Cereal,fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals

Context  People older than 65 years are the fastest-growing segment of the population and account for the majority of cardiovascular disease (CVD) morbidity, mortality, and health care expenditures. Additionally, the influence of dietary habits on risk may be less pronounced in elderly persons, when atherosclerosis is more advanced. However, few data address the influence of diet on CVD risk in this population. Objective  To determine whether fiber consumption from fruit, vegetable, and cereal sources (including whole grains and bran) is associated with incident CVD in elderly persons. Design  Prospective cohort study conducted from 1989 to June 2000. Setting and Participants  Population-based, multicenter study among 3588 men and women aged 65 years or older and free of known CVD at baseline in 1989-1990. Usual dietary fiber consumption was assessed at baseline (mean participant age, 72 years) using a 99-item food frequency questionnaire. Main Outcome Measure  Incident CVD (combined stroke, ischemic heart disease death, and nonfatal myocardial infarction). Results  During 8.6 years mean follow-up, there were 811 incident CVD events. After adjustment for age, sex, education, diabetes, ever smoking, pack-years of smoking, daily physical activity, exercise intensity, alcohol intake, and fruit and vegetable fiber consumption, cereal fiber consumption was inversely associated with incident CVD (P for trend = .02), with 21% lower risk (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.62-0.99) in the highest quintile of intake, compared with the lowest quintile. In similar analyses, neither fruit fiber intake (P for trend = .98) nor vegetable fiber intake (P for trend = .95) were associated with incident CVD. When CVD events were separately evaluated, higher cereal fiber intake was associated with lower risk of total stroke and ischemic stroke and a trend toward lower risk of ischemic heart disease death. In a post hoc analysis, dark breads such as wheat, rye, or pumpernickel were associated with a lower risk of incident CVD (HR, 0.76; 95% CI, 0.64-0.90) rather than cereal fiber from other sources. Conclusions  Cereal fiber consumption late in life is associated with lower risk of incident CVD, supporting recommendations for elderly individuals to increase consumption of dietary cereal fiber.      

Fruit and vegetable intake in relation to risk of ischemic stroke.

CONTEXT: Few studies have evaluated the relationship between fruit and vegetable intake and cardiovascular disease. OBJECTIVE: To examine the associations between fruit and vegetable intake and ischemic stroke. DESIGN, SETTING, AND SUBJECTS: Prospective cohort studies, including 75 596 women aged 34 to 59 years in the Nurses' Health Study with 14 years of follow-up (1980-1994), and 38683 men aged 40 to 75 years in the Health Professionals' Follow-up Study with 8 years of follow-up (1986-1994). All individuals were free of cardiovascular disease, cancer, and diabetes at baseline. MAIN OUTCOME MEASURE: Incidence of ischemic stroke by quintile of fruit and vegetable intake. RESULTS: A total of 366 women and 204 men had an ischemic stroke. After controlling for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake (median of 5.1 servings per day among men and 5.8 servings per day among women) had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.52-0.92) compared with those in the lowest quintile. An increment of 1 serving per day of fruits or vegetables was associated with a 6% lower risk of ischemic stroke (RR, 0.94; 95 % CI, 0.90-0.99; P =.01, test for trend). Cruciferous vegetables (RR, 0.68 for an increment of 1 serving per day; 95% CI, 0.49-0.94), green leafy vegetables (RR, 0.79; 95% CI, 0.62-0.99), citrus fruit including juice (RR, 0.81; 95% CI, 0.68-0.96), and citrus fruit juice (RR, 0.75; 95% CI, 0.61-0.93) contributed most to the apparent protective effect of total fruits and vegetables. Legumes or potatoes were not associated with lower ischemic stroke risk. The multivariate pooled RR for total stroke was 0.96 (95% CI, 0.93-1.00) for each increment of 2 servings per day. CONCLUSIONS: These data support a protective relationship between consumption of fruit and vegetables-particularly cruciferous and green leafy vegetables and citrus fruit and juice-and ischemic stroke risk.     

