):91-93. doi: 10.1056/NEJMe1814933. Epub 2018 Nov 10. No abstract available.
PMID: 30415594
http://www.natap.org/2018/HIV/nejme1814933.pdf

Mortality risk reduction differs according to bisphosphonate class: a 15-year observational study.
Bliuc D, Tran T, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse RG, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR; CaMOS Research Group.
Osteoporos Int. 2019 Jan 3. doi: 10.1007/s00198-018-4806-0. [Epub ahead of print]
PMID: 30607457
https://sci-hub.tw/https://link.springer.com/article/10.1007/s00198-018-4806-0
Abstract
In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways.
INTRODUCTION:
Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture.
METHODS:
A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, fragility fracture status) and time to starting the BP medication from the population-based Canadian Multicentre Osteoporosis Study from nine Canadian centres followed from 1995 to 2013. Mortality risk for bisphosphonate users vs matched non-users was assessed using pairwise multivariable Cox proportional hazards models.
RESULTS:
There were 2048 women and 308 men on BP and 1970 women and 1794 men who did not receive medication for osteoporosis. The relationship between BP and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of BP users and no treatment (etidronate, n = 599, alendronate, n = 498, and risedronate n = 213). Nitrogen BP (n-BP) (alendronate and risedronate) was associated with lower mortality risks [pairwise HR, 0.66 (95% CI, 0.48-0.91)] while the less potent non-n-BP, etidronate, was not [pairwise HR: 0.89 (95% CI, 0.66-1.20)]. A direct comparison between n-BP and etidronate (n = 340 pairs) also suggested a better survival for n-BP [paired HR, 0.47 (95%CI, (95% CI, 031-0.70)] for n-BP vs. etidronate].
CONCLUSION:
Compared to no treatment, nitrogen but not non-nitrogen bisphosphonates appear to be associated with better survival.
KEYWORDS:
Bisphosphonate; Fracture; Mortality risk; Osteoporosis; Prospective study

Urinary Levels of Trimethylamine-N-Oxide and Incident Coronary Heart Disease: A Prospective Investigation Among Urban Chinese Adults.
Yu D, Shu XO, Rivera ES, Zhang X, Cai Q, Calcutt MW, Xiang YB, Li H, Gao YT, Wang TJ, Zheng W.
J Am Heart Assoc. 2019 Jan 8;8(1):e010606. doi: 10.1161/JAHA.118.010606.
PMID: 30606084
https://www.ahajournals.org/doi/pdf/10.1161/JAHA.118.010606
Abstract
Background Trimethylamine-N-oxide ( TMAO ), a diet-derived, gut microbial-host cometabolite, has been associated with adverse cardiovascular outcomes in patient populations; however, evidence is lacking from prospective studies conducted in general populations and non-Western populations. Methods and Results We evaluated urinary levels of TMAO and its precursor metabolites (ie, choline, betaine, and carnitine) in relation to risk of coronary heart disease ( CHD ) among Chinese adults in a nested case-control study, including 275 participants with incident CHD and 275 individually matched controls. We found that urinary TMAO , but not its precursors, was associated with risk of CHD . The odds ratio for the highest versus lowest quartiles of TMAO was 1.91 (95% CI, 1.08-3.35; Ptrend=0.008) after adjusting for CHD risk factors including obesity, diet, lifestyle, and metabolic diseases and 1.75 (95% CI, 0.96-3.18; Ptrend=0.03) after further adjusting for potential confounders or mediators including central obesity, dyslipidemia, inflammation, and intake of seafood and deep-fried meat or fish, which were associated with TMAO level in this study. The odds ratio per standard deviation increase in log- TMAO was 1.30 (95% CI, 1.03-1.63) in the fully adjusted model. A history of diabetes mellitus modified the TMAO - CHD association. A high TMAO level (greater than or equal to versus lower than the median) was associated with odds ratios of 6.21 (95% CI, 1.64-23.6) and 1.56 (95% CI, 1.00-2.43), respectively, among diabetic and nondiabetic participants ( Pinteraction=0.02). Diabetes mellitus status also modified the associations of choline, betaine, and carnitine with risk of CHD ; significant positive associations were found among diabetic participants, but null associations were noted among total and nondiabetic participants. Conclusions Our study suggests that TMAO may accelerate the development of CHD , highlighting the importance of diet-gut microbiota-host interplay in cardiometabolic health.
KEYWORDS:
Chinese; cardiovascular disease risk factors; gut microbiota; metabolomics; nested case‐control study; nutrition; prospective cohort study; trimethylamine‐N‐oxide

Saturated Fatty Acid Intake Is Associated with Total Mortality in a Nationwide Cohort Study.
Zhuang P, Cheng L, Wang J, Zhang Y, Jiao J.
J Nutr. 2019 Jan 4. doi: 10.1093/jn/nxy237. [Epub ahead of print]
PMID: 30608597
Abstract
BACKGROUND:
Dietary intakes of total and specific types of saturated fatty acids (SFAs) in relation to total mortality remain largely unknown in China.
OBJECTIVE:
We assessed the associations of total and individual SFA intakes with total mortality in a Chinese nationwide population.
METHODS:
This prospective analysis included 7888 women and 6495 men, aged >20 y, from the China Health and Nutrition Survey (1989-2011). Cumulative mean of SFA intake was calculated based on 3 d of 24-h records in each round of the survey. Multivariable Cox proportional hazard models were used to estimate HR and 95% CI.
RESULTS:
There were 1011 deaths during a median of 14 y of follow-up. In isocaloric nutrient density models that replace total carbohydrates, intakes of total SFAs and even-chain SFAs were associated with higher total mortality in women but not in men. Compared with the lowest quartiles, the HRs (95% CIs) in the highest quartiles were 1.65 (1.03, 2.62) for total SFAs (P-trend = 0.042) and 1.83 (1.13, 2.94) for even-chain SFAs (P-trend = 0.016) in women. Intake of odd-chain SFAs was associated with lower total mortality both in men [HR (95% CI): 0.64 (0.47, 0.87); P-trend = 0.01] and in women [HR (95% CI): 0.59 (0.42, 0.84); P-trend = 0.0013]. Moreover, intake of medium-chain SFAs was linked with lower total mortality in men [HR (95% CI): 0.64 (0.44, 0.93); P-trend = 0.013]. However, isocalorically replacing 1% of energy from unsaturated fatty acids with even-chain SFAs was associated with higher total mortality in men [HRs (95% CIs): 1.08 (0.97, 1.20) and 1.39 (1.20, 1.60) for replacing PUFAs and MUFAs, respectively].
CONCLUSIONS:
Total SFA and even-chain SFA intake was associated with higher total mortality in women, whereas intake of odd-chain SFAs was related to lower total mortality in both sexes. 

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Mitochondria Inspire a Lifestyle.
Kramer P, Bressan P.
Adv Anat Embryol Cell Biol. 2019 Jan 5. doi: 10.1007/102_2018_5. [Epub ahead of print]
PMID: 30610376
https://sci-hub.tw/10.1007/102_2018_5
Abstract
Tucked inside our cells, we animals (and plants, and fungi) carry mitochondria, minuscule descendants of bacteria that invaded our common ancestor 2 billion years ago. This unplanned breakthrough endowed our ancestors with a convenient, portable source of energy, enabling them to progress towards more ambitious forms of life. Mitochondria still manufacture most of our energy; we have evolved to invest it to grow and produce offspring, and to last long enough to make it all happen. Yet because the continuous generation of energy is inevitably linked to that of toxic free radicals, mitochondria give us life and give us death. Stripping away clutter and minutiae, here we present a big-picture perspective of how mitochondria work, how they are passed on virtually only by mothers, and how they shape the lifestyles of species and individuals. We discuss why restricting food prolongs lifespan, why reproducing shortens it, and why moving about protects us from free radicals despite increasing their production. We show that our immune cells use special mitochondria to keep control over our gut microbes. And we lay out how the fabrication of energy and free radicals sets the internal clocks that command our everyday rhythms-waking, eating, sleeping. Mitochondria run the show.
KEYWORDS:
Antioxidants; Circadian rhythms; Dietary restriction; Free radicals; Longevity; Mitochondria

Effect of Genetically Low 25-Hydroxyvitamin D on Mortality Risk: Mendelian Randomization Analysis in 3 Large European Cohorts.
Aspelund T, Grübler MR, Smith AV, Gudmundsson EF, Keppel M, Cotch MF, Harris TB, Jorde R, Grimnes G, Joakimsen R, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML, März W, Kleber ME, Tomaschitz A, Grove-Laugesen D, Rejnmark L, Swart KMA, Brouwer IA, Lips P, van Schoor NM, Sempos CT, Durazo-Arvizu RA, Škrabáková Z, Dowling KG, Cashman KD, Kiely M, Pilz S, Gudnason V, Eiriksdottir G.
Nutrients. 2019 Jan 2;11(1). pii: E74. doi: 10.3390/nu11010074.
PMID: 30609725Abstract
The aim of this study was to determine if increased mortality associated with low levels of serum 25-hydroxyvitamin D (25(OH)D) reflects a causal relationship by using a Mendelian randomisation (MR) approach with genetic variants in the vitamin D synthesis pathway. Individual participant data from three European cohorts were harmonized with standardization of 25(OH)D according to the Vitamin D Standardization Program. Most relevant single nucleotide polymorphisms of the genes CYP2R1 (rs12794714, rs10741657) and DHCR7/NADSYN1 (rs12785878, rs11234027), were combined in two allelic scores. Cox proportional hazards regression models were used with the ratio estimator and the delta method for calculating the hazards ratio (HR) and standard error of genetically determined 25(OH)D effect on all-cause mortality. We included 10,501 participants (50.1% females, 67.1±10.1 years) of whom 4003 died during a median follow-up of 10.4 years. The observed adjusted HR for all-cause mortality per decrease in 25(OH)D by 20 nmol/L was 1.20 (95% CI: 1.15⁻1.25). The HR per 20 nmol/L decrease in genetically determined 25(OH)D was 1.32 (95% CI: 0.80⁻2.24) and 1.35 (95% CI of 0.81 to 2.37) based on the two scores. In conclusion, the results of this MR study in a combined sample from three European cohort studies provide further support for a causal relationship between vitamin D deficiency and increased all-cause mortality. However, as the current study, even with ~10,000 participants, was underpowered for the study of the effect of the allele score on mortality, larger studies on genetics and mortality are needed to improve the precision.
KEYWORDS:
Individual Participant Data; Mendelian randomization; Vitamin D; cohorts; mortality; standardized 25(OH)D

