Usual Cruciferous Vegetable Consumption and Ovarian Cancer: A Case-Control Study

Ovarian cancer is the fifth leading cause of cancer-related deaths among women, primarily due to diagnosis at late stages. Therefore, identification of modifiable risk factors for this disease is warranted. Using the Patient Epidemiology Data System (PEDS), collected from 1981 to 1998 at Roswell Park Cancer Institute, Buffalo, NY, we conducted a hospital-based, case-control analysis of self-reported cruciferous vegetable intake and ovarian cancer among 675 women with primary, incident ovarian cancer, and 1275 without cancer. Cruciferous vegetable intake was queried using a 44-item food frequency questionnaire (FFQ). Odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression, adjusting for age, body mass index (BMI), education, smoking status, parity, family history of ovarian cancer, total fruit consumption, total meat consumption, and total noncruciferous vegetable consumption. We observed a significant inverse association for women with highest vs. lowest intakes of total vegetables (OR = 0.65, 95% CI = 0.46–0.92), cooked cauliflower (OR = 0.82, 95% CI = 0.67–0.99), and cooked greens (OR = 0.63, 95% CI = 0.46–0.86) and an inverse, dose-dependent association between cooked cruciferous vegetables intake and ovarian cancer (for each additional ten servings per month, OR = 0.85, 95% CI = 0.76–0.96). These findings suggest that a diet that includes cruciferous vegetables could be an important modifiable risk factor for ovarian cancer.     

Vegetable Consumption Is Linked to Decreased Visceral and Liver Fat and Improved Insulin Resistance in Overweight Latino Youth

There are limited data on the influence of vegetable consumption on adiposity and metabolic health, specifically nonstarchy vegetables and vegetables that are dark green and deep orange/yellow (also known as nutrient-rich vegetables). Our study examines the relationship between vegetable intake and adiposity, liver fat, and insulin dynamics in overweight Latino youth. This cross-sectional study of 175 overweight (body mass index ≥85th percentile) Latino youth (aged 8 to 18 years), with data collected during 2006-2011, included the following: dietary intake via multiple 24-hour recalls, total body fat via dual-energy x-ray absorptiometry, adipose tissue distribution and liver fat via magnetic resonance imaging, and insulin dynamics via frequently sampled intravenous glucose tolerance test. Linear regression and analysis of covariance were used for analysis, with the following a priori covariates: age, sex, energy intake, and total body fat. Participants who consumed the most nonstarchy vegetables (mean intake=1.7±1.0 servings/day) compared with the least (mean intake=0.1±0.1 servings/day) had 44% less liver fat (10.0%±8.5% vs 5.6%±8.7%; P=0.01). Nutrient-rich vegetable intake was positively correlated with insulin sensitivity (r=0.19; P=0.03). Consumers of nutrient-rich vegetables (mean intake=0.3±0.4 servings/day [n=107]), compared with nonconsumers (n=68), had 31% increased insulin sensitivity (1.6±1.6 vs 2.1±1.3×10^–4/min/μU/mL; P=0.03) and 17% less visceral adipose tissue (2.3±0.9 vs 1.9±0.7 L; P=0.01). Consumption of specific vegetable types by overweight Latino youth is associated with positive metabolic outcomes, including reduced visceral and liver fat and risk factors for type 2 diabetes, even when consumed in small quantities. These may be relevant targets for interventions.     

