The Associations of C-Reactive Protein with Serum Levels of Polyunsaturated Fatty Acids and Trans Fatty Acids Among Middle-Aged Men from Three Populations.

BACKGROUND: C-reactive protein (CRP) and many fatty acids (FAs) have been linked to cardiovascular disease. Associations of serum CRP with FAs in different populations have not been established. METHODS: Participants were 926 men aged 40-49 (2002-2006) from a population-based sample; 310 Whites from Pennsylvania, U.S., 313 Japanese from Shiga, Japan, and 303 Japanese Americans from Hawaii, U.S. Serum CRP (mg/L) was measured using immunosorbent assay while serum FAs (%) were measured using capillary-gas-liquid chromatography. RESULTS: Whites had CRP (mg/L) levels higher than Japanese with Japanese Americans in-between (age-adjusted geometric mean "GM" 0.96, 0.38, 0.66, respectively). Whites had also higher levels of total n-6 FAs (%) and trans fatty acids (TFAs) but lower levels of marine-derived n-3 FAs compared to Japanese (41.78 vs. 35.05, 1.04 vs. 0.58, and 3.85 vs. 9.29, respectively). Japanese Americans had FAs levels in-between the other two populations. Whites had significant inverse trends between CRP and tertiles of total n-6 FAs (GM 1.20, 0.91 and 0.80; p=0.002) and marine-derived n-3 FAs (GM 1.22, 1.00 and 0.72; p<0.001) but a significant positive trend with TFAs (GM 0.80, 0.95 and 1.15; p=0.007). Japanese had a significant inverse trend between CRP and only total n-6 FAs (GM 0.50, 0.35 and 0.31; p<0.001). Japanese Americans had CRP associations with n-3 FAs, n-6 FAs, and TFAs similar to but weaker than Whites. CONCLUSIONS: With the exception of consistent inverse association of CRP with total n-6 FAs, there are considerable variations across the three populations in the associations of CRP with different FAs.

Significant inverse association of marine n-3 fatty acids with plasma fibrinogen levels in Japanese in Japan but not in whites or Japanese Americans.

BACKGROUND/OBJECTIVES: Numerous studies reported beneficial effects of marine n-3 fatty acids (n-3 FAs) on cardiovascular disease (CVD) and its risk factors. However, the association of marine n-3 FAs with plasma fibrinogen, a risk factor for CVD, remains uncertain. SUBJECTS/METHODS: In a population-based, cross-sectional study of 795 men aged 40-49 without CVD (262 whites in Allegheny County, Pennsylvania, USA, 302 Japanese in Kusatsu, Japan and 229 Japanese Americans in Honolulu, Hawaii, USA), we examined the association of marine n-3 FAs with plasma fibrinogen. Serum FAs were measured by capillary gas-liquid chromatography. Marine n-3 FAs were defined as the sum of docosahexaenoic, eicosapentaenoic and docosapentaenoic acids. Plasma fibrinogen was measured by an automated clot-rate assay. Multiple linear regression analyses were performed to assess the association. RESULTS: White, Japanese and Japanese-American men had mean marine n-3 FAs levels of 3.47%, 8.78% and 4.46%, respectively. Japanese men had a significant inverse association of marine n-3 FAs with fibrinogen (standardized regression coefficient of -0.11, P=0.049), after adjusting for age, body-mass index and current smoking. The significant inverse association remained after further adjusting for diabetes, C-reactive protein, triglycerides and other variables. White or Japanese-American men did not show a significant association. CONCLUSIONS: We observed the significant inverse association of marine n-3 FAs with fibrinogen in Japanese, but not in whites or Japanese Americans. The observation suggests that marine n-3 FAs at very high levels, as seen in the Japanese, may decrease plasma fibrinogen levels.

Benefits of fatty fish on dementia risk are stronger for those without APOE epsilon4.

