Dietary fat intake and risk of type 2 diabetes in women

BACKGROUND: The long-term relations between specific types of dietary fat and risk of type 2 diabetes remain unclear. OBJECTIVE: Our objective was to examine the relations between dietary fat intakes and the risk of type 2 diabetes. DESIGN: We prospectively followed 84204 women aged 34-59 y with no diabetes, cardiovascular disease, or cancer in 1980. Detailed dietary information was assessed at baseline and updated in 1984, 1986, and 1990 by using validated questionnaires. Relative risks of type 2 diabetes were obtained from pooled logistic models adjusted for nondietary and dietary covariates. RESULTS: During 14 y of follow-up, 2507 incident cases of type 2 diabetes were documented. Total fat intake, compared with equivalent energy intake from carbohydrates, was not associated with risk of type 2 diabetes; for a 5% increase in total energy from fat, the relative risk (RR) was 0.98 (95% CI: 0.94, 1.02). Intakes of saturated or monounsaturated fatty acids were also not significantly associated with the risk of diabetes. However, for a 5% increase in energy from polyunsaturated fat, the RR was 0.63 (0.53, 0.76; P < 0.0001) and for a 2% increase in energy from trans fatty acids the RR was 1.39 (1.15, 1.67; P = 0.0006). We estimated that replacing 2% of energy from trans fatty acids isoenergetically with polyunsaturated fat would lead to a 40% lower risk (RR: 0.60; 95% CI: 0.48, 0.75). CONCLUSIONS: These data suggest that total fat and saturated and monounsaturated fatty acid intakes are not associated with risk of type 2 diabetes in women, but that trans fatty acids increase and polyunsaturated fatty acids reduce risk. Substituting nonhydrogenated polyunsaturated fatty acids for trans fatty acids would likely reduce the risk of type 2 diabetes substantially.     

Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials

BACKGROUND: The effects of dietary fats on the risk of coronary artery disease (CAD) have traditionally been estimated from their effects on LDL cholesterol. Fats, however, also affect HDL cholesterol, and the ratio of total to HDL cholesterol is a more specific marker of CAD than is LDL cholesterol. OBJECTIVE: The objective was to evaluate the effects of individual fatty acids on the ratis of total to HDL cholesterol and on serum lipoproteins. DESIGN: We performed a meta-analysis of 60 selected trials and calculated the effects of the amount and type of fat on total:HDL cholesterol and on other lipids. RESULTS: The ratio did not change if carbohydrates replaced saturated fatty acids, but it decreased if cis unsaturated fatty acids replaced saturated fatty acids. The effect on total:HDL cholesterol of replacing trans fatty acids with a mix of carbohydrates and cis unsaturated fatty acids was almost twice as large as that of replacing saturated fatty acids. Lauric acid greatly increased total cholesterol, but much of its effect was on HDL cholesterol. Consequently, oils rich in lauric acid decreased the ratio of total to HDL cholesterol. Myristic and palmitic acids had little effect on the ratio, and stearic acid reduced the ratio slightly. Replacing fats with carbohydrates increased fasting triacylglycerol concentrations. CONCLUSIONS: The effects of dietary fats on total:HDL cholesterol may differ markedly from their effects on LDL. The effects of fats on these risk markers should not in themselves be considered to reflect changes in risk but should be confirmed by prospective observational studies or clinical trials. By that standard, risk is reduced most effectively when trans fatty acids and saturated fatty acids are replaced with cis unsaturated fatty acids. The effects of carbohydrates and of lauric acid-rich fats on CAD risk remain uncertain.     

