A 10-year longitudinal study on the associations between changes in plant-based diet indices, anthropometric parameters and blood lipids in a Flemish adult population.

AIM: Plant-based diets are recommended in the context of environmental sustainability and health. Since not all plant foods can be considered beneficial, a distinction needs to be made between healthful and unhealthful plant foods. The aim of this study was to investigate longitudinal associations between changes in an overall plant-based diet index, a healthful plant-based diet index and an unhealthful plant-based diet index, with changes in anthropometrics and blood lipids as indicators of morphological and metabolic fitness, respectively. METHODS: A 3-day dietary record was completed by 650 Flemish adults (420 men, 230 women) in 2002-2004 and 2012-2014. Three plant-based diet indices were calculated based on quintile scores regarding the intake of animal- or plant-based food items. Associations between 10-year changes in diet indices and changes in anthropometrics and blood lipids were tested using multivariate linear regression. RESULTS: Plant-based diet indices did not differ over time. Using the unadjusted model, few significant associations were found between changes in diet indices and changes in anthropometrics and blood lipids. However, these relationships disappeared after adjusting for confounding. In women, a positive association was found between changes in overall plant-based diet index and changes in body mass index in the adjusted model. CONCLUSIONS: Index values did not differ over time and few longitudinal associations were found.

Stability of potential renal acid load.

AIM: The potential renal acid load (PRAL) has been described in relation to different health outcomes. Outcomes over time and conclusions made are often based on baseline dietary intake values. However, to study reliable long-term associations, parameters calculated based on dietary intake data, such as PRAL, must be stable over time. Therefore, the aim of the present study was to assess the stability of PRAL and its components over a 10-year time period. METHODS: PRAL values of three-day dietary intake data from 197 women and 373 men on two assessment moments (2002-2004 and 2012-2014) were calculated. Pearson correlation and intra-class correlation coefficients were used for assessing the stability of PRAL and its components. Level of agreement between the two assessment moments was estimated after splitting up subjects in quintiles of PRAL, calculating kappa values and changes of quintiles over time. RESULTS: No significant differences in mean PRAL over time were found. Stability of PRAL and its components was low. Poor agreement between the first and second assessment was shown by low kappa values and change of most of the subjects to an adjacent and non-adjacent quintile after 10 years. CONCLUSIONS: Based on nutrition assessments carried out using three-day dietary records, stability of PRAL over a 10-year time period could not be confirmed, even though no significant difference between mean PRAL and its components over time was found. Therefore, interpretation of longitudinal outcomes based on PRAL and its component calculated at baseline should be interpreted with caution.

Low 10-year reproducibility of glycaemic index and glycaemic load in a prospective cohort study.

When relating glycaemic index (GI) and glycaemic load (GL) to health outcomes, many prospective cohort studies assess the nutritional exposure only once in time, that is, at the start of the study, presuming a stability in nutritional consumption during the course of the study. The aim of this study is to investigate the reproducibility of GI and GL. This is a prospective cohort study in which 562 middle-aged Belgian adults noted all foods and drinks consumed during 3 d in 2002 and 2012. GI and GL were calculated after reference tables. The Pearson correlation coefficients between 2002 and 2012 were 0·27 for GI and 0·41 for GL. For GI, 33 % of the participants remained in the same quintile between 2002 and 2012, whereas 31 % moved to a non-adjacent quintile. For GL, this was 34 and 28 %, respectively. The lowest and the highest quintiles of GI were the most stable, with 40 and 44 % of the participants staying in the same quintile. This was only 22 % for the fourth quintile. The same tendency was present for GL - that is, the most extreme quintiles were the most stable. This study shows 10-year correlation coefficients for GI and GL below 0·50. Multiple nutritional assessments and limiting the analysis to the extreme quintiles of GI and GL will limit a possible misclassification in the prospective cohort studies owing to the low reproducibility.

Intensity-Specific Differential Leukocyte DNA Methylation in Physical (In)Activity: An Exploratory Approach.