OBJECTIVE: To compare associations of lean fish vs fatty fish (tuna or other fish) intake with dementia, Alzheimer disease (AD), and vascular dementia (VaD) and in relation to APOE epsilon4 status in the Cardiovascular Health Cognition Study (CHCS). METHODS: Fish intake was assessed by food frequency questionnaires. Incident dementia, AD, and VaD were determined through a series of cognitive tests, physician's assessment, and committee consensus. We used Cox proportional hazards regression to calculate hazard ratios of dementia, AD, and VaD with lean fried fish, fatty fish, or total fish intake, which were then stratified by the presence of APOE epsilon4. RESULTS: Although consumption of lean fried fish had no protective effect, consumption of fatty fish more than twice per week was associated with a reduction in risk of dementia by 28% (95% CI: 0.51 to 1.02), and AD by 41% (95% CI: 0.36 to 0.95) in comparison to those who ate fish less than once per month. Stratification by APOE epsilon4 showed this effect to be selective to those without the epsilon4 allele. Adjustment by education and income attenuated the effect. CONCLUSION: In the Cardiovascular Health Cognition Study, consumption of fatty fish was associated with a reduced risk of dementia and Alzheimer disease for those without the APOE epsilon4 allele.

Less salt intake or more salt excretion: is hypertension preventable?

Hypertension is preventable by modification of the common source (i.e., sodium chloride) and by prevention of weight gain and increased consumption of "good" nutrients. Unfortunately, the necessary societal changes are unlikely to occur. Individual behavioral approaches are weak. A pharmacologic approach as a "crutch" for our unsuccessful control of a "common source" epidemic may work and have a major impact on morbidity and mortality due to hypertensive diseases. Once-a-day diuretics may be a better health dose than once-a-day vitamins for our nutrient-rich society. (c)2001 by Le Jacq Communications, Inc.

Factors associated with calcium absorption efficiency in pre- and perimenopausal women.

BACKGROUND: The amount of calcium ingested by an individual may affect several chronic conditions, including osteoporosis, hypertension, and colon cancer. However, individuals vary in their ability to absorb the calcium they consume. OBJECTIVE: The purpose of this study was to examine sources of interindividual variation in the efficiency of calcium absorption in women. DESIGN: Fractional calcium absorption was estimated in 142 healthy pre- and perimenopausal women. Dietary habits, lifestyle factors, calciotropic hormones, and vitamin D receptor gene polymorphisms were also assessed. RESULTS: Calcium absorption values averaged 35% and ranged from 17% to 58%. Fractional calcium absorption was positively associated with body mass index (r = 0.22, P = 0.007), dietary fat intake (r = 0.29, P = 0.001), serum 1,25 dihydroxyvitamin D [1,25(OH)(2)D] concentrations (r = 0.23, P = 0. 006), and parathyroid hormone concentrations (r = 0.21, P = 0.015). Fractional calcium absorption was inversely associated with total calcium intake (r = -0.18, P = 0.030), dietary fiber intake (r = -0. 19, P = 0.028), alcohol consumption (r = -0.14, P = 0.094), physical activity (r = -0.22, P = 0.007), and symptoms of constipation (r = -0.16, P = 0.059). In stepwise regression analysis, dietary fat, dietary fiber, serum 1,25(OH)(2)D, and alcohol consumption emerged as independent predictors of calcium absorption, explaining 21.02% of the observed variation. Women in the lowest tertile of the ratio of dietary fat to fiber had 19% lower fractional calcium absorption values than did women in the highest tertile of ratio of dietary fat to fiber (test of trend, P < 0.001). CONCLUSIONS: There is a wide range of calcium absorption values in healthy women. The amount of dietary fat consumed relative to dietary fiber appears to have an important role in determining differences in calcium absorption performance among individuals.

Correlates of quantitative ultrasound in the Women's Healthy Lifestyle Project.

Quantitative ultrasound (QUS) assessment of bone is a strong predictor of hip fractures and is currently an FDA-approved tool to identify women at risk of osteoporosis. However, few studies have investigated the lifestyle and genetic correlates of QUS in women. This study investigated the cross-sectional associates of several lifestyle, demographic and genetic factors with calcaneal QUS parameters (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) in 393 women aged 45-53 years. Leisure-time and historical physical activity, dietary calcium and protein, body composition, vitamin D receptor genotypes, menopause status, other health behaviors, calcaneal QUS parameters and bone mineral density (BMD) were assessed at a single clinic visit. Lean mass, recent physical activity and African-American race were the strongest correlates of SOS whereas dietary protein, calcium and recent physical activity were the strongest correlates of BUA. These predictors explained 13% and 6% of the variance in SOS and BUA, respectively. Smoking, alcohol intake, education, hormone replacement therapy, calcium and vitamin D supplements, historical physical activity and vitamin D receptor genotypes were not significantly associated with BUA or SOS. Lean body mass and premenopausal status were the strongest correlates of lumbar BMD whereas lean body mass, physical activity, African-American race and body mass index were significantly related to femoral neck BMD. Physical activity remained predictive of SOS after controlling for lumbar BMD. The spectrum and magnitude of risk factors for SOS and BUA, including lean body mass, physical activity, race, protein and calcium intake, parallel previously observed predictors of BMD.