Meat consumption and risk of stomach cancer in Uruguay: a case-control study

We previously reported an association between meat intake and stomach cancer in Uruguay: in that analysis, we did not control for total energy intake. To better study the relationship between intake of meat and meat constituents and gastric cancer, we conducted a further case-control study including 123 cases and 282 controls who were enrolled between September 1997 and August 1999. Total meat intake (highest tertile) was associated with an odds ratio (OR) of 4.6 [95% confidence interval (CI) = 2.3-9.0]. After adjustment for total energy intake and intake of proteins and total fat by the residuals method, the OR was 1.7 (95% CI = 0.7-4.0). The energy-adjusted OR for high intake of processed meat was 1.9 (95% CI = 1.1-3.5). Intake of fried, barbecued, and salted meat and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine was not associated with risk of gastric cancer. The energy-adjusted OR of high intake of nitrosodimethylamine was 1.5 (95% CI = 0.9-2.8). These results suggest that, in a country with elevated meat consumption, total energy intake and intake of proteins and fat are powerful confounders in the relationship between meat intake and gastric cancer risk. However, a modest independent effect of meat, in particular of processed meat, is suggested.     

Longitudinal changes in BMI in older adults are associated with meat consumption differentially, by type of meat consumed

Hypotheses regarding the role of meat consumption in body weight modulation are contradictory. Prospective studies on an association between meat consumption and BMI change are limited. We assessed the association between meat consumption and change in BMI over time in 3902 men and women aged 55-69 y from the Netherlands Cohort Study. Dietary intake was estimated at baseline using a FFQ. BMI was ascertained through baseline self-reported height (1986) and weight (1986, 1992, and 2000). Analyses were based on sex-specific categories of daily total fresh meat, red meat, beef, pork, minced meat, chicken, processed meat, and fish consumption at baseline. Linear mixed effect modeling adjusted for confounders was used to assess longitudinal associations. Significant cross-sectional differences in BMI between quintiles of total meat intake were observed (P-trend < 0.01; both sexes). No association between total fresh meat consumption and prospective BMI change was observed in men (BMI change highest vs. lowest quintile after 14 y: -0.06 kg/m2; P = 0.75) and women (BMI change: 0.26 kg/m2; P = 0.20). Men with the highest intake of beef experienced a significantly lower increase in BMI after 6 and 14 y than those with the lowest intake (BMI change after 14 y 0.60 kg/m2). After 14 y, a significantly higher increase in BMI was associated with higher intakes of pork in women (BMI change highest vs. lowest quintile: 0.47 kg/m2) and chicken in both sexes (BMI change highest vs. lowest category in both men and women: 0.36 kg/m2). The results remained similar when stratifying on median baseline BMI, and age-stratified analyses yielded mixed results. Differential BMI change effects were observed for several subtypes of meat. However, total meat consumption, or factors directly related to total meat intake, was not strongly associated with weight change during the 14-y prospective follow-up in this elderly population.     

Dietary Red and Processed Meat Intake and Markers of Adiposity and Inflammation: The Multiethnic Cohort Study

Objective: The potential influence of dietary factors on inflammation is important for cancer prevention. Utilizing data from control participants (312 men, 911 women) in 2 nested case–control studies of cancer within the Multiethnic Cohort, we examined the associations of red and processed meat intake with serum levels of leptin, adiponectin, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 and the mediator effect of body mass index (BMI) on the above associations (if present).

Methods: Multivariable linear models were applied to assess the association between red and processed meat intake at cohort entry and serum biomarker levels measured 9.1 years later after adjusting for covariates and to determine the mediator effect of BMI.

Results: Overall red and processed meat intake was positively associated with serum leptin levels in men (β = 0.180, p = 0.0004) and women (β = 0.167, p < 0.0001). In women, higher red and processed meat consumption was significantly associated with higher CRP (β = 0.069, p = 0.03) and lower adiponectin levels (β = ?0.082, p = 0.005). In mediation analyses with red and processed meat intake and BMI as predictors, the associations of red and processed meat with biomarkers decreased substantially (as indicated by percentage change in effect: leptin in men, 13.4%; leptin in women, 13.7%; adiponectin in women, ?4.7%; CRP in women, 7.4%) and were no longer significant (p > 0.05), whereas BMI remained significantly associated with serum leptin (men: β = 3.209, p < 0.0001; women: β = 2.891, p < 0.0001), adiponectin (women: β = ?1.085, p < 0.0001), and CRP (women: β = 1.581, p < 0.0001).