Yogurt Intake Reduces All-Cause and Cardiovascular Disease Mortality: A Meta-Analysis of Eight Prospective Cohort Studies

Objective: To assess the relationship between yogurt intake and mortality risk from prospective cohort studies. Methods: The PubMed, EMBASE, and Web of Science databases were searched for all records related to yogurt intake and mortality risk [all-cause or cardiovascular disease (CVD) or cancer mortality] before October 1, 2018. The Newcastle-Ottawa Quality Scale was used to estimate the quality of all eligible articles. The results of the highest and lowest categories of yogurt intake in each study were collected and the effect size was pooled using a random effects model. The dose-response analysis was calculated using the generalized least squares trend estimation model. Results: Eight eligible cohort studies were included in this meta-analysis. There were 235,676 participants in the 8 studies, and the number of deaths was 14,831. Compared with the lowest category, the highest category of yogurt intake was not significantly related with all cause mortality [hazard ratio (HR)=0.93; 95% confidence interval (CI): 0.85, 1.01], CVD mortality (HR=0.92; 95% CI: 0.81, 1.03) and cancer mortality (HR=0.97; 95% CI: 0.83, 1.12). These studies were homogenous, since the homogeneity test showed that I2 was 28.7%, 15.1% and 11.8%, respectively. However, yogurt intake 200 g/d was significantly associated with a lower all-cause mortality (HR=0.88; 95% CI: 0.80, 0.96) and CVD mortality (HR=0.87; 95% CI: 0.77, 0.99) in the subgroup analysis. The dose-response analysis showed that yogurt intake of 200 g/d was inversely associated with all-cause mortality (P=0.041, HR=0.95, 95% CI: 0.92, 1.00) and CVD mortality (P=0.009, HR=0.92, 95% CI: 0.86, 0.98), and all of which were linear relationship (P>0.05). Conclusions: This review provided the evidence regarding yogurt intake can reduce all-cause and CVD mortality. Although some positive findings were identified, more high-quality cohort studies and randomized controlled trials are warranted on a possible protective effect of yoghurt on health.     

Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies

Context  Inconsistent findings from observational studies have continued the controversy over the effects of dietary fiber on colorectal cancer. Objective  To evaluate the association between dietary fiber intake and risk of colorectal cancer. Design, Setting, and Participants  From 13 prospective cohort studies included in the Pooling Project of Prospective Studies of Diet and Cancer, 725 628 men and women were followed up for 6 to 20 years across studies. Study- and sex-specific relative risks (RRs) were estimated with the Cox proportional hazards model and were subsequently pooled using a random-effects model. Main Outcome Measure  Incident colorectal cancer. Results  During 6 to 20 years of follow-up across studies, 8081 colorectal cancer cases were identified. For comparison of the highest vs lowest study- and sex-specific quintile of dietary fiber intake, a significant inverse association was found in the age-adjusted model (pooled RR = 0.84; 95% confidence interval [CI], 0.77-0.92). However, the association was attenuated and no longer statistically significant after adjusting for other risk factors (pooled multivariate RR = 0.94; 95% CI, 0.86-1.03). In categorical analyses compared with dietary fiber intake of 10 to <15 g/d, the pooled multivariate RR was 1.18 (95% CI, 1.05-1.31) for less than 10 g/d (11% of the overall study population); and RR, 1.00 (95% CI, 0.85-1.17) for 30 or more g/d. Fiber intake from cereals, fruits, and vegetables was not associated with risk of colorectal cancer. The pooled multivariate RRs comparing the highest vs lowest study- and sex-specific quintile of dietary fiber intake were 1.00 (95% CI, 0.90-1.11) for colon cancer and 0.85 (95% CI, 0.72-1.01) for rectal cancer (P for common effects by tumor site = .07). Conclusions  In this large pooled analysis, dietary fiber intake was inversely associated with risk of colorectal cancer in age-adjusted analyses. However, after accounting for other dietary risk factors, high dietary fiber intake was not associated with a reduced risk of colorectal cancer.      

Dietary fat and fiber in relation to risk of breast cancer. An 8-year follow-up.

