Role of Polyunsaturated Fat in Modifying Cardiovascular Risk Associated With Family History of Cardiovascular Disease: Pooled De Novo Results From 15 Observational Studies.

BACKGROUND: It is unknown whether dietary intake of polyunsaturated fatty acids (PUFA) modifies the cardiovascular disease (CVD) risk associated with a family history of CVD. We assessed interactions between biomarkers of low PUFA intake and a family history in relation to long-term CVD risk in a large consortium. METHODS: Blood and tissue PUFA data from 40 885 CVD-free adults were assessed. PUFA levels ≤25th percentile were considered to reflect low intake of linoleic, alpha-linolenic, and eicosapentaenoic/docosahexaenoic acids (EPA/DHA). Family history was defined as having ≥1 first-degree relative who experienced a CVD event. Relative risks with 95% CI of CVD were estimated using Cox regression and meta-analyzed. Interactions were assessed by analyzing product terms and calculating relative excess risk due to interaction. RESULTS: After multivariable adjustments, a significant interaction between low EPA/DHA and family history was observed (product term pooled RR, 1.09 [95% CI, 1.02-1.16]; P=0.01). The pooled relative risk of CVD associated with the combined exposure to low EPA/DHA, and family history was 1.41 (95% CI, 1.30-1.54), whereas it was 1.25 (95% CI, 1.16-1.33) for family history alone and 1.06 (95% CI, 0.98-1.14) for EPA/DHA alone, compared with those with neither exposure. The relative excess risk due to interaction results indicated no interactions. CONCLUSIONS: A significant interaction between biomarkers of low EPA/DHA intake, but not the other PUFA, and a family history was observed. This novel finding might suggest a need to emphasize the benefit of consuming oily fish for individuals with a family history of CVD.

A mixed-methods study on the dietary practices of early postpartum women during the summer rainy season in Belgaum, Karnataka, India.

The current mixed-method study uses Food Frequency Questionnaires and 24-hour dietary recalls (n = 41) to assess the food/nutrient intake; and qualitative interviews to identify local perceptions of food among 41 early postpartum women in Belgaum, India. The results show that total energy, protein, and most micronutrient intake were significantly lower than the Recommended Dietary Allowance of India (p < .05 individually); ninety percent of mothers restricted the consumption of some specific fruits, vegetables, and other foods during postpartum due to their perceptions of foods, folk medicines, and health beliefs. Culturally sensitive programs relevant to postpartum diet practices for women should be implemented.

The Association of Prenatal Vitamins and Folic Acid Supplement Intake with Odds of Autism Spectrum Disorder in a High-Risk Sibling Cohort, the Early Autism Risk Longitudinal Investigation (EARLI).

We examined maternal prenatal vitamin use or supplemental folic acid intake during month one of pregnancy for association with autism spectrum disorder (ASD) in the Early Autism Risk Longitudinal Investigation, an enriched-risk pregnancy cohort. Total folic acid intake was calculated from monthly prenatal vitamins, multivitamins, and other supplement reports. Clinical assessments through age 3 years classified children as ASD (n = 38) or non-ASD (n = 153). In pregnancy month one, prenatal vitamin use (59.7%) was not significantly associated with odds of ASD (OR = 0.70, 95%CI 0.32, 1.53). Sample size was limited and residual confounding was possible. Given the estimated effect sizes in this and previous work, prenatal vitamin intake during early pregnancy could be a clinically useful preventative measure for ASD.

Starchy Vegetables and Metabolic Syndrome in Costa Rica.

Only a few studies primarily examined the associations between starchy vegetables (other than potatoes) and metabolic syndrome (MetS). We aimed to evaluate the association between starchy vegetables consumption and MetS in a population-based sample of Costa Rican adults. We hypothesized that a higher overall intake of starchy vegetables would not be associated with higher MetS prevalence. In this cross-sectional study, log-binomial regression models were used to estimate prevalence ratios (PRs) of MetS across quintiles of total, unhealthy, healthy starchy vegetables, and individual starchy vegetables (potatoes, purple sweet potatoes, etc.), among 1881 Costa Rican adults. Least square means and 95% confidence intervals (CIs) from linear regression models were estimated for each MetS component by categories of starchy vegetable variables. Higher intakes of starchy vegetables were associated with a higher prevalence of MetS in crude models, but no significant trends were observed after adjusting for confounders. A significant inverse association was observed between total starchy and healthy starchy vegetables consumption and fasting blood glucose. In this population, starchy vegetables might be part of a healthy dietary pattern.