The role of fat in the diet – quantity,quality and sustainability

Dietary fat should supply at least 15% of food energy including 2.5% energy and 0.5% energy as linoleic acid and alpha‐linolenic acid respectively: docosahexaenoic acid may also need to be supplied in infants. The proportion of energy from fat is not linked to risk of obesity, cardiovascular disease and cancer. The total cholesterol/HDL cholesterol, which is the most robust lipid indicator of risk of coronary heart disease (CHD), is lowered by unsaturated fatty acids, increased by trans fatty acids and not affected by saturated fatty acids compared with carbohydrates. Using clinical outcomes as endpoints, trans fatty acids increase, polyunsaturated fatty acids decrease and monounsaturated and saturated fatty acids have no effect on CHD risk. Recent recommendations for the prevention of CHD suggest partial replacement of saturated with polyunsaturated fatty acids to give energy intakes in the range of 6–11% energy and a daily intake of 0.25 g long‐chain n‐3 polyunsaturated fatty acids. The recommendation to increase the intake of long‐chain n‐3 fatty acids needs to be considered against the backdrop of falling fish stocks; it is likely that a novel source will be needed in the future. The projected growth in world population will require more fat, mainly for food energy. The oil palm requires only one tenth of the land required by oil seeds to produce the same amount of oil. The impact of increased use of vegetable oils as biodiesel needs to be urgently reconsidered owing to the adverse environmental and economic consequences to people living in South East Asia.     

Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes

BACKGROUND: Nutritional therapy is a cornerstone of diabetes management, but no epidemiologic studies have investigated the relation between specific dietary fatty acids and cholesterol and cardiovascular disease (CVD) risk among diabetic patients. OBJECTIVE: This study assessed the relation between specific dietary fatty acids and cholesterol and CVD risk among women with type 2 diabetes. DESIGN: Among 5672 women with type 2 diabetes from the Nurses' Health Study, diet was assessed prospectively and updated periodically. Relative risks of CVD were estimated from Cox proportional hazards analysis after adjustment for potential confounders. RESULTS: Between 1980 and 1998, we identified 619 new cases of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and stroke). The relative risk (RR) of CVD for an increase of 200 mg cholesterol/1000 kcal was 1.37 (95% CI: 1.12, 1.68; P = 0.003). Each 5% of energy intake from saturated fat, as compared with equivalent energy from carbohydrates, was associated with a 29% greater risk of CVD (RR: 1.29; 95% CI: 1.02, 1.63; P = 0.04). The ratio of polyunsaturated to saturated fat (P:S) was inversely associated with the risk of fatal CVD. We estimated that replacement of 5% of energy from saturated fat with equivalent energy from carbohydrates or monounsaturated fat was associated with a 22% or 37% lower risk of CVD, respectively. CONCLUSIONS: A higher intake of cholesterol and saturated fat and a low P:S were related to increased CVD risk among women with type 2 diabetes. Among diabetic persons, replacement of saturated fat with monounsaturated fat may be more effective in lowering CVD risk than is replacement with carbohydrates.     

Diet during early pregnancy and development of gestational diabetes

Diet composition may be a modifiable predictor of risk for abnormal glucose tolerance during pregnancy. Prior studies suggest that diets high in total fat, saturated fat, red and processed meats, and with high glycaemic load increase the risk of developing gestational diabetes mellitus (GDM), while polyunsaturated fats, carbohydrates and fibre are protective. The aim of this study was to investigate associations of these and other nutrients and foods, including n-3 fatty acids, trans fats, whole grains and dietary patterns, with risk of GDM. We studied 1733 women with singleton pregnancies enrolled in Project Viva, a prospective pregnancy and birth cohort study in eastern MA. Using multinomial logistic regression, we examined associations of first trimester diet, assessed by validated food frequency questionnaire, with results of glucose tolerance testing at 26-28 weeks of gestation. A total of 91 women developed GDM and 206 women had impaired glucose tolerance (IGT). Pre-pregnancy body mass index (BMI) was a strong predictor for GDM risk (OR 3.44 [95% CI 1.88, 6.31] for pre-pregnancy BMI > or =30 vs. <25 kg/m(2)). After adjustment for confounders, the OR [95% CI] for risk of GDM for total dietary fat was 1.00 [0.96, 1.05], for saturated fat 0.98 [0.88, 1.08], for polyunsaturated fat 1.09 [0.94, 1.26], for trans fat 0.87 [0.51, 1.49], and for carbohydrates 1.00 [0.96, 1.03] per each 1% of total energy. The adjusted OR [95% CI] for risk of GDM for a one standard deviation increase in energy-adjusted glycaemic load (32 units, about two soft drinks) was 0.96 [0.76, 1.22] and for each daily serving of whole grains was 0.90 [0.73, 1.13]. Dietary patterns and intake of red and processed meats were not predictive of glucose tolerance outcome. Estimates for IGT were similar to those for GDM. Intake of n-3 fatty acids was associated with increased GDM risk (OR 1.11 [95% CI 1.02, 1.22] per each 300 mg/day), but not with IGT risk. Except for this finding, perhaps due to chance, these data do not show that nutrient or food intake in early pregnancy is linked to risk of GDM. Nutritional status entering pregnancy, as reflected by pre-pregnancy BMI, is probably more important than pregnancy diet in development of GDM.     