OBJECTIVE--To address the hypotheses that dietary fat increases and fiber decreases the risk of breast cancer. DESIGN--Prospective cohort study with dietary assessment at baseline, using a validated, self-administered food frequency questionnaire. SETTING/PARTICIPANTS--89,494 women in the Nurses' Health Study who were 34 through 59 years of age in 1980 and who were followed up for 8 years (> 95% complete). RESULTS--1439 incident cases of breast cancer were diagnosed, including 774 among postmenopausal women. After adjustment for age, established risk factors, and total energy intake, we observed no evidence of any positive association between total fat intake and breast cancer incidence (relative risks [RRs] for increasing quintiles of fat intake were 1.0, 0.85, 0.96, 0.91, and 0.90; 95% confidence interval for highest vs lowest quintile, 0.77 to 1.07). Among postmenopausal women alone, corresponding RRs were 1.0, 0.89, 1.00, 0.95, and 0.91. Comparing extreme deciles of total fat intake (> or = 49% vs < 29% of total energy intake), the RR was 0.86 (95% confidence interval, 0.67 to 1.08). A similar absence of any positive association was observed without adjustment for energy intake; for tumors less than 2 cm as well as 2 cm or greater in diameter; for saturated, monounsaturated, and polyunsaturated fat; and after excluding the first 4 years of follow-up. Also, we found no suggestion of any positive association when using a more detailed and precise dietary questionnaire completed in 1984 (666 subsequent cases), even when women consuming less than 25% of energy from fat were used as the comparison group. No suggestion of a protective effect of dietary fiber was observed (RRs for increasing quintiles were 1.0, 0.95, 0.93, 1.02, and 1.02). CONCLUSIONS--These data provide evidence against both an adverse influence of fat intake and a protective effect of fiber consumption by middle-aged women on breast cancer incidence over 8 years. Nevertheless, the positive association between intake of animal fat and risk of colon cancer observed in many studies provides ample reason to limit this source of energy.     

Long-term Intake of Dietary Fiber and Decreased Risk of Coronary Heart Disease Among Women

Context  Epidemiological studies of men suggest that dietary fiber intake protects against coronary heart disease (CHD), but data on this association in women are sparse. Objective  To examine the association between long-term intake of total dietary fiber as well as fiber from different sources and risk of CHD in women. Design and Setting  The Nurses' Health Study, a large, prospective cohort study of US women followed up for 10 years from 1984. Dietary data were collected in 1984, 1986, and 1990, using a validated semiquantitative food frequency questionnaire. Participants  A total of 68,782 women aged 37 to 64 years without previously diagnosed angina, myocardial infarction (MI), stroke, cancer, hypercholesterolemia, or diabetes at baseline. Main Outcome Measure  Incidence of acute MI or death due to CHD by amount of fiber intake. Results  Response rate averaged 80% to 90% during the 10-year follow-up. We documented 591 major CHD events (429 nonfatal MIs and 162 CHD deaths). The age-adjusted relative risk (RR) for major CHD events was 0.53 (95% confidence interval [CI], 0.40-0.69) for women in the highest quintile of total dietary fiber intake (median, 22.9 g/d) compared with women in the lowest quintile (median, 11.5 g/d). After controlling for age, cardiovascular risk factors, dietary factors, and multivitamin supplement use, the RR was 0.77 (95% CI, 0.57-1.04). For a 10-g/d increase in total fiber intake (the difference between the lowest and highest quintiles), the multivariate RR of total CHD events was 0.81 (95% CI, 0.66-0.99). Among different sources of dietary fiber (eg, cereal, vegetables, fruit), only cereal fiber was strongly associated with a reduced risk of CHD (multivariate RR, 0.63; 95% CI, 0.49-0.81 for each 5-g/d increase in cereal fiber). Conclusions  Our findings in women support the hypothesis that higher fiber intake, particularly from cereal sources, reduces the risk of CHD.      