Conclusion: The current data suggest that the amount of excess body weight or the degree of adiposity may mediate the relations between dietary red and processed meat intake and serum biomarkers associated with obesity and inflammation.     

Association of Calcium Intake and Adiposity in Postmenopausal Women

Objective: The purpose of this study was to examine the relationship between calcium intake and 1) body composition and 2) body fat distribution in postmenopausal women.

Methods: Archived data from a previous study including forty-nine Caucasian women, aged 51–73 and at least three years postmenopausal, were used for analysis. Data included medical and diet history from a questionnaire, average nutrient intake from computerized analysis of a 3-day diet record, anthropometric measures including height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Calcium intake represented both food and supplement sources of calcium. Lean and fat mass were determined from dual energy x-ray absorptiometry (DXA) total body scans, and abdominal fat mass was defined as fat mass between the top of the iliac crest and L1 on the DXA scan.

Results: Subjects were 60.5 ± 0.9 y/o with an average BMI of 26.9 ± 0.7 and percent body fat of 42.8 ± 1.2. Average calcium intake was 1151 ± 83 g/d. There was a significant inverse relationship between calcium intake and percent body fat (r = ?0.36, p < 0.01) and abdominal fat mass (r = ?0.25, p < 0.05), but there was no significant correlation between calcium intake and body mass index, fat mass, lean mass, waist circumference, or WHR. When kcalories were controlled, the inverse correlation between dietary calcium intake and percent body fat remained (r = ?0.24, p < 0.05). Total fat was significantly greater (p < 0.05) in the low dairy intake (1–2 servings/d) vs. high dairy intake group (3–4 servings/d), but there were no significant differences between the groups in other body composition variables.

Conclusions: Increased calcium intake was associated with lower percent body fat and higher dairy intake was associated with lower fat mass in postmenopausal women, but there was no association between calcium intake and body fat distribution measures in this population.     

Whole grain intake and its cross-sectional association with obesity, insulin resistance, inflammation, diabetes and subclinical CVD: The MESA Study

We examined the relationship between whole grain intake and obesity, insulin resistance, inflammation, diabetes and subclinical CVD using baseline data from the Multi-Ethnic Study of Atherosclerosis. Whole grain intake was measured by a 127-item FFQ in 5496 men and women free of CHD and previously known diabetes. Mean whole grain intake was 0.5 (sd 0.5) servings per d; biochemical measures reflect fasting levels. After adjustment for demographic and health behaviour variables, mean differences for the highest quintile of whole grain intake minus the lowest quintile of intake were 0.6 kg/m2 for BMI, 0.36 mg/l for C-reactive protein, 0.82 micromol/l for homocysteine, 0.15 mU/l*mmol/l for homeostasis model assessment (HOMA), 0.48 mU/l for serum insulin, 2.0 mg/dl for glucose and 5.7 % for prevalence of newly diagnosed impaired fasting glucose (glucose >or= 100 mg/dl or diabetes medication). These differences represent 11-13 % of a standard deviation of BMI, HOMA, glucose and impaired fasting glucose, but 23 %, 52 % and 80 % of a standard deviation of homocysteine, C-reactive protein and insulin, respectively. An inverse association between whole grains and urine albumin excretion was suggested but retained statistical significance after adjustment only in Chinese and Hispanic participants. No associations were observed between whole grain intake and two subclinical disease measures: carotid intima-media thickness and coronary artery calcification. Concordant with previous research, whole grain intake was inversely associated with obesity, insulin resistance, inflammation and elevated fasting glucose or newly diagnosed diabetes. Counter to hypothesis, however, whole grain intake was unrelated to subclinical CVD.     