Plasma DHA Is Related to Sleep Timing and Duration in a Cohort of Mexican Adolescents.

BACKGROUND: Delayed sleep timing and short sleep duration represent a significant public health burden in adolescents. Whether intake of nutrients affects the pineal gland, where sleep/wake cycles are regulated, remains unclear. OBJECTIVES: In a cross-sectional analysis, we investigated whether plasma concentrations of DHA and arachidonic acid (AA), long-chain fatty acids that can be obtained through diet, were related to sleep timing and duration in adolescents. METHODS: The study population included 405 Mexico City adolescents (mean age ± SD = 14.2 ± 2.1 y; 48% males) who took part in a 2015-2016 follow-up visit as a part of an ongoing cohort study. Fatty acid concentrations were measured in plasma using GLC, as a percentage of total fatty acids. Sleep midpoint and duration were assessed with 7-d wrist actigraphy. We categorized DHA and AA plasma concentrations into quartiles (Q1-Q4; Q4 = highest fatty acids). We conducted cross-sectional linear regression analysis with sleep characteristics as separate outcomes and quartiles of DHA and AA as exposures, adjusting for sex, age, and BMI z-scores. RESULTS: Mean ± SD plasma DHA (as percentage of total fatty acids) was 1.2 ± 0.4%, whereas mean ± SD plasma AA was 6.2 ± 1.5%. In adjusted analysis, higher plasma DHA was linearly associated with longer sleep duration on the weekends; to illustrate, those in Q4 compared with Q1 had 32 min longer duration (95% CI: 7, 57; P trend = 0.005). Higher DHA was also associated with earlier sleep timing during weekdays and weekends, although in a nonlinear fashion. The largest difference was a 0.75-h (45-min) later sleep midpoint in Q2 compared with Q4 (95% CI: 0.36, 1.14). CONCLUSIONS: Plasma DHA was associated with earlier sleep timing and longer weekend sleep duration in Mexican adolescents. Whether DHA supplementation improves sleep in adolescent populations deserves consideration in randomized trials.

Prospective associations between beverage intake during the midlife and subclinical carotid atherosclerosis: The Study of Women's Health Across the Nation.

BACKGROUND: The potential impacts of beverage intake during the midlife on future subclinical atherosclerosis among women are unclear. The aim of this study was to evaluate the prospective associations between the intakes of eight beverage groups and subclinical carotid atherosclerosis in midlife women. METHODS: Data came from the Study of Women's Health Across the Nation, a multicenter, multiethnic, and prospective cohort study. A total of 1,235 midlife women had measures of subclinical carotid atherosclerosis and repeatedly beverage intake data collected using a validated food frequency questionnaire. Beverages were aggregated into eight groups, including coffee, tea, sugar-sweetened beverages, artificially sweetened beverages, fruit juices, whole milk, milk with lower fat content, and alcoholic beverages. The associations of beverage intake with common carotid artery intima-media thickness (CCA-IMT) and adventitial diameter (CCA-AD) were estimated using linear models; the associations with carotid plaque were estimated using log-binomial models. RESULTS: Coffee intake was associated with CCA-IMT in an inverted J-shaped pattern. After adjusting for covariates, women with >0 to <1 cup/day and 1 to <2 cups/day of coffee intake had a 0.031 mm (95% CI: 0.012, 0.051) and a 0.027 mm (95% CI: 0.005, 0.049) larger CCA-IMT, respectively, than coffee non-drinkers. Women who consumed ≥2 cups/day of coffee did not have significantly different CCA-IMT than non-drinkers. There was an inverse linear association between moderate alcoholic beverages intake and CCA-IMT (P-trend = 0.014). Whole milk intake had inverted U-shaped associations with CCA-IMT and carotid plaque. No significant associations were found between other beverage groups and subclinical atherosclerosis. CONCLUSIONS: In midlife women, occasional coffee intake may be associated with more subclinical atherosclerosis while moderate alcoholic beverages intake may be associated with less subclinical atherosclerosis. Future work should focus on the determination of the optimal beverage intake profile for maximum cardiovascular benefits in midlife women.