Intake of fish and omega-3 fatty acids and risk of stroke in women

CONTEXT: Some prospective studies have shown an inverse association between fish intake and risk of stroke, but none has examined the relationship of fish and omega-3 polyunsaturated fatty acid intake with risk of specific stroke subtypes. OBJECTIVE: To examine the association between fish and omega-3 polyunsaturated fatty acid intake and risk of stroke subtypes in women. DESIGN, SETTING, AND SUBJECTS: Prospective cohort study of women in the Nurses' Health Study cohort, aged 34 to 59 years in 1980, who were free from prior diagnosed cardiovascular disease, cancer, and history of diabetes and hypercholesterolemia and who completed a food frequency questionnaire including consumption of fish and other frequently eaten foods. The 79 839 women who met our eligibility criteria were followed up for 14 years. MAIN OUTCOME MEASURE: Relative risk of stroke in 1980-1994 compared by category of fish intake and quintile of omega-3 polyunsaturated fatty acid intake. RESULTS: After 1 086 261 person-years of follow-up, 574 incident strokes were documented, including 119 subarachnoid hemorrhages, 62 intraparenchymal hemorrhages, 303 ischemic strokes (264 thrombotic and 39 embolic infarctions), and 90 strokes of undetermined type. Among thrombotic infarctions, 90 large-artery occlusive infarctions and 142 lacunar infarctions were identified. Compared with women who ate fish less than once per month, those with higher intake of fish had a lower risk of total stroke: the multivariate relative risks (RRs), adjusted for age, smoking, and other cardiovascular risk factors, were 0.93 (95% confidence interval [CI], 0.65-1.34) for fish consumption 1 to 3 times per month, 0.78 (95% CI, 0.55-1.12) for once per week, 0.73 (95% CI, 0.47-1.14) for 2 to 4 times per week, and 0.48 (95% CI, 0.21-1.06) for 5 or more times per week (P for trend =.06). Among stroke subtypes, a significantly reduced risk of thrombotic infarction was found among women who ate fish 2 or more times per week (multivariate RR, 0.49; 95% CI, 0.26-0.93). Women in the highest quintile of intake of long-chain omega-3 polyunsaturated fatty acids had reduced risk of total stroke and thrombotic infarction, with multivariate RRs of 0.72 (95% CI, 0.53-0.99) and 0.67 (95% CI, 0.42-1.07), respectively. When stratified by aspirin use, fish and omega-3 polyunsaturated fatty acid intakes were inversely associated with risk of thrombotic infarction, primarily among women who did not regularly take aspirin. There was no association between fish or omega-3 polyunsaturated fatty acid intake and risk of hemorrhagic stroke. CONCLUSIONS: Our data indicate that higher consumption of fish and omega-3 polyunsaturated fatty acids is associated with a reduced risk of thrombotic infarction, primarily among women who do not take aspirin regularly, but is not related to risk of hemorrhagic stroke.     

膳食宏量营养素摄入量与年龄相关白内障危险性分析

目的探讨中老年人膳食宏量摄入量与年龄相关白内障(ARC)危险性之间的关系。方法选取2009年9月—2011年3月45～85岁的白内障患者360例为病例组,对照组为同期入院的360例非白内障患者。采用标准调查表对研究对象进行调查,内容包括人口学特征、生活方式以及既往疾病史等,同时采用一份有效的半定量化食物频率调查表(FFQ),获取研究对象膳食营养素的摄入情况。应用多因素Logistic回归分析估计各种宏量营养素摄入量与3种类型白内障关联的比值比(OR)及其相应的95%可信区间(CI)。结果调整多种潜在性混杂因素后,总碳水化合物摄入量与皮质性白内障呈正相关,与摄入量为最低四分位数的患者相比,摄入量为最高四分位数的患者发生皮质性白内障的OR=2.471〔95%CI(1.348,6.043),P=0.027〕。蛋白质摄入量增加对后囊膜下白内障(PSC)具有预防作用〔OR=0.528,95%CI(0.148,0.869),P=0.023〕。总脂肪摄入量与任一类型白内障均无相关性,但多不饱和脂肪酸摄入量为最高四分位数者发生核性白内障的危险性是最低四分位数者的2.7倍〔OR=2.742,95%CI(1.790,4.200),P=0.033〕。结论大量摄入碳水化合物和多不饱和脂肪酸可分别使发生皮质性和核性白内障的危险性升高,而蛋白质,尤其是动物蛋白摄入量增加能够预防PSC,调整中老年人群膳食习惯可能有助于预防ARC。     