The aim of this exploratory study was to investigate how sedentary behavior (SB) and physical activity (PA) influence DNA methylation at a global, gene-specific, and health-related pathway level. SB, light PA (LPA), and moderate-to-vigorous PA (MVPA) were assessed objectively for 41 Flemish men using the SenseWear Pro 3 Armband. CpG site-specific methylation in leukocytes was determined using the Illumina HumanMethylation 450 BeadChip. Correlations were calculated between time spent on the three PA intensity levels and global DNA methylation, using a z-score-based method to determine global DNA methylation levels. To determine whether CpG site-specific methylation can be predicted by these three PA intensity levels, linear regression analyses were performed. Based on the significantly associated CpG sites at α = 0.005, lists were created including all genes with a promoter region overlapping these CpG sites. A biological pathway analysis determined to what extent these genes are overrepresented within several pathways. No significant associations were observed between global DNA methylation and SB (r = 0.084), LPA (r = -0.168), or MVPA (r = -0.125), although the direction of the correlation coefficients is opposite to what is generally reported in literature. SB has a different impact on global and gene-specific methylation than PA, but also LPA and MVPA affect separate genes and pathways. Furthermore, the function of a pathway seems to determine its association with SB, LPA, or MVPA. Multiple PA intensity levels, including SB, should be taken into account in future studies investigating the effect of physical (in)activity on human health through epigenetic mechanisms.

Substituting Sedentary Time With Light and Moderate to Vigorous Physical Activity is Associated With Better Cardiometabolic Health.

BACKGROUND: The purpose of the current study was to apply a more novel approach to systematically examine (1) associations of clustered cardiometabolic risk and cardiometabolic risk factors and (2) theoretical substitution of sedentary time with either sleep, light physical activity (LPA), or moderate to vigorous physical activity (MVPA) and substituting LPA with MVPA. METHODS: Physical activity and sleep were objectively measured in 410 Flemish adults [55.5 (9.6) y, 64% men] with a SenseWear Pro 3 Armband. Cardiometabolic risk factors (obesity, hyperglycemia, dyslipidemia, and hypertension) and cardiorespiratory fitness were objectively measured. Isotemporal substitution analyses were performed to assess the associations between substituting time from a potentially negative behavior into another potentially positive behavior. RESULTS: Theoretical substitution of sedentary time with MVPA was associated with decreased clustered cardiometabolic risk, b = -0.06 (-0.08 to -0.04), and substituting LPA with MVPA was associated with a decrease in clustered cardiometabolic risk, b = -0.08 (-0.11 to -0.04). Substituting sedentary time with LPA or sleep improved high-density lipoprotein-cholesterol, systolic and diastolic blood pressures, and waist circumference. CONCLUSION: Theoretical replacement of sedentary time with either sleep, LPA, or MVPA was positively associated with improved cardiometabolic risk factor status. Interventions for increasing cardiometabolic health can focus on replacing sedentary time with either sleep, LPA, or MVPA depending on the risk parameters that need to be targeted.

Ten-year change in sedentary behaviour, moderate-to-vigorous physical activity, cardiorespiratory fitness and cardiometabolic risk: independent associations and mediation analysis.

BACKGROUND: We aimed to study the independent associations of 10-year change in sedentary behaviour (SB), moderate-to-vigorous physical activity (MVPA) and objectively measured cardiorespiratory fitness (CRF), with concurrent change in clustered cardiometabolic risk and its individual components (waist circumference, fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides and blood pressure). We also determined whether associations were mediated by change in CRF (for SB and MVPA), waist circumference (for SB, MVPA and CRF) and dietary intake (for SB). METHODS: A population-based sample of 425 adults (age (mean±SD) 55.83±9.40; 65% men) was followed prospectively for 9.62±0.52 years. Participants self-reported SB and MVPA and performed a maximal cycle ergometer test to estimate peak oxygen uptake at baseline (2002-2004) and follow-up (2012-2014). Multiple linear regression and the product of coefficients method were used to examine independent associations and mediation effects, respectively. RESULTS: Greater increase in SB was associated with more detrimental change in clustered cardiometabolic risk, waist circumference, HDL cholesterol and triglycerides, independently of change in MVPA. Greater decrease in MVPA was associated with greater decrease in HDL cholesterol and increase in clustered cardiometabolic risk, waist circumference and fasting glucose, independent of change in SB. Greater decrease in CRF was associated with more detrimental change in clustered cardiometabolic risk and all individual components. Change in CRF mediated the associations of change in SB and MVPA with change in clustered cardiometabolic risk, waist circumference and, only for MVPA, HDL cholesterol. Change in waist circumference mediated the associations between change in CRF and change in clustered cardiometabolic risk, fasting glucose, HDL cholesterol and triglycerides. CONCLUSIONS: A combination of decreasing SB and increasing MVPA, resulting in positive change in CRF, is likely to be most beneficial towards cardiometabolic health.

