The Southern European Atlantic diet and depression risk: a European multicohort study.

The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of north-western Spain and northern Portugal, but it may resemble that of other European countries. The SEAD has been found associated with lower risk for myocardial infarction and mortality. Since dietary patterns may also influence mental health, we examined the association between the SEAD and depression risk in southern, central, eastern, and western European populations. We conducted a prospective analysis of five cohorts (13,297 participants aged 45-92 years, free of depression at baseline): Seniors-ENRICA-1 and Seniors-ENRICA-2 (Spain), HAPIEE (Czechia and Poland), and Whitehall-II (United Kingdom). The SEAD comprised cod, other fresh fish, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Depression at follow-up was defined according to presence of depressive symptoms (based on available scales), use of prescribed antidepressants, inpatient admissions, or self-reported diagnosis. Associations were adjusted for sociodemographic, lifestyle, and dietary variables. During a median follow-up of 3.9 years (interquartile range 3.4-4.9), there were 1437 new depression cases. Higher adherence to the SEAD was associated with lower depression risk in the pooled sample. Individual food groups showed a similar tendency, albeit non-significant. The fully adjusted odds ratio (95% confidence interval) per 1-standard deviation increment in the SEAD was 0.91 (0.86, 0.96). This association was rather consistent across countries [Spain = 0.86 (0.75, 0.99), Czechia = 0.86 (0.75, 0.99), Poland = 0.97 (0.89, 1.06), United Kingdom = 0.85 (0.75, 0.97); p for interaction = 0.24], and was of similar magnitude as that found for existing healthy dietary patterns. In conclusion, the SEAD was associated with lower depression risk across European populations. This may support the development of mood disorder guidelines for Southern European Atlantic regions based on their traditional diet, and for central, eastern, and western European populations based on the SEAD food groups that are culturally rooted in these places.

Association between a mediterranean lifestyle and Type 2 diabetes incidence: a prospective UK biobank study.

BACKGROUND: There is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population. METHODS: We used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40-69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) "Mediterranean food consumption", (b) "Mediterranean dietary habits", (c) "Physical activity, rest, social habits, and conviviality". Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders. RESULTS: After a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82-0.99), 0.80 (0.72-0.89) and 0.70 (0.62-0.79) (p-trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes. CONCLUSIONS: Higher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes.

The Southern European Atlantic Diet and all-cause mortality in older adults.

BACKGROUND: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain. Higher adherence to the SEAD has been associated with lower levels of some cardiovascular risk factors and reduced risk for myocardial infarction, but whether this translates into lower all-cause mortality is uncertain. We hence examined the association between adherence to the SEAD and all-cause mortality in older adults. METHODS: Data were taken from the Seniors-ENRICA-1 cohort, which included 3165 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Food consumption was assessed with a validated diet history, and adherence to the SEAD was measured with an index comprising 9 food components: fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Vital status was ascertained with the National Death Index of Spain. Statistical analyses were performed with Cox regression models and adjusted for the main confounders. RESULTS: During a median follow-up of 10.9 years, 646 deaths occurred. Higher adherence to the SEAD was associated with lower all-cause mortality (fully adjusted hazard ratio [95% confidence interval] per 1-SD increment in the SEAD score 0.86 [0.79, 0.94]; p-trend < 0.001). Most food components of the SEAD showed some tendency to lower all-cause mortality, especially moderate wine consumption (hazard ratio [95% confidence interval] 0.71 [0.59, 0.86]). The results were robust in several sensitivity analyses. The protective association between SEAD and all-cause death was of similar magnitude to that found for the Mediterranean Diet Adherence Screener (hazard ratio [95% confidence interval] per 1-SD increment 0.89 [0.80, 0.98]) and the Alternate Healthy Eating Index (0.83 [0.76, 0.92]). CONCLUSIONS: Adherence to the SEAD is associated with a lower risk of all-cause death among older adults in Spain.

Health Decline Is Associated with Reports of No Coffee Consumption Years After Reporting Coffee Consumption Among Older Adults in Spain.