Influence of dietary patterns on the risk of acute myocardial infarction in China population: the INTERHEART China study

Background Some dietary patterns are risk factors for acute myocardial infarction (AMI).Chinese traditional food and habits vary from other cultures.The present study determined whether different dieta...     

A prospective study of folate intake and the risk of breast cancer

CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.     

膳食钠盐、体质量指数与良性前列腺增生关系的研究

目的 探讨老年男性膳食钠盐、体质量指数(BMI)与良性前列腺增生(BPH)危险性之间的关系.方法 采取以医院为基础的病例对照研究.研究组由经组织学检查证实患BPH的男性患者组成,对照组由因患其他疾病入住与研究组患者相同医院的同期患者组成.研究组与对照组各360例,1∶1匹配.采用标准调查表对全部研究对象进行问卷调查,同...     

Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults

CONTEXT: Dietary sodium is positively associated with blood pressure, and ecological and animal studies both have suggested that high dietary sodium intake increases stroke mortality. OBJECTIVE: To examine the risk of cardiovascular disease associated with dietary sodium intake in overweight and nonoverweight persons. DESIGN: Prospective cohort study. SETTING: The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: Of those aged 25 to 74 years when the survey was conducted in 1971 -1975 (14407 participants), a total of 2688 overweight and 6797 nonoverweight persons were included in the analysis. MAIN OUTCOME MEASURES: Dietary sodium and energy intake were estimated at baseline using a single 24-hour dietary recall method. Incidence and mortality data for cardiovascular disease were obtained from medical records and death certificates. RESULTS: For overweight and nonoverweight persons, over an average of 19 years of follow-up, the total number of documented cases were as follows: 680 stroke events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular disease deaths, and 2486 deaths from all causes. Among overweight persons with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence interval [CI], 1.07-1.64; P = .01) in stroke incidence, 89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001) in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61; 95% CI, 1.32-1.96; P<.001) in cardiovascular disease mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was not significantly associated with cardiovascular disease risk in nonoverweight persons. CONCLUSIONS: Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons.     

卵巢早衰与膳食营养相关研究

目的探讨膳食营养与卵巢早衰发病之间的关系,以便在膳食营养方面为卵巢早衰的预防提供依据。方法收集2015年11月至2017年1月于我院生殖内分泌门诊就诊的患者,以1∶3的病例对照设计,纳入病例组与对照组研究对象,分析两组间日实际摄入量、蛋白质日摄入量、碳水化合物日摄入量和膳食纤维日摄入量、维生素日摄入量、微量元素日摄入量的差异,进一步用多因素logistic回归,分析膳食营养与卵巢早衰发病之间的关系。结果本研究共纳入卵巢早衰组70例,对照组224例,卵巢早衰组18~40岁,平均31.41岁。对照组19~40岁,平均28.74岁。两组年龄、性别分布、身高、体质量、体质量指数（BMI）差异均无统计学意义,基线可比。日实际摄入量、蛋白质日摄入量、碳水化合物日摄入量和膳食纤维日摄入量在卵巢早衰组和对照组之间差异有统计学意义（POR）值分别为11.652（95%CI:3.864~35.135）和7.851（95%CI:2.272~27.137）。结论碳水化合物及膳食纤维日摄入量的不足均可能增加卵巢早衰患病风险。     

Past medical history and risk of death due to hepatocellular carcinoma, univariate analysis of JACC study data