Limited potential of genetic predisposition scores to predict muscle mass and strength performance in Flemish Caucasians between 19 and 73 years of age.

Since both muscle mass and strength performance are polygenic in nature, the current study compared four genetic predisposition scores (GPS) in their ability to predict these phenotypes. Data were gathered within the framework of the first-generation Flemish Policy Research Centre "Sport, Physical Activity and Health" (2002-2004). Results are based on muscle characteristics data of 565 Flemish Caucasians (19-73 yr, 365 men). Skeletal muscle mass was determined from bioelectrical impedance. The Biodex dynamometer was used to measure isometric (PTstatic120°) and isokinetic strength (PTdynamic60° and PTdynamic240°), ballistic movement speed (S20%), and muscular endurance (Work) of the knee extensors. Genotyping was done for 153 gene variants, selected on the basis of a literature search and the expression quantitative trait loci of selected genes. Four GPS were designed: a total GPS (based on the sum of all 153 variants, each favorable allele = score 1), a data-driven and weighted GPS [respectively, the sum of favorable alleles of those variants with significant b-coefficients in stepwise regression (GPSdd), and the sum of these variants weighted with their respective partial r2 (GPSw)], and an elastic net GPS (based on the variants that were selected by an elastic net regularization; GPSen). It was found that four different models for a GPS were able to significantly predict up to ~7% of the variance in strength performance. GPSen made the best prediction of SMM and Work. However, this was not the case for the remaining strength performance parameters, where best predictions were made by GPSdd and GPSw.

Associations between physical activity and health-related fitness - volume versus pattern.

Approximately 3.2 million people die of non-communicable diseases (NCD) each year due to insufficient physical activity. Physical activity guidelines are possibly perceived as too demanding and might thus pose a barrier. We addressed the question if a more stable physical activity pattern is associated with higher levels of health-related fitness than one with high and low intensities, regardless of the physical activity level (PAL). Physical activity was objectively measured in 296 men and women (53.7 ± 8.94 years) with the SenseWear Pro Armband®. Using this data, the PAL and a Gini index were calculated to report the physical activity pattern. Health-related fitness was expressed as a fitness index. PAL was weakly correlated to health-related fitness (r = 0.38, P < .0001). The Gini index was also weakly correlated to the fitness index (r = 0.23, P < .0001). Results of the ANCOVA showed that participants in the first quartile of PAL always scored significantly lower for health-related fitness than participants in quartile four, after adjustment for the Gini index. These results suggest that as long as the volume of physical activity is high, health-related fitness will be high as well, independent of the physical activity pattern or variability in intensities throughout the day.

Assessment of sugar-sweetened beverage consumption and weight change: a prospective cohort study.

BACKGROUND: In prospective studies, sugar-sweetened beverages (SSB) have been associated with weight increase. However, most prospective studies examine changes in body weight over time according to amounts of SSB intake at baseline, generally without considering changes over time in SSB, energy intake and physical activity. The objective of the present study was to examine how SSB intakes influence changes in weight, according to the way SSB intakes are analysed. METHODS: For a prospective cohort study with two nutritional assessments in time, 46 Flemish municipalities were selected by clustered random sampling. Within these municipalities, a random sample of men and women between 18 and 75 years of age was selected and invited to participate. In total, 562 middle-aged Belgian adults were tested in 2002 and 2012 for the same anthropometric, lifestyle, nutrition and physical activity parameters. The main outcome measured were weight changes from 2002 to 2012 were analysed according to various ways to parametrise SSB intakes in 2002 and changes in SSB, energy intake, and physical activity from 2002 to 2012. RESULTS: In a multivariable model including age, sex, the best predictors of weight changes were the weight at baseline (P < 0.001), then the change in energy intake (p = 0.068). No association was found with SSB intake at baseline (P = 0.267) and the change in SSB intake (P = 0.130). CONCLUSIONS: Results of prospective studies on SSB intake and body weight depend much on the way SSB intakes are analysed, and on the inclusion of changes in energy intake and physical activity in analyses.