Women's health as a paradigm for understanding factors that mediate disease.

Women's health research provides an opportunity to focus on the mechanisms underlying health and disease in both men and women. We propose that differences in risk between men and women and among individual women are primarily determined by biologic factors, such as sex steroid hormone metabolism, anatomy, immunologic function, genetic influences, and the effects of reproduction, interacting with external influences, such as psychologic development, sociocultural environment, and economic status. We provide examples whereby a comparison of disease frequencies between men and women and among women allows a focus on underlying mechanisms of disease. We then demonstrate the importance of posing questions about the genesis of differences in disease frequency.

Efficacy of nonpharmacologic interventions in adults with high-normal blood pressure: results from phase 1 of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group.

Phase 1 of the Trials of Hypertension Prevention was conducted in 2182 adults, aged 35-54 y, with diastolic blood pressure of 80-89 mm Hg to test the feasibility and blood pressure-lowering effects of seven nonpharmacologic interventions (weight loss, sodium reduction, stress management, and supplementation with calcium, magnesium, potassium, and fish oil). At 6 and 18 mo, weight loss and sodium reduction were well-tolerated and produced significant declines in systolic and diastolic blood pressures (-2.9/-2.4 and -2.1/-1.2 mm Hg for weight loss and sodium reduction, respectively, at 18 mo). None of the other interventions lowered blood pressure significantly at either the 6- or 18-mo follow-up visits. These results suggest that both weight loss and sodium reduction provide an effective means to prevent hypertension. The long-term effects of both of these interventions are being tested in phase 2 of the trial.

The effect of potassium supplementation in persons with a high-normal blood pressure. Results from phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOHP) Collaborative Research Group.

We conducted a randomized, double-blind, placebo-controlled trial of oral potassium chloride supplementation (60 mmol/d) in 353 men and women with an initial average diastolic blood pressure between 80 and 89 mm Hg. In the active (n = 178) compared to the placebo (n = 175) treatment group, the urinary potassium level was significantly (p < 0.001) increased by an average of 44.0 and 42.3 mmol/24 h following 3 and 6 months of therapy, respectively. Compared to placebo, active treatment was associated with a small (mean = 1.8 mm Hg) but significant (p = 0.04) reduction in diastolic blood pressure following 3 months of therapy. Following 6 months, however, this apparent treatment effect had virtually disappeared (mean reduction in diastolic blood pressure = 0.3 mm Hg). There was no significant effect of potassium supplementation on systolic blood pressure at either follow-up visit. There was a significant, independent, dose-response relationship between change in both 24-hour urinary potassium excretion and urinary sodium-potassium ratio and the corresponding change in diastolic blood pressure (-1.49 mm Hg for the highest versus the lowest quartile of change in urinary potassium excretion.

Coffee consumption: relationship to blood lipids in middle-aged women.

BACKGROUND: There is controversy about the relationship between coffee intake and blood lipids in women and many studies fail to control for potential confounding factors. METHODS: In 1983 and 1984, 541 randomly selected premenopausal women were recruited from a list of licenced drivers, aged 42-50, within selected areas in Allegheny County, Pennsylvania. They were invited to participate in a 5-year study of biological and behavioural changes associated with menopause. At baseline and the first follow-up visit, lipoprotein, lipid and apoprotein levels, physical activity, dietary intake and coffee consumption were measured. Pearson correlations between coffee consumption and the various lipid values were calculated. Multivariate analyses, which controlled for the potential confounding effects of body mass index, alcohol intake, percent of calories from carbohydrate and fat, number of cigarettes smoked per day, physical activity level, and age in months, were also employed to investigate the relationships. RESULTS: Mean coffee consumption for the group was 3.35 cups of coffee per day at baseline and 3.02 cups per day at follow-up. Results of analyses of correlation between coffee consumption and blood lipids as well as multiple regressions to control for menopausal status at follow-up were non-significant (P > 0.05) for all blood lipid values with the exception of triglycerides, which were inversely related to coffee consumption at follow-up. CONCLUSIONS: These results do not support a relationship between coffee consumption and lipoprotein, lipid or apoprotein levels with the exception of an inverse relationship between coffee consumption and triglyceride level at follow-up.