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High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial.
Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR.
Osteoporos Int. 2019 Jan 5. doi: 10.1007/s00198-018-04829-z. [Epub ahead of print]
PMID: 30612163
Abstract
Our aim was to assess risk of vertebral fracture during high-intensity resistance and impact training (HiRIT) for postmenopausal women with low bone mass. HiRIT did not induce vertebral fracture, as evidenced by a reduction in kyphosis following 8 months of training and a lack of change in vertebral morphology.
INTRODUCTION:
The LIFTMOR trial demonstrated a novel, HiRIT program notably improved bone mass in postmenopausal women with osteopenia and osteoporosis. While no clinical signs or symptoms of vertebral crush fracture were evident during the trial, anecdotal feedback suggests that concerns about safety of HiRIT in the osteoporosis demographic remain. The aim of the current work was to assess vertebral body morphology, Cobb angle, and clinical measures of thoracic kyphosis in participants in the LIFTMOR trial for evidence of vertebral fracture following 8 months of supervised HiRIT.
METHODS:
Participants were randomized to either 8 months of 30-min, twice-weekly, supervised HiRIT or unsupervised, low-intensity, home-based exercise (CON). Lateral thoracolumbar DXA scans (Medix DR, Medilink, France) were performed at baseline and follow-up. Cobb angle was determined, and vertebral fracture identification was performed using the semiquantitative Genant method. Clinical kyphosis measurements were performed in relaxed standing (neutral posture) and standing tall using an inclinometer and a flexicurve.
RESULTS:
The HiRIT group exhibited a reduction in inclinometer-determined standing tall thoracic kyphosis compared to CON (- 6.7 ± 8.2° vs - 1.6 ± 8.1°, p = 0.031). Both the HiRIT and CON groups exhibited within-group improvement in kyphosis in relaxed standing as measured by both inclinometer and flexicurve (p < 0.05). There were no changes in vertebral fracture classification in the HiRIT group post-intervention. A single, new, wedge deformity was observed for CON.
CONCLUSIONS:
Supervised HiRIT was not associated with an increased risk of vertebral fracture in postmenopausal women with low bone mass. Indeed, a clinically relevant improvement in thoracic kyphosis was observed following 8 months of supervised HiRIT, further supporting its efficacy as an osteoporosis intervention for postmenopausal women with low to very low bone mass.
KEYWORDS:
Exercise; Osteoporosis; Vertebral fracture

Individual and Combined Effects of Environmental Risk Factors for Esophageal Cancer Based on Results From the Golestan Cohort Study.
Sheikh M, Poustchi H, Pourshams A, Etemadi A, Islami F, Khoshnia M, Gharavi A, Hashemian M, Roshandel G, Khademi H, Zahedi M, Abedi-Ardekani B, Boffetta P, Kamangar F, Dawsey SM, Pharaoh PD, Abnet CC, Day NE, Brennan P, Malekzadeh R.
Gastroenterology. 2019 Jan 3. pii: S0016-5085(18)35439-8. doi: 10.1053/j.gastro.2018.12.024. [Epub ahead of print]
PMID: 30611753
Abstract
BACKGROUND & AIMS:
Northeast Iran has one of the highest reported rates of esophageal squamous cell carcinoma (ESCC) worldwide. Decades of investigations in this region have identified some local habits and environmental exposures that increase risk. We analyzed data from the Golestan Cohort Study to determine the individual and combined effects of the major environmental risk factors of ESCC.
METHODS:
We performed a population-based cohort of 50,045 individuals, 40-75 years old, from urban and rural areas across Northeast Iran. Detailed data on demographics, diet, lifestyle, socioeconomic status, temperature of drinking beverages, and different exposures were collected using validated methods, questionnaires, and physical examinations, from 2004 through 2008. Participants were followed from the date of enrolment to the date of first diagnosis of esophageal cancer, date of death from other causes, or date of last follow up, through December 31, 2017. Proportional hazards regression models were used to estimate hazard ratios (HRs) and corresponding 95% CIs for the association between different exposures and ESCC.
RESULTS:
During an average 10 years of follow up, 317 participants developed ESCC. Opium smoking (HR, 1.85; 95% CI, 1.18-2.90), drinking hot tea (≥60oC) (HR, 1.60; 95% CI, 1.15-2.22), low intake of fruits (HR, 1.48; 95% CI, 1.07-2.05) and vegetables (HR, 1.62; 95% CI, 1.03-2.56), excessive tooth loss (HR, 1.66; 95% CI, 1.04-2.64), drinking un-piped water (HR, 2.04; 95% CI, 1.09-3.81), and exposure to indoor air pollution (HR, 1.57; 95% CI, 1.08-2.29) were significantly associated with increased risk of ESCC, in a dose-dependent manner. Combined exposure to these risk factors was associated with a stepwise increase in the risk of developing ESCC, reaching a more than 7-fold increase in risk in the highest category. Approximately 75% of the ESCC cases in this region can be attributed to a combination of the identified exposures.
CONCLUSIONS:
Analysis of data from the Golestan Cohort Study in Iran identified multiple risk factors for ESCC in this population. Our findings support hypothesis that the high rates of ESCC are due to a combination of factors, including thermal injury (from hot tea), exposure to polycyclic aromatic hydrocarbons (from opium and indoor air pollution), and nutrient-deficient diets. We also associated ESCC risk with exposure to un-piped water and tooth loss.
KEYWORDS:
GCS; PAH exposure; epidemiology; esophageal carcinoma

Association of fish intake and smoking with risk of rheumatoid arthritis and age of onset: a prospective cohort study.
Sparks JA, O'Reilly ÉJ, Barbhaiya M, Tedeschi SK, Malspeis S, Lu B, Willett WC, Costenbader KH, Karlson EW.
BMC Musculoskelet Disord. 2019 Jan 5;20(1):2. doi: 10.1186/s12891-018-2381-3.
PMID: 30611246
https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/s12891-018-2381-3
Abstract
BACKGROUND:
Prior studies suggest that fish may be protective for rheumatoid arthritis (RA) risk perhaps through the anti-inflammatory effect of omega-3 fatty acid, but this relationship has not been clearly established. Therefore, we investigated fish intake and RA risk by serologic status, age of onset, and smoking using a prospective cohort study with large sample size, repeated measures of dietary intake, and lengthy follow-up.
METHODS:
We studied fish intake and RA risk among 166,013 women in two prospective cohorts, the Nurses' Health Study (NHS, 1984-2014) and NHSII (1991-2015). Fish intake was assessed using food frequency questionnaires at baseline and every 4 years. Incident RA during follow-up and serologic status were determined by medical record review. Pooled Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) for RA (overall and by serologic status and age at diagnosis) for fish intake frequency. We tested for a smoking-fish interaction for RA risk.
RESULTS:
During 3,863,909 person-years of follow-up, we identified 1080 incident RA cases. Increasing fish intake was not associated with all RA (≥4 servings/week: multivariable HR 0.93 [95%CI 0.67-1.28] vs. < 1 serving/month; p for trend = 0.42), seropositive RA (p for trend = 0.66), or seronegative RA (p for trend = 0.45), but had increased risk for RA diagnosed > 55 years old (p for trend = 0.037). Among women ≤55 years old, frequent fish intake (vs. infrequent) had HRs (95%CIs) of: 0.73 (0.52-1.02) for all RA, 0.85 (0.55-1.32) for seropositive RA, and 0.55 (0.32-0.94) for seronegative RA. Ever smokers with infrequent fish intake had highly elevated risk for RA onset ≤55 years (HR 2.59, 95%CI 1.65-4.06), while ever smokers with frequent fish intake had modestly elevated RA risk (HR 1.29, 95%CI 1.07-1.57; vs. never smokers/frequent fish intake; p for smoking-fish interaction = 0.039).
CONCLUSION:
In this large prospective cohort study, we found no clear protective effect of fish or marine omega-3 fatty acid intake on RA risk, overall or by serologic status. We found that fish intake attenuated the strong association of smoking for RA diagnosed ≤55 years of age, but this requires further study.
KEYWORDS:
Diet; Epidemiology; Fish; Inflammation; Omega-3 fatty acids; Rheumatoid arthritis; Smoking

Food allergies reported by a 'high' rate of U.S. adults
Shellfish, milk and peanuts cause the most common problems
Amina Zafar · CBC News · Posted: Jan 06, 2019
https://www.cbc.ca/news/health/food-allergy-adults-1.4967117
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Prevalence and Severity of Food Allergies Among US Adults
Ruchi S. Gupta, MD, MPH1,2,3,4; Christopher M. Warren, BA5; Bridget M. Smith, PhD1,6; et al Jialing Jiang, BA1; Jesse A. Blumenstock, BS1; Matthew M. Davis, MD, MAPP1,2,3,4,7,8; Robert P. Schleimer, PhD4; Kari C. Nadeau, MD, PhD9
Author Affiliations Article Information
JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720064
Key Points
Question  What are the prevalence and severity of food allergy in US adults?
Findings  In a population-based survey study of 40 443 US adults, an estimated 10.8% were food allergic at the time of the survey, whereas nearly 19% of adults believed that they were food allergic. Nearly half of food-allergic adults had at least 1 adult-onset food allergy, and 38% reported at least 1 food allergy–related emergency department visit in their lifetime.
Meaning  The findings suggest that food allergies are common and severe among US adults, often starting in adulthood.
Abstract
Importance  Food allergy is a costly, potentially life-threatening condition. Although studies have examined the prevalence of childhood food allergy, little is known about prevalence, severity, or health care utilization related to food allergies among US adults.
Objective  To provide nationally representative estimates of the distribution, severity, and factors associated with adult food allergies.
Design, Setting, and Participants  In this cross-sectional survey study of US adults, surveys were administered via the internet and telephone from October 9, 2015, to September 18, 2016. Participants were first recruited from NORC at the University of Chicago’s probability-based AmeriSpeak panel, and additional participants were recruited from the non–probability-based Survey Sampling International (SSI) panel.
Exposures  Demographic and allergic participant characteristics.
Main Outcomes and Measures  Self-reported food allergies were the main outcome and were considered convincing if reported symptoms to specific allergens were consistent with IgE-mediated reactions. Diagnosis history to specific allergens and food allergy–related health care use were also primary outcomes. Estimates were based on this nationally representative sample using small-area estimation and iterative proportional fitting methods. To increase precision, AmeriSpeak data were augmented by calibration-weighted, non–probability-based responses from SSI.
Results  Surveys were completed by 40 443 adults (mean [SD] age, 46.6 [20.2] years), with a survey completion rate of 51.2% observed among AmeriSpeak panelists (n = 7210) and 5.5% among SSI panelists (n = 33 233). Estimated convincing food allergy prevalence among US adults was 10.8% (95% CI, 10.4%-11.1%), although 19.0% (95% CI, 18.5%-19.5%) of adults self-reported a food allergy. The most common allergies were shellfish (2.9%; 95% CI, 2.7%-3.1%), milk (1.9%; 95% CI, 1.8%-2.1%), peanut (1.8%; 95% CI, 1.7%-1.9%), tree nut (1.2%; 95% CI, 1.1%-1.3%), and fin fish (0.9%; 95% CI, 0.8%-1.0%). Among food-allergic adults, 51.1% (95% CI, 49.3%-52.9%) experienced a severe food allergy reaction, 45.3% (95% CI, 43.6%-47.1%) were allergic to multiple foods, and 48.0% (95% CI, 46.2%-49.7%) developed food allergies as an adult. Regarding health care utilization, 24.0% (95% CI, 22.6%-25.4%) reported a current epinephrine prescription, and 38.3% (95% CI, 36.7%-40.0%) reported at least 1 food allergy–related lifetime emergency department visit.
Conclusions and Relevance  These data suggest that at least 10.8% (>26 million) of US adults are food allergic, whereas nearly 19% of adults believe that they have a food allergy. Consequently, these findings suggest that it is crucial that adults with suspected food allergy receive appropriate confirmatory testing and counseling to ensure food is not unnecessarily avoided and quality of life is not unduly impaired.

