Determinants of serum uric acid levels in an adult general population: results from the Moli-sani Study.

OBJECTIVES: High levels of serum uric acid (UA) are associated with cerebro-cardiovascular disease risk factors. This study aimed at evaluating the main determinants of serum UA levels in relation to biochemical, lifestyle, and clinical variables. METHODS: The study population included 15,594 participants (48% men, age ≥ 35 years) to the Moli-sani Study, for whom data on serum UA levels were available. Association of UA with dependent variables was investigated by multivariable linear regression analysis separately for men and women. RESULTS: Average serum UA levels were higher in men than in women (6.1 ± 1.3 vs 4.6 ± 1.2 mg/dL, respectively). Cystatin C, creatinine, albumin, triglycerides, body mass index (BMI), and diuretic therapy were the major determinants of the heterogeneity of UA levels. In women, the final model, resulting from the stepwise analysis, explained 41.6% of the UA variability. In particular, cystatin C explained 22.5% of UA variance, followed by BMI (7.2%), albumin (4.0%), and creatinine (1.9%). The final model in men fitted the data less than in women (total R2 = 29.1%), and creatinine was found to be the main determinant of UA levels (10.1%), followed by triglycerides (7.6%), BMI (3.7%), and albumin (2.0%). CONCLUSIONS: In a general adult population, the major determinants of serum UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics. Knowledge of its main determinants will be useful to better evaluate the relationship between UA levels and detrimental health outcomes and to clarify if an increase in uricemia is a marker or an independent risk factor. Key Points • Increased serum uric acid (UA) levels are reportedly associated with cardiovascular disease risk factors. • The major determinants of heterogeneity of UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics, in a general adult population. • Studying the main determinants associated with high levels of serum uric acid would help better understanding if uric acid is a marker or an independent cardiovascular risk factor.

Alcohol consumption and hospitalization burden in an adult Italian population: prospective results from the Moli-sani study.

BACKGROUND AND AIMS: Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations. DESIGN: Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013). SETTING: Molise region, Italy. PARTICIPANTS: A total of 20 682 individuals (48% men, age ≥ 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline. MEASUREMENTS: The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person. FINDINGS: During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases. CONCLUSIONS: Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.

Postoperative atrial fibrillation and total dietary antioxidant capacity in patients undergoing cardiac surgery: The Polyphemus Observational Study.

OBJECTIVE: Postoperative atrial fibrillation is a major cause of morbidity and mortality for stroke after cardiac surgery. Both systemic inflammation and oxidative stress play a role in the initiation of postoperative atrial fibrillation after cardiac surgery. The possible association between long-term intake of antioxidant-rich foods and postoperative atrial fibrillation incidence was examined in patients undergoing cardiac surgery. METHODS: A total of 217 consecutive patients (74% were men; median age, 68.4 years) undergoing cardiac surgery, mainly coronary artery bypass grafting and valve replacement or repair, were recruited from January 2010 to September 2012. Total antioxidant capacity was measured in foods by the Trolox equivalent antioxidant capacity assay. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary total antioxidant capacity assessment. The association among tertiles of dietary total antioxidant capacity and postoperative atrial fibrillation incidence was assessed using multivariable logistic analysis. RESULTS: The overall incidence of total arrhythmias and postoperative atrial fibrillation was 42.4% and 38.2%, respectively. In multivariable analysis, after adjustment for age, gender, use of hypoglycemic drugs, physical activity, education, previous diagnosis of atrial fibrillation, and total energy intake, patients in the highest tertile of dietary total antioxidant capacity had a lower risk of postoperative atrial fibrillation than patients in the 2 lowest tertiles (odds ratio, 0.46; 95% confidence interval, 0.22-0.95; P = .048). A restricted cubic spline transformation confirmed the nonlinear relationship between total antioxidant capacity (in continuous scale) and postoperative atrial fibrillation (P = .023). When considering only coronary artery bypass grafting, valve replacement/repair, and combined surgeries, the protective effect on postoperative atrial fibrillation of a diet rich in antioxidants was confirmed. CONCLUSIONS: Long-term consumption of antioxidant-rich foods is associated with a reduced incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery.

Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study.

A Mediterranean dietary pattern has been associated with reducing the risk of cardiovascular and chronic disease. The aim of this study was to evaluate the role of nutrition knowledge in determining possible differences among dietary patterns in a general population from a Mediterranean region. We conducted a cross-sectional study on a subsample of 744 subjects enrolled in the population-based cohort of the Moli-sani Project. A 92-item questionnaire on nutrition knowledge was elaborated, validated and administered. Dietary information were obtained from the EPIC food frequency questionnaire and adherence to a Mediterranean dietary pattern was evaluated both by the a priori Greek Mediterranean diet score and the a posteriori approach obtained by principal component analysis. Nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern. The odds of having higher adherence to a Mediterranean dietary pattern increased with greater nutrition knowledge. The odds ratio of being obese significantly decreased with increasing nutrition knowledge levels. The results showed that nutrition knowledge was significantly associated with higher adherence to a Mediterranean dietary pattern and with lower prevalence of obesity in a Southern Italian region with Mediterranean diet tradition independently from education and other socioeconomic factors.

Association of D-dimer levels with all-cause mortality in a healthy adult population: findings from the MOLI-SANI study.

Elevated D-dimer levels are reportedly associated with higher risk of total mortality in patients with different diseases. We investigated whether a similar association could be found in a large, apparently healthy population. A large sample of individuals (N=17,359, 47% men, age ≥ 35 years) free of clinically recognized cardiovascular and cancer disease, for whom baseline D-dimer level was available, were studied within the MOLI-SANI cohort, randomly recruited from the general adult population of Southern Italy. The cohort was followed for a median of 4.2 years (73,807 person-years). D-dimer was measured in fresh citrated plasma by an automated latex-enhanced immunoassay. Hazard ratios were calculated using three Cox-proportional hazard models. Two hundred and eighty deaths were recorded. When modeled as a continuous variable, D-dimer level at baseline showed a non-linear association with mortality, whose incidence increased only in the upper quartile of the distribution (D-dimer ≥ 221 ng/mL). Thus, the group of individuals with D-dimer <221 ng/mL (75% of the population) acted as the reference group, while the remaining individuals were subdivided in tertiles and compared with the former group. Multivariable hazard ratios for mortality were 1.06, 1.45 and 1.97, respectively (P for trend <0.0001) across the three categories of increasing D-dimer concentration. The association was slightly attenuated, but still highly significant (P for trend 0.0002), after further adjustment for white blood cell count and C-reactive protein. In conclusion, Elevated D-dimer levels were independently associated with increased risk of death from any cause in an apparently healthy adult population.