Whole grain intake is associated with lower body mass and greater insulin sensitivity among adolescents

The authors tested the hypothesis that consumption of whole grain is associated with greater insulin sensitivity and lower body mass index (BMI) (weight (kg)/height (m)(2)) in adolescents and that this association is stronger among the heaviest adolescents. Two 127-item food frequency questionnaires were administered at the mean ages of 13 years (standard deviation 1.2) and 15 years (standard deviation 1.3) to 285 Minnesota adolescents who underwent two euglycemic insulin clamp studies 2 years apart as part of a protocol evaluating the influence of insulin resistance on development of adverse cardiovascular disease risk factors. Intake of whole grain was examined for associations with BMI and insulin sensitivity (measured as milligrams of glucose uptake per kilogram of lean body mass (M(lbm)) per minute). After adjustment for age, gender, race, Tanner stage, and energy intake, mean BMI was 23.6 for adolescents consuming less than serving/day of whole-grain foods, 22.6 for -1 servings/day, and 21.9 for more than 1 servings/day (p = 0.05). After adjustment for age, gender, race, Tanner stage, energy intake, BMI, and physical activity, M(lbm) was 11.6, 12.3, and 13.2 mg/kg/minute, respectively, in the three whole grain intake groups (p = 0.02). This relation was stronger among adolescents with higher BMIs (p = 0.001). Whole grain intake was associated with greater insulin sensitivity and lower BMI in adolescents, especially among the heaviest persons.     

Associations of red and processed meat intake with major molecular pathological features of colorectal cancer

Red and processed meat is an established risk factor for colorectal cancer (CRC). However, exact mechanisms to explain the associations remain unclear. Few studies have investigated the association with CRC by molecular tumor features, which could provide relevant information on associated molecular pathways. In this population-based case–control study from Germany (DACHS), 2449 cases and 2479 controls provided information on risk factors of CRC and completed a food frequency questionnaire. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between meat intake and risk of CRC by molecular pathologic features and specific subtypes. Red and processed meat intake was associated with increased risk of colorectal (>1 time/day vs ≤1 time/week OR 1.66, 95% CI 1.34–2.07), colon and rectal cancer. Among the single molecular tumor features investigated, the results were similar for associations of red and processed meat with CRC risk by microsatellite instability, CpG island methylator phenotype, BRAF, oestrogen receptor-β and p53 status. Red and processed meat intake was associated less strongly with risk of KRAS-mutated CRC (OR >1 time/day vs ≤1 time/week: 1.49, 95% CI 1.09–2.03) than with risk of KRAS-wildtype CRC (OR 1.82, 95% CI 1.42–2.34; p _{heterogeneity} 0.04). These results support an association between red and processed meat and CRC risk similar for subsites of CRC and most of the investigated major molecular pathological features. Potential differences were observed in more specific subtype analyses. Further large studies are needed to confirm these results and to help further elucidate potential underlying mechanisms.     

Processed Meat and Risk of Renal Cell and Bladder Cancers

We assessed the association of processed meat intake with the risk of renal cell carcinoma (RCC) and bladder cancer. We used data from two Italian hospital-based case-control studies, including 1,115 RCC cases and 2,582 controls, and 1,417 bladder cancer cases and 1,732 controls. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) with unconditional logistic regression models, adjusted for major confounders. The median consumption of processed meat in cases and controls was around 2 portions/week (50 g/portion). The ORs for a daily 10 g increment of processed meat was 0.89 (95% CI 0.84–0.94) for RCC and 1.00 (95% CI 0.94–1.06) for bladder cancer. The OR for the highest vs. the lowest consumption was 0.80 (95% CI 0.66–0.96) for RCC and 0.98 (95% CI 0.80–1.21) for bladder cancer. The ORs were consistent in strata of various covariates. For bladder cancer, however, a significant 23% excess risk was found in women (95% CI 1.03–1.47) for a daily increase of 10 g, significantly heterogeneous from the risk recorded in men (OR 0.96, 95% CI 0.90–1.02). The inconsistent results between men and women and the absence of association in both sexes combined indicate that the apparent association between processed meat and bladder cancer in women is unlikely to be causal.     