Dietary intakes of fat and risk of Parkinson's disease

Previous epidemiologic studies have generated inconsistent results regarding the associations between fat intakes and risk of Parkinson's disease. The authors investigated these associations in two large, prospective US cohorts. They documented 191 incident cases of Parkinson's disease in men (1986-1998) and 168 in women (1980-1998) during the follow-up. Overall, intakes of total fat or major types of fat were not significantly associated with the risk. The relative risks comparing the highest quintile of animal fat intake with the lowest were 1.42 for men (95% confidence interval (CI): 0.91, 2.20; p for trend = 0.1) and 0.65 for women (95% CI: 0.36, 1.16; p for trend = 0.3). For men, but not women, replacement of polyunsaturated fat with saturated fat was associated with a significantly increased risk (5% of energy intake, relative risk (RR) = 1.83, 95% CI: 1.10, 3.03). Of the individual polyunsaturated fatty acids, arachidonic acid tended to be inversely associated with the risk (pooled RR between extreme quintiles = 0.65, 95% CI: 0.46, 0.91; p for trend = 0.05). Results do not support an important role of overall fat intake in the pathogenesis of Parkinson's disease, but a possible adverse effect of saturated fat for men could not be excluded.     

Acides gras trans : nature, origine et impact sur la santé

Trans fatty acids include mono- and poly-unsaturated fatty acids having methylene interrupted double bonds. Trans monounsaturated fatty acids are formed during hydrogenation of oils to produce margarine and shortening but are also present in ruminant meat and milk as a result of biohydrogenation in the rumen. The linoleic and a-linolenic acid trans isomers may also be present in non-hydrogenated fats as the result of exposure of these polyunsaturated fatty acids to heat treatment, such as steam deodorization, or deep fat frying in food.Trans monounsaturated isomers are the major trans isomers consumed by humans. Data on trans fatty acids were obtained from nutritional interventions but also from epidemiological studies. For example, a meta analysis of 60 controlled trials published between 1970 to 1998 which included over 1,600 volunteers showed that replacing carbohydrates isoenergetically (1% of total energy) by 18: 1 trans would increase LDL cholesterol while the effect on HDL would be similar. The calculated impact on the ratio of total cholesterol/HDL would be of +0.022nmoles/L (p=0.015). A recent meta analysis of the four larger epidemiological studies showed that increasing the total energy intake with 2% trans fatty acids would result in a 23% increase in cardiovascular disease risk.However, it is essential now to answer the following question: Are trans fatty acids from natural origin have the same effects as those demonstrated for the “industrial ones”. Some studies which are being carried out should give some new information on this important still pending question despite the number of studies so far carried out.     