Seasonal Epidemiology of Serum 25-Hydroxyvitamin D Concentrations among Healthy Adults Living in Rural and Urban Areas in Mongolia.

Many factors put Mongolians at risk of vitamin D deficiency. Despite low levels observed in Mongolian children and pregnant women, there are few data published on the vitamin D status of non-pregnant adults. Between summer 2011 and winter 2013, paired summer and winter blood samples were collected from 320 healthy men and women (20-58 years) living in eight Mongolian provinces. Mean serum 25(OH)D concentrations were 22.5 ng/mL (95% CI: 14.5, 32.5) in summer and 7.7 ng/mL (95% CI: 4.6, 10.8) in winter, with a distribution (<10/10-20/20-30/≥30 ng/mL) of 3.1%/39.3%/39.6%/17.9% in summer and 80.1%/19.5%/0.3%/0.0% in winter. Residents of the capital, Ulaanbaatar, had lower levels in both seasons than any other region, whereas residents of the Gobi desert had the highest. In summer, indoor workers had significantly lower levels than outdoor workers (-2.3 ng/mL; 95% CI: -4.1, -5.7) while levels in males exceeded those in females (4.0 ng/mL; 95% CI: 2.3, 5.7). Effects of region, occupation, and sex were also significant in multivariable regression. In conclusion, Mongolian adults had extremely low serum 25(OH)D, particularly in winter, when 80.1% had concentrations below 10 ng/mL. These results indicate a need for effective vitamin D interventions for the Mongolian adult population, particularly among women and residents of Ulaanbaatar.

Cooking with soyabean oil increases whole-blood α-linolenic acid in school-aged children: results from a randomized trial.

OBJECTIVE: Supply of essential n-3 PUFA is limited worldwide. While fish-oil supplementation effectively improves n-3 PUFA status, it may not be a sustainable intervention. The use of α-linolenic acid (ALA)-rich cooking oils in the household may be a suitable alternative but its effect on PUFA status is unclear. We aimed to compare the effect of providing families with soyabean oil, an ALA-rich cooking oil, v. sunflower oil on whole-blood PUFA levels of children aged 11-18 years. DESIGN: In a randomized, masked, parallel trial, we assigned families to receive a one-month supply of either soyabean or sunflower oil. Fatty acid concentrations were quantified in whole-blood samples obtained from the children before and at the end of the intervention. Changes in fatty acids were compared between treatment arms with use of linear regression for repeated measures. SUBJECTS: Sixty low- and middle-income families. SETTING: Bogotá, Colombia. RESULTS: Soyabean oil significantly increased ALA concentrations by 0.05 percentage points of total serum fatty acids whereas sunflower oil decreased them by 0.12 percentage points (soyabean v. sunflower oil effect=0.17; 95% CI 0.11, 0.24). Concentrations of both n-3 and n-6 very-long-chain PUFA, including docosapentaenoic acid, DHA, dihomo-γ-linolenic acid and arachidonic acid, increased significantly in both intervention arms. Levels of oleic acid and palmitic acid decreased, irrespective of oil assignment. Total energy or energy intake from saturated fat did not change. CONCLUSIONS: Replacing cooking oils at the household level is an effective intervention to improve essential PUFA status of children.

Trans-fatty acids in cooking oils in Bogota, Colombia: changes in the food supply from 2008 to 2013.

OBJECTIVE: Long-chain n-3 fatty acid intake in Colombia is low because fish consumption is limited. Vegetable oils with high n-3 fatty acid content are recommended, but their concentrations of trans fats were high in previous studies. Thus, regular monitoring of the fatty acid composition of vegetable oils is required. Our objective was to quantify the fatty acid composition in commercially available oils in Bogota, Colombia and determine if composition changed from 2008 to 2013. DESIGN: Cross-sectional study. We obtained samples of all commercially available oils reported in a survey of low- and middle-income families with a child participating in the Bogota School Children Cohort. SETTING: Bogota, Colombia. SUBJECTS: Not applicable. RESULTS: Sunflower oil had the highest trans-fatty acid content (2.18%). Canola oil had the lowest proportion of trans-fatty acids (0.40%) and the highest n-3 fatty acid content (9.37%). In terms of percentage reduction from 2008 to 2013 in 18:1 and 18:2 trans-fatty acids, canola oil had 89% and 65% reduction, mixed oils had 44% and 48% reduction, and sunflower oil had 25% and 51 % reduction, respectively. Soyabean oil became widely available in 2013. CONCLUSIONS: The content of trans-fatty acids decreased in all oils from 2008 to 2013, suggesting a voluntary reduction by industry. We believe that regular monitoring of the fatty acid composition of oils is warranted.

