Dietary vitamin D intake, cardiovascular disease and cardiometabolic risk factors: a sex-based analysis from the ATTICA cohort study.

BACKGROUND: The present study aimed to evaluate the association between dietary vitamin D intake and 10-year first fatal/nonfatal cardiovascular disease (CVD), conventional CVD risk factors and surrogate markers related to inflammation, coagulation, insulin resistance, liver and renal function. METHODS: The ATTICA study was conducted during 2001-2012 including 1514 men and 1528 women (aged >18 years) from the greater Athens area, Greece. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Daily intake of vitamin D was calculated using a standardised food database. Follow-up (2011-2012) was achieved in 2020 participants (n = 317 cases). RESULTS: Ranking from first to third vitamin D tertile, CVD events were 24%, 17% and 12% for men (P = 0.002) and 14%, 10% and 11% for women (P = 0.59). Inverse associations between vitamin D and CVD in total sample [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.60-0.97] and in men (HR = 0.66 95% CI = 0.49-0.89) were observed, and lost after adjusting for inflammation/coagulation markers; for women, no significant trends were observed. Regarding 10-year onset of conventional risk factors, inverse associations of vitamin D with hypertension in men (HR = 0.62 95% CI = 0.39-0.99) and transition to metabolically unhealthy status in women (HR = 0.69 95% CI = 0.51-0.93) were observed. Significant inverse associations for C-reactive protein, interleukin-6 and fibrinogen in both sexes, whereas these were revealed only in women for insulin resistance. CONCLUSIONS: Contradicting the neutral/modest associations in vitamin-D supplementation trials, increased food-generated vitamin D may protect against hard and intermediate CVD endpoints, implying different paths between sexes.

The evaluation of inflammatory and oxidative stress biomarkers on coffee-diabetes association: results from the 10-year follow-up of the ATTICA Study (2002-2012).

BACKGROUND/OBJECTIVES: The purpose of this work was to investigate the association between coffee drinking and diabetes development and potential mediation by oxidative stress and inflammatory biomarkers. SUBJECTS/METHODS: In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) were selected to participate in the ATTICA study (Athens metropolitan area, Greece). A validated food-frequency questionnaire was used to assess coffee drinking (abstention, casual, habitual) and other lifestyle and dietary factors. Evaluation of oxidative stress and inflammatory markers was also performed. During 2011-2012, the 10-year follow-up of the ATTICA study was carried out. The outcome of interest in this work was incidence of type 2 diabetes, defined according to American Diabetes Association criteria. RESULTS: During follow-up, 191 incident cases of diabetes were documented (incidence 13.4% in men and 12.4% in women). After various adjustments, individuals who consumed ⩾250 ml of coffee (≈1.5cup) had 54% lower odds of developing diabetes (95% confidence interval: 0.24, 0.90), as compared with abstainers. A dose-response linear trend between coffee drinking and diabetes incidence was also observed (P for trend=0.017). When controlling for several oxidative stress and inflammatory biomarkers, the inverse association between habitual coffee drinking and diabetes was found to be mediated by serum amyloid-A levels. CONCLUSIONS: This work highlights the significance of long-term habitual coffee drinking against diabetes onset. The anti-inflammatory effect of several coffee components may be responsible for this protection.

Gender-specific distribution of selenium to serum selenoproteins: associations with total selenium levels, age, smoking, body mass index, and physical activity.

The epidemiology of selenium (Se) is mainly based on the determination of total serum selenium levels (TSe) which by many aspects is an inadequate marker of Se status. In this study we applied a recently developed LC-ICP-MS method, for the determination of the selenium content of the three main serum selenium-containing proteins, in a subcohort of the ATTICA study. This enables us to investigate whether the selenium distribution to selenoproteins may correlate with demographic (age, gender) and lifestyle variables (smoking, physical activity) that are crucial for the development of chronic diseases. A sub-sample from the ATTICA Study, consisted of 236 males (40 ± 11 years) and 163 females (38 ± 12 years), was selected. The selenium content of glutathione peroxidase (GPx-3), selenoprotein P (SelP) and selenoalbumin (SeAlb) was determined in serum by LC-ICP/MS method. We found that 26% of TSe is found in GPx-3, 61% in SelP and 13% in SeAlb. We have assessed the different ratios of selenoproteins' selenium content (Se-GPX-3/Se-SelP, Se-GPX-3/Se-SeAlb, Se-SelP/Se-SeAlb), showing that people with similar TSe may have different distribution of this selenium to selenoproteins. Total selenium levels and gender are the variables that mostly affect selenium distribution to selenoproteins while age, smoking, physical activity and BMI do not significantly influence selenium distribution. In conclusion, the simultaneous determination of the selenium content of serum selenium-containing selenoproteins is necessary for a thorough estimation of selenium status. The ratio of the Se content between selenoproteins may be proven a novel, valid marker of selenium status.

Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).

Changes in biochemical indices of bone metabolism in post-menopausal women following a dietary intervention with fortified dairy products.

BACKGROUND: In southern Europe, calcium supplementation alone is a common practice for osteoporosis prevention. The present study aimed to examine whether calcium supplementation alone could be as effective in achieving favourable changes on bone metabolism indices of Greek post-menopausal women as a holistic dietary approach combining consumption of dairy products fortified with calcium and vitamin D(3) and nutrition counselling sessions for five winter months. METHODS: A sample of 101 post-menopausal women was randomised to a dairy intervention group (IG: n = 39), receiving approximately 1200 mg of calcium and 7.5 microg of vitamin D(3) per day via fortified dairy products and attending biweekly nutrition counselling sessions; a calcium-supplemented group (SG: n = 26) receiving a total of 1200 mg calcium per day; and a control group (CG: n = 36). RESULTS: Regarding insulin-like growth factor (IGF)-I, a higher increase was observed for the IG compared to the changes in the CG and the SG (P = 0.049). Regarding serum parathyroid hormone (PTH) levels, the increase observed in the CG was higher than the changes observed in the other two groups but the differences were of marginal significance (P = 0.055). No significant differences were observed among groups regarding the changes in serum osteocalcin and type I collagen cross-linked C-telopeptide levels. CONCLUSIONS: The application of a holistic intervention approach combining nutrition counselling and consumption of fortified dairy products for five winter months induced some more favourable changes in IGF-I and PTH levels compared to calcium supplementation alone. Intervention periods longer than 5 months might be required to achieve significant differences among groups for bone remodelling biomarkers as well.

Dietary supplementation with flaxseed oil lowers blood pressure in dyslipidaemic patients.

OBJECTIVE: Alpha-linolenic acid (ALA) is the natural precursor of the cardioprotective long-chain n-3 fatty acids. Available data indicate a possible beneficial effect of ALA on cardiovascular disease (CVD), but the response of various CVD risk factors to increased ALA intake is not well characterized. The purpose of the present study was to examine the effect of increased ALA intake on blood pressure in man. DESIGN, SETTING, SUBJECTS AND INTERVENTIONS: We used a prospective, two-group, parallel-arm design to examine the effect of a 12-week dietary supplementation with flaxseed oil, rich in ALA (8 g/day), on blood pressure in middle-aged dyslipidaemic men (n=59). The diet of the control group was supplemented with safflower oil, containing the equivalent n-6 fatty acid (11 g/day linoleic acid (LA); n=28). Arterial blood pressure was measured at the beginning and at the end of the dietary intervention period. RESULTS: Supplementation with ALA resulted in significantly lower systolic and diastolic blood pressure levels compared with LA (P=0.016 and P=0.011, respectively, from analysis of variance (ANOVA) for repeated measures). CONCLUSIONS: We observed a hypotensive effect of ALA, which may constitute another mechanism accounting in part for the apparent cardioprotective effect of this n-3 fatty acid.

Obesity in byzantine and in modern era from a public health perspective.

Obesity is one of today's most serious and amplified public health problems. Surprisingly, obesity constituted a health problem through the Byzantine Empire (3rd to 15th century AD) as well; the extent of the problem was then very much alike to that one seen in modem industrialized and developing countries of today. In this report we perform an historical throwback in Byzantine years in order to explore the link regarding the aspects of obesity in these years and in modem era.