BACKGROUND: Part of the health benefits of coffee reported in observational studies might be due to health status influencing coffee intake rather than the opposite. OBJECTIVE: We examined whether changes in health influenced subsequent reports of no coffee consumption in older adults. METHODS: Data came from 718 coffee drinkers aged ≥60 y recruited in the Seniors-Estudio de Nutrición y Salud Cardiovascular en España (ENRICA) cohort in 2008-2010 (wave 0) and followed-up in 2012 (wave 1), 2015 (wave 2), and 2017 (wave 3). Health status was measured with a 52-item deficit accumulation index (DAI) with 4 domains: functionality, self-rated health/vitality, mental health, and morbidity/health services use. Coffee intake was estimated with a validated diet history. We examined how changes in health status over a 3-y period (wave 0 to wave 1) influenced reports of no coffee consumption during the subsequent 5 y (wave 1 to wave 3) by using logistic regression models. RESULTS: Health deterioration over 3 y was associated with a higher frequency of reports of no regular coffee consumption during the subsequent 5 y (fully adjusted OR: 1.48 per 1-SD increment in DAI; 95% CI: 1.17-1.87). Deteriorating function (OR: 1.38 per 1-SD increment; 95% CI: 1.06-1.81) and mental health (OR: 1.34 per 1-SD increment; 95% CI: 1.04-1.73) were the DAI domains associated with increased reports of no regular coffee consumption. Also, individuals with worsened perceived health or hypertension onset were more likely to report no regular coffee consumption. No associations were found for decaffeinated coffee. CONCLUSIONS: Health deterioration was associated with reports of no regular coffee consumption years after reporting regular coffee consumption among older adults in Spain. A potential implication of this finding is that part of the beneficial effect of coffee consumption on health in observational studies might be due to reverse causation, which should be confirmed in future research.

Dietary Vitamin C Intake and Changes in Frequency, Severity, and Location of Pain in Older Adults.

BACKGROUND: Oral vitamin C supplementation has been associated with lower risk of chronic postsurgical pain. However, the effect of dietary vitamin C on pain in a nonsurgical setting is unknown. We aimed to investigate the association between dietary vitamin C intake and changes over time in chronic pain and its characteristics in community-dwelling adults aged 60 + years. METHODS: We pooled data from participants of the Seniors-ENRICA-1 (n = 864) and Seniors-ENRICA-2 (n = 862) cohorts who reported pain at baseline or at follow up. Habitual diet was assessed with a face-to-face diet history and dietary vitamin C intake was estimated using standard food composition tables. Pain changes over time were the difference between scores at baseline and follow up obtained from a pain scale that considered the frequency, severity, and number of pain locations. Multivariable-adjusted relative risk ratios were obtained using multinomial logistic regression. RESULTS: After a median follow-up of 2.6 years, pain worsened for 696 (40.3%) participants, improved for 734 (42.5%), and did not change for 296 (17.2%). Compared with the lowest tertile of energy-adjusted vitamin C intake, those in the highest tertile had a higher likelihood of overall pain improvement (RRR 1.61 [95% confidence interval 1.07-2.41], p-trend .02). Higher vitamin C intake was also associated with lower pain frequency (1.57 [1.00-2.47], p-trend = .05) and number of pain locations (1.75 [1.13-2.70], p-trend = .01). CONCLUSIONS: Higher dietary vitamin C intake was associated with improvement of pain and with lower pain frequency and number of pain locations in older adults. Nutritional interventions to increase dietary vitamin C intake with the aim of improving pain management require clinical testing.

Association between Planetary Health Diet and Cardiovascular Disease: A Prospective Study from the UK Biobank.