Diet and basal cell carcinoma of the skin in a prospective cohort of men

BACKGROUND: Low intake of fat and high intake of specific vitamins have been hypothesized to reduce risk of basal cell carcinoma of the skin (BCC). OBJECTIVE: Our objective was to examine intakes of fat, antioxidant nutrients, retinol, folate, and vitamin D in relation to risk of BCC. DESIGN: In 1986, diet was assessed by a validated food-frequency questionnaire in 43217 male participants of the Health Professionals Follow-up Study who were 40-75 y of age and free of cancer. During 8 y of follow-up, we ascertained 3190 newly diagnosed cases of BCC. RESULTS: Total fat consumption was associated with a lower risk of BCC [relative risk (RR): 0.81; 95% CI: 0.72, 0.90 for the highest compared with the lowest quintile of intake; P for trend < 0.001). Simultaneous modeling of specific fatty acids suggested that this inverse association was limited to monounsaturated fat (RR: 0.79; 95% CI: 0.65, 0.96; P for trend = 0. 02); saturated and polyunsaturated fat were not associated with BCC risk. Folate intake was associated with a slightly higher risk of BCC (RR: 1.19; 95% CI: 1.01, 1.40; P for trend = 0.11), whereas alpha-carotene was associated with a slightly lower risk (RR: 0.88; 95% CI: 0.79, 0.99; P for trend = 0.01). Intakes of long-chain n-3 fatty acids, retinol, vitamin C, vitamin D, or vitamin E were not materially related to BCC risk. CONCLUSIONS: These findings do not support the hypothesis that diets low in fat or high in specific vitamins lower risk of BCC.     

Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women

BACKGROUND: Metabolic studies suggest that saturated fatty acids differ in their effects on blood lipids. OBJECTIVE: The objective was to examine the associations between intakes of individual saturated fatty acids and their food sources in relation to the risk of coronary heart disease (CHD). DESIGN: This was a prospective cohort study of 80082 women in the Nurses' Health Study aged 34-59 y. Subjects had no known cardiovascular disease, cancer, hypercholesterolemia, or diabetes, and completed validated food-frequency questionnaires in 1980. RESULTS: During 14 y of follow-up, we documented 939 incident cases of major CHD events. In multivariate analyses in which age, smoking, and other covariates were controlled for, intakes of short- to medium-chain saturated fatty acids (4:0-10:0) were not significantly associated with the risk of CHD. In contrast, intakes of longer-chain saturated fatty acids (12:0-18:0) were each separately associated with a small increase in risk. The multivariate RR for a 1% energy increase from stearic acid was 1.19 (95% CI: 1.02, 1.37). The ratio of polyunsaturated to saturated fat was strongly and inversely associated with CHD risk (multivariate RR for a comparison of the highest with the lowest deciles: 0.58; 95% CI: 0.41, 0.83; P for trend < 0.0001). Conversely, higher ratios of red meat to poultry and fish consumption and of high-fat to low-fat dairy consumption were associated with significantly greater risk. CONCLUSION: A distinction between stearic acid and other saturated fats does not appear to be important in dietary advice to reduce CHD risk, in part because of the high correlation between stearic acid and other saturated fatty acids in typical diets.     

Trans fatty acids: are the effects only marginal?

In the process of converting vegetable oils into solid fats, a process known as partial hydrogenation, some unsaturated bonds are converted to an unnatural trans position. In humans, trans fatty acids increase low-density lipoprotein cholesterol and decrease high-density lipoprotein cholesterol. In addition, positive associations between intake of trans fatty acids and coronary heart disease have been observed in epidemiological studies. The combined results of metabolic and epidemiological studies provide strong evidence that trans fatty acid intake is causally related to risk of coronary disease. Because the consumption of partially hydrogenated fats is almost universal in the United States, the number of deaths attributable to such fats is likely to be substantial. Federal regulations should require manufacturers to include trans fatty acid content in food labels and should aim to greatly reduce or eliminate the use of partially hydrogenated vegetable fats.     

