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1.
Int J Epidemiol ; 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33245137

RESUMO

BACKGROUND: Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD. RESULTS: There was a lower risk of IHD with a higher intake of fruit and vegetables combined [HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90-0.99, P-trend = 0.009], and with total fruits (per 100 g/day 0.97, 0.95-1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82-0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85-0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91-0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95-1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk. CONCLUSIONS: In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.

2.
Diabetes Care ; 43(11): 2660-2667, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32868270

RESUMO

OBJECTIVE: There is sparse evidence for the association of suitable food substitutions for red and processed meat on the risk of type 2 diabetes. We modeled the association between replacing red and processed meat with other protein sources and the risk of type 2 diabetes and estimated its population impact. RESEARCH DESIGN AND METHODS: The European Prospective Investigation into Cancer (EPIC)-InterAct case cohort included 11,741 individuals with type 2 diabetes and a subcohort of 15,450 participants in eight countries. We modeled the replacement of self-reported red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk, and nuts. Country-specific hazard ratios (HRs) for incident type 2 diabetes were estimated by Prentice-weighted Cox regression and pooled using random-effects meta-analysis. RESULTS: There was a lower hazard for type 2 diabetes for the modeled replacement of red and processed meat (50 g/day) with cheese (HR 0.90, 95% CI 0.83-0.97) (30 g/day), yogurt (0.90, 0.86-0.95) (70 g/day), nuts (0.90, 0.84-0.96) (10 g/day), or cereals (0.92, 0.88-0.96) (30 g/day) but not for replacements with poultry, fish, eggs, legumes, or milk. If a causal association is assumed, replacing red and processed meat with cheese, yogurt, or nuts could prevent 8.8%, 8.3%, or 7.5%, respectively, of new cases of type 2 diabetes. CONCLUSIONS: Replacement of red and processed meat with cheese, yogurt, nuts, or cereals was associated with a lower rate of type 2 diabetes. Substituting red and processed meat by other protein sources may contribute to the prevention of incident type 2 diabetes in European populations.

3.
BMJ ; 370: m2194, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641421

RESUMO

OBJECTIVE: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes. DESIGN: Prospective case-cohort study. SETTING: Populations from eight European countries. PARTICIPANTS: 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study. MAIN OUTCOME MEASURE: Incident type 2 diabetes. RESULTS: In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and individual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis. CONCLUSIONS: These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.


Assuntos
Ácido Ascórbico/sangue , Carotenoides/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Frutas , Verduras , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Dieta , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Prospectivos
5.
Circulation ; 139(25): 2835-2845, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31006335

RESUMO

BACKGROUND: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition). METHODS: In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates. RESULTS: The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol. CONCLUSIONS: Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.


Assuntos
Laticínios , Dieta Saudável , Ovos , Carne , Isquemia Miocárdica/epidemiologia , Valor Nutritivo , Recomendações Nutricionais , Comportamento de Redução do Risco , Alimentos Marinhos , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea , HDL-Colesterol/sangue , Estudos Transversais , Laticínios/efeitos adversos , Inquéritos sobre Dietas , Ovos/efeitos adversos , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Carne/efeitos adversos , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/prevenção & controle , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Alimentos Marinhos/efeitos adversos , Fatores de Tempo
6.
Br J Nutr ; 114(9): 1331-40, 2015 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-26349405