Consumption of red and processed meat and risk for esophageal squamous cell carcinoma based on a meta-analysis

PurposeTo provide a quantitative assessment of the association between red and processed meat intake and the risk of esophageal squamous cell carcinoma (ESCC), we summarized the evidence from observational studies.MethodsRelevant studies were identified in MEDLINE and EMBASE until October 31, 2012. Summary relative risks with 95% confidence intervals (CIs) were pooled with high versus low and linear dose-response random-effects models.ResultsA total of 21 studies (19 case-control and two cohort studies) with 6499 ESCC cases were included in this meta-analysis. Based on high versus low analysis, the summary relative risks of ESCC were 1.57 (95% CI, 1.26–1.95; P_{heterogeneity} = .003, I² = 56.0%) for red meat intake and 1.55 (95% CI, 1.22–1.97; P_{heterogeneity} = .029, I² = 45.3%) for processed meat intake. Subgrouped and sensitivity analyses revealed that the increment of ESCC risk with intakes of red meat and processed meat was stable and robust. These results are consistent with the results of the dose-response analyses. There was evidence of a nonlinear association of processed meat intake and ESCC risk (P_nonlinearity = .019).ConclusionsIntake of red and processed meat may be associated with significantly increased risk of ESCC. Further investigations with prospective designs are warranted.     

The impact of supervised weight loss and intentional weight regain on sex hormone binding globulin and testosterone in premenopausal women

What is the impact of intentional weight loss and regain on serum androgens in women? We conducted an ancillary analysis of prospectively collected samples from a randomized controlled trial. The trial involved supervised 10% weight loss (8.5 kg on average) with diet and exercise over 4-6 months followed by supervised intentional regain of 50% of the lost weight (4.6 kg on average) over 4-6 months. Participants were randomized prior to the partial weight regain component to either continuation or cessation of endurance exercise. Analytic sample included 30 obese premenopausal women (mean age of 40 ± 5.9 years, mean baseline body mass index (BMI) of 32.9 ± 4.2 kg/m²) with metabolic syndrome. We evaluated sex hormone binding globulin (SHBG), total testosterone (T), free androgen index (FAI), and high molecular weight adiponectin (HMWAdp). Insulin, homeostasis model assessment (HOMA), and quantitative insulin sensitivity check index (QUICKI), and visceral adipose tissue (VAT) measured in the original trial were reanalyzed for the current analytic sample. Insulin, HOMA, and QUICKI improved with weight loss and were maintained despite weight regain. Log-transformed SHBG significantly increased from baseline to weight loss, and then significantly decreased with weight regain. LogFAI and logVAT decreased similarly and increased with weight loss followed by weight regain. No changes were found in logT and LogHMWAdp. There was no significant difference in any tested parameters by exercise between the groups. SHBG showed prominent sensitivity to body mass fluctuations, as reduction with controlled intentional weight regain showed an inverse relationship to VAT and occurred despite stable HMWAdp and sustained improvements with insulin resistance. FAI showed opposite changes to SHBG, while T did not change significantly with weight. Continued exercise during weight regain did not appear to impact these findings.     

Macronutrient Intake as a Mediator with FTO to Increase Body Mass Index

Background: The fat mass and obesity-associated (FTO) single nucleotide polymorphisms (SNPs; rs1421085, rs17817449, rs9939609, rs8050136) and macronutrient intake (carbohydrate, protein, fat, total calories) are associated with body mass index (BMI). However, the mechanism for this relationship has not been fully elucidated.

Objective: This study examined whether macronutrient intake mediates the association between FTO SNPs and BMI.

Design: Baseline cross-sectional data from the Atherosclerosis Risk in Communities (ARIC) study of whites (n = 10,176) and African Americans (n = 3641) aged 45 to 64 years were analyzed.