Dietary fat in relation to risk of multiple sclerosis among two large cohorts of women

Ecologic correlations suggest that higher intake of saturated fat and lower intake of polyunsaturated fat might increase the risk of multiple sclerosis (MS), but the results of case-control studies have been inconsistent. Because no prospective data are available, the authors examined these associations in two large cohorts, the Nurses' Health Study, which consisted of 92,422 women with 14 years of follow-up (1980-1994) and the Nurses' Health Study II, which consisted of 95,389 women with 4 years of follow-up (1991-1995). They documented 195 new cases of MS. The pooled multivariate relative risks comparing women in the highest quintile with those in the lowest were 1.1 (95% confidence interval: 0.7, 1.7) for total fat, 0.7 (95% confidence interval: 0.5, 1.2) for animal fat, 1.2 (95% confidence interval: 0.7, 2.1) for vegetable fat, 0.8 (95% confidence interval: 0.5, 1.3) for saturated fat, 1.1 (95% confidence interval: 0.7, 1.7) for monounsaturated fat, 1.7 (95% confidence interval 1.0, 2.8) for n-6 polyunsaturated fat, 1.3 (95% confidence interval: 0.8, 2.0) for trans unsaturated fat, and 0.7 (95% confidence interval: 0.4, 1.1) for cholesterol. Omega-3 fatty acids from fish were also unrelated to risk. However, the authors observed a nonsignificantly lower risk of MS for a higher intake of linolenic acid. These findings do not support relations between intakes of total fat or major specific types of fat and the risk of MS.     

Intake of α-linolenic acid and other fatty acids in relation to the risk of bladder cancer: results from the New Hampshire case-control study

The role of dietary fat in bladder cancer aetiology is currently unclear due to few studies, equivocal findings and a lack of information on important dietary fatty acids. The aim of the present study was to investigate the association between the intake of major dietary fats and fatty acids and the risk of bladder cancer. A case-control study was conducted in New Hampshire, USA. Dietary data were collected from 322 cases and 239 controls, and OR and 95?% CI were calculated using unconditional logistic regression. Adjustment was made for potential confounders: sex, age, smoking status, pack-years smoked, cholesterol and energy intake. Statistically significant reduced odds of bladder cancer were observed for high intakes (highest quartile v. lowest quartile) of α-linolenic acid (ALA) (OR 0·26, 95?% CI 0·10, 0·65; P for trend?=?0·01) and vegetable fat (OR 0·39, 95?% CI 0·18, 0·86; P for trend?=?0·03). Borderline statistically significant reduced odds were detected for polyunsaturated fat (OR 0·43, 95?% CI 0·19, 0·98; P for trend?=?0·07) and linoleic acid (OR 0·43, 95?% CI 0·19, 0·96; P for trend?=?0·06). These fats and fatty acids were highly correlated and following adjustment for each other, the only potential inverse association to remain was for ALA. The present findings suggest that ALA may have a protective role against developing bladder cancer; however, further investigation and replication in other epidemiological studies are required. Future research should focus on the type, source and quantities of different dietary fatty acids consumed.     

Isomeric trans fatty acids in the U.S. diet

Since actual consumption data for trans fatty acid (FA) intakes for the U.S. population do not exist, estimates of trans fatty acids (FAs) available in the U.S. food supply have been calculated from U.S. Department of Agriculture-Economic Research Service (USDA-ERS) fats and oils production figures and food disappearance data for fats and oils. Based on weighted averages for the trans levels in each fats and oils category, these estimates of trans FAs available in the U.S. food supply range from 12.5 to 15.2 g/person/day (average 13.3 +/- 1.1 g/person/day). Estimates of trans FA consumption have been calculated; these estimates predict a wide range from 1.6 to 38.7 g/person/day. These calculations are based on published estimates of trans FAs available in the total fat of 5-15%, and the total fat intake (range 31-258 g/person/day) of a representative sample of adults (ages 20-59) as determined by the Lipid Research Clinics (LRC). Using an equation based on a relationship between trans FAs in adipose tissue and dietary fat, an intake range of 0.7-28.7 g/person/day trans FAs for the same LRC fat consumption data can be predicted. Adipose tissue isomer profiles that indicate 90-95% of the trans FAs in the tissues comes from partially hydrogenated vegetable fats and oils allow us to predict a dietary intake range from 11.1 to 27.6 g/person/day trans FAs. The significance of these estimates to nutrition policy is discussed.     