The relationship between the past history of selected diseases and the risk of dying from hepatocellular carcinoma (HCC) was analyzed using 110,792 cohort members (46,465 males and 64,327 females) recruited between 1988 and 1990 by the JACC Study (the Japan Collaborative Cohort Study for Evaluation of Cancer Risk). Significantly elevated hazard ratios (HRs) were observed in both genders for the past history of kidney diseases, liver diseases, gallstones or cholecystitis, diabetes mellitus, and blood transfusion. Further, when analyzed by age group (those 40-59 years of age were "younger" and those 60-79 years of age were "older"), although the significant associations were generally maintained, the magnitude of the HRs for liver diseases and diabetes mellitus seemed to be considerably different between the younger and older age groups for male cohort members. When the analyses were limited to cohort members without the past history of liver diseases, the past histories which had significantly elevated HRs were hypertension (HR = 3.14, 95% confidence interval (CI): 1.25-7.89), diabetes mellitus (HR = 4.17, 95% CI: 1.22-14.25), and blood transfusion (HR = 7.69, 95% CI: 3.09-19.15) in the younger male age group and gallstone or cholecystitis (HR = 2.58, 95% CI: 1.11-5.98) in the older male age group. On the other hand, for females, the significantly elevated HRs were gastric or duodenal ulcer (HR = 4.33, 95% CI: 1.09-17.25) in the younger age group and diabetes mellitus (HR = 6.16, 95%CI: 2.25-16.90) and blood transfusion (HR = 3.86, 95%CI: 1.58-9.41) in the older age group. However, since the evidence from our univariate analyses might not be decisive, multivariate Cox proportional hazards models controlling for potential confounders and effect modifiers will be required to obtain more valid or unbiased hazard ratios.     

Whole grain consumption and risk of ischemic stroke in women: A prospective study

CONTEXT: Although increased intake of grain products has been recommended to prevent cardiovascular disease (CVD), prospective data examining the relation of whole grain intake to risk of ischemic stroke are sparse, especially among women. OBJECTIVE: To examine the hypothesis that higher whole grain intake reduces the risk of ischemic stroke in women. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 75,521 US women aged 38 to 63 years without previous diagnosis of diabetes mellitus, coronary heart disease, stroke, or other CVDs in 1984, who completed detailed food frequency questionnaires (FFQs) in 1984, 1986, 1990, and 1994, and were followed up for 12 years as part of the Nurses' Health Study. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, confirmed by medical records, by quintile of whole grain intake according to FFQ responses. RESULTS: During 861,900 person-years of follow-up, 352 confirmed incident cases of ischemic stroke occurred. We observed an inverse association between whole grain intake and ischemic stroke risk. The age-adjusted relative risks (RRs) from the lowest to highest quintiles of whole grain intake were 1.00 (referent), 0.68 (95% confidence interval [CI], 0.49-0.94), 0.69 (95% CI, 0.51-0.95), 0.49 (95% CI, 0.35-0.69), and 0.57 (95% CI, 0.42-0.78; P =.003 for trend). Adjustment for smoking modestly attenuated this association (RR comparing extreme quintiles, 0.64; 95% CI, 0.47-0.89). This inverse association remained essentially unchanged with further adjustment for known CVD risk factors, including saturated fat and transfatty acid intake (multivariate-adjusted RR comparing extreme quintiles, 0.69; 95% CI, 0.50-0.98). The inverse relation between whole grain intake and risk of ischemic stroke was also consistently observed among subgroups of women who never smoked, did not drink alcohol, did not exercise regularly, or who did not use postmenopausal hormones. No significant association was observed between total grain intake and risk of ischemic stroke. CONCLUSIONS: In this cohort, higher intake of whole grain foods was associated with a lower risk of ischemic stroke among women, independent of known CVD risk factors. These prospective data support the notion that higher intake of whole grains may reduce the risk of ischemic stroke.     

