Proinflammatory dietary pattern and depression risk in older adults: Prospective analyses from the Seniors-ENRICA studies.

BACKGROUND & AIMS: Only a few studies have assessed the association between a proinflammatory diet and the risk of depression in older adults, and they have rendered weak results. The present study analysed the association between the Dietary Inflammatory Index (DII) and incident self-reported diagnosis or symptoms of depression in two cohorts of community-dwelling older adults in Spain. METHODS: We used data from the Seniors-ENRICA-I (SE-I) and Seniors-ENRICA-II (SE-II) cohorts. In both cohorts, the baseline DII was calculated from habitual food consumption estimated with a validated computer-based diet history. The incidence of both physician self-reported diagnosis of depression and mild-to-major depressive symptoms (≥3 on the 10-item Geriatric Depression Scale) was analysed. Logistic regression models were adjusted for the main potential confounders, such as sociodemographics, lifestyles, and comorbidities. The results of both cohorts were pooled using a random effects model. RESULTS: Among the 1627 participants in SE-I (mean age 71.5 ± 5.5 y, 53.1% women) and the 1579 in SE-II (mean age 71.4 ± 4.2, 46.7% women), 86 (5.3%) and 140 (8.9%) incident cases of depression were identified after a mean 3.2-y and 2.3-y follow-up, respectively. The fully adjusted odds ratio (95% confidence interval) of incident depression for the highest (the highest proinflammatory diet) versus the lowest quartile of DII was 2.76 (1.25-6.08, p-for-trend = 0.005) in the SE-I, 1.90 (1.04-3.40, p-for-trend = 0.005) in the SE-II and 2.07 (1.01-3.13) in the pooled cohorts. The results were consistent across strata defined by sex, age, physical activity, loneliness/poor social network, and morbidity. CONCLUSIONS: A proinflammatory dietary pattern is associated with depression risk in older adults. Future research should evaluate whether reducing the inflammatory component of diet leads to reduced depression symptoms in this population.

Concerning “The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care”

Dear editor, We read with interest the article entitled “The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care” by Ordunez and colleagues, published on March 28th, 2022 (1). This article describes a recently developed app to assess cardiovascular disease (CVD) risk, as well as its use, potential functionality, and validation process. Despite the central role of the HEARTS initiative in the Americas and in the vulnerable region of Latin America and the Caribbean (LAC), we believe that the interpretation of the findings of this study requires some caution. There are some methodological issues in this manuscript that could compromise the strong conclusion that “the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.” First, the risk prediction models that inform this app are derived from 85 cohorts from high-income countries in the Emerging Risk Factors Collaboration study (2). Of these, we were only able to identify the Puerto Rico Heart Health Program study as directly representative of the LAC region. Therefore, the lack of representativeness of the models for risk-prediction should be made more explicit. At the same time, the important role of the STEPwise approach to surveillance to obtain population-level indicators and trends, as well as calibration of the risk-prediction models should be both considered as potential solutions to this issue. Second, the authors state that “the app is intended to be used in clinical practice, especially at the primary health care level” although it can also “be used by anyone in the general population.” If the use of the app is available to the general public, this could systematically exclude underrepresented groups by creating differential engagement and generating digital inequity (3). Hence, the “ideal” target population of the app in low- and middle-income countries should be specified. Third, the language of the article should reflect the uncertainty regarding the long-term success of this digital health application in the region, which will likely depend on how it is implemented and maintained over time, and the promptness of the initiation of effective pharmacological treatment after the obtention of a risk score. Several barriers to the implementation of CVD risk calculators in primary care have been described, including time constraints, lack of electronic health records integration, and patient fears (4). Low-resource contexts potentially require tailoring of the app to address some of these barriers and ensure sustainability. The burden of CVD in LAC, estimated at 3 497.14 disabilityadjusted life years per 100 000 (range, 3 226.2 – 3 790.1), appears to be highly influenced by the years lived with disability due to ischemic heart disease (5) and by the increasing impact of high systolic blood-pressure (≥110-115 mmHg according to the Global Burden of Disease definition) as the leading mortality risk factor in the region. This public health scenario presents both a tremendous challenge and an opportunity for improvement. The HEARTS app is a promising driver of change. However, its validity should be evaluated in view of some methodological caveats and its implementation capacity should stress the letter “A” of its acronym to advocate for equitable “access to essential medicines and technology” in places where the availability and affordability of generic drugs is still scarce. To read the complete letter, please download the manuscript using the link on the left.

Low vitamin intake is associated with risk of frailty in older adults.