RESUMO

Circulating vitamin C and carotenoids are used as biomarkers of fruit and vegetable intake in research, but their comparative validity has never been meta-analysed. PubMed, EMBASE, CENTRAL, CINAHL and Web of Science were systematically searched up to December 2013 for randomised trials of different amounts of fruit and vegetable provision on changes in blood concentrations of carotenoids or vitamin C. Reporting followed PRISMA guidelines. Evidence quality was assessed using the GRADE system. Random effects meta-analysis combined estimates and meta-regression tested for sub-group differences. In all, nineteen fruit and vegetable trials (n 1382) measured at least one biomarker, of which nine (n 667) included five common carotenoids and vitamin C. Evidence quality was low and between-trial heterogeneity (I 2) ranged from 74% for vitamin C to 94 % for α-carotene. Groups provided with more fruit and vegetables had increased blood concentrations of vitamin C, α-carotene, ß-carotene, ß-cryptoxanthin and lutein but not lycopene. However, no clear dose-response effect was observed. Vitamin C showed the largest between-group difference in standardised mean change from the pre-intervention to the post-intervention period (smd 0·94; 95% CI 0·66, 1·22), followed by lutein (smd 0·70; 95% CI 0·37, 1·03) and α-carotene (smd 0·63; 95% CI 0·25, 1·01), but all CI were overlapping, suggesting that none of the biomarkers responded more than the others. Therefore, until further evidence identifies a particular biomarker to be superior, group-level compliance to fruit and vegetable interventions can be indicated equally well by vitamin C or a range of carotenoids. High heterogeneity and a lack of dose-response suggest that individual-level biomarker responses to fruit and vegetables are highly variable.


Assuntos
Ácido Ascórbico/sangue , Biomarcadores/sangue , Frutas , Verduras , Carotenoides/sangue , Criptoxantinas/sangue , Dieta , Humanos , Luteína/sangue , Licopeno , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , beta Caroteno/sangue
7.
Am J Epidemiol ; 181(11): 857-60, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-25899093

RESUMO

It remains largely unclear whether consumption of total and individual polyunsaturated fatty acids (PUFAs) is associated with chronic systemic inflammation in healthy, free-living individuals. While available evidence (stemming principally from mechanistic studies) has indicated that greater intake of n-6 PUFAs may lead to increased levels of inflammation-for instance, by their acting as precursors to proinflammatory eicosanoids and increasing levels of oxidized linoleic acid metabolites-n-3 PUFAs are precursors to some antiinflammatory eicosanoids. New human data from a Dutch prospective study, the Rotterdam Study-as presented by Muka et al. ( Am J Epidemiol. 2015;181(11):846-856) in this issue of the Journal-now make an important contribution to the relatively scarce literature on the association of dietary n-3 and n-6 PUFAs with serum levels of C-reactive protein (CRP), a key marker of inflammation, in a general population. The study by Muka et al. benefitted from repeated CRP measurements, comprehensive correction for potential confounding, and wide-ranging sensitivity analyses. The findings show no significant trend regarding n-3 PUFAs but indicate an important inverse association between n-6 PUFAs and chronic systemic inflammation. This study provides support for existing dietary guidelines, which encourage consumption of a combination of n-3 and n-6 PUFAs in the diet.


Assuntos
Proteína C-Reativa/análise , Gorduras Insaturadas na Dieta/administração & dosagem , Ácidos Graxos Insaturados/administração & dosagem , Idoso , Biomarcadores , Gorduras Insaturadas na Dieta/sangue , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-6/administração & dosagem , Ácidos Graxos Insaturados/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia
9.
Eur J Epidemiol ; 28(3): 205-21, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23456138

RESUMO

The evidence on the association between baseline vitamin D status and risk of incident hypertension in general populations is limited and has not been reliably quantified. We conducted a systematic review and meta-analysis of published prospective studies evaluating the associations of baseline vitamin D status (circulating 25-hydroxyvitamin D [25(OH)D] levels and dietary vitamin D intake) with risk of hypertension. Eligible studies were identified in a literature search of MEDLINE, EMBASE, and Web of Science up to November 2012. Pooled relative risks (RRs) with 95% confidence intervals were calculated using random effects models. Generalized least-squares trend estimation was used to assess dose-response relationships. Of the 2,432 articles reviewed for eligibility, eight unique prospective cohorts with aggregate data on 283,537 non-overlapping participants and 55,816 incident hypertension cases were included. The RRs (95% CIs) for hypertension in a comparison of extreme thirds of baseline levels of vitamin D were 0.70 (0.58, 0.86) for seven studies that measured blood 25(OH) D levels and 1.00 (0.95, 1.05) for four studies that assessed dietary vitamin D intake. The pooled RR of incident hypertension per 10 ng/mL increment in baseline 25(OH)D levels was 0.88 (0.81, 0.97) in dose-response analysis. Evidence was lacking of heterogeneity among studies that measured blood 25(OH) D levels and those that assessed dietary vitamin D status. Studies are needed to determine whether the association of vitamin D with hypertension represents a causal association and also to determine whether vitamin D therapy may be beneficial in the prevention or the treatment of hypertension.