Prevalence of Undernutrition and Related Dietary Factors among People Aged 75 Years or Older in China during 2010-2012

Objective Undernutrition is highly prevalent among older people. The aim of this study was to estimate the prevalence of undernutrition in elderly Chinese residents and explore the relationship between undernutrition and dietary factors. Methods Data were collected from 2,552 elderly people aged 75 years and over from the Chinese Nutrition and Health Surveillance during 2010-2012 using questionnaires, anthropometric measurement, and individual consecutive 3-day 24-hour dietary records. Results The present study showed that 10.5% of participants had undernutrition. The prevalence was higher among the population living in rural areas, those living in the South region, those who smoked, and those with low income levels. Most participants failed to meet the Chinese Dietary Reference Intakes for energy (66.1%) and protein (72.1%). When comparing quartiles of food intake, high rice consumption [odds ratio ( OR )=2.44, 95% confidence interval ( CI ): 1.35-4.40)], animal oil intake ( OR=1.60, 95% CI : 1.18-2.17), and high fat intake from animal sources ( OR=1.56, 95% CI : 1.06-2.31) were positively associated with underweight whereas high wheat consumption (OR=0.44, 95% CI : 0.26-0.74), a proper proportion (24%-32%) of energy intake from fat ( OR=0.54, 95% CI : 0.35-0.83), and high fat intake from plant sources ( OR=0.67, 95% CI : 0.46-0.99) were inversely related. Conclusion The prevalence of undernutrition was high among elderly Chinese people, especially in rural areas. Dietary factors, such as high consumption of rice, were associated with undernutrition.     

2型糖尿病患者膳食因素与平均血糖波动幅度的关联性研究

  目的  应用动态血糖监测系统观察2型糖尿病(T2DM)患者的膳食状况与血糖波动情况之间的关联。  方法  选取2016年1月—2017年12月在河南中医药大学第一附属医院内分泌科住院的18~60岁2型糖尿病患者346例作为研究对象,行连续72 h动态血糖监测并分析其血糖波动情况。采用24 h膳食回顾法和3 d调味品估算法得到各类食物的平均每日摄入量,运用调整的膳食平衡指数(DBI-07)计算各类食物摄入分值。根据平均血糖波动幅度(MAGE)三分位数将研究对象分为3组,比较各组患者各类食物摄入分值差异并运用多因素线性回归模型分析膳食因素对2型糖尿病患者血糖波动情况的影响。  结果  随着平均血糖波动幅度增加,前白蛋白水平及四肢骨骼肌量降低,差异有统计学意义(F=47.124、17.354,趋势性P < 0.001、 < 0.001);奶制品摄入量达到250 mL/d的T2DM人群其平均血糖波动幅度相较奶制品摄入不足患者下降14.0%(OR=0.860,95% CI:0.818~0.895),而蔬菜摄入量达到150 g/d的T2DM人群平均血糖波动幅度较蔬菜摄入不足者下降9.9%(OR=0.901,95% CI:0.845~0.962),将年龄、性别、HbA1c等因素纳入模型进行校正后关联依然存在。  结论  奶制品及蔬菜摄入不足和血糖波动性增加相关,在2型糖尿病的医学营养治疗中应重视预防蛋白质性营养不良和膳食纤维的摄入。      

老年高血压人群发生糖代谢异常风险的10年队列研究

目的 观察老年高血压(HT)及非高血压(NHT)人群糖代谢异常的发生情况及其危险因素.方法 采用前瞻性队列研究方法,研究对象为1999至2009年在解放军总医院体检的60岁以上老年人,除外基线时已确诊2型糖尿病(T2DM)及糖调节受损(IGR)者.观察在10年中发生DM及IGR的情况及影响因素,应用COX风险比例模型分析相关危险因素,Kaplan-Meier法分析累计发病率.结果 (1) 1999年调查人数为1 136人,纳入糖耐量正常582人,其中HT组384例,NHT组198人.随访10年后,HT组发生T2DM显著高于NHT组(27.6％比18.7％,P＜0.05),HR( 95％ CI)为1.48(1.07～2.04);两组DM发病密度分别为33.8‰和20.6‰.HT组与NHT组的IGR发生率差异无统计学意义(P＞0.05);新发HT组与NHT组相比,DM及IGR的发生率差异无统计学意义(P＞0.05).(2)血脂紊乱及HT是发生T2DM的独立危险因素,HR(95％CI)分别为1.459(1.027～2.072)及1.516(1.039～2.212);同时也是发生糖代谢异常的独立危险因素,HR (95％ CI)分别为1.545(1.087～2.195)及1.524(1.044 ～2.224);HT与NHT人群T2DM及糖代谢异常的累积发生率差异均有统计学意义(均P ＜0.05).结论 老年人群合并HT后其糖尿病风险增加,是非NHT人群的1.52倍.血脂紊乱也是T2DM及糖代谢异常的独立危险因素.     