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The effects of concurrent Coenzyme Q10, L-carnitine supplementation in migraine prophylaxis: A randomized, placebo-controlled, double-blind trial.
Hajihashemi P, Askari G, Khorvash F, Reza Maracy M, Nourian M.
Cephalalgia. 2019 Jan 6:333102418821661. doi: 10.1177/0333102418821661. [Epub ahead of print]
PMID: 30612463
Abstract
PURPOSE:
The present study aimed to determine the effects of combined supplementation of Coenzyme Q10 with L-carnitine on mitochondrial metabolic disorders marker and migraine symptoms among migraine patients.
METHODS:
A total of 56 men and women, between 20-40 years of age with migraine headache, participated in this randomized, double-blind, placebo-controlled, parallel study. The subjects were randomly assigned to receive either 30 mg/day Coenzyme Q10 and 500 mg/day L-carnitine at the same time and/or placebo tablets for 8 weeks. The measurements were completed at the beginning and end of the study. The primary outcome was severity of headache attacks. The secondary outcomes included duration, frequency of headache attacks, the headache diary results (HDR), and serum levels of lactate.
RESULTS:
A significant reduction was obtained in serum levels of lactate (-2.28 mg/dl, 95% CI: -3.65, -0.90; p = 0.002), severity (-3.03, 95% CI: -3.65, -2.40; p ≤ 0.001), duration (-7.67, 95% CI: -11.47, -3.90; p ≤ 0.001), frequency (-5.42, 95% CI: -7.31, -3.53; p ≤ 0.001) and HDR (-103.03, 95% CI: -145.76, -60.29; p ≤ 0.001) after 8 weeks.
CONCLUSION:
This double-blind parallel study provides evidences supporting the beneficial effects of Coenzyme Q10 and L-carnitine supplements on serum levels of lactate and migraine symptoms.
KEYWORDS:
Coenzyme Q10; L-carnitine; migraine symptoms; serum lactate

Elevated liver enzymes and cardiovascular mortality: a systematic review and dose-response meta-analysis of more than one million participants.
Rahmani J, Miri A, Namjoo I, Zamaninour N, Maljaei MB, Zhou K, Cerneviciute R, Mousavi SM, Varkaneh HK, Salehisahlabadi A, Zhang Y.
Eur J Gastroenterol Hepatol. 2019 Jan 5. doi: 10.1097/MEG.0000000000001353. [Epub ahead of print]
PMID: 30614883
Abstract
Gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) are commonly used liver function markers. We performed a dose-response meta-analysis to investigate the association between liver enzymes and cardiovascular disease (CVD) mortality in prospective cohort studies. We conducted a systematic search up to April 2018 in Medline/PubMed, Scopus, Cochrane, and Embase databases. Combined hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a random-effects model as described by DerSimonian and Laird. Dose-response analysis was also carried out. Twenty-three studies with 1 067 922 participants reported association between GGT and CVD mortality and were included in our analysis. Pooled results showed a significant association between GGT and risk of CVD mortality (HR: 1.62; 95% CI: 1.47-1.78, P=0.001, P-heterogeneity=0.001) and it was HR: 0.87; 95% CI: 0.73-1.07; P=0.221, P-heterogeneity=0.028, for ALT. There was a direct association between baseline levels of ALP and AST/ALT ratio with CVD mortality (HR: 1.45; 95% CI: 1.11-1.89; P=0.005, P-heterogeneity=0.026, and HR: 2.20; 95% CI: 1.60-3.04; P=0.001, P-heterogeneity=0.540, respectively). Pooled results did not show any significant association between AST and the risk of CVD mortality (HR: 1.20; 95% CI: 0.83-1.73; P=0.313, P-heterogeneity=0.024). Moreover, there was a significant nonlinear association between GGT and ALP levels and the risk of CVD mortality (P=0.008 and 0.016, respectively). Our dose-response meta-analysis revealed a direct relationship between GGT and ALP levels and the risk of CVD mortality. High levels of GGT, ALP and AST/ALT were associated with an increased CVD mortality rate.

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Longevity defined as top 10% survivors and beyond is transmitted as a quantitative genetic trait.
van den Berg N, Rodríguez-Girondo M, van Dijk IK, Mourits RJ, Mandemakers K, Janssens AAPO, Beekman M, Smith KR, Slagboom PE.
Nat Commun. 2019 Jan 7;10(1):35. doi: 10.1038/s41467-018-07925-0.
PMID: 30617297
https://www.nature.com/articles/s41467-018-07925-0
Abstract
Survival to extreme ages clusters within families. However, identifying genetic loci conferring longevity and low morbidity in such longevous families is challenging. There is debate concerning the survival percentile that best isolates the genetic component in longevity. Here, we use three-generational mortality data from two large datasets, UPDB (US) and LINKS (Netherlands). We study 20,360 unselected families containing index persons, their parents, siblings, spouses, and children, comprising 314,819 individuals. Our analyses provide strong evidence that longevity is transmitted as a quantitative genetic trait among survivors up to the top 10% of their birth cohort. We subsequently show a survival advantage, mounting to 31%, for individuals with top 10% surviving first and second-degree relatives in both databases and across generations, even in the presence of non-longevous parents. To guide future genetic studies, we suggest to base case selection on top 10% survivors of their birth cohort with equally long-lived family members.

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Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study.
Donat-Vargas C, Bergdahl IA, Tornevi A, Wennberg M, Sommar J, Kiviranta H, Koponen J, Rolandsson O, Åkesson A.
Environ Int. 2018 Dec 19;123:390-398. doi: 10.1016/j.envint.2018.12.026. [Epub ahead of print]
PMID: 30622063
https://reader.elsevier.com/reader/sd/pii/S0160412018317288?token=E7471B2696C6A89CCD86120132F9327995E1A13D7F0D32E9720266610D971DDD43B73E1D0B1AEA40AC45985E1E342F03
Abstract
BACKGROUND:
Perfluoroalkyl substances (PFAS) have drawn much attention due to bioaccumulation potential and their current omnipresence in human blood. We assessed whether plasma PFAS, suspected to induce endocrine-disrupting effects, were prospectively associated with clinical type 2 diabetes (T2D) risk.
METHODS:
We established a nested case-control study within the Swedish prospective population-based Västerbotten Intervention Programme cohort. Several PFAS were measured in plasma from a subset of 124 case-control pairs at baseline (during 1990-2003) and at 10-year follow-up. T2D cases were matched (1:1) according to gender, age and sample date with participants without T2D (controls). Conditional logistic regressions were used to prospectively assess risk of T2D by baseline PFAS plasma concentrations. Associations between long-term PFAS plasma levels (mean of baseline and follow-up) and insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B%) at follow-up were prospectively explored among 178 and 181 controls, respectively, by multivariable linear regressions.
RESULTS:
After adjusting for gender, age, sample year, diet and body mass index, the odds ratio of T2D for the sum of PFAS (Σ z-score PFAS) was 0.52 (95% confidence interval, CI: 0.20, 1.36), comparing third with first tertile; and 0.92 (95% CI: 0.84, 1.00) per one standard deviation increment of sum of log-transformed PFAS. Among the controls, the adjusted β of HOMA2-IR and HOMA-B% for the sum of PFAS were -0.26 (95% CI: -0.52, -0.01) and -9.61 (95% CI: -22.60, 3.39) respectively comparing third with first tertile.
CONCLUSIONS:
This prospective nested case-control study yielded overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.
KEYWORDS:
Diabetes; Endocrine disruption; Environmental contaminants; Environmental epidemiology; Environmental risk factors; Insulin resistance; Nested case-control study; Plasma perfluoroalkyl substances; Prospective assessment

The Impact of Dairy Protein Intake on Muscle Mass, Muscle Strength, and Physical Performance in Middle-Aged to Older Adults with or without Existing Sarcopenia: A Systematic Review and Meta-Analysis.
Hanach NI, McCullough F, Avery A.
Adv Nutr. 2019 Jan 8. doi: 10.1093/advances/nmy065. [Epub ahead of print]
PMID: 30624580
Abstract
Sarcopenia is an age-related condition associated with a progressive loss of muscle mass and strength. Insufficient protein intake is a risk factor for sarcopenia. Protein supplementation is suggested to improve muscle anabolism and function in younger and older adults. Dairy products are a good source of high-quality proteins. This review evaluates the effectiveness of dairy proteins on functions associated with sarcopenia in middle-aged and older adults. Randomized controlled trials were identified using PubMed, CINAHL/EBSCO, and Web of Science databases (last search: 10 May 2017) and were quality assessed. The results of appendicular muscle mass and muscle strength of handgrip and leg press were pooled using a random-effects model. The analysis of the Short Physical Performance Battery is presented in narrative form. Adverse events and tolerability of dairy protein supplementation were considered as secondary outcomes. Fourteen studies involving 1424 participants aged between 61 and 81 y met the inclusion criteria. Dairy protein significantly increased appendicular muscle mass (0.13 kg; 95% CI: 0.01, 0.26 kg; P = 0.04); however, it had no effect on improvement in handgrip (0.84 kg; 95% CI: -0.24, 1.93 kg; P = 0.13) or leg press (0.37 kg; 95% CI: -4.79, 5.53 kg; P = 0.89). The effect of dairy protein on the Short Physical Performance Battery was inconclusive. Nine studies reported the dairy protein to be well tolerated with no serious adverse events. Although future high-quality research is required to establish the optimal type of dairy protein, the present systematic review provides evidence of the beneficial effect of dairy protein as a potential nutrition strategy to improve appendicular muscle mass in middle-aged and older adults.