BACKGROUND: The Planetary Health Diet index (PHDI) prioritizes the well-being of both individuals and the planet but has yielded mixed results on cardiovascular disease (CVD). Our aim was to assess the association between the PHDI and risk of CVD. METHODS: A cohort of 118,469 individuals aged 40-69 years from the UK Biobank, who were free of CVD at 2009-2012 and followed-up to 2021. The PHDI was calculated using at least two 24-h dietary assessments and included 14 food groups, with a possible range from 0 to130 points. CVD incidence was defined as primary myocardial infarction or stroke and obtained from clinical records and death registries. RESULTS: During a 9.4-year follow-up, 5,257 incident cases of CVD were ascertained. When comparing the highest (89.9-128.5 points) versus the lowest quartile (21.1-71.1 points) of PHDI adherence, the multivariable-adjusted hazard ratio (95% confidence interval) was 0.86 (0.79, 0.94) for CVD, 0.88 (0.80, 0.97) for myocardial infarction, and 0.82 (0.70, 0.97) for stroke. The association was linear until a plateau effect was reached at 80 points of adherence to PHDI. Results remained robust when excluding participants with type 2 diabetes, including only those with three or more diet assessments, or excluding CVD cases in the first three years of follow-up. The food group components of the PHDI more strongly associated with reduced CVD risk were higher consumption of whole grains, whole fruits, fish and lower consumption of added sugars and fruit juices. CONCLUSION: In this large cohort of middle-aged and older British adults, adherence to the PHDI was associated with lower risk of CVD. These results provide empirical evidence that this dietary pattern, thought to be environmentally sustainable, benefits cardiovascular health.

This study found that adherence to the Planetary Health Diet Index (PHDI) was associated with a reduced risk of cardiovascular disease (CVD) among middle-aged and older adults in the UK. Key Findings:Higher adherence to the PHDI, which emphasizes whole grains, fruits, fish, and reduced intake of added sugars and fruit juices, is linked to a significantly lower risk of CVD, myocardial infarction, and stroke.The results were consistent even after accounting for various factors, including excluding participants with type 2 diabetes and focusing on those with more dietary assessments, highlighting the robustness of the association between the PHDI and cardiovascular health.

The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study.

AIMS: The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin. METHODS AND RESULTS: We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]. CONCLUSION: The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.

In this study of 35 917 subjects from southern, central, eastern, and western European countries, the Southern European Atlantic diet (traditional dietary pattern of northwestern Spain and northern Portugal) was associated with lower 13.6-year mortality from any cause, cardiovascular disease, and cancer. The associations of the Southern European Atlantic diet with lower mortality were not significantly different between countries (Spain, Czechia, Poland, and the United Kingdom). Study associations were similar as those found for existing healthy dietary patterns, suggesting that rather different diets could confer comparable benefits on health.

Protein Intake and Mortality in Older Adults With Chronic Kidney Disease.

Importance: Avoiding high protein intake in older adults with chronic kidney disease (CKD) may reduce the risk of kidney function decline, but whether it can be suboptimal for survival is not well known. Objective: To estimate the associations of total, animal, and plant protein intake with all-cause mortality in older adults with mild or moderate CKD and compare the results to those of older persons without CKD. Design, Setting, and Participants: Data from 3 cohorts (Study on Cardiovascular Health, Nutrition and Frailty in Older Adults in Spain 1 and 2 and the Swedish National Study on Aging and Care in Kungsholmen [in Sweden]) composed of community-dwelling adults 60 years or older were used. Participants were recruited between March 2001 and June 2017 and followed up for mortality from December 2021 to January 2024. Those with no information on diet or mortality, with CKD stages 4 or 5, or undergoing kidney replacement therapy and kidney transplant recipients were excluded. Data were originally analyzed from June 2023 to February 2024 and reanalyzed in May 2024. Exposures: Cumulative protein intake, estimated via validated dietary histories and food frequency questionnaires. Main Outcomes and Measures: The study outcome was 10-year all-cause mortality, ascertained with national death registers. Chronic kidney disease was ascertained according to estimated glomerular filtration rates, urine albumin excretion, and diagnoses from medical records. Results: The study sample consisted of 8543 participants and 14 399 observations. Of the 4789 observations with CKD stages 1 to 3, 2726 (56.9%) corresponded to female sex, and mean (SD) age was 78.0 (7.2) years. During the follow-up period, 1468 deaths were recorded. Higher total protein intake was associated with lower mortality among participants with CKD; adjusted hazard ratio (HR) for 1.00 vs 0.80 g/kg/d was 0.88 (95% CI, 0.79-0.98); for 1.20 vs 0.80 g/kg/d, 0.79 (95% CI, 0.66-0.95); and for 1.40 vs 0.80 g/kg/d, 0.73 (95% CI, 0.57-0.92). Associations with mortality were comparable for plant and animal protein (HRs, 0.80 [95% CI, 0.65-0.98] and 0.88 [95% CI, 0.81-0.95] per 0.20-g/kg/d increment, respectively) and for total protein intake in participants younger than 75 years vs 75 years or older (HRs, 0.94 [95% CI, 0.85-1.04] and 0.91 [95% CI, 0.85-0.98] per 0.20-g/kg/d increment in total protein intake, respectively). However, the hazards were lower among participants without CKD than in those with CKD (HRs, 0.85 [95% CI, 0.79-0.92] and 0.92 [95% CI, 0.86-0.98] per 0.20-g/kg/d increment, respectively; P = .02 for interaction). Conclusions and Relevance: In this multicohort study of older adults, higher intake of total, animal, and plant protein was associated with lower mortality in participants with CKD. Associations were stronger in those without CKD, suggesting that the benefits of proteins may outweigh the downsides in older adults with mild or moderate CKD.