Circulating and dietary omega-3 and omega-6 polyunsaturated fatty acids and incidence of CVD in the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Dietary guidelines support intake of polyunsaturated fatty acids (PUFAs) in fish and vegetable oils. However, some controversy remains about benefits of PUFAs, and most prior studies have relied on self-reported dietary assessment in relatively homogeneous populations. METHODS AND RESULTS: In a multiethnic cohort of 2837 US adults (whites, Hispanics, African Americans, Chinese Americans), plasma phospholipid PUFAs were measured at baseline (2000-2002) using gas chromatography and dietary PUFAs estimated using a food frequency questionnaire. Incident cardiovascular disease (CVD) events (including coronary heart disease and stroke; n=189) were prospectively identified through 2010 during 19 778 person-years of follow-up. In multivariable-adjusted Cox models, circulating n-3 eicosapentaenoic acid and docosahexaenoic acid were inversely associated with incident CVD, with extreme-quartile hazard ratios (95% CIs) of 0.49 for eicosapentaenoic acid (0.30 to 0.79; Ptrend=0.01) and 0.39 for docosahexaenoic acid (0.22 to 0.67; Ptrend<0.001). n-3 Docosapentaenoic acid (DPA) was inversely associated with CVD in whites and Chinese, but not in other race/ethnicities (P-interaction=0.01). No significant associations with CVD were observed for circulating n-3 alpha-linolenic acid or n-6 PUFA (linoleic acid, arachidonic acid). Associations with CVD of self-reported dietary PUFA were consistent with those of the PUFA biomarkers. All associations were similar across racial-ethnic groups, except those of docosapentaenoic acid. CONCLUSIONS: Both dietary and circulating eicosapentaenoic acid and docosahexaenoic acid, but not alpha-linolenic acid or n-6 PUFA, were inversely associated with CVD incidence. These findings suggest that increased consumption of n-3 PUFA from seafood may prevent CVD development in a multiethnic population.

Long-term alcohol and caffeine intake and risk of sudden cardiac death in women.

BACKGROUND: Alcohol and caffeine intakes may play a role in the development of sudden cardiac death (SCD) because of their effects on cholesterol, blood pressure, heart rate variability, and inflammation. OBJECTIVE: Our objective was to examine the association between long-term alcohol and caffeine intakes and risk of SCD in women. DESIGN: We examined 93,676 postmenopausal women who participated in the Women's Health Initiative Observational Study. Women were enrolled between 1993 and 1998 and were followed until August 2009. Women completed a food-frequency questionnaire at baseline and again at year 3. We modeled exposure to alcohol 3 ways: by using baseline intake only, a cumulative average of baseline and year 3 intake, and the most recent reported intake (a simple time-varying analysis). RESULTS: Intake of 5-15 g alcohol/d (about one drink) was associated with a nonsignificantly reduced risk of SCD compared with 0.1-5 g/d of baseline intake (HR: 0.64; 95% CI: 0.40, 1.02), of cumulative average intake (HR: 0.69; 95% CI: 0.43, 1.11), and of most recent intake (HR: 0.58; 95% CI: 0.35, 0.96), with adjustment for age, race, income, smoking, body mass index, physical activity, hormone use, and total energy. No association was found between SCD and total caffeine intake (mg/d) or cups of caffeinated coffee, decaffeinated coffee, and caffeinated tea. CONCLUSIONS: Our results suggest that about one drink per day (or 5.1-15 g/d) may be associated with a reduced risk of SCD in this population; however, this association was only statistically significant for a model using the most recent alcohol intake. Total caffeine, regular coffee, decaffeinated coffee, and regular tea intake were not associated with the risk of SCD. This trial was registered at clinicaltrials.gov as NCT00000611.