Dietary vitamin and carotenoid intake and risk of age-related cataract.
Jiang H, Yin Y, Wu CR, Liu Y, Guo F, Li M, Ma L.
Am J Clin Nutr. 2019 Jan 9. doi: 10.1093/ajcn/nqy270. [Epub ahead of print]
PMID: 30624584
Abstract
BACKGROUND:
Existing studies suggest that dietary vitamins and carotenoids might be associated with a reduced risk of age-related cataract (ARC), although a quantitative summary of these associations is lacking.
OBJECTIVES:
The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) and cohort studies of dietary vitamin and carotenoid intake and ARC risk.
METHODS:
The MEDLINE, EMBASE, ISI Web of Science, and Cochrane Library databases were searched from inception to June 2018. The adjusted RRs and corresponding 95% CIs for the associations of interest in each study were extracted to calculate pooled estimates. Dose-response relations were assessed with the use of generalized least-squares trend estimation.
RESULTS:
We included 8 RCTs and 12 cohort studies in the meta-analysis. Most vitamins and carotenoids were significantly associated with reduced risk of ARC in the cohort studies, including vitamin A (RR: 0.81; 95% CI: 0.71, 0.92; P = 0.001), vitamin C (RR: 0.80; 95% CI: 0.72, 0.88; P < 0.001), vitamin E (RR: 0.90; 95% CI: 0.80, 1.00; P = 0.049), β-carotene (RR: 0.90; 95% CI: 0.83, 0.99; P = 0.023), and lutein or zeaxanthin (RR: 0.81; 95% CI: 0.75, 0.89; P < 0.001). In RCTs, vitamin E (RR: 0.97; 95% CI: 0.91, 1.03; P = 0.262) or β-carotene (RR: 0.99; 95% CI: 0.92, 1.07; P = 0.820) intervention did not reduce the risk of ARC significantly compared with the placebo group. Further dose-response analysis indicated that in cohort studies the risk of ARC significantly decreased by 26% for every 10-mg/d increase in lutein or zeaxanthin intake (RR: 0.74; 95% CI: 0.67, 0.80; P < 0.001), by 18% for each 500-mg/d increase in vitamin C intake (RR: 0.82; 95% CI: 0.74, 0.91; P < 0.001), by 8% for each 5-mg/d increase in β-carotene intake (RR: 0.92; 95% CI: 0.88, 0.96; P < 0.001), and by 6% for every 5 mg/d increase in vitamin A intake (RR: 0.94; 95% CI: 0.90, 0.98; P < 0.001).
CONCLUSIONS:
Higher consumption of certain vitamins and carotenoids was associated with a significant decreased risk of ARC in cohort studies, but evidence from RCTs is less clear.

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Effect of an Energy-Restricted, Nutritionally Complete, Higher Protein Meal Plan on Body Composition and Mobility in Older Adults With Obesity: A Randomized Controlled Trial.
Beavers KM, Nesbit BA, Kiel JR, Sheedy JL, Arterburn LM, Collins AE, Ford SA, Henderson RM, Coleman CD, Beavers DP.
J Gerontol A Biol Sci Med Sci. 2018 Jun 21. doi: 10.1093/gerona/gly146. [Epub ahead of print]
PMID: 30629126
Abstract
BACKGROUND:
Increasing protein content of the diet might be an effective strategy to preserve muscle mass in older adults undergoing caloric restriction, thereby preserving muscle function.
METHODS :
Ninety-six older adults (70.3 ± 3.7 years, 74% women, 27% African American) with obesity (35.4 ± 3.3 kg/m2; 47% total body fat) were randomized to a 6-month higher protein (providing 1.2-1.5 g/kg/d) weight loss (WL) program, utilizing the Medifast 4&2&1 Plan, or to weight stability (WS). Dual-energy x-ray absorptiometry-acquired total body mass and composition, and fast gait speed over 400 m was assessed at baseline, 3, and 6 months.
RESULTS:
At baseline, dual-energy x-ray absorptiometry-acquired total body, fat, and lean masses were 95.9 ± 14.6, 44.6 ± 7.6, and 48.7 ± 9.5 kg, respectively, and 400-m gait speed was 1.17 ± 0.20 m/s. Total body mass was significantly reduced in the WL group (-8.17 [-9.56, -6.77] kg) compared with the WS group (-1.16 [-2.59, 0.27] kg), with 87% of total mass lost as fat (WL: -7.1 [-8.1, -6.1] kg; -15.9% change from baseline). A differential treatment effect was not observed for change in lean mass (WL: -0.81 [-1.40, -0.23] kg vs WS: -0.24 [-0.85, 0.36] kg). Four-hundred-meter gait speed was also unchanged from baseline although trends suggest slightly increased gait speed in the WL group [0.01 (-0.02, 0.04) m/s] compared with the WS group [-0.02 (-0.05, 0.01) m/s].
CONCLUSION:
Intentional weight loss using a high-protein diet is effective in producing significant total body mass and fat mass loss, while helping preserve lean body mass and mobility, in relatively high-functioning older adults with obesity.

Acute effect of equicaloric meals varying in glycemic index and glycemic load on arterial stiffness and glycemia in healthy adults: a randomized crossover trial.
Zurbau A, Jenkins AL, Jovanovski E, Au-Yeung F, Bateman EA, Brissette C, Wolever TMS, Hanna A, Vuksan V.
Eur J Clin Nutr. 2018 May 17. doi: 10.1038/s41430-018-0182-2. [Epub ahead of print]
PMID: 29777241

Triglycerides Paradox Among the Oldest Old: "The Lower the Better?"
Lv YB, Mao C, Gao X, Yin ZX, Kraus VB, Yuan JQ, Zhang J, Luo JS, Zeng Y, Shi XM.
J Am Geriatr Soc. 2019 Jan 10. doi: 10.1111/jgs.15733. [Epub ahead of print]
PMID: 30628728
Abstract
OBJECTIVES:
Currently, most treatment guidelines suggest lowering hypertriglyceridemia of any severity, even in elderly individuals. However associations of serum triglycerides (TGs) with adverse health and mortality risk decrease with age, it remains unclear among the oldest old (aged 80 years and older). The study was to investigate the relationship of serum TG concentrations with cognitive function, activities of daily living (ADLs), frailty, and mortality among the oldest old in a prospective cohort study.
DESIGN:
Longitudinal prospective cohort study.
SETTING:
Community-based setting in longevity areas in China.
PARTICIPANTS:
A total of 930 (mean age = 94.0 years) Chinese oldest old.
MEASUREMENTS:
The TG concentrations were measured at baseline survey in 2009. Cognitive function, ADLs, frailty, and mortality were determined over 5 years of follow-up. Cox proportional hazards models and competing risk models were performed to explore the association, adjusting for potential confounders.
RESULTS:
Each 1-mmol/L increase in TGs was associated with a nearly 20% lower risk of cognitive decline, ADL decline, and frailty aggravation during the 5 years of follow-up. Consistently, higher TGs (each 1 mmol/L) was associated with lower 5-year all-cause mortality after fully adjustment (hazard ratio


= 0.79; 95% confidence interval [CI] = 0.69-0.89). Nonelevated TG concentrations (less than 2.26 mmol/L) were associated with higher mortality risk (HR = 1.72; 95% CI = 1.22-2.44), relative to TGs of 2.26 mmol/L or more. We observed similar results regarding TG concentrations and mortality in 1-year lag analysis and when excluding participants with identified chronic disease.
CONCLUSION:
In the oldest old, a higher concentration of TGs was associated with a lower risk of cognitive decline, ADL decline, frailty aggravation, and mortality. This paradox suggests the clinical importance of revisiting the concept of "the lower the better" for the oldest old.
KEYWORDS:
activities of daily living; cognitive function; frailty; mortality; triglycerides

Effect of frequent interruptions of sedentary time on nutrient metabolism in sedentary overweight male and female adults.
De Jong NP, Rynders CA, Goldstrohm DA, Pan Z, Lange AH, Mendez C, Melanson EL, Bessesen DH, Bergouignan A.
J Appl Physiol (1985). 2019 Jan 10. doi: 10.1152/japplphysiol.00632.2018. [Epub ahead of print]
PMID: 30629473
https://sci-hub.tw/10.1152/japplphysiol.00632.2018
Abstract
OBJECTIVE:
This study compared 24-h nutrient oxidation responses between a sedentary condition (SED) and a condition where short 5-min bouts of moderate-intensity physical activity were performed hourly for 9 consecutive hours over 4-d (MICRO). To determine whether any shifts in fuel use were due solely to increases in energy expenditure we also studied a condition consisting of a single isoenergetic 45-min bout of moderate-intensity exercise (ONE).
METHODS:
Twenty sedentary overweight or obese adults (10M/10F; 32.4±6.3 years; BMI, 30.6±2.9kg/m2) completed all three conditions (MICRO, SED, and ONE) in a randomized order. Each condition consisted of a 3 d free-living run-in followed by a 24-h stay in a whole-room calorimeter to measure total energy expenditure (TEE) and substrate utilization. Dietary fat oxidation was also assessed during the chamber stay by administering a [1-13C] oleic acid tracer at breakfast. Energy intake was matched across conditions.
RESULTS:
Both MICRO and ONE increased TEE relative to SED resulting in a negative energy balance. HOMA-IR improved in both activity conditions. MICRO increased 24-h carbohydrate oxidation compared to both ONE and SED (p<0.01 for both). ONE was associated with higher 24-h total fat oxidation compared to SED, and higher 24-h dietary fat oxidation compared to both SED and MICRO. Differences in substrate oxidation remained significant after adjusting for energy balance.
CONCLUSION:
In overweight and obese men and women, breaking up sitting time increased reliance upon carbohydrate as fuel over 24-h while a single energy-matched continuous bout of exercise preferentially relies upon fat over 24-h.
KEYWORDS:
carbohydrate oxidation; dietary fatty acid oxidation; microbouts of activity; physical inactivity; whole-room calorimetry

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Low-carbohydrate diets and prevalence, incidence and progression of coronary artery calcium in the Multi-Ethnic Study of Atherosclerosis (MESA).
Hu T, Jacobs DR, Bazzano LA, Bertoni AG, Steffen LM.
Br J Nutr. 2019 Jan 11:1-8. doi: 10.1017/S0007114518003513. [Epub ahead of print]
PMID: 30630542
https://sci-hub.tw/10.1017/S0007114518003513
Abstract
The evidence linking low-carbohydrate diets (LCD) to CVD is controversial, and results from epidemiological studies are inconsistent. We aimed to assess the relationship between LCD patterns and coronary artery Ca (CAC) scores from computed tomography in the Multi-Ethnic Study of Atherosclerosis cohort. Our sample included 5614 men and women free of clinical CVD at baseline (2000-2002), who had a FFQ, a baseline measure and ≥1 measure of CAC during follow-up. We excluded those with implausible energy intake or daily physical activity. The overall, animal-based and plant-based LCD scores were calculated based on intakes of macronutrients. Relative risk regression and robust regression models were used to examine the cross-sectional and longitudinal relationship between LCD score quintile and CAC outcomes, after adjustment for multiple cardiovascular risk factors. The mean age of participants was 63 years. The median intakes of total carbohydrate, fat and protein were 53·7, 30·5 and 15·6 % energy/d, respectively. Among 2892 participants with zero CAC scores at baseline, 264 developed positive scores during 2·4-year follow-up (11-59 months). Among those with positive scores at baseline, the median increase in CAC was 47 units over the course of follow-up. The overall, the animal-based and the plant-based LCD scores were not associated with CAC prevalence, incidence and progression. In conclusion, diets low in carbohydrate and high in fat and/or protein, regardless of the sources of protein and fat, were not associated with higher levels of CAC, a validated predictor of cardiovascular events, in this large multi-ethnic cohort.
KEYWORDS:
CAC coronary artery calcium; CAD coronary artery disease; CT computed tomography; LCD low-carbohydrate diet; MESA Multi-Ethnic Study of Atherosclerosis; Atherosclerosis; Cohort studies; Coronary artery calcium; Low-carbohydrate diets