Animal and vegetable protein intake and malnutrition in older adults: a multicohort study.

OBJECTIVES: Malnutrition is a global concern in older adults, as it negatively affects morbidity and mortality. While higher animal protein intake may help prevent and treat malnutrition, it might also increase the risk of chronic diseases and death. Conversely, vegetable protein intake might have a lower anabolic effect and not be as effective to improve nutritional status. We studied whether animal and vegetable protein intake are associated with changes in nutritional status in older adults. DESIGN: We used pooled data from two Spanish cohorts: the Seniors-ENRICA 1 and Seniors-ENRICA 2. SETTINGS AND PARTICIPANTS: 2,965 community-dwelling adults aged 62-92 years. MEASUREMENTS: Protein intake was estimated at baseline via an electronic, validated diet history. Nutritional status was assessed at baseline and after 2.6 years with the GLIM (Global Leadership Initiative on Malnutrition) phenotypic criteria: weight loss, low body mass index, and reduced muscle mass. The odds of improvements in nutritional status were assessed with logistic regression models, extensively adjusted for potential confounders. RESULTS: Higher animal and vegetable protein intake were associated with improvements in nutritional status [odds ratios (95% confidence intervals) per 0.25 g/kg/day were 1.15 (1.00, 1.32) and 1.77 (1.35, 2.32), respectively]. Cereal protein intake drove most of the latter association [2.07 (1.44, 2.98)]. Replacing 0.25 g/kg/day of total animal protein, meat, or fish protein (but not dairy or egg protein) with vegetable protein was associated with improvements in nutritional status [1.54 (1.13, 2.09), 1.70 (1.20, 2.41), and 1.77 (1.18, 2.64), respectively]. CONCLUSIONS: Higher animal and, especially, vegetable protein intake were associated with improvements in nutritional status in older adults. Replacing total animal protein, meat, or fish protein with vegetable protein may help improve malnutrition.

Growth Differentiation Factor 15 as a Biomarker of Cardiovascular Risk in Chronic Musculoskeletal Pain.

BACKGROUND: It is unknown whether growth differentiation factor 15 (GDF-15) is associated with chronic musculoskeletal pain (CMP) and whether or not its association with incident cardiovascular disease (CVD) changes according to CMP status. METHODS: In total, 1 957 randomly selected adults aged ≥65 years without prior CVD were followed up between 2015 and 2023. CMP was classified according to its intensity, frequency, and interference with daily activities. The association between GDF-15 levels and CMP was assessed using linear models with progressive inclusion of potential confounders, whereas the association between GDF-15 and CVD risk was evaluated with Cox proportional hazard models with similar adjustment and interaction terms between GDF-15 and CMP. The incremental predictive performance of GDF-15 over standard predictors was evaluated using discrimination and risk reclassification metrics. RESULTS: GDF-15 concentrations were 6.90% (95% confidence interval [CI]: 2.56; 11.25) higher in individuals with CMP, and up to 8.89% (4.07; 15.71) and 15.79% (8.43; 23.16) higher in those with ≥3 CMP locations and interfering pain. These increased levels were influenced by a higher prevalence of cardiometabolic risk factors, functional impairments, depressive symptoms, and greater levels of inflammation in individuals with CMP. In fully adjusted models, a twofold increase in GDF-15 was associated with a 1.49 increased risk (95% CI: 1.08; 2.05) of a CVD event in individuals with CMP, but not among those without CMP (1.02 [0.77; 1.35]); p-interaction 0.041. Adding GDF-15 to models including the Framingham Risk Score improved predictive performance among individuals with CMP. CONCLUSIONS: We provide evidence that GDF-15 could serve as a biomarker to assess CMP, as well as to predict CVD incidence in individuals with CMP.