Short report: the effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention.

OBJECTIVE: To study the effects of moderate doses of fish oil on blood pressure and high-density lipoprotein (HDL)-cholesterol. METHODS: The participants were 350 normotensive men and women aged 30-54 years who were enrolled from seven academic medical centers in phase I of the Trials of Hypertension Prevention. They were randomly assigned to receive placebo or 6 g purified fish oil once a day, which supplied 3 g n-3 polyunsaturated fatty acids for 6 months. RESULTS: Baseline blood pressure was (mean +/- SD) 123 +/- 9/81 +/- 5 mmHg. The mean differences in the blood pressure changes between the fish oil and placebo groups were not statistically significant. There was no tendency for fish oil to reduce blood pressure more in subjects with baseline blood pressure in the upper versus the lower quartile (132/87 versus 114/75 mmHg), low habitual fish consumption (0.4 versus 2.9 times a week) or low baseline plasma levels of n-3 fatty acids. Fish oil increased HDL2-cholesterol significantly compared with the placebo group. Subgroup analysis showed this effect to be significant in the women but not in the men. Increases in serum phospholipid n-3 fatty acids were significantly correlated with increases in HDL2-cholesterol and decreases in systolic blood pressure. CONCLUSION: Moderate amounts of fish oil (6 g/day) are unlikely to lower blood pressure in normotensive persons, but may increase HDL2-cholesterol, particularly in women.

The effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group.

OBJECTIVE: To study the effects of moderate doses of fish oil on blood pressure and high-density lipoprotein (HDL)-cholesterol. METHODS: The participants were 350 normotensive men and women aged 30-54 years who were enrolled from seven academic medical centers in phase I of the Trials of Hypertension Prevention. They were randomly assigned to receive placebo or 6 g purified fish oil once a day, which supplied 3 g n-3 polyunsaturated fatty acids for 6 months. RESULTS: Baseline blood pressure was (mean +/- SD) 123 +/- 9/81 +/- 5 mmHg. The mean differences in the blood pressure changes between the fish oil and placebo groups were not statistically significant. There was no tendency for fish oil to reduce blood pressure more in subjects with baseline blood pressures in the upper versus the lower quartile (132/87 versus 114/75 mmHg), low habitual fish consumption (0.4 versus 2.9 times a week) or low baseline plasma levels of n-3 fatty acids. Fish oil increased HDL2-cholesterol significantly compared with the placebo group. Subgroup analysis showed this effect to be significant in the women but not in the men. Increases in serum phospholipid n-3 fatty acids were significantly correlated with increases in HDL2-cholesterol and decreases in systolic blood pressure. CONCLUSION: Moderate amounts of fish oil (6 g/day) are unlikely to lower blood pressure in normotensive persons, but may increase HDL2-cholesterol, particularly in women.

Prevalence and correlates of lower extremity arterial disease in elderly women.

Although lower extremity arterial disease occurs in 15-20% of the population over the age of 75 years, little is known about the etiology of the disease in women. In this cross-sectional study involving 1,601 healthy elderly women (mean age, 71 years; range, 65-93 years), the occurrence of lower extremity arterial disease was assessed noninvasively by measuring brachial and ankle pressures bilaterally. Disease prevalence ranged from 2.9% in those aged 65-69 years to 15.5% in those aged 80 years or older. Approximately 20% of those with disease had symptoms of claudication. Age, systolic blood pressure, and current smoking status were strong independent risk factors for arterial disease; a history of arthritis, use of nonthiazide diuretics, current coffee drinking, and upper body obesity were also independent correlates. The number of pack-years in current and former smokers and the number of cigarettes per day used by current smokers showed a dose-response relation with disease. The population attributable risk for current smoking was 26%. The major correlates for symptomatic arterial disease were current smoking and systolic blood pressure. It is concluded that the major risk factors for lower extremity arterial disease in elderly women are similar to those in men. Preventive efforts should focus on smoking cessation and management of hypertension.

Trials of hypertension prevention. Phase I design.