Dietary and circulating vitamin C, vitamin E, β-carotene and risk of total cardiovascular mortality: a systematic review and dose-response meta-analysis of prospective observational studies.
Jayedi A, Rashidy-Pour A, Parohan M, Zargar MS, Shab-Bidar S.
Public Health Nutr. 2019 Jan 11:1-16. doi: 10.1017/S1368980018003725. [Epub ahead of print]
PMID: 30630552
https://sci-hub.tw/https://www.cambridge.org/core/journals/public-health-nutrition/article/dietary-and-circulating-vitamin-c-vitamin-e-carotene-and-risk-of-total-cardiovascular-mortality-a-systematic-review-and-doseresponse-metaanalysis-of-prospective-observational-studies/71D0B7C4B76F03C3E8FB00A4925551F0
Abstract
OBJECTIVE:
The present review aimed to quantify the association of dietary intake and circulating concentration of major dietary antioxidants with risk of total CVD mortality.
DESIGN:
Systematic review and meta-analysis.
SETTING:
Systematic search in PubMed and Scopus, up to October 2017.ParticipantsProspective observational studies reporting risk estimates of CVD mortality across three or more categories of dietary intakes and/or circulating concentrations of vitamin C, vitamin E and β-carotene were included. A random-effects meta-analysis was conducted.
RESULTS:
A total of fifteen prospective cohort studies and three prospective evaluations within interventional studies (320 548 participants and 16 974 cases) were analysed. The relative risks of CVD mortality for the highest v. the lowest category of antioxidant intakes were as follows: vitamin C, 0·79 (95 % CI 0·68, 0·89; I 2=46 %, n 10); vitamin E, 0·91 (95 % CI 0·79, 1·03; I 2=51 %, n 8); β-carotene, 0·89 (95 % CI 0·73, 1·05; I 2=34 %, n 4). The relative risks for circulating concentrations were: vitamin C, 0·60 (95 % CI 0·42, 0·78; I 2=65 %, n 6); α-tocopherol, 0·82 (95 % CI 0·76, 0·88; I 2=0 %, n 5); β-carotene, 0·68 (95 % CI 0·52, 0·83; I 2=50 %, n 6). Dose-response meta-analyses demonstrated that the circulating biomarkers of antioxidants were more strongly associated with risk of CVD mortality than dietary intakes.
CONCLUSIONS:
The present meta-analysis demonstrates that higher vitamin C intake and higher circulating concentrations of vitamin C, vitamin E and β-carotene are associated with a lower risk of CVD mortality.
KEYWORDS:
Antioxidants; CVD; Meta-analysis; Observational studies

Dietary Patterns and Foods Associated With Cognitive Function in Taiwanese Older Adults: The Cross-sectional and Longitudinal Studies.
Chuang SY, Lo YL, Wu SY, Wang PN, Pan WH.
J Am Med Dir Assoc. 2019 Jan 7. pii: S1525-8610(18)30591-7. doi: 10.1016/j.jamda.2018.10.017. [Epub ahead of print]
PMID: 30630727
Abstract
OBJECTIVES:
To find dietary patterns and foods associated with cognitive function.
DESIGN:
A cross-sectional study of short-term effects and a prospective study for long-term effects.
SETTING:
Nutrition and Health Survey in Taiwan (NAHSIT) 2014-2016 and NAHSIT 1999-2000.
PARTICIPANTS:
A total of 1245 older patients enrolled in the NAHSIT 2014-2016 and 1436 in the NAHSIT 1999-2000.
MEASUREMENTS:
Dietary intake was appraised with a food-frequency questionnaire. Cognitive function was assessed by the Mini-Mental State Examination score (MMSE).
RESULTS:
Using reduced rank regression to data-mine NAHSIT 2014-2016 cross-sectional data, we found in both genders a dietary pattern associated with high MMSE score, which was characterized by higher intakes of fresh fruits, nuts and seeds, whole grains, breakfast cereals, coffee, dairy products, seafood products, and fish. Moreover, in women, the pattern included a few additional items: tea, eggs, soybean products, and vegetables. Presence of mild cognitive impairment was inversely associated with the dietary pattern score, with declined adjusted odds ratio (95% confidence interval) from tertile 1 (as reference), tertile 2, to tertile 3 in both men [1 → 0.85(0.45-1.61) → 0.32 (0.14-0.78)] and women [1→0.44 (0.25-0.76) → 0.39 (0.20-0.75)]. Using the NAHSIT 1999-2000 as a baseline, along with 11 years of follow-up, we found with the Cox proportional hazards model that higher intake (≥4 vs <1 time/wk) of either tea or fish, but not other foods, was associated with a lower risk of developing dementia. Higher intakes of both tea and fish were associated with an even lower risk.
CONCLUSIONS/IMPLICATIONS:
A dietary pattern characterized by high intakes of phytonutrient-rich plant foods (fruits, whole grains, nuts/seeds, and vegetables), tea and coffee, and protein-rich foods such as eggs, dairy products, and fish, was associated with the presence of better cognitive function in older adult. Higher intakes of fish and tea combined showed a long-term protective effect. Further research is warranted to understand the long- and short-term effects of diet.
KEYWORDS:
Dementia; Nutrition and Health Survey in Taiwan (NAHSIT); dietary pattern; elderly; mild cognitive impairment; reduced rank regression

Does alpha-lipoic acid affect lipid profile? A meta-analysis and systematic review on randomized controlled trials.
Haghighatdoost F, Hariri M.
Eur J Pharmacol. 2019 Jan 8. pii: S0014-2999(19)30009-3. doi: 10.1016/j.ejphar.2019.01.001. [Epub ahead of print] Review.
PMID: 30633888
Abstract
Randomized controlled trials (RCTs) have demonstrated that alpha lipoic acid (ALA) may change lipid profile, but their results are contradictory. The aim of this study is to conduct a meta-analysis to assess the effects of ALA on lipid profile. Electronic databases including ISI web of science, Ovid, PubMed/Medline, SCOPUS, and Google Scholar were searched up to February 2018. RCTs which assessed ALA effects on lipid profile were selected. Weighted mean difference (WMD) and 95% confidence intervals (CIs) in serum lipids concentrations were defined as intervention effects. Random effects model was used to estimate the pooled effect. Heterogeneity was measured by using I2 test. The protocol was registered with PROSPERO (No. CRD42017072365). Database search retrieved 12 articles. Serum total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-) levels were significantly lower in subjects supplemented with alpha-lipoic acid compared with controls (WMD=-10.18mg/dL; 95% CI: -16.16, -4.20mg/dL; P=0.001 and WMD=-9.22mg/dL; 95% CI: -18.28, -0.16mg/dL; P=0.001, respectively), but no significant changes were found for high density lipoprotein-cholesterol (HDL-c) (WMD: 3.02mg/dL; 95% CI: -0.39, 6.43; P=0.082). The overall effect of ALA on serum triglyceride did not reveal any significant change, but in subgroup analysis based on health status (diabetic vs. non-diabetic), ALA decreased serum triglyceride levels in both diabetic and non-diabetic groups compared with controls. This meta-analysis revealed that ALA might favorably affect lipid profile especially LDL and TC. However, for confirming these results, more studies particularly among hyperlipidemic patients are needed.
KEYWORDS:
Alpha lipoic acid; Cholesterol; Lipids; Lipoprotein; Meta-analysis; Triglyceride

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Cancer death rate in U.S. has now been falling for 25 years
Decline in smoking, advances in treatment and early detection credited
The Associated Press · Posted: Jan 11, 2019
https://www.cbc.ca/news/health/cancer-death-rates-canada-us-1.4975106

Orange juice may get squeezed out of Canada's revised food guide
Concern over sugar content of juice has many consumers avoiding it
Jill English · CBC News · Posted: Jan 13, 2019
https://www.cbc.ca/news/health/orange-juice-may-get-squeezed-out-of-canada-s-revised-food-guide-1.4973894

Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study.
Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d'Elia H, Carlsten H, Eliasson B, Larsson I.
Arthritis Res Ther. 2019 Jan 11;21(1):17. doi: 10.1186/s13075-019-1810-5.
PMID: 30635024
Abstract
BACKGROUND:
Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2).
METHODS:
VLED (640 kcal/day) was taken during 12-16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria.
RESULTS:
Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48-62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6-26.5) or 18.6% (IQR 14.7-26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively.
CONCLUSIONS:
Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA.
KEYWORDS:
Cardiovascular disease; Metabolic syndrome; Obesity; Psoriasis; Psoriatic arthritis; VLED; Weight loss

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Controversies Surrounding Vitamin 😧 Focus on Supplementation and Cancer.
Minisola S, Ferrone F, Danese V, Cecchetti V, Pepe J, Cipriani C, Colangelo L.
Int J Environ Res Public Health. 2019 Jan 11;16(2). pii: E189. doi: 10.3390/ijerph16020189. Review.
PMID: 30641860
https://www.mdpi.com/1660-4601/16/2/189/htm
Abstract
There has recently been a huge number of publications concerning various aspects of vitamin D, from the physiological to therapeutic fields. However, as a consequence of this very fast-growing scientific area, some issues still remain surrounded by uncertainties, without a final agreement having been reached. Examples include the definitions of vitamin D sufficiency and insufficiency, (i.e., 20 vs. 30 ng/mL), the relationship between 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, (i.e., linear vs. no linear), the referent to consider, (i.e., total vs. free determination), the utility of screening versus universal supplementation, and so on. In this review, the issues related to vitamin D supplementation in subjects with documented hypovitaminosis, and the role of vitamin D in cancer will be concisely considered. Daily, weekly, or monthly administration of cholecalciferol generally leads to essentially similar results in terms of an increase in 25(OH)D serum levels. However, we should also consider possible differences related to a number of variables, (i.e., efficiency of intestinal absorption, binding to vitamin D binding protein, and so on). Thus, adherence to therapy may be more important than the dose regimen chosen in order to allow long-term compliance in a sometimes very old population already swamped by many drugs. It is difficult to draw firm conclusions at present regarding the relationship between cancer and vitamin D. In vitro and preclinical studies seem to have been more convincing than clinical investigations. Positive results in human studies have been mainly derived from post-hoc analyses, secondary end-points or meta-analyses, with the last showing not a decrease in cancer incidence but rather in mortality. We must therefore proceed with a word of caution. Until it has been clearly demonstrated that there is a causal relationship, these positive "non-primary, end-point results" should be considered as a background for generating new hypotheses for future investigations.
KEYWORDS:
cancer incidence; cancer mortality; supplementation; vitamin D

Association of Obesity With Mortality Over 24 Years of Weight History: Findings From the Framingham Heart Study.
Xu H, Cupples LA, Stokes A, Liu CT.
JAMA Netw Open. 2018 Nov 2;1(7):e184587. doi: 10.1001/jamanetworkopen.2018.4587.
PMID: 30646366
[pdf availed fromhttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2714501 ]
Abstract
IMPORTANCE:
Many studies of the association between obesity and mortality rely on weight status at a single point in time, making it difficult to adequately address bias associated with reverse causality.
OBJECTIVE:
To investigate the association between maximum body mass index (BMI) and all-cause mortality without the consequences of reverse causality.
DESIGN, SETTING, AND PARTICIPANTS:
Prospective cohort studies for the original and offspring cohorts of the Framingham Heart Study. The follow-up period started from baseline examination 13 for the original cohort and from baseline examination 6 for the offspring cohort and ended December 31, 2014. The analyses were conducted in 2017. Participants were 6197 individuals with 3478 deaths during a mean of 17 years of follow-up.
MAIN OUTCOMES AND MEASURES:
Maximum BMI over 24 years of weight history before the beginning of follow-up for all-cause mortality and cause-specific mortality. All-cause mortality and cause-specific mortality (deaths due to cardiovascular disease, cancer, or other causes).
RESULTS:
Among 6197 participants (mean [SD] age at baseline, 62.79 [8.98] years; 55.5% female), 3478 (56.1%) died during the follow-up. A monotonic association was observed between maximum BMI and mortality, with increasing risks observed across obese I (BMI of 30 to <35; hazard ratio