A novel fatty acid lipophilic index and risk of CHD in US men: the health professionals follow-up study.

Few epidemiological studies have examined the association between an overall fatty acid (FA) profile and CHD risk. The aim of the present study was to examine a novel index that summarises individual FA levels based on FA affinity and fluidity in relation to CHD risk in men. In a prospective nested case­control study, FA in plasma and erythrocytes were measured in 459 CHD cases and 879 matched controls. Lipophilic index (LI) was computed by summing the products between FA levels and melting point of each FA to reflect the overall FA lipophilicity. Among controls, higher plasma LI was significantly correlated with adverse profiles of blood lipids, inflammatory markers and adiponectin. After multivariate adjustment for age, smoking, BMI and other CHD risk factors, plasma LI was significantly associated with an increased risk of CHD: the relative risk was 1·61 (95% CI 1·03, 2·53; P for trend»0·04) comparing extreme quintiles. This association was attenuated to 1·21 (95% CI 0·48, 3·09; P for trend»0·77) after adjusting for plasma levels of total trans-FA, long-chain n-3 FA and polyunsaturated:saturated fat ratio. Erythrocyte LI was not significantly associated with CHD risk. The present data indicate that a novel LI is associated with an adverse profile of cardiovascular risk markers and increased risk of CHD in men; its usefulness as a complement of individual FA in assessing disease risk needs to be elucidated in future studies.

Provision of a school snack is associated with vitamin B-12 status, linear growth, and morbidity in children from Bogota, Colombia.

In 2004, Bogotá's Secretary of Education (SED) initiated a snack program in public primary schools. A midmorning food ration was provided free of charge to children to supplement 30 and 50% of their daily requirements of energy and iron, respectively. The purpose of this study, an observational investigation of 3202 children ages 5-12 y, was to examine whether the snack program improved children's nutritional and health status. We measured micronutrient levels (plasma ferritin and vitamin B-12, and erythrocyte folate), anthropometry, and reported morbidity during the first semester of the 2006 school year. After adjusting for socioeconomic status and other school interventions, children at schools receiving the snack (n = 1803) had greater increases in plasma vitamin B-12 (42 pmol/L; P < 0.0001) from baseline to 3 mo of follow-up than children at schools not receiving the snack (n = 1399). They also experienced a smaller decrease in height-for-age Z-scores than children who did not receive the snack (P = 0.001). Provision of the SED snack was associated with significantly fewer reported days with morbidity symptoms (e.g. cough with fever, diarrhea with vomiting), 44% fewer doctor visits (P = 0.02), and 23% fewer days of school absenteeism (P = 0.03). The snack was not related to ferritin or folate levels. In conclusion, provision of a school-administered snack was related to improved vitamin B-12 status and linear growth and decreased reported morbidity. Although provision of the snack was not related to BMI changes over a 4-mo period, snack components such as candy and sugar-sweetened beverages should be replaced with healthier options, as the rates of child overweight in Colombia are not negligible.

Predictors of usage and fatty acid composition of cooking fats in Bogotá, Colombia.

OBJECTIVE: To examine correlates of home usage of commercially available cooking fats in Bogotá, Colombia and to determine their fatty acid composition. DESIGN: Cross-sectional survey. SETTING: Bogotá, Colombia. SUBJECTS: A representative sample of low- and middle-income families (n 2408). RESULTS: The types of fat primarily used for cooking at home were mixed vegetable oils (66 %), sunflower oil (21 %) and other oils/fats including margarine (13 %). In multivariate analysis, usage of sunflower oil as the primary cooking fat was positively related to home ownership, age of the father and health as a reason for choosing the main cooking fat, and inversely associated with the number of people per room and an index of household food insecurity. The trans fat content of sunflower oil was unexpectedly higher (mean 4.2 %, range 2.2-8.6) than that of the vegetable mixture oils (mean 3.1 %, range 1.1-6.5). CONCLUSIONS: Vegetable oils are the primary home cooking fats in Bogotá, Colombia. Higher socio-economic status is associated with usage of sunflower oil. Paradoxically, oblivious to the higher trans content of sunflower oil and the negligible amount of n-3 fatty acids, families commonly reported 'health' as a reason to choose sunflower over other oils.