The Inflammatory Potential of Diet and Pain Incidence: A Cohort Study in Older Adults.

BACKGROUND: Despite its importance, evidence regarding pain prevention is inadequate. Leveraging the growing knowledge on how diet regulates inflammation, we examined the association of 3-year changes in the inflammatory potential of diet with pain incidence over the subsequent 3 years. METHODS: We used data from 819 individuals aged ≥60 years and free of pain in 2012, drawn from the Spanish Seniors-ENRICA-1 cohort. The inflammatory potential of diet was estimated via a validated diet history and 2 indices: the dietary inflammatory index (DII) and the empirical dietary inflammatory index (EDII). The frequency, severity, and number of locations of incident pain were combined into a scale that classified participants as suffering from no pain, intermediate pain, or highest pain. RESULTS: Shifting the diet toward a higher inflammatory potential was associated with subsequent increased risk of highest pain (fully-adjusted relative risk ratio [95% confidence interval] per 1-standard deviation increment in the DII and the EDII = 1.45 [1.16,1.80] and 1.21 [0.98,1.49], respectively) and intermediate pain (0.99 [0.75,1.31] and 1.37 [1.05,1.79]). The 3 components of the pain scale followed similar trends, the most consistent one being pain severity (moderate-to-severe pain: DII = 1.39 [1.11,1.74]; EDII = 1.35 [1.08,1.70]). The association of increasing DII with highest incident pain was only apparent among the less physically active participants (2.08 [1.53,2.83] vs 1.02 [0.76,1.37]; p-interaction = .002). CONCLUSION: An increase in the inflammatory potential of diet was associated with higher pain incidence over the following years, especially among the less physically active participants. Future studies in older adults should assess the efficacy of pain prevention interventions targeting the inflammatory potential of diet.

Plant-based diets and risk of frailty in community-dwelling older adults: the Seniors-ENRICA-1 cohort.

Frailty is a geriatric syndrome that leads to increased risk of hospitalization, disability, and death. The effect of plant-based diets defined by the quality of their plant foods is unclear. Our objective is to study the association between two plant-based diet indices and the occurrence of frailty among community-dwelling older adults in Spain. We analyzed data from 1880 individuals aged ≥ 60 years from the Spanish Seniors ENRICA-1 cohort. We used a validated diet history to build two indices: (a) the healthful Plant-based Diet Index (hPDI) where healthy plant foods received positive scores, whereas less-healthy plant foods and animal foods received reverse scores; and (b) the unhealthful Plant-based Diet Index (uPDI), with positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Incident frailty was defined with the Fried phenotype. Study associations were summarized with odds ratios (OR) and 95% confidence intervals (CI) obtained from multivariable logistic models. After 3.3 years of follow-up, 136 incident frailty cases were ascertained. Comparing the highest vs. the lowest tertile of adherence, the OR [95% CI] for frailty was 0.43 (0.25-0.74; p-trend = .003) for the hPDI, and 2.89 (1.73-4.84; p-trend < .001) for the uPDI. Higher consumption of healthy plant foods was inversely associated with frailty (0.39 [0.23-0.66; p-trend < 0.001]); higher consumption of unhealthy plant foods was associated with higher frailty risk (2.40 [1.23-4.71; p-trend = .01]). In older adults, the hPDI was associated with lower risk of frailty, while the opposite was found for the uPDI.

Blood Selenium Concentrations Are Inversely Associated with the Risk of Undernutrition in Older Adults.