, 1.27; 95% CI, 1.14-1.41) and obese II (BMI of 35 to <40; HR, 1.93; 95% CI, 1.68-2.20) categories. A significant association was not observed for the overweight category (BMI of 25 to <30; HR, 1.08; 95% CI, 0.99-1.18). Among never smokers, the risks increased, with a significant association emerging for individuals with maximum BMI in the overweight range (HR, 1.31; 95% CI, 1.13-1.51). The mortality rates of normal-weight individuals who were formerly overweight or obese were 47.48 and 66.67 per 1000 person-years, respectively, while individuals who never exceeded normal weight had a mortality rate of 27.93 per 1000 person-years.
CONCLUSIONS AND RELEVANCE:
A monotonic association was found between maximum BMI over 24 years of weight history and subsequent all-cause mortality. Maximum BMI in the normal-weight range was associated with the lowest risk of mortality in this cohort, highlighting the importance of obesity prevention.

Nut and peanut butter consumption and the risk of lung cancer and its subtypes: A prospective cohort study.
Nieuwenhuis L, van den Brandt PA.
Lung Cancer. 2019 Feb;128:57-66. doi: 10.1016/j.lungcan.2018.12.018. Epub 2018 Dec 18.
PMID: 30642454
https://www.lungcancerjournal.info/article/S0169-5002(18)30715-3/fulltext
Abstract
OBJECTIVES:
Nut consumption has been associated with reduced cancer-related mortality, but evidence for a relation between nut intake and lung cancer risk is limited. We investigated the association between total nut, tree nut, peanut, and peanut butter intake and the risk of lung cancer and its subtypes in the Netherlands Cohort Study.
MATERIALS AND METHODS:
In 1986, dietary and lifestyle habits of 120,852 participants, aged 55-69 years, were measured with a questionnaire. After 20.3 years of follow-up, 3720 subcohort members and 2861 lung cancer cases were included in multivariable case-cohort analyses.
RESULTS:
Total nut intake was not significantly associated with total lung cancer risk in men or women. For small cell carcinoma, a significant inverse association with total nut intake was observed in men after controlling for detailed smoking habits (HR (95%CI) for 10+ g/day vs. nonconsumers: 0.62 (0.43-0.89), p-trend: 0.024). Inverse relations with small cell carcinoma were also found for tree nut and peanut intake in men in continuous analyses (HR (95%CI) per 5 g/day increment: 0.70 (0.53-0.93) and 0.93 (0.88-0.98), respectively). For the other lung cancer subtypes, no significant associations were seen in men. Nut intake was not related to the risk of lung cancer subtypes in women, and no associations were found for peanut butter in both sexes.
CONCLUSION:
Increased nut intake might contribute to the prevention of small cell carcinoma in men. No significant associations were found in men for the other subtypes or total lung cancer, in women, or for peanut butter intake.
KEYWORDS:
Cohort studies; Lung cancer; Nuts; Peanut butter; Peanuts; Prevention


Probiotic and selenium co-supplementation, and the effects on clinical, metabolic and genetic status in Alzheimer's disease: A randomized, double-blind, controlled trial.
Tamtaji OR, Heidari-Soureshjani R, Mirhosseini N, Kouchaki E, Bahmani F, Aghadavod E, Tajabadi-Ebrahimi M, Asemi Z.
Clin Nutr. 2018 Dec 10. pii: S0261-5614(18)32572-X. doi: 10.1016/j.clnu.2018.11.034. [Epub ahead of print]
PMID: 30642737
Abstract
BACKGROUND AND AIMS:
Combined probiotic and selenium supplementation may improve Alzheimer's disease (AD) by correcting metabolic abnormalities, and attenuating inflammation and oxidative stress. This study aimed to determine the effects of probiotic and selenium co-supplementation on cognitive function and metabolic status among patients with AD.
METHODS:
This randomized, double-blind, controlled clinical trial was conducted among 79 patients with AD. Patients were randomly assigned to receive either selenium (200 μg/day) plus probiotic containing Lactobacillus acidophilus, Bifidobacterium bifidum, and Bifidobacterium longum (2 × 109 CFU/day each) (n = 27), selenium (200 μg/day) (n = 26) or placebo (n = 26) for 12 weeks.
RESULTS:
Selenium supplementation, compared with the placebo, significantly reduced serum high sensitivity C-reactive protein (hs-CRP) (P < 0.001), insulin (P = 0.001), homeostasis model of assessment-insulin resistance (HOMA-IR) (P = 0.002), LDL-cholesterol (P = 0.04) and total-/HDL-cholesterol ratio (P = 0.004), and significantly increased total glutathione (GSH) (P = 0.001) and the quantitative insulin sensitivity check index (QUICKI) (P = 0.01). Compared with only selenium and placebo, probiotic and selenium co-supplementation resulted in a significant increase in mini-mental state examination score (+1.5 ± 1.3 vs. +0.5 ± 1.2 and -0.2 ± 1.1, respectively, P < 0.001). Probiotic plus selenium intake resulted in a significant reduction in hs-CRP (-1.6 ± 1.4 vs. -0.8 ± 1.0 and +0.1 ± 0.5 mg/L, respectively, P < 0.001), and a significant increase in total antioxidant capacity (+89.4 ± 129.6 vs. +20.0 ± 62.5 and -0.7 ± 27.2 mmol/L, respectively, P = 0.001) and GSH (+122.8 ± 136.5 vs. +102.2 ± 135.2 and +1.5 ± 53.2 μmol/L, respectively, P = 0.001) compared with only selenium and placebo. In addition, subjects who received probiotic plus selenium supplements had significantly lower insulin levels (-2.1 ± 2.5 vs. -1.0 ± 1.3 and +0.7 ± 2.0 μIU/mL, respectively, P < 0.001), HOMA-IR (-0.5 ± 0.6 vs. -0.2 ± 0.3 and +0.1 ± 0.4, respectively, P < 0.001), and higher QUICKI (+0.01 ± 0.01 vs. +0.005 ± 0.007 and -0.002 ± 0.01, respectively, P < 0.006) compared with only selenium and placebo. Additionally, probiotic and selenium co-supplementation resulted in a significant reduction in serum triglycerides (-17.9 ± 26.1 vs. -3.5 ± 33.9 and +0.3 ± 9.3 mg/dL, respectively, P = 0.02), VLDL- (-3.6 ± 5.2 vs. -0.7 ± 6.8 and +0.05 ± 1.8 mg/dL, respectively, P = 0.02), LDL- (-8.8 ± 17.8 vs. -8.1 ± 19.2 and +2.7 ± 19.0 mg/dL, respectively, P = 0.04) and total-/HDL-cholesterol (-0.3 ± 0.7 vs. -0.4 ± 0.9 and +0.3 ± 0.6, respectively, P = 0.005) compared with only selenium and placebo.
CONCLUSIONS:
Overall, we found that probiotic and selenium co-supplementation for 12 weeks to patients with AD improved cognitive function and some metabolic profiles.
KEYWORDS:
Alzheimer's disease; Cognitive function; Metabolic profiles; Probiotic; Selenium

Association of vegetable, fruit, and Okinawan vegetable consumption with incident stroke and coronary heart disease.
Yoshizaki T, Ishihara J, Kotemori A, Yamamoto J, Kokubo Y, Saito I, Yatsuya H, Yamagishi K, Sawada N, Iwasaki M, Iso H, Tsugane S; JPHC Study Group.
J Epidemiol. 2019 Jan 12. doi: 10.2188/jea.JE20180130. [Epub ahead of print]
PMID: 30643101
Abstract
BACKGROUND:
Few studies have investigated the effects of Okinawan vegetable consumption on the risk of incident stroke and coronary heart disease. This study aimed to examine associations of vegetable, fruit, and Okinawan vegetable consumption with risk of incident stroke and coronary heart disease in the Japanese population of Okinawa.
METHODS:
Study design was a prospective cohort study. During 1995-1998, a validated food frequency questionnaire was administered in two study areas to 16,498 participants aged 45-74 years. In 217,467 person-years of follow-up until the end of 2012, a total of 839 stroke cases and 197 coronary heart disease cases were identified.
RESULTS:
No statistically significant association between total Okinawan vegetable consumption and risk of stroke and coronary heart disease was obtained: the multivariable adjusted hazard ratios for the highest versus lowest tertile of consumption were 1.09 (95% confidence interval, 0.93-1.29; p for trend = 0.289) in model 2. Total vegetable and fruit and specific Okinawan vegetable consumption were also not statistically significantly associated with risk of cardiovascular outcomes.
CONCLUSIONS:
This study demonstrated that consumption of total vegetable and fruit, total Okinawan vegetables, and specific Okinawan vegetables in Japanese residents of Okinawa was not associated with risk of incident stroke and coronary heart disease.
KEYWORDS:
Cohort study; Okinawan vegetable; cardiovascular disease

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Of aging mice and men: gait speed decline is a translatable trait, with species-specific underlying properties.
Bair WN, Petr M, Alfaras I, Mitchell SJ, Bernier M, Ferrucci L, Studenski SA, de Cabo R.
J Gerontol A Biol Sci Med Sci. 2019 Jan 14. doi: 10.1093/gerona/glz015. [Epub ahead of print]
PMID: 30649206
https://sci-hub.tw/10.1093/gerona/glz015
Abstract
In the last two decades, great strides were made in our ability to extend the lifespan of model organisms through dietary and other manipulations. Survival curves provide evidence of altered aging processes but are uninformative on what lead to that increase in lifespan. Longitudinal assessments of health and function during intervention studies could help in the identification of predictive biomarkers for health and survival. Comparable biomarkers of healthspan are necessary to effectively translate interventions into human clinical trials. Gait speed is a well-established predictive biomarker of healthspan in humans for risk of disability, health outcomes and mortality, and is relatively simple to assess non-invasively in rodents. In this study, we assessed and compared gait speed in males from two species (mice and humans), from young adulthood to advanced old age. Although gait speed decreases non-linearly with age in both species, the underlying drivers of this change in gait speed were different, with humans exhibiting a shortened step length, and mice displaying a decrease in cadence. Future longitudinal and interventional studies in mice should examine the predictive value of longitudinal declines in gait speed for health and survival.