Independent Associations between Sedentary Time, Moderate-To-Vigorous Physical Activity, Cardiorespiratory Fitness and Cardio-Metabolic Health: A Cross-Sectional Study.

We aimed to study the independent associations of sedentary time (ST), moderate-to-vigorous physical activity (MVPA), and objectively measured cardiorespiratory fitness (CRF) with clustered cardio-metabolic risk and its individual components (waist circumference, fasting glucose, HDL-cholesterol, triglycerides and blood pressure). We also investigated whether any associations between MVPA or ST and clustered cardio-metabolic risk were mediated by CRF. MVPA, ST, CRF and individual cardio-metabolic components were measured in a population-based sample of 341 adults (age 53.8 ± 8.9 years; 61% men) between 2012 and 2014. MVPA and ST were measured with the SenseWear pro 3 Armband and CRF was measured with a maximal exercise test. Multiple linear regression models and the product of coefficients method were used to examine independent associations and mediation effects, respectively. Results showed that low MVPA and low CRF were associated with a higher clustered cardio-metabolic risk (ß = -0.26 and ß = -0.43, both p<0.001, respectively). CRF explained 73% of the variance in the association between MVPA and clustered cardio-metabolic risk and attenuated this association to non-significance. After mutual adjustment for MVPA and ST, CRF was the most important risk factor for a higher clustered cardio-metabolic risk (ß = -0.39, p<0.001). In conclusion, because of the mediating role of CRF, lifestyle-interventions need to be feasible yet challenging enough to lead to increases in CRF to improve someone's cardio-metabolic health.

Age-related decline in muscle mass and muscle function in Flemish Caucasians: a 10-year follow-up.

Aging is a complex process that is accompanied with changes in both muscle mass and muscle function (strength and performance). Therefore, the current longitudinal study aimed to provide a better insight in 10-year aging-related changes in whole-body muscle mass and strength performance of the leg extensors during the adult life span. Data were gathered within the framework of the first- (2002-2004: baseline) and third-generation Flemish Policy Research Center Sport (2012-2014: follow-up). Results are based on muscle characteristics data of 591 Flemish Caucasian adults (19-73 years, 381 men). Skeletal muscle mass (SMM) was determined with bioelectrical impedance analysis. Biodex Medical System 3® dynamometer was used to measure isometric (PTstatic120°) and isokinetic (PTdynamic60° and PTdynamic240°) strength, ballistic movement speed (S 20 %), and muscular endurance (work) of the knee extensors. Overall strength performance was higher at both evaluation moments in men compared to women (p < 0.01). But only S 20 % declined significantly faster in men compared to women (p < 0.01). Age and baseline strength performance were negatively related with the change in strength performance, even when corrected for SMM, protein intake, and energy expenditure during sports (E sport). In conclusion, strength performance was not associated with E sport in this study, but protein intake was associated with isometric strength in men, and with ballistic and isokinetic strength in women. Changes in S 20 % were significantly greater in men compared to women. Baseline values of strength performance and age were associated with changes in strength performance parameters, even after correction for SMM, protein intake, and E sport.

Longitudinal Study on the Association Between Cardiorespiratory Fitness, Anthropometric Parameters and Blood Lipids.

BACKGROUND: Longitudinal evidence concerning the association between cardiorespiratory fitness (CRF) and blood lipids and between anthropometric parameters (ANTP) and blood lipids is limited. This study aimed to investigate the association between changes in CRF and ANTP and changes in blood lipids. METHODS: In 2002-2004 and 2012-2014, 652 participants were tested. CRF was measured as VO2peak using a maximal ergometer test. Waist circumference (WC) and Body Mass Index (BMI) were used as ANTP. Blood samples were analyzed for total cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides. A linear regression analysis was performed to investigate associations between changes in CRF and ANTP and changes in blood lipids. RESULTS: After adjustment a decrease in CRF was associated with an increase in triglycerides and a decrease in HDL cholesterol in men. An increase in WC was associated with an increase in TC, LDL cholesterol and ratio total/HDL cholesterol and a decrease in HDL cholesterol, while an increase in BMI was associated with an increase in ratio total/HDL cholesterol and a decrease in HDL cholesterol. CONCLUSIONS: WC and BMI were more longitudinally associated with blood lipids compared with CRF. Improving ANTP can enhance the blood lipid profile, while CRF had only limited influence.

Longitudinal study on the association between three dietary indices, anthropometric parameters and blood lipids.