Isomeric trans fatty acids in the U.S. diet.

Since actual consumption data for trans fatty acid (FA) intakes for the U.S. population do not exist, estimates of trans fatty acids (FAs) available in the U.S. food supply have been calculated from U.S. Department of Agriculture-Economic Research Service (USDA-ERS) fats and oils production figures and food disappearance data for fats and oils. Based on weighted averages for the trans levels in each fats and oils category, these estimates of trans FAs available in the U.S. food supply range from 12.5 to 15.2 g/person/day (average 13.3 +/- 1.1 g/person/day). Estimates of trans FA consumption have been calculated; these estimates predict a wide range from 1.6 to 38.7 g/person/day. These calculations are based on published estimates of trans FAs available in the total fat of 5-15%, and the total fat intake (range 31-258 g/person/day) of a representative sample of adults (ages 20-59) as determined by the Lipid Research Clinics (LRC). Using an equation based on a relationship between trans FAs in adipose tissue and dietary fat, an intake range of 0.7-28.7 g/person/day trans FAs for the same LRC fat consumption data can be predicted. Adipose tissue isomer profiles that indicate 90-95% of the trans FAs in the tissues comes from partially hydrogenated vegetable fats and oils allow us to predict a dietary intake range from 11.1 to 27.6 g/person/day trans FAs. The significance of these estimates to nutrition policy is discussed.     

Coconut fat and serum lipoproteins: effects of partial replacement with unsaturated fats

The aim of the present study was to examine the effect of reducing saturated fat in the diet, or partly replacing it with unsaturated fat, on the serum lipoprotein profile of human subjects. The study had two intervention periods, 8 weeks (phase 1) and 52 weeks (phase 2). In phase 1, total fat was reduced from 31 to 25% energy (polyunsaturated fatty acids (PUFA):saturated fatty acids (SFA) ratio increased from 0.2 to 0.4) by reducing the quantity of coconut fat (CF) in the diet from 17.8 to 9.3% energy intake. In phase 2, subjects were randomised to groups A and B. In group A total fat was reduced from 25 to 20% energy (PUFA:SFA ratio increased from 0.4 to 0.7) by reducing the quantity of CF in the diet from 9.3 to 4.7% total energy intake. In group B, the saturated fat content in the diet was similar to group A. In addition a test fat (a mixture of soyabean oil and sesame oil, PUFA:monosaturated fatty acids ratio 2) contributed 3.3% total energy intake and total fat contributed 24% energy intake (PUFA:SFA ratio increased from 0.7 to 1.1). At the end of phase 1, there was a 7.7% reduction in cholesterol (95% CI -3.6, -12.2) and 10.8% reduction in LDL (95% CI -4.9, -16.5) and no significant change in HDL and triacylglycerol. At the end of phase 2, the reduction in cholesterol in both groups was only about 4% (95% CI -12, 3.2) partly due the concomitant rise in HDL. The reduction in LDL at 52 weeks was significantly higher in group B (group A mean reduction 11%, 95% CI -20.1, -2.0 and group B mean reduction 16.2% 95% CI -23.5, -8.9). In phase 2, triacylglycerol levels showed a mean reduction of 6.5% in group 2A and a mean increase of 8.2% in group 2B. The reduction of saturated fat in the diet is associated with a lipoprotein profile that would be expected to reduce cardiovascular risk. The reduction of dietary saturated fat with partial replacement of unsaturated fat brings about changes in total cholesterol, HDL- and LDL-cholesterol that are associated with a lower cardiovascular risk.     