Less beef, more beans. Experts say world needs a new diet
Plant-based diet has enough flexibility to accommodate food cultures around the world, report's authors say
Candice Choi · The Associated Press · Posted: Jan 16, 2019
https://www.cbc.ca/news/health/planetary-health-diet-1.4981264

Folate intake and the risk of breast cancer: an up-to-date meta-analysis of prospective studies.
Zeng J, Wang K, Ye F, Lei L, Zhou Y, Chen J, Zhao G, Chang H.
Eur J Clin Nutr. 2019 Jan 15. doi: 10.1038/s41430-019-0394-0. [Epub ahead of print]
PMID: 30647438
Abstract
Epidemiological studies focusing on the association between folate and breast cancer risk reported inconsistent findings. We conducted a systematic search of the literature using PubMed and EMBASE databases. A total of 23 prospective studies involving 41,516 cases and 1,171,048 individuals were included for meta-analysis. Folate intake may decrease the risk of oestrogen receptor (ER) negative (-) and ER-/progesterone receptor (PR)- breast cancer, with pooled risk ratios (RRs) of 0.88 [95% confidence interval (CI): 0.78-1.00] and 0.82 (95% CI: 0.68-0.97), respectively. An increment of folate intake of 100 μg per day was associated with a deceased risk of ER- (RR = 0.94, 95% CI: 0.88-0.99) and ER-/PR- (RR = 0.90, 95% CI: 0.85-0.97) breast cancer. Moreover, high folate intake may have preventive effects against breast cancer in premenopausal women (RR = 0.94, 95% CI: 0.88-1.00) and individuals with moderate or high levels of alcohol consumption (RR = 0.82, 95% CI: 0.72-0.94).

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Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans.
Han SV, Park M, Kwon YM, Yoon HJ, Chang Y, Kim H, Lim YH, Kim SG, Ko A.
Korean J Fam Med. 2019 Jan 17. doi: 10.4082/kjfm.17.0089. [Epub ahead of print]
PMID: 30650952
https://www.kjfm.or.kr/upload/pdf/kjfm-17-0089.pdf
Abstract
BACKGROUND:
Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects.
METHODS:
A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models.
RESULTS:
Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality hazard ratio (HR, 2.28; 95% confidence interval [CI], 1.54- 3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22-4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03-7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group.
CONCLUSION:
The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.
KEYWORDS:
Aged; Anemia; Cause of Death; Mortality

Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies.
Garcia-Arellano A, Martínez-González MA, Ramallal R, Salas-Salvadó J, Hébert JR, Corella D, Shivappa N, Forga L, Schröder H, Muñoz-Bravo C, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Rekondo J, Toledo E, Razquin C, Ruiz-Canela M; SUN and PREDIMED Study Investigators.
Clin Nutr. 2018 May 24. pii: S0261-5614(18)30175-4. doi: 10.1016/j.clnu.2018.05.003. [Epub ahead of print]
PMID: 30651193
Abstract
BACKGROUND:
Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet.
OBJECTIVE:
We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts.
DESIGN:
We assessed 18,566 participants in the "Seguimiento Universidad de Navarra" (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the "PREvencion con DIeta MEDiterránea" (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality.
RESULTS:
After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio {HR}= 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%-32%, for the highest vs lowest category of DII).

CONCLUSION:
Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality.
KEYWORDS:
CRP; Cohort studies; Dietary inflammatory index; Inflammation; Mediterranean diet; Mortality

Genistein Prevents Development of Spontaneous Ovarian Cancer and inhibits Tumor Growth in Hen Model.
Sahin K, Yenice E, Bilir B, Orhan C, Tuzcu M, Sahin N, Ozercan IH, Kabil N, Ozpolat B, Kucuk O.
Cancer Prev Res (Phila). 2019 Jan 16. pii: canprevres.0289.2017. doi: 10.1158/1940-6207.CAPR-17-0289. [Epub ahead of print]
PMID: 30651293
Abstract
Genistein, the major isoflavone in soybean, has been reported to exert anticancer effects on various types of cancer including ovarian cancer; however, its chemopreventive effects and mechanisms of action in ovarian cancer have not been fully elucidated in spontaneously developing ovarian cancer models. In the present study, we demonstrated the preventive effects and mechanisms of genistein in the laying hen model that develops spontaneous ovarian cancer at high incidence rates. Laying hens were randomized to three groups: control (3.01 mg/hen, n = 100) or low (52.48 mg/hen n=100) and high genistein supplementation (106.26 mg/hen per day; per group). At the end of 78 weeks, hens were euthanized and ovarian tumors were collected and analyzed. We observed that genistein supplementation significantly reduced the ovarian tumor incidence (p = 0.002) as well as the number and size of the tumors (p= 0.0001). Molecular analysis of the ovarian tumors revealed that genistein downregulated serum malondialdehyde (MDA), a marker for oxidative stress and the expression of NF-κB, Bcl-2 and whereas it upregulated Nrf2, HO-1 and Bax expression at protein level in ovarian tissues. Moreover, genistein intake decreased the activity of mTOR pathway as evidenced by reduced phosphorylation of mTOR, p70S6K1, and 4E-BP1. Taken together, our findings strongly support the potential of genistein in the chemoprevention of ovarian cancer and highlight the effects of the genistein on the molecular pathways involved in ovarian tumorigenesis.

Edited by AlPater

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Residential greenness and mortality in oldest-old women and men in China: a longitudinal cohort study.
Ji JS, Zhu A, Bai C, Wu CD, Yan L, Tang S, Zeng Y, James P.
Lancet Planet Health. 2019 Jan;3(1):e17-e25. doi: 10.1016/S2542-5196(18)30264-X.
PMID: 30654864
https://www.sciencedirect.com/science/article/pii/S254251961830264X?via%3Dihub
Abstract
BACKGROUND:
Exposure to natural vegetation, or greenness, might affect health through several pathways, including increased physical activity and social engagement, improved mental health, and reductions in exposure to air pollution, extreme temperatures, and noise. Few studies of the effects of greenness have focused on Asia, and, to the best of our knowledge, no study has assessed the effect on vulnerable oldest-old populations. We assessed the association between residential greenness and mortality in an older cohort in China.
METHODS:
We used five waves (February, 2000-October, 2014) of the China Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort representative of the general older population in China. We assessed exposure to greenness through satellite-derived Normalised Difference Vegetation Index (NDVI) values in the 250 m and 1250 m radius around the residential address for each individual included in the study. We calculated contemporaneous NDVI values, cumulative NDVI values, and changes in NDVI from the start of the study over time. The health outcome of the study was all-cause mortality, excluding accidental deaths. Mortality rate ratios were estimated with Cox proportional hazards models, adjusted for age, sex, ethnicity, marital status, geographical region, childhood and adult socioeconomic status, social and leisure activity, smoking status, alcohol consumption, and physical activity.
FINDINGS:
Among 23 754 individuals (mean age at baseline 93 years [SD 7·5]) totaling 80 001 person-years, we observed 18 948 deaths during 14 years of follow-up, between June, 2000, and December, 2014. Individuals in the highest quartile of contemporaneous NDVI values had 27% lower mortality than those in the lowest quartile for the 250 m radius (hazard ratio


0·73, 95% CI 0·70-0·76), and 30% lower mortality for the 1250 m radius (0·70, 0·67-0·74). No clear association was observed for cumulative NDVI measurements and mortality. We did not detect an association between area-level changes in NDVI and mortality.
INTERPRETATION:
Our research suggests that proximity to more green space is associated with increased longevity, which has policy implications for the national blueprint of ecological civilisation and preparation for an ageing society in China.

The association between fasting plasma glucose and all-cause and cause-specific mortality by sex: The Rural Chinese Cohort Study.
Liu L, Chen X, Liu Y, Sun X, Yin Z, Li H, Zhang M, Wang B, Ren Y, Zhao Y, Liu D, Zhou J, Liu X, Zhang D, Cheng C, Liu F, Zhou Q, Xu Q, Xiong Y, Liu J, You Z, Hong S, Wang C, Hu D.
Diabetes Metab Res Rev. 2019 Jan 17:e3129. doi: 10.1002/dmrr.3129. [Epub ahead of print]
PMID: 30657630
https://sci-hub.tw/10.1002/dmrr.3129
Abstract
AIMS:
To evaluate the association between fasting plasma glucose (FPG) and mortality by sex.
MATERIALS AND METHODS:
A total of 17,248 eligible participants from a rural Chinese prospective cohort population were included. The same questionnaire interview, anthropometric and laboratory measurements were performed at both baseline (2007-2008) and follow-up (2013-2014). Participants were classified according to baseline FPG and diabetic status by sex. Restricted cubic splines and Cox proportional-hazards regression models, estimating hazard ratio (HR) and 95% confidence interval (CI), were used to assess the FPG-mortality relation.
RESULTS:
During the 6-year follow-up, 618 men and 489 women died. The FPG-mortality relation was J-shaped for both sexes. For men, risk of all-cause and non-cardiovascular disease (CVD)/non-cancer mortality was greater with low fasting glucose (LFG) than normal fasting glucose (adjusted HR [aHR] 1.60, 95% CI 1.05-2.43, and 2.16, 1.15-4.05). Men with diabetes mellitus (DM) showed increased risk of all-cause, CVD, and non-CVD/non-cancer mortality (aHR, 95% CI 2.04, 1.60-2.60; 1.98, 1.36-2.89; and 2.62, 1.76-3.91, respectively). Men with impaired fasting glucose (IFG) had borderline risk of CVD mortality (aHR 1.34, 95% CI 1.00-1.79). Women with LFG had increased risk of non-CVD/non-cancer mortality (aHR 2.27, 95% CI 1.04-4.95) and women with DM had increased risk of all-cause, CVD, and non-CVD/non-cancer mortality (aHR 1.73, 95% CI 1.35-2.23; 1.76, 1.24-2.50; and 1.97, 1.27-3.08, respectively).
CONCLUSIONS:
LFG is positively associated with all-cause mortality risk in rural Chinese men but not women.
KEYWORDS:
Cohort study; Fasting plasma glucose; Mortality; Sex-specific

Dietary fat, the gut microbiota, and metabolic health - A systematic review conducted within the MyNewGut project.
Wolters M, Ahrens J, Romaní-Pérez M, Watkins C, Sanz Y, Benítez-Páez A, Stanton C, Günther K.
Clin Nutr. 2018 Dec 24. pii: S0261-5614(18)32592-5. doi: 10.1016/j.clnu.2018.12.024. [Epub ahead of print] Review.
PMID: 30655101
https://sci-hub.tw/10.1016/j.clnu.2018.12.024
Abstract
BACKGROUND AND AIMS:
Studies indicate that dietary fat quantity and quality influence the gut microbiota composition which may as a consequence impact metabolic health. This systematic review aims to summarize the results of available studies in humans on dietary fat intake (quantity and quality), the intestinal microbiota composition and related cardiometabolic health outcomes.
METHODS:
We performed a systematic review (CRD42018088685) following PRISMA guidelines and searched for literature in Medline, EMBASE, and Cochrane databases.
RESULTS:
From 796 records, 765 records were excluded based on title or abstract. After screening of 31 full-text articles six randomized controlled trials (RCT) and nine cross-sectional observational studies were included. Our results of interventional trials do not suggest strong effects of different amounts and types of dietary fat on the intestinal microbiota composition or on metabolic health outcomes while observational studies indicate associations with the microbiota and health outcomes. High intake of fat and saturated fatty acids (SFA) may negatively affect microbiota richness and diversity and diets high in monounsaturated fatty acids (MUFA) may decrease total bacterial numbers whereas dietary polyunsaturated fatty acids (PUFA) had no effect on richness and diversity.
CONCLUSIONS:
High fat and high SFA diets can exert unfavorable effects on the gut microbiota and are associated with an unhealthy metabolic state. Also high MUFA diets may negatively affect gut microbiota whereas PUFA do not seem to negatively affect the gut microbiota or metabolic health outcomes. However, data are not consistent and most RCT and observational studies showed risks of bias.
KEYWORDS:
Fat; Fatty acids; Intestinal microbiota; Metabolic health; Saturated fatty acids; Unsaturated fatty acids