BACKGROUND: From a health promotion perspective, the use of dietary indices is preferred above single nutrients and foods to evaluate diet quality. Longitudinal research about the association between dietary indices and respectively anthropometric parameters and blood lipids is lacking. The aim of this study was to investigate the longitudinal association between three dietary indices (Healthy Eating Index-2010 (HEI), Mediterranean Diet Score (MDS) and Diet Quality Index (DQI)) and respectively anthropometric parameters and blood lipids. METHODS: A three day diet record was completed by 373 men and 197 women in 2002-2004 and 2012-2014. HEI, MDS and DQI were calculated. Waist circumference (WC) and Body Mass Index (BMI) were used as anthropometric parameters. A linear regression analysis was performed to investigate associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, adjusted for potential confounders. RESULTS: Only in men an increase in all three dietary indices was associated with a decrease in WC and BMI in the non-adjusted analysis and for HEI and DQI also in the adjusted analysis. No longitudinal associations were found between dietary indices and blood lipids both in men and women. CONCLUSIONS: Only few associations were found between dietary indices and anthropometric parameters, whilst no associations were found with blood lipids. An increase in dietary indices was associated with an improvement in anthropometric parameters only in men. As this is the first study investigating associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, further research is needed to evaluate these possible associations.

Muscle mass and muscle function over the adult life span: a cross-sectional study in Flemish adults.

BACKGROUND: Aging is accompanied with a progressive deterioration of skeletal muscle mass (SMM) and muscle function, also termed sarcopenia. METHODS: The aim was to describe SMM (based on bioelectrical impedance) and muscle function of the leg extensors over the adult age span in 819 men and 578 women, aged 18-78 years. The distribution of skeletal muscle index (SMI; SMM/height(2)) groups was described and muscle force-velocity characteristics were examined between SMI-groups over the adult life span. Subjects were divided into age categories and SMI groups to compare their muscle strength characteristics. Isometric and isokinetic strength, ballistic movement speed and muscular endurance of the knee extensors were evaluated on a Biodex dynamometer. RESULTS: Age by gender interaction effects were found significant (P<0.01) for all strength tests. In general, the overall drop in slow and faster knee extension strength was larger than the isometric component, with women showing larger losses by the age of 60-70 years compared to men. Regression analysis revealed significant (P<0.01) age-related reductions, with the largest explained variance for the muscular endurance parameter (24%). No age by SMI-group interaction effect was observed for muscle function, but main effects of age and SMI were significant (P<0.01). CONCLUSION: The age-related decline in muscle function was stronger in women. Furthermore, a low SMI results in a weaker muscle function compared to a normal SMI in each age-category, pointing out that its relationship with physical disability should therefore be further examined over the adult life-span.

Cross-sectional study on the relationship between the Mediterranean Diet Score and blood lipids.

BACKGROUND: Blood lipids are cardiovascular health indicators. High LDL cholesterol values and/or high total cholesterol (TC)/HDL cholesterol ratios are positively related with cardiovascular mortality. Evidence suggests that a Mediterranean diet can reduce the incidence of cardiovascular diseases. Adherence to the Mediterranean diet is often measured by the Mediterranean Diet Score (MDS). However, the association between the Mediterranean diet and blood lipid profiles seems still inconclusive. The aim of this study was to investigate the relationship between the MDS, its different components and blood lipid profiles. METHODS: A sample of 506 women and 707 men (aged 18-75 years) was recruited. Three-day diet records were used to calculate the MDS. Blood samples were analyzed for serum TC, LDL and HDL cholesterol. ANOVA was used to analyze blood lipids across the MDS tertiles. A multivariate linear regression analysis was performed to investigate the associations between the MDS, its components and blood lipids, adjusted for several confounders. All analyses were stratified by gender. RESULTS: Few gender-specific associations were found between the MDS, its components and blood lipids. Only in men, the total MDS was negatively related with LDL cholesterol and the ratio TC/HDL cholesterol while positively with HDL cholesterol. In women, respectively two (MUFA/SFA and cereals) and in men three (fruits & nuts, meat and alcohol) of the nine MDS components were related with blood lipids. CONCLUSIONS: Analyses investigating the relationship between the MDS, its components and blood lipid profiles indicate only limited influence of the Mediterranean diet on blood lipids. More associations were detected in men compared to women.