Saturated fats: what dietary intake?

Public health recommendations for the US population in 1977 were to reduce fat intake to as low as 30% of calories to lower the incidence of coronary artery disease. These recommendations resulted in a compositional shift in food materials throughout the agricultural industry, and the fractional content of fats was replaced principally with carbohydrates. Subsequently, high-carbohydrate diets were recognized as contributing to the lipoprotein pattern that characterizes atherogenic dyslipidemia and hypertriacylglycerolemia. The rising incidences of metabolic syndrome and obesity are becoming common themes in the literature. Current recommendations are to keep saturated fatty acid, trans fatty acid, and cholesterol intakes as low as possible while consuming a nutritionally adequate diet. In the face of such recommendations, the agricultural industry is shifting food composition toward lower proportions of all saturated fatty acids. To date, no lower safe limit of specific saturated fatty acid intakes has been identified. This review summarizes research findings and observations on the disparate functions of saturated fatty acids and seeks to bring a more quantitative balance to the debate on dietary saturated fat. Whether a finite quantity of specific dietary saturated fatty acids actually benefits health is not yet known. Because agricultural practices to reduce saturated fat will require a prolonged and concerted effort, and because the world is moving toward more individualized dietary recommendations, should the steps to decrease saturated fatty acids to as low as agriculturally possible not wait until evidence clearly indicates which amounts and types of saturated fatty acids are optimal?     

Prospective study of diet, lifestyle, and intermittent claudication in male smokers

The association between dietary and lifestyle factors and intermittent claudication was investigated in the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The cohort comprised 26,872 male smokers aged 50-69 years who were free of claudication at study entry. At baseline (1985-1988), subjects completed a diet history questionnaire. During a median follow-up period of 4 years (ending in spring 1993), 2,578 men reported symptoms of claudication on the Rose questionnaire, which was administered annually. Smoking status was assessed every 4 months. Smoking, systolic blood pressure, serum total cholesterol, and diabetes mellitus were positively associated with risk for claudication, whereas serum high density lipoprotein cholesterol, education, and leisure time exercise were inversely associated with risk. Dietary carbohydrates, fiber, and n-6 polyunsaturated fatty acids were inversely associated with risk for claudication, as were some dietary and serum antioxidants: dietary vitamin C (highest quartile vs. lowest: relative risk (RR) = 0.86; 95% confidence interval (CI): 0.77, 0.97), dietary gamma-tocopherol (RR = 0.89; 95% CI: 0.79, 1.00), dietary carotenoids (RR = 0.82; 95% CI: 0.73, 0.92), serum alpha-tocopherol (RR = 0.88; 95% CI: 0.77, 1.00), and serum beta-carotene (RR = 0.77; 95% CI: 0.68, 0.86). Smoking cessation reduced subsequent risk for claudication (RR = 0.86; 95% CI: 0.75, 0.99). The authors conclude that classical risk factors for atherosclerosis are associated with claudication. High intakes of antioxidant vitamins may be protective. Further research is needed before antioxidants can be recommended for the prevention of intermittent claudication.     

Diet during pregnancy and risk of preeclampsia or gestational hypertension

PURPOSE: We sought to examine associations of first-trimester intake of calcium, n-3 and n-6 fatty acids, trans fatty acids, magnesium, folate, and vitamins C, D, and E with preeclampsia (PE) and gestational hypertension (GH). METHODS: We studied associations of diet with PE or GH among 1718 women in the prospective cohort study Project Viva, using logistic regression and adjusting for maternal age, prepregnancy body mass index, first trimester systolic blood pressure, race/ethnicity, education, and parity. We assessed first-trimester diet using a validated semiquantitative food frequency questionnaire. RESULTS: A total of 59 (3%) women developed PE, and 119 developed (7%) GH. We found a somewhat-lower risk of PE associated with higher intake of the elongated n-3 fatty acids docosahexaenoic and eicosapentaenoic acids (odds ratio [OR] 0.84, 95% confidence interval [95% CI]: 0.69-1.03 per 100 mg/day), fish (OR 0.91, 95% CI 0.75-1.09 per serving/day), and the ratio of docosahexaenoic + eicosapentaenoic to arachadonic acid (OR 0.82, 95% CI 0.66-1.01). We did not observe a lower risk of GH or PE with a greater intake of calcium; vitamin C, D, or E; milk; magnesium; folate; or with lower intake of n-6 or trans fatty acids. CONCLUSIONS: Our results support a potential benefit for elongated n-3 fatty acids in preventing preeclampsia.     