Dietary intake of marine n-3 polyunsaturated fatty acids and future risk of venous thromboembolism.
Isaksen T, Evensen LH, Johnsen SH, Jacobsen BK, Hindberg K, Brækkan SK, Hansen JB.
Res Pract Thromb Haemost. 2018 Dec 13;3(1):59-69. doi: 10.1002/rth2.12168. eCollection 2019 Jan.
PMID: 30656277
Abstract
BACKGROUND:
Studies on the association between long-chained n-3 polyunsaturated fatty acids (n-3 PUFAs) and risk of venous thromboembolism (VTE) are conflicting, potentially due to challenges related to assessment of n-3 PUFA intake and changes in diet during follow-up.
OBJECTIVES:
To investigate whether dietary intake of marine n-3 PUFAs was associated with risk of incident VTE in a population-based cohort with repeated assessments of n-3 PUFA intake.
METHODS:
We recruited 21 970 participants (after excluding 7570 with incomplete data) from the fourth (1994-1995) and sixth (2007-2008) surveys of the Tromsø Study, and recorded incident VTEs up to 2016. Intake of n-3 PUFAs was computed from self-reported consumption of fat and lean fish, fish spread, and supplements. Cox proportional hazards regression models with n-3 PUFA intake as a time-varying variable were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE across quartiles (Q) of n-3 PUFA intake.
RESULTS:
There were 541 incident VTEs during follow-up. Compared to Q1, subjects in Q2-4 had 22%-26% lower risk of VTE (HR Q2 0.74, 95% CI 0.57-0.96; HR Q3 0.77, 95% CI 0.59-0.99; HR Q4 0.78, 95% CI 0.61-1.00). The association was most pronounced for provoked VTE, particularly provoked pulmonary embolism (PE), with risk estimates of 0.42 (95% CI 0.25-0.72), 0.40 (95% CI 0.23-0.68), and 0.61 (95% CI 0.38-0.96) for Q2-4, respectively.
CONCLUSIONS:
Dietary intake of marine n-3 PUFAs was associated with a lower risk of VTE, particularly provoked PE. The association displayed a threshold pattern and suggested a protective effect of an n-3 PUFA intake ≥4.7 g/week.

Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women.
Blekkenhorst LC, Lewis JR, Bondonno CP, Sim M, Devine A, Zhu K, Lim WH, Woodman RJ, Beilin LJ, Thompson PL, Prince RL, Hodgson JM.
Eur J Nutr. 2019 Jan 17. doi: 10.1007/s00394-019-01902-z. [Epub ahead of print]
PMID: 30656478
Abstract
PURPOSE:
Increasing vegetable intake and diversity are recommended to maintain better health. Evidence for the health benefits of vegetable diversity, separate from total intake, is scarce. We aimed to investigate the associations of vegetable diversity with subclinical measures of atherosclerosis and atherosclerotic vascular disease (ASVD) mortality.
METHODS:
Vegetable diversity was assessed within a validated food frequency questionnaire using a single question, 'How many different vegetables do you usually consume each day (< 1 to ≥ 6 per day)'. Cox proportional hazards modelling was used to examine the association between vegetable diversity and ASVD mortality in 1226 women aged ≥ 70 years without clinical ASVD or diabetes mellitus at baseline (1998). In 2001, B-mode ultrasonography was used to measure common carotid artery intima-media thickness (CCA-IMT) (n = 954) and carotid plaque severity (n = 968).
RESULTS:
Over 15 years (15,947 person-years) of follow-up, 238 ASVD-related deaths were recorded. For each additional different vegetable consumed per day, there was 17% lower hazard for ASVD mortality (HR = 0.83, 95% CI 0.78, 0.93, P = 0.001); a 1.7% lower mean CCA-IMT (B ± SE: - 0.013 ± 0.004, P < 0.001); and a 1.8% lower maximum CCA-IMT (B ± SE: - 0.017 ± 0.004, P < 0.001). Further adjustment for total vegetable intake attenuated the association between vegetable diversity and ASVD mortality (P = 0.114), but not CCA-IMT (P = 0.024). No association was observed between vegetable diversity and carotid plaque severity (P > 0.05).
CONCLUSIONS:
Vegetable diversity may contribute to benefits in lowering risk of ASVD in older women. The reduction in risk is partly explained by increased total vegetable consumption.
KEYWORDS:
Atherosclerosis; Cardiovascular diseases; Diversity; Mortality; Older women; Vegetables

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Prediction of mortality in Chinese very old people through the frailty index based on routine laboratory data.
Hao Q, Sun X, Yang M, Dong B, Dong B, Wei Y.
Sci Rep. 2019 Jan 18;9(1):221. doi: 10.1038/s41598-018-36569-9.
PMID: 30659252
https://www.nature.com/articles/s41598-018-36569-9.pdf
Abstract
The increased risk of death in older adults can be successfully identified through frailty index (FI), based on comprehensive geriatric assessment data and self-reported data from the accumulated deficit, although the method depending on routine laboratory data (FI-LAB) remains uncertain. In the current study, the capacity of FI-LAB in evaluating the risk of mortality in a very old Chinese community cohort was analyzed. The 90-year- and above old individuals from a Dujiangyan community in Sichuan Province, China, who had completed a health assessment at baseline (in 2005) and whose laboratory data were analyzed (n = 736) from cumulative data from the Project of Longevity and Aging. The FI-LAB data was constructed from routine laboratory data and calculated as the ratio of abnormal factors in 22 variables (including red blood cells, white blood cells, and alanine transaminase) that can be assessed through blood tests. The multivariable Cox regression was used to evaluate the effect of frailty on death. In the four-year follow-up, 53.5% of the 736 participants (age = 93.6 ± 3.4 years; 67.5% women), were reported dead. The FI-LAB mean baseline value was 0.21 (standard deviation = 0.10; range = 0 to 0.55). Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased death risk, with a hazard ratio of 1.31 (95% confidence interval (CI): 1.07-1.61) in comparison with those without frailty among the individuals. Frailty as defined by FI-LAB, established only on routine laboratory data, indicates a significant death risk in the very old people.

Visit-to-Visit Glycemic Variability and Risks of Cardiovascular Events and All-Cause Mortality: The ALLHAT Study.
Echouffo-Tcheugui JB, Zhao S, Brock G, Matsouaka RA, Kline D, Joseph JJ.
Diabetes Care. 2019 Jan 18. pii: dc181430. doi: 10.2337/dc18-1430. [Epub ahead of print]
PMID: 30659073
https://sci-hub.tw/10.2337/dc18-1430
Abstract
OBJECTIVE:
The prognostic value of long-term glycemic variability is incompletely understood. We evaluated the influence of visit-to-visit variability (VVV) of fasting blood glucose (FBG) on incident cardiovascular disease (CVD) and mortality.
RESEARCH DESIGN AND METHODS:
We conducted a prospective cohort analysis including 4,982 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) who attended the baseline, 24-month, and 48-month visits. VVV of FBG was defined as the SD or variability independent of the mean (VIM) across FBG measurements obtained at the three visits. Participants free of CVD during the first 48 months of the study were followed for incident CVD (coronary heart disease [CHD], stroke, and heart failure [HF]) and all-cause mortality.
RESULTS:
Over a median follow-up of 5 years, there were 305 CVD events (189 CHD, 45 stroke, and 81 HF) and 154 deaths. The adjusted hazard ratio (HR) comparing participants in the highest versus lowest quartile of SD of FBG (≥26.4 vs. <5.5) was 1.43 (95% CI 0.93-2.19) for CVD and 2.22 (95% CI 1.22-4.04) for all-cause mortality. HR for VIM was 1.17 (95% CI 0.84-1.62) for CVD and 1.89 (95% CI 1.21-2.93) for all-cause mortality. Among individuals without diabetes, the highest quartile of SD of FBG (HR 2.67 [95% CI 0.14-6.25]) or VIM (HR 2.50 [95% CI 1.40-4.46]) conferred a higher risk of death.
CONCLUSIONS:
Greater VVV of FBG is associated with increased mortality risk. Our data highlight the importance of achieving normal and consistent glycemic levels for improving clinical outcomes.

Association of Dietary Niacin Intake With Incident Hip Fracture, BMD, and Body Composition: The Cardiovascular Health Study.
Carbone LD, Bůžková P, Fink HA, Raiford M, Le B, Isales CM, Shikany JM, Coughlin SS, Robbins JA.
J Bone Miner Res. 2019 Jan 19. doi: 10.1002/jbmr.3639. [Epub ahead of print]
PMID: 30659655
Abstract
Interest in niacin has increased in the setting of reports suggesting that niacin plays a role in diseases of aging. No study to date has examined the association of dietary niacin intake with multiple skeletal health parameters including bone mineral density (BMD), hip fractures, and body composition, and none have included both African American and white men and women. Participants included 5187 men and women ≥65 years from the Cardiovascular Health Study (CHS). Mean daily dietary niacin intake was 32.6 mg, with quartiles 1 through 4 defined as 3.6 to 21.8 mg/day, 21.9 to 30.2 mg/day, 30.3 to 40.9 mg/day, and 41.0 to 102.4 mg/day, respectively. Risk of incident hip fracture per 10 mg increment of daily dietary niacin intake was estimated using proportional hazards models. During a median follow-up of 13 years, 725 participants had an incident hip fracture. In models adjusted for demographic and clinical characteristics and diet, dietary niacin intake was significantly associated with an increased risk of hip fractures (hazard ratio {HR} 1.12; 95% CI, 1.01 to 1.24) with spline models suggesting a U-shaped association. In post hoc analyses, both the lowest (HR 1.31; 95% CI, 1.04 to 1.66) and highest (HR 1.53; 95% CI, 1.20 to 1.95) quartiles of niacin intake were associated with an increased risk of incident hip fracture versus quartiles 2 and 3. There was a trend for a significant inverse association of dietary niacin intake with hip BMD (p = 0.06), but no significant association with total body BMD or any body composition measures. In this cohort of elderly, community-dwelling African American and white men and women, both high and low dietary niacin intakes were associated with a significantly increased risk of subsequent hip fracture, suggesting a possible U-shaped association. By comparison, dietary niacin may have an inverse linear association with hip BMD.

Edited by AlPater

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