孕期进餐频率与孕期过度增重及新生儿出生体质量关系的队列研究

目的探讨孕期进餐频率与孕期过度增重及新生儿出生体质量的关系。 方法采用前瞻性队列研究,选取2015年4～10月就诊于四川大学华西第二医院的578例健康孕早期孕妇作为调查对象,并追踪随访至分娩。分别于孕早、中、晚期通过问卷调查收集孕妇的膳食摄入和体力活动资料,孕妇增重情况和新生儿胎龄、体质量等信息。采用多因素logistic回归模型分析孕期孕妇进餐频率与孕期过度增重及适龄胎龄儿的关系,采用多重线性回归模型分析孕期孕妇进餐频率与新生儿出生体质量的关系。 结果最终纳入503例孕妇。在调整年龄、教育年限、家庭人均月收入、体力活动、怀孕次数、生产次数和膳食摄入（蛋白质、脂肪、碳水化合物）后,与孕早期进餐总次数和加餐次数低值相比,孕早期进餐总次数和加餐次数高值可增加孕期过度增重的发生风险（进餐总次数:OR=2.03;95%CI:1.18~3.47;加餐次数:OR=1.84;95%CI:1.08~3.15）;与孕早期正餐次数为3次相比,孕早期正餐次数多于或少于3次可增加不适龄胎龄儿（小于胎龄儿和大于胎龄儿）的发生风险（多于3次:OR=2.83;95%CI:1.07~4.58;少于3次:OR=1.92;95%CI:1.08~3.61）。孕早期正餐次数与新生儿出生体质量呈正相关（β=236.17;P<0.001）。孕中期、孕晚期均未发现相关性。结论孕早期孕妇进餐频率与孕期过度增重和新生儿出生体质量有关,孕早期每日3次正餐有利于正常新生儿体质量。     

膳食维生素 C 与 2 型糖尿病的关系

目的：探讨膳食维生素C摄入量与2型糖尿病的关系。方法：从中南大学湘雅医院体检中心随机选取被体 检人员5 168名为研究对象,根据不同维生素摄入水平分为5组,分别为第一五分位数组(Q1,n=1 033)、第二五分位数 组(Q2,n=1 034)、第三五分位数组(Q3,n=1 034)、第四五分位数组(Q4,n=1 034)、第五五分位数组(Q5,n=1 033); 根据是否有2型糖尿病分为2型糖尿病组(n=502)和非2型糖尿病组(n=4 666)。测量空腹血糖、身高、体质量、血压等指 标,利用食物频率调查问卷测量膳食维生素C摄入情况。运用方差分析、卡方检验、Mann-Whitney U检验以及logistic 回归模型等统计学方法分析膳食维生素C与2型糖尿病的关系。结果：单因素分析结果显示：不同维生素C摄入水 平组的能量摄入、运动量、膳食纤维摄入、是否服用营养制剂、是否饮酒、学历等方面,差异均有统计学意义(均 P<0.05);同时2型糖尿病组与非2型糖尿病组在年龄、性别、体质量指数、吸烟情况、维生素C摄入情况等方面,差 异亦均有统计学意义(均P<0.05)。在校正年龄、性别、高血压患病情况、吸烟情况等相关因素后,以维生素C摄入水 平的最低分类(≤63.26 mg/d)作为参照,最高分类(>154.78 mg/d)的OR(95%CI)为0.610(0.428~0.870),维生素C摄入水平 的高低与2型糖尿病之间呈负线性关系(r=−0.029,P<0.05)。结论：膳食维生素C摄入与2型糖尿病之间存在负相关。