Results: In linear regression models with BMI as the dependent variable, FTO SNPs were significantly associated with higher BMI after adjusting for covariates. The addition of energy-adjusted macronutrients attenuated the FTO effect estimates, indicating partial mediation. In whites, β ranged from 0.40 (95% confidence interval [CI], 0.20, 0.60) for rs17817449 heterozygous carriers to 0.93 (95% CI, 0.64, 122) for rs8050136 homozygous carriers; for African Americans rs17817449 homozygous carriers β was 0.65 (95% CI, 0.03, 1.27). In models with macronutrient intake as the dependent variable, all FTO SNPs were associated with higher protein intake for homozygous carriers after adjusting for BMI and other covariates. Among whites, β ranged from 1.44 (95% CI, 0.51, 2.37) for rs8050136 to 1.73 (95% CI, 0.85, 2.61) for rs17817449; among African American rs8050136 homozygous carriers β was 2.46 (95% CI, 0.77, 4.14). In mediation analysis, in whites only, FTO high-risk alleles were associated with higher BMI partly through their small effects on carbohydrate and protein intake.

Conclusions: These findings suggest that in adults, the relationship between FTO variants and BMI is not primarily through mediation of food intake.     

Milk intakes are not associated with percent body fat in children from ages 10 to 13 years

Epidemiologic studies report conflicting results for the relationship between milk intake and adiposity in children. We examined prospective and cross-sectional associations between milk intake and percent body fat among 2245 children from the Avon Longitudinal Study of Parents and Children. Cross-sectional analyses were performed at age 13 y between total, full-fat, and reduced-fat milk intake assessed using 3-d dietary records and body fat from DXA. Prospective analyses were conducted between milk intakes at age 10 y and body fat at 11 and 13 y. Models were adjusted for age, sex, height, physical activity, pubertal status, maternal BMI, maternal education, and intakes of total fat, sugar-sweetened beverages, 100% fruit juice, and ready-to-eat cereals; baseline BMI was added to prospective models. Subset analyses were performed for those with plausible dietary intakes. Mean milk consumption at 10 and 13 y was (mean ± SD) 0.90 ± 0.73 and 0.85 ± 0.78 servings/d [1 serving = 8 oz of milk (244 g of plain and 250 g flavored milk)], respectively. Cross-sectional results indicated an inverse association between full-fat milk intake and body fat [β = -0.47 (95% CI = -0.76, -0.19); P = 0.001]. Milk intake at age 10 y was inversely associated with body fat at 11 y [β = -0.16 g/d (95%CI = -0.28, -0.04); P = 0.01], but not among those with plausible dietary intakes, suggesting that this association was influenced by dietary measurement errors. Milk intake was not associated with body fat at age 13 y after adjustment. Although our prospective results corroborate other findings of a null associations between milk intake and adiposity, our inconsistent findings across analyses suggest further investigation is needed to clarify the relation, and accounting for dietary reporting errors is an important consideration.     

Meat intake and bladder cancer risk in 2 prospective cohort studies

BACKGROUND: Nitrosamines, which are known bladder carcinogens, or their precursors are found in certain meat items, and concentrations of these compounds are especially high in bacon. Only 3 cohort studies, all with <100 case subjects, have examined the relation between meat intake and bladder cancer, and few studies have examined the relation of different meat types with bladder cancer. OBJECTIVE: The aim was to examine the association between specific meat items and bladder cancer in 2 large prospective studies. DESIGN: We analyzed data from 2 cohorts with up to 22 y of follow-up and 808 incident bladder cancer cases. Detailed data on meat were obtained from multiple food-frequency questionnaires administered over time. Multivariate relative risks (RRs) and 95% CIs were estimated by using Cox proportional hazards models with control for potential confounders, including detailed smoking history. RESULTS: Men and women with a high intake of bacon (>/=5 servings/wk) had an elevated risk of bladder cancer compared with those who never ate bacon (multivariate RR = 1.59; 95% CI = 1.06, 2.37), although the overall association was not statistically significant (P for trend = 0.06). However, the association with bacon was stronger and became statistically significant after the removal of individuals who indicated having "greatly" changed their red meat (men) or bacon (women) intake during the 10 y before baseline (multivariate RR = 2.10; 95% CI = 1.24, 3.55; P for trend = 0.006). A positive association was also detected for intake of chicken without skin, but not for chicken with skin or for other meats, including processed meats, hot dogs, and hamburgers. CONCLUSIONS: In these 2 cohorts combined, frequent consumption of bacon was associated with an elevated risk of bladder cancer. Other studies with data on specific meat items are necessary to confirm our findings.     