Diet and peripheral arterial occlusive disease: the role of poly-, mono-, and saturated fatty acids

A case-control study concerning the association between diet and peripheral arterial occlusive disease was conducted in Athens, Greece. The case series consisted of 100 patients with this disease, whereas controls were 100 patients with conditions requiring minor surgical care who were admitted to the same teaching hospital. Diet was ascertained through a semiquantitative food frequency questionnaire. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a selected typical portion size for each specified food item by the frequency that the food was used per month and summing these estimates for all food items. Data were analyzed using multiple logistic regression procedures, controlling for total energy intake by taking nutrient residuals and by using multivariate nutrient density models. Saturated fatty acids (odds ratio (OR) and 95% confidence interval (CI) contrasting the 75th centile (upper) with the 25th centile = 1.96 and 1.14-3.39), proteins (OR = 2.86, 95% CI 1.47-5.55), and dietary cholesterol (OR = 6.07, 95% CI 2.74-13.46) were associated with increased risk of peripheral arterial occlusive disease, whereas polyunsaturated fatty acids (OR = 0.48, 95% CI 0.24-0.93) and crude fiber (OR = 0.33, 95% CI 0.17-0.64) were related to reduced risk. Monounsaturated fatty acids and, by inference, olive oil occupy an intermediate neutral position between polyunsaturates and saturates (corresponding OR = 1.14, 95% CI 0.68-1.91). Higher intakes of fiber and vitamin C were associated with lower risk of peripheral arterial occlusive disease. The low occurrence of atherosclerotic diseases in Greece and other Mediterranean countries may be due to the substitution of olive oil in place of saturated fats and/or the consumption of a diet high in vegetables, fruits, and other fiber-containing foods.     

Calorie and macronutrients intake in people with spinal cord injuries: an analysis by sex and injury-related variables

ObjectiveCurrent studies suggest that two of every three persons with spinal cord injury are at risk for the metabolic consequences of obesity. The objective of this study was to assess the dietary intakes in people with spinal cord injury based on sex- and injury-related variables.MethodsIn total 162 people with spinal cord injury participated in this cross-sectional study. Their dietary intakes were assessed by a semiquantitative food-frequency questionnaire.ResultsThe percentages of total energy intake derived from macronutrients were 53% carbohydrate, 10% protein, and 37% fat for men and 52% carbohydrate, 11% protein, and 39% fat for women. There was excessive consumption of simple carbohydrates (102.17 ± 40.83). The participants with longer times since injury had lower cholesterol intakes (P = 0.02). The individuals with an incomplete injury consumed significantly more monounsaturated fatty acids (n = 114, 27.2 ± 12.01 g) than those with a complete injury (n = 48, 23.6 ± 8.08 g, P = 0.03). There was a significant positive correlation of age and time since injury with fiber intake (P < 0.05).ConclusionThe balance of macronutrients shifted toward intakes of fat and simple carbohydrates at the expense of complex carbohydrates, fiber, and protein in these participants. Mean amounts of polyunsaturated and monounsaturated fatty acids in these participants were above the recommended intakes. Older participants and those with a longer time since injury tended to have lower calorie, fat, carbohydrate, saturated fat, and cholesterol intakes and higher fiber intakes.