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Background: Research concerning the link between individual vascular risk factors and cognition is plentiful but few studies have investigated the role of global vascular risk. We examined the cross-time associations of several vascular risk scores with cognitive performance during aging., Methods: Using data from the French SU.VI.MAX cohort, we studied a sample of 3061 participants. Framingham coronary heart disease, cardiovascular and stroke risk profiles were computed using baseline data (1994-1996). Cognitive performance was assessed after a mean of 13 years via a battery of six validated instruments. Principal component analysis identified scores for verbal memory and working memory. Associations between risk profiles (as continuous variables and in quartiles (Q)) and subsequent poor performance (defined as cognitive score ≤10th percentile) were examined via logistic regression (odds ratios, 95% CI) and analysis of covariance., Results: All continuous-scale Framingham risk scores assessed at midlife were inversely and uniformly associated with subsequent poor global cognitive performance, and especially in terms of verbal memory. Considering risk score Q, higher Q were associated with poorer performance in verbal memory: The fully-adjusted odds ratios (95% CI), comparing Q4 versus Q1, were 2.84 (1.70, 4.75), 2.31 (1.43, 3.73) and 1.77 (1.13, 2.76) for Framingham coronary heart disease, cardiovascular and stroke risk profiles, respectively. Similar findings were observed when modeling cognitive outcomes as continuous variables using covariance analyses., Conclusion: This study supports the existence of an inverse cross-time association between midlife vascular risk profiles and subsequent