Alpha-linolenic acid and risk of nonfatal acute myocardial infarction.

BACKGROUND: Intake of long-chain n-3 fatty acids found in fish is low in many countries worldwide. alpha-Linolenic acid could be a viable cardioprotective alternative to these fatty acids in these countries. METHODS AND RESULTS: Cases (n=1819) with a first nonfatal acute myocardial infarction and population-based controls (n=1819) living in Costa Rica matched for age, sex, and area of residence were studied. Fatty acids were assessed by gas chromatography in adipose tissue samples and by a validated food frequency questionnaire specifically designed for this population. Odds ratios and 95% confidence intervals were calculated from multivariate conditional logistic regression models. alpha-Linolenic acid in adipose tissue ranged from 0.36% in the lowest decile to 1.04% in the highest decile. The corresponding median levels of intake were 0.42% and 0.86% energy. Greater alpha-linolenic acid (assessed either in adipose or by questionnaire) was associated with lower risk of myocardial infarction. The odds ratios for nonfatal myocardial infarction for the highest compared with the lowest deciles were 0.41 (95% confidence interval, 0.25 to 0.67) for alpha-linolenic acid in adipose tissue and 0.61 (95% confidence interval, 0.42 to 0.88) for dietary alpha-linolenic acid. The relationship between alpha-linolenic acid and myocardial infarction was nonlinear; risk did not decrease with intakes > approximately 0.65% energy (1.79 g/d). Fish or eicosapentaenoic acid and docosahexaenoic acid intake at the levels found in this population did not modify the observed association. CONCLUSIONS: Consumption of vegetable oils rich in alpha-linolenic acid could confer important cardiovascular protection. The apparent protective effect of alpha-linolenic acid is most evident among subjects with low intakes.

Coffee consumption and risk of type 2 diabetes and heart disease.

Coffee seems to have distinct acute and long-term effects on health, which can be modified by genetic background. Coffee consumption is potentially protective against the development of type 2 diabetes, but given the lack of a solid biological basis for this association, and the possible adverse cardiovascular effects of coffee, recommendations for optimal coffee intake are difficult to establish.

Socio-economic status and health awareness are associated with choice of cooking oil in Costa Rica.

OBJECTIVE: To examine the socio-economic and lifestyle determinants of cooking oil choice in Costa Rica during the last decade (1994-2004). DESIGN: Cross-sectional study. Subjects (total n = 2274) belonged to the control population of a large case-control study; they were recruited yearly. Data about type of oil used for cooking, dietary intake, socio-economic and demographic characteristics were collected. SETTING: A dietitian visited all subjects and conducted the interviews at their homes; all subjects lived in the Costa Rican central valley region. SUBJECTS: Adult, free-living, rural and urban Costa Ricans with no history of myocardial infarction and physical or mental disability. RESULTS: The odds of choosing soybean over palm oil increased significantly each year (P < 0.05) and was determined by high socio-economic status (SES) and variables that suggest health awareness (self-reported history of hypertension, high cholesterol, multivitamin use and intake of green leafy vegetables). The odds of choosing other unsaturated oils, namely corn and sunflower, over soybean oil also increased yearly (P < 0.05) and was associated with the same two factors (high SES and health awareness). Palm oil users remained in the lowest SES tertile and were more likely to live in rural areas. Across all SES tertiles, high health awareness determined the odds of choosing other unsaturated oils over palm oil, and soybean oil (P < 0.05). CONCLUSION: These data show that, in addition to SES, health awareness is associated with the selection of unsaturated oils over palm oil in a developing country undergoing transition. These data should be considered when targeting nutrition messages and policies that promote better dietary choices.

Transient exposure to coffee as a trigger of a first nonfatal myocardial infarction.