Oily Fish Intake and Cognitive Performance in Community-Dwelling Older Adults: The Atahualpa Project

Due to their high content of omega-3 polyunsaturated fatty acids, oily fish consumption is likely associated with a better cognitive performance. However, information on this association is controversial, with some studies showing a positive effect while others showing no association. We aimed to assess the effects of oily fish consumption on cognitive performance in a population of frequent fish consumers living in rural coastal Ecuador. Atahualpa residents aged ≥60 years were identified during a door-to-door survey and evaluated by the use of the Montreal Cognitive Assessment (MoCA). Oily fish servings per week were calculated in all participants. We estimated whether fish intake correlated with MoCA scores in generalized multivariate linear models adjusted for demographics, cardiovascular risk factors, edentulism and symptoms of depression. Out of 330 eligible persons, 307 (93 %) were enrolled. Mean MoCA scores were 19 ± 4.8 points, and mean oily fish consumption was 8.6 ± 5.3 servings per week. In multivariate analyses, MoCA scores were related to fish servings (β 0.097, 95 % CI 0.005–0.188, p = 0.038). Locally weighted scatterplot smoothing showed an inflection point in the total MoCA score curve at four fish servings per week. However, predictive margins of the MoCA score were similar across groups below and above this point, suggesting a direct linear relationship between oily fish intake and cognitive performance. Simple preventive measures, such as modifying dietary habits might be of value to reduce the rate of cognitive decline in community-dwelling older adults living in underserved populations.     

Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study

BACKGROUND: Increased intake of whole-grain foods has been related to a reduced risk of developing diabetes and heart disease. One underlying pathway for this relation may be increased insulin sensitivity. OBJECTIVE: We assessed the relation between dietary intake of whole grain-containing foods and insulin sensitivity (S(I)). DESIGN: We evaluated data from the Insulin Resistance Atherosclerosis Study (IRAS Exam I, 1992-1994). Usual dietary intakes in 978 middle-aged adults with normal (67%) or impaired (33%) glucose tolerance were ascertained by using an interviewer-administered, validated food-frequency questionnaire. Whole-grain intake (servings per day) was derived from dark breads and high-fiber and cooked cereals. S(I) was assessed by minimal model analyses of the frequently sampled intravenous-glucose-tolerance test. Fasting insulin was measured by using a radioimmunoassay. We modeled the relation of whole-grain intake to log(S(I) + 1) and to log(insulin) by using multivariable linear regression. RESULTS: On average, IRAS participants consumed 0.8 servings of whole grains/d. Whole-grain intake was significantly associated with S(I) (beta = 0.082, P = 0.0005) and insulin (beta = -0.0646, P = 0.019) after adjustment for demographics, total energy intake and expenditure, smoking, and family history of diabetes. The addition of body mass index and waist circumference attenuated but did not explain the association with S(I). The addition of fiber and magnesium resulted in a nonsignificant association that is consistent with the hypothesis that these constituents account for some of the effect of whole grains on S(I). CONCLUSION: Higher intakes of whole grains were associated with increases in insulin sensitivity.     