BACKGROUND: Selenium is an essential trace element with an antioxidant and anti-inflammatory capacity that has been associated in experimental studies with beneficial effects on appetite control, the regulation of the gut microbiota, and control of the anabolic-catabolic balance. The main aim of the present study was to evaluate the association between circulating selenium concentrations and the risk of developing undernutrition in older adults. METHODS: This was a cohort study with 1398 well-nourished community-dwelling individuals aged ≥ 65 years residing in Spain in 2017, who were followed for a mean of 2.3 years. Whole blood selenium was measured at baseline using inductively coupled plasma-mass spectrometry. Undernutrition was assessed at baseline and at follow-up, and defined as having at least one of the three GLIM phenotypic criteria (involuntary weight loss, a low body mass index, and a reduced muscle mass) and at least one of the two etiologic criteria (reduced food consumption or nutrient assimilation and inflammation/disease burden). RESULTS: During the follow-up, 142 participants (11%) developed moderate undernutrition and 113 (8.8%) severe undernutrition. The standardized relative risks of moderate and severe undernutrition at the 75th percentile of Se levels versus the 25th were 0.90 and 0.70, respectively. In dose-response analyses, the risk of severe undernutrition decreased linearly with increasing selenium concentrations. This association was independent of protein intake or diet quality and was stronger among participants with a diagnosis of a musculoskeletal disorder. CONCLUSIONS: The results suggest that an adequate dietary selenium status is needed to prevent undernutrition in older adults. Also, this may open the door for clinical trials with selenium supplementation, at doses considered as safe, to prevent undernutrition.

Fish consumption, omega-3 fatty acid intake, and risk of pain: the Seniors-ENRICA-1 cohort.

BACKGROUND & AIMS: Omega-3 fatty acids have anti-inflammatory and analgesic (anti-nociceptive) actions. However, the relation of habitual omega-3 fatty acid intake and fish consumption - its main food source - with pain remains largely unknown. We examined the association of fish consumption and marine omega-3 fatty acid intake with pain incidence and worsening over 5 years among older adults. METHODS: Data were taken from the Seniors - ENRICA-1 cohort, which included 950 individuals aged ≥60 years in Spain. Habitual fish consumption and marine omega-3 fatty acid intake during the previous year were assessed in 2008-2010 and 2012 with a validated diet history. Pain was assessed in 2012 and 2017 with a scale developed from the Survey on Chronic Pain in Europe, ranging from 0 (no pain) to 6 (highest pain), according to its severity, frequency, and number of locations. Analyses on pain incidence were conducted in the 524 participants free of pain at baseline, while those on pain worsening were performed in the overall cohort, and both were adjusted for sociodemographic variables, lifestyle, morbidity, and diet quality. RESULTS: Higher oily fish consumption was associated with reduced pain incidence and worsening over 5 years [fully adjusted odds ratios (95% confidence interval) = 0.68 (0.50,0.94) and 0.70 (0.55,0.88) for every 25 g/day increment (1.5 servings/week), respectively]. Total and white fish consumption were not associated with pain. Higher marine omega-3 fatty acid intake was inversely associated with pain worsening [odds ratio (95% confidence interval) per 0.5 g/day increment = 0.83 (0.72,0.96)]. The corresponding associations for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were 0.53 (0.33,0.87) and 0.73 (0.57,0.94). CONCLUSIONS: In this cohort of Spanish older adults, increased oily fish consumption was inversely associated with pain incidence and worsening over 5 years, while higher marine omega-3 fatty acid intake (and that of EPA and DHA) was linked to less pain worsening.

Metabolic syndrome and Growth Differentiation Factor 15 in older adults.

Growth Differentiation Factor 15 (GDF-15) is a cytokine produced in response to tissue injury and inflammatory states that may capture distinct pathways between the risk factors aggregated within metabolic syndrome (MS) and the development of diabetes and cardiovascular disease. This work aims to study the association of MS and its components with GDF-15 among older adults, examining the roles of body fat distribution, glucose metabolism, and inflammation. Data were taken from the Seniors-ENRICA-2 study in Spain, which included 1938 non-institutionalized individuals aged ≥65 years free of diabetes and cardiovascular disease. MS was defined as the presence of ≥3 of the following components: high waist circumference, elevated fasting blood glucose levels, raised blood pressure, increased triglyceride levels, and low serum high-density lipoprotein (HDL) cholesterol. Statistical analyses were performed with linear regression models and adjusted for potential sociodemographic and lifestyle confounders. MS was associated with higher GDF-15 levels (fully adjusted mean increase [95% confidence interval] = 9.34% [5.16,13.7]). The MS components showing the strongest associations were high waist circumference (6.74% [2.97,10.6]), elevated glucose levels (4.91% [0.77,9.23]), and low HDL-cholesterol (8.13% [3.51,13.0]). High waist-to-hip ratio (7.07% [2.63,11.7]), urine albumin (12.1% [2.57,22.5]), and C-reactive protein (10.4% [3.89,17.3]) were also associated with increased GDF-15. In conclusion, MS was associated with higher GDF-15 levels in older adults. Abdominal obesity, hyperglycemia -possibly linked to microvascular disease, as inferred from elevated urine albumin-, low HDL-cholesterol, and inflammation were the main drivers of this association.