Phase I of the Trials of Hypertension Prevention (TOHP) was a National Heart, Lung, and Blood Institute-sponsored, 3-year, national, multicenter, randomized, controlled trial designed to test the feasibility and efficacy of three life-style (weight loss, sodium restriction, and stress management) and four nutrition supplement (calcium, magnesium, fish oil, and potassium) interventions aimed at lowering diastolic blood pressure in those whose blood pressure was initially in the high normal range (80 to 89 mm Hg). A total of 2182 volunteers were recruited and allocated to the various treatment arms, such that each hypothesis was tested with a power of 85% or higher to detect a diastolic blood pressure treatment effect of 2 mm Hg. The four nutrition supplement interventions were delivered in a double-blinded fashion and the three life-style interventions, single (observed) -blinded. Phase I was designed to provide a rigorous test of short-term lowering of blood pressure for each of the seven treatments chosen and provides the basis for planning of a subsequent long-term trial of hypertension prevention.

Lack of an association between coffee consumption and lipoprotein lipids and apolipoproteins in young adults: the Beaver County Study.

The relationship between coffee consumption and lipoprotein lipids and apolipoproteins was examined in 472 white men and women (20-24 years of age) in Beaver County, Pennsylvania, during 1981-1982. Coffee intake, expressed as nondrinker, one to two cups per day, and three or more cups per day, was unrelated to total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or apoproteins AI, AII, or B. After covariate adjustment for cigarette smoking, alcohol intake, body mass index, and adherence to a diet low in cholesterol and saturated fat, the results remained essentially unchanged. The only statistically significant finding was that women who consumed three or more cups of coffee per day had significantly lower triglyceride concentrations compared with coffee nondrinkers (P less than 0.05). Thus, these findings fail to substantiate a significant association of low to moderate coffee intake with an increased lipid and apoprotein risk profile in these young adults.

The relationship of plasma carotenoids to health and biochemical factors in middle-aged men.

The relationship between plasma carotenoids, plasma cholesterol, cigarette smoking, vitamin supplement use, and intakes of alcohol, vitamin A, and carotene were investigated in 1981 for 187 Multiple Risk Factor Intervention Trial men in Pittsburgh. The total plasma carotenoid value was positively correlated with the dietary carotene and vitamin A indices (estimated by a food frequency questionnaire), vitamin A supplement usage, and plasma cholesterol, and inversely related to cigarette smoking, alcohol intake, and serum aspartate transaminase. The mean plasma carotenoid level was higher in nonsmokers (means = 186 micrograms/dl, 95% confidence interval (CI) 178-195) as compared with cigarette smokers (means = 164 micrograms/dl, 95% CI 151-178) and in vitamin A supplement users (means = 206 micrograms/dl, 95% CI 188-224) as compared with nonusers (means = 172 micrograms/dl, 95% CI 164-179). Variables associated with the total plasma carotenoids in multiple regression analyses included dietary vitamin A and carotene, calorie intake, weekly alcohol intake, cigarette smoking, vitamin supplement usage, and plasma cholesterol, and accounted for 27% of the variance. The total plasma carotenoid value was also highly correlated with plasma beta-carotene (r = 0.67) and lycopene (r = 0.68). The mean beta-carotene (30 micrograms/dl), however, accounted for only 16% of the total plasma carotenoids.

Infant blood pressure and heart rate: relation to ethnic group (black or white), nutrition and electrolyte intake.

Blood pressure (BP) and heart rate were measured during non-rapid-eye-movement sleep in 392 full-term newborns and in 318 of these infants at age six months. Two-day records of food intake were collected at age six months for 150 infants. Black babies did not differ substantially in BP from white babies either at birth or at six months. The earliest BP tracking was from age six to 15 months (systolic (SBP): r = .29, p less than .001; diastolic:r = .45, p less than .001). No relationship was found between BP at six months and breast- or bottle-feeding, infant weight or weight change, or nutrient intake. The relationship between parental BP, on the one hand, and infant electrolyte intake and BP on the other, suggested that electrolyte intake was related to BP in the six-month-old infant, and that the relationship was different in white babies than in black babies. Among 56 white infants whose mother's mean BP was above the median for this population, infant sodium intake correlated with infant SBP (r = .31, p less than .009). Among 32 black infants, regardless of parents' BP, sodium intake was negatively correlated with SBP (r = -.36, p less than .021).