Dietary fiber reduces peripheral arterial disease risk in men

We prospectively evaluated the relationship between dietary fiber and peripheral arterial disease risk (PAD) among 46,032 men, aged 40 to 75 y, in 1986. Subjects answered a vascular disease questionnaire and completed a validated 131-item food frequency questionnaire, and were free of PAD, cardiovascular disease and diabetes. During 12 y of follow-up 308 incident PAD cases were documented. After adjusting for age, smoking, hypertension, hypercholesterolemia, family history of early coronary heart disease, alcohol consumption, BMI, physical activity and energy intake, PAD risk in each quintile of cereal fiber intake compared with the lowest quintile was 0.69, 95% CI 0.49-0.97 for quintile 2; 0.65, 95% CI 0.45-0.94 for quintile 3; 0.68, 95% CI 0.47-0.98 for quintile 4; and 0.67, 95% CI 0.47-0.97 for quintile 5. In a nonlinear model the overall inverse association (P = 0.02) and nonlinear components (P = 0.03) were significant. Fruit, vegetable and total fiber intakes were not associated with PAD risk. These results suggest an inverse association between cereal fiber intake and PAD risk in men. Increasing cereal fiber intake may prevent PAD.     

Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians' Health Study

BACKGROUND: Previous studies of diet and coronary heart disease (CHD) have focused on intake of nutrients rather than whole foods. Because of the findings that dietary fibre, folate and antioxidants may be protective for CHD, increased intake of vegetables has been recommended. However, due to the chemical and physical complexity of vegetables, the effects of individual nutrients may differ if eaten as whole foods. Moreover, little is known about the direct association between vegetable intake and risk of CHD. METHODS: We prospectively evaluated the relation between vegetable intake and CHD risk in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among 22 071 US male physicians aged 40-84 years in 1982. In this analysis, we included 15 220 men without heart disease, stroke or cancer at baseline who provided information on their vegetable intake at baseline, and in the 2nd, 4th and 6th years of follow-up using a simple semiquantitative food frequency questionnaire including eight vegetables. We confirmed 1148 incident cases of CHD (387 incident cases of myocardial infarction and 761 incident cases of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty) during 12 years of follow-up. RESULTS: After adjusting for age, randomized treatment, body mass index (BMI), smoking, alcohol intake, physical activity, history of diabetes, history of hypertension, history of high cholesterol, and use of multivitamins, men who consumed at least 2.5 servings/day of vegetables had a relative risk (RR) of 0.77 (95% CI : 0.60-0.98) for CHD, compared with men in the lowest category (<1 serving/day). Adjusting for the same covariates in an analysis of the overall trend that considered intake of vegetables as a continuous variable, we found a RR of 0.83 (95% CI : 0.71-0.98) for risk of CHD for each additional serving/day of vegetables. The inverse relation between vegetable intake and CHD risk was more evident among men with a BMI > or =25 (RR = 0.71, 95% CI : 0.51-0.99) or current smokers (RR = 0.40, 95% CI : 0.18-0.86) comparing highest to the lowest categories of intake. CONCLUSIONS: Our results suggest an inverse association between vegetable intake and risk of CHD. These prospective data support current dietary guidelines to increase vegetable intake for the prevention of CHD.     

Association between dietary flavonoids intake and obesity in a cohort of adults living in the Mediterranean area

Abstract

Dietary polyphenols, including flavonoids, are abundantly present in a healthy and balanced diet. Evidence for their role in preventing non-communicable diseases is emerging. We examined the association between estimated habitual intake of dietary flavonoid and obesity in a cohort study. After adjusting for potential confounding factors, inverse association between total flavonoid intake and excess weight (BMI?≥25) was found (OR?=?0.66, 95% CI: 0.45, 0.99); among individual classes of flavonoids, only flavanones were inversely associated with excess body weight (OR?=?0.68, 95% CI: 0.48, 0.97). However, when considering adjustment for dietary factors (adherence to the Mediterranean diet), the associations were no more significant. When considering obesity as the outcome (BMI?≥30), individuals with high intake of total flavonoids and flavonols resulted less likely to be obese (OR?=?0.38, 95% CI: 0.21, 0.66 and OR?=?0.63, 95% CI: 0.39, 0.99, respectively), even after adjustment for confounding factors. The results of the present study add to the current literature further evidence of the association between higher flavonoid intake and decreased body weight. Further studies are needed to confirm retrieved association.