Alcohol consumption patterns and growth differentiation factor 15 among life-time drinkers aged 65+ years in Spain: a cross-sectional study.

AIMS: To examine the association of alcohol consumption patterns with growth differentiation factor 15 (GDF-15) in older drinkers, separately among individuals with cardiovascular disease (CVD)/diabetes and those without them, as GDF-15 is a strong biomarker of chronic disease burden. DESIGN: Cross-sectional study. SETTING: Population-based study in Madrid (Spain). PARTICIPANTS: A total of 2051 life-time drinkers aged 65+ years included in the Seniors-ENRICA-2 study in 2015-17. Participants' mean age was 71.4 years and 55.4% were men. MEASUREMENTS: According to their average life-time alcohol intake, participants were classified as occasional (≤ 1.43 g/day), low-risk (men: > 1.43-20 g/day; women: > 1.43-10 g/day), moderate-risk (men: > 20-40 g/day; women: > 10-20 g/day) and high-risk drinkers (men: > 40 g/day; women: > 20 g/day; or binge drinkers). We also ascertained wine preference (> 80% of alcohol derived from wine), drinking with meals and adherence to a Mediterranean drinking pattern (MDP) defined as low-risk drinking, wine preference and one of the following: drinking only with meals; higher adherence to the Mediterranean diet; or any of these. FINDINGS: In participants without CVD/diabetes, GDF-15 increased by 0.27% [95% confidence interval (CI) = 0.06%, 0.48%] per 1 g/day increment in alcohol among high-risk drinkers, but there was no clear evidence of association in those with lower intakes or in the overall group, or across categories of alcohol consumption status. Conversely, among those with CVD/diabetes, GDF-15 rose by 0.19% (95% CI = 0.05%, 0.33%) per 1 g/day increment in the overall group and GDF-15 was 26.89% (95% CI = 12.93%, 42.58%) higher in high-risk versus low-risk drinkers. Drinking with meals did not appear to be related to GDF-15, but among those without CVD/diabetes, wine preference and adherence to the MDP were associated with lower GDF-15, especially when combined with high adherence to the Mediterranean diet. CONCLUSIONS: Among older life-time drinkers in Madrid, Spain, high-risk drinking was positively associated with growth differentiation factor 15 (a biomarker of chronic disease burden). There was inconclusive evidence of a beneficial association for low-risk consumption.

Alcohol consumption patterns and unhealthy aging among older lifetime drinkers from Spain.

BACKGROUND: The protective health effects of light alcohol consumption are debated due to potential selection biases, reverse causation and confounding. We examined cross-sectional and prospective associations of alcohol consumption patterns with unhealthy aging among older drinkers addressing these methodological issues. METHODS: 2081 lifetime drinkers aged 65 + years from the Seniors-ENRICA-2 cohort followed-up for 2.4 years were classified as occasional (average lifetime alcohol intake [g/day] ≤1.43), low-risk (men: >1.43-20; women: >1.43-10), moderate-risk (men: >20-40; women: >10-20) and high-risk drinkers (men: >40; women: >20; or binge drinkers). A Mediterranean drinking pattern (MDP) was defined as occasional/low-risk drinking, wine preference and drinking only with meals. Unhealthy aging was measured with a 52-item health deficit accumulation index (DAI), with higher values indicating more health deficits. RESULTS: A 10-g/day increment in lifetime average alcohol intake was cross-sectionally associated with a higher DAI among all drinkers (mean difference [95% confidence interval] = 0.35 [0.16, 0.53]) and moderate-/high-risk drinkers (0.41 [0.17, 0.65]), but not among occasional/low-risk drinkers. Also, the DAI was 1.35 (0.06, 2.65) points higher in high-risk versus low-risk drinkers and 2.07 (0.59, 3.60) points higher in non-adherers versus adherers to the MDP. Most associations strengthened when restricting analyses to individuals with lower disease burden and did not generally remain after 2.4 years. CONCLUSIONS: We found no evidence of a beneficial association between low-risk alcohol consumption and unhealthy aging, but a detrimental one for high-risk drinking, which strengthened when accounting for reverse causation, although attenuated over the follow-up likely due to selective attrition of those less resilient to the harmful effects of alcohol.