BACKGROUND: The effects of coffee on myocardial infarction are uncertain. We hypothesize that coffee in the presence of predisposing factors can induce a cascade of events that, through sympathetic nervous activation, can induce the onset of myocardial infarction. METHODS: We recruited 503 incident cases of nonfatal myocardial infarction between 1994 and 1998 in Costa Rica. We used a case-crossover design to calculate relative risks (RRs) and 95% confidence intervals (95% CIs). RESULTS: The RR of myocardial infarction in the hour after coffee intake was 1.49 (95% CI = 1.17-1.89). Occasional coffee drinkers (< or =1 cup/day, n = 103) had a RR of myocardial infarction of 4.14 (2.03-8.42), moderate coffee drinkers (2-3 cups/day, n = 280) had a RR of 1.60 (1.16-2.21), and heavy coffee drinkers (> or =4 cups/d, n = 120) had a RR of 1.06 (0.69-1.63; P = 0.006, test of homogeneity). Patients with 3 or more risk factors (n = 101) had a RR of myocardial infarction of 2.10 (1.30-3.39), whereas patients with fewer than 3 risk factors (n = 396) had a RR of 1.39 (1.04-1.82; P = 0.15, test of homogeneity); and RR was 1.72 (1.30-2.30) among sedentary patients compared with 1.07 (0.66-1.72) among nonsedentary (P = 0.10, test of homogeneity). CONCLUSIONS: The findings indicate that coffee intake may trigger myocardial infarction. The association is particularly strong among people with light/occasional intake of coffee (< or =1 cup/day), with sedentary lifestyle, or with 3 or more risk factors for coronary heart disease.

The type of oil used for cooking is associated with the risk of nonfatal acute myocardial infarction in costa rica.

Palm oil and soybean oil are the 2 most widely used cooking oils in the world. Palm oil is consumed mainly in developing countries, where morbidity and mortality due to cardiovascular disease (CVD) are on the rise. Although claims about adverse or protective effects of these oils are commonly made, there are no epidemiologic studies assessing the association between these oils and cardiovascular disease endpoints. We examined whether consumption of palm oil relative to soybean oil and other unsaturated oils (predominantly sunflower) is associated with myocardial infarction (MI) in Costa Rica. The cases (n = 2111) were survivors of a first acute MI and were matched to randomly selected population controls (n = 2111). Dietary intake was assessed with a validated semiquantitative FFQ. Adipose tissue profiles of essential fatty acids were assessed to validate cooking oil intake and found to be consistent with self-reported major oils used for cooking. The data were analyzed using conditional logistic regression. Palm oil users were more likely to have an MI than users of soybean oil [odds ratio (OR) = 1.33; 95% CI: 1.08-1.63] or other cooking oils (OR = 1.23; CI: 0.99-1.52), but they did not differ from users of soybean oil with a high trans-fatty acid content (OR = 1.14; CI: 0.84-1.56). These data suggest that as currently used in Costa Rica, and most likely in many other developing countries, the replacement of palm oil with a polyunsaturated nonhydrogenated vegetable oil would reduce the risk of MI.

Vitamin supplementation of HIV-infected women improves postnatal child growth.

BACKGROUND: Linear growth retardation and wasting are common in children born to HIV-infected women. Inexpensive interventions that could improve the postnatal growth pattern of such children are needed. OBJECTIVE: The objective was to examine the effect of supplementing HIV-infected women with multivitamins or vitamin A and beta-carotene, during and after pregnancy, on the growth of their children during the first 2 y of life. DESIGN: We conducted a randomized placebo-controlled trial in 886 mother-infant pairs in Tanzania. At the first prenatal visit, HIV-infected women were randomly assigned to 1 of 4 daily oral regimens in a 2 x 2 factorial fashion: multivitamins (MV: thiamine, riboflavin, vitamin B-6, niacin, vitamin B-12, vitamin C, vitamin E, and folic acid), preformed vitamin A + beta-carotene (VA/BC), MV including VA/BC, or placebo. Supplementation continued during the first 2 y postpartum and thereafter. Children were weighed and measured monthly, and all received vitamin A supplements after 6 mo of age per the standard of care. RESULTS: Multivitamins had a significant positive effect on attained weight (459 g; 95% CI: 35, 882; P = 0.03) and on weight-for-age (0.42; 95% CI: 0.07, 0.77; P = 0.02) and weight-for-length (0.38; 95% CI: 0.07, 0.68; P = 0.01) z scores at 24 mo. VA/BC seemed to reduce the benefits of MV on these outcomes. No significant effects were observed on length, midupper arm circumference, or head circumference. CONCLUSION: Supplementation of HIV-infected women with multivitamins (vitamin B complex, vitamin C, and vitamin E) during pregnancy and lactation is an effective intervention for improving ponderal growth in children.