Background: the association between vitamin intake and frailty has hardly been studied. The objective was to assess the association of dietary vitamin intake with incident frailty in older adults from Spain. Methods: data came from a cohort of 1,643 community-dwelling individuals aged ≥65, recruited in 2008-10 and followed up prospectively throughout 2012. At baseline, 10 vitamins were assessed (vitamin A, thiamine, riboflavin, niacin, vitamins B6, B12, C, D, E and folates) using a validated face-to-face diet history. Incident frailty was identified using Fried's definition as having ≥3 of the following five criteria: unintentional weight loss of ≥4.5 kg, exhaustion, weakness, slow walking speed and low physical activity. Nonadherence to the recommended dietary allowances (RDA) was considered when the intake of a vitamin was below the recommendation. Analyses were performed with logistic regression and adjusted for main confounders. Results: during a 3.5-year follow-up, 89 (5.4%) participants developed frailty. The odds ratios (95% confidence interval) of frailty for those in the lowest versus the highest tertile of vitamin intake were 2.80 (1.38-5.67), P-trend: 0.004, for vitamin B6; 1.65 (0.93-2.95), P-trend: 0.007, for vitamin C; 1.93 (0.99-3.83), P-trend: 0.06, for vitamin E and 2.34 (1.21-4.52), P-trend: 0.01, for folates. Nonadherence to the RDAs of vitamins was related to frailty for thiamine odds ratio (OR): 2.09 (1.03-4.23); niacin OR: 2.80 (1.46-5.38) and vitamin B6; 2.23 (1.30-3.83). When considering tertiles of RDAs for the 10 vitamins those who met <5 RDAs had a higher risk of frailty, OR: 2.84 (1.34-6.03); P-trend: <0.001, compared to those who met >7. Conclusion: a lower intake of vitamins B6, C, E and folates was associated with a higher risk of frailty. Not meeting RDAs for vitamins was also strongly associated.

The burden of blood-pressure-related cardiovascular mortality in Mexico.

This study shows that in Mexico, a country at an advanced stage in the epidemiologic transition, with the national burden of disease dominated by noncommunicable diseases, elevated blood pressure is a major clinical and public health problem. 31.7% of the Mexican individuals aged 50 and over had systolic hypertension, and 47.3% were at systolic prehypertensive levels. Also, approximately half of all cardiovascular deaths that occurred annually in the population of Mexico aged ≥50 years are attributable to above optimal levels of systolic blood pressure. We think these estimates may help order health priorities in Mexico (and other middle-income countries) at a time when the costs of medical care take a considerable share of the gross national product in most countries.

Blood pressure responses in young adults first exposed to high altitude for 12 months at 3550 m.

To determine the changes in blood pressure (BP) and related variables in sea-level young adults with chronic exposure to high altitude, a longitudinal study was performed in male army recruits (n = 346; age 17.9 +/- 0.1 yr; BMI, 22.5 +/- 0.3 kg/m(2)) first exposed to 3550-m altitude for 12 months. Fifty male recruits (age 17.8 +/- 0.6 and BMI 22.6 +/- 0.3 kg/m(2)) never exposed to altitude were used as controls. A sustained higher mean diastolic BP (DBP) (82.1 +/- 1.0 mmHg at month 3; 81.3 +/- 0.9 mmHg at month 12) was observed, compared to first exposure and the control group (p < 0.001). The BP values were always higher than those of the sea-level control group (systolic blood pressure (SBP) 109 +/- 2.3 and DBP 67.4 +/- 0.8; p < 0.001), and a large proportion of subjects steadily presented overoptimal values for either systolic BP (SBP) (64%) or DBP (77%) and hypertensive DBP values (40%). The higher DBP was associated with lower Sao(2) (OR = 0.919; p < 0.05). In addition, the acute mountain sickness (AMS) score showed a slight decrease during re-exposure (3.9 +/- 0.3 vs.3.4 +/- 0.3; p < 0.001) and an inverse association to the before-descending Sao(2) at month 3 (OR = 0.906, p < 0.01). These data suggest that BP stabilization can take longer than currently thought and that each parameter has a different profile of change. Further, a sustained high DBP should be a matter of epidemiological concern and emphasizes the need for BP monitoring among young lowlanders exposed to high altitude.

An international comparative study of blood pressure in populations of European vs. African descent.

BACKGROUND: The consistent finding of higher prevalence of hypertension in US blacks compared to whites has led to speculation that African-origin populations are particularly susceptible to this condition. Large surveys now provide new information on this issue. METHODS: Using a standardized analysis strategy we examined prevalence estimates for 8 white and 3 black populations (N = 85,000 participants). RESULTS: The range in hypertension prevalence was from 27 to 55% for whites and 14 to 44% for blacks. CONCLUSIONS: These data demonstrate that not only is there a wide variation in hypertension prevalence among both racial groups, the rates among blacks are not unusually high when viewed internationally. These data suggest that the impact of environmental factors among both populations may have been under-appreciated.