Assuntos
Biomarcadores/sangue , Hipertensão/sangue , Vitamina D/análogos & derivados , Pressão Sanguínea/efeitos dos fármacos , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Humanos , Hipertensão/etiologia , Hipertensão/prevenção & controle , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Vitamina D/administração & dosagem , Vitamina D/sangue
10.
Int J Pediatr Obes ; 6(2-2): e170-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20883125

RESUMO

OBJECTIVE: To develop a decision rule by which children with a high risk to develop overweight can be distinguished at birth from children at low risk. DESIGN, SETTING AND PARTICIPANTS: Data of 1 687 Dutch children born in 1996/1997 who participated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) longitudinal birth cohort study were analysed. Perinatal candidate predictors of overweight at 8 years of age were selected and a prediction model was developed using stepwise model selection based on the Akaike Information Criterion (AIC). The prediction model was internally validated using resampling techniques. Outcome measure. Overweight at the age of 8 years. RESULTS: A total of 13.9% (n = 253) of the children were overweight at 8 years of age. Independent positive predictors of overweight were paternal and maternal body mass index, female gender, smoking in the parental house, birth weight and hospital delivery. From the model, a decision rule was derived by which an overweight score could be calculated. Of the children with an overweight score below 89.45, only 2.7% were overweight at the age of 8, whereas in children with an overweight score above 105.02 the prevalence of overweight was 35.4%. CONCLUSION: The risk of overweight at the age of 8 years can be predicted with six characteristics that are available at birth. The decision rule developed in this study may help to target early preventive measures against overweight in high-risk children.


Assuntos
Envelhecimento , Técnicas de Apoio para a Decisão , Indicadores Básicos de Saúde , Sobrepeso/epidemiologia , Fatores Etários , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Países Baixos , Sobrepeso/diagnóstico , Sobrepeso/fisiopatologia , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Ganho de Peso
11.
Public Health Nutr ; 14(2): 340-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20854716

RESUMO

OBJECTIVE: Vegetarians and vegans exclude certain food sources of vitamin D from their diet, but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D (25(OH)D). The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters, fish eaters, vegetarians and vegans. DESIGN: A cross-sectional analysis. SETTING: United Kingdom. SUBJECTS: Plasma 25(OH)D concentrations were measured in 2107 white men and women (1388 meat eaters, 210 fish eaters, 420 vegetarians and eighty-nine vegans) aged 20-76 years from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford cohort. RESULTS: Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and, hence, dietary intake of vitamin D; meat eaters had the highest mean intake of vitamin D (3·1 (95 % CI 3·0, 3·2) µg/d) and mean plasma 25(OH)D concentrations (77·0 (95 % CI 75·4, 78·8) nmol/l) and vegans the lowest (0·7 (95 % CI 0·6, 0·8) µg/d and 55·8 (95 % CI 51·0, 61·0) nmol/l, respectively). The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller (20 %) among those participants who had a blood sample collected during the summer months (July-September) compared with the winter months (38 %; January-March). The prevalence of low plasma concentrations of 25(OH)D (<25 nmol/l) during the winter and spring ranged from <1 % to 8 % across the diet groups. CONCLUSIONS: Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters; diet is an important determinant of plasma 25(OH)D in this British population.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Comportamento Alimentar , Estado Nutricional , Vitamina D/análogos & derivados , Vitamina D/administração & dosagem , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Estudos Transversais , Dieta Vegetariana , Inglaterra , Feminino , Humanos , Masculino , Carne , Pessoa de Meia-Idade , Alimentos Marinhos , Estações do Ano , Vitamina D/sangue , Adulto Jovem
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