Dietary Vitamin D Intake, Pain Incidence, and Pain Changes in Older Adults: The Seniors-ENRICA-1 Cohort.

Background: Vitamin D plays a role in bone health, pain signaling, and inflammation. We examined the largely unknown relation of dietary vitamin D intake with pain incidence and pain changes over time in older adults. Methods: Data were taken from the Seniors-ENRICA-1 cohort, which included 950 individuals aged ≥60 years. Habitual vitamin D intake was assessed in 2012 with a validated diet history, and pain both in 2012 and 2017 with a scale ranging from 0 (no pain) to 6 (highest pain), according to its severity, frequency, and number of locations. Analyses on pain incidence and pain changes were performed in the 524 participants free of pain at baseline and the overall sample, respectively. Results: Higher dietary vitamin D intake was associated with lower 5-year pain incidence; the multivariable-adjusted odds ratio (95% confidence interval) was 0.88 (0.79,0.99) for every 1-µg/day increase in vitamin D intake, and 0.49 (0.28,0.88) for the highest (>3.52 µg/day) vs. lowest (<1.85 µg/day) tertile. Dietary vitamin D intake (highest vs. lowest tertile) was also associated with 5-year favorable pain changes: the multivariable-adjusted odds ratio of pain worsening vs. no change/pain improvement was 0.55 (0.36,0.86), and the ß coefficient for changes in the pain scale was −0.56 (−1.03,−0.09). Similar results were found for pain severity, frequency, and number of pain locations. Conclusions: In an older adult population, where compliance with vitamin D intake recommendations was very low, a slightly increased dietary intake was associated with lower pain incidence and favorable pain changes over 5 years.

Consumption of food fried in olive oil and unhealthy aging in a Mediterranean country.

BACKGROUND & AIMS: Fried food has usually shown neutral or detrimental effects on many chronic diseases, possibly depending on the type of food fried and the frying oil, but its relationship with unhealthy aging is unknown. We examined how changes in fried food consumption over a 3-year period were linked to unhealthy aging over 3 and 6 years. METHODS: Prospective cohort study in Spain with 2043 individuals aged ≥60 years, recruited in 2008-2010 and followed-up to 2012 and 2015. Fried food consumption was ascertained with a validated diet history, and unhealthy aging was measured with a 52-item health deficit accumulation index. RESULTS: Compared with participants who reduced fried food consumption, those who increased it showed less deficit accumulation over 3 years (multivariable ß [95% confidence interval]: -1.45 [-2.30, -0.61]), but not over 6 years of follow-up. More 3-year deficit accumulation was observed when replacing 100 g/day of fried food with an equal amount of non-fried food (1.48 [0.59, 2.37]); corresponding values in substitution analyses were 2.03 [1.03, 3.03] for fried protein-rich food, 10.76 [5.20, 16.33] for fried eggs, and 2.06 [0.68, 3.43] for fried fish. Also, increased olive oil intake was significantly associated with less 3-year deficit accumulation (total olive oil: -1.14 [-2.07, -0.21], and olive oil with non-fried food: -0.99 [-1.89, -0.08]). CONCLUSIONS: In a Mediterranean country, where olive oil is the most common frying medium, increased fried food consumption was associated with delayed unhealthy aging over 3 years of follow-up; consumption of olive oil and fried protein-rich food (especially eggs and fish) were its main drivers. However, these associations did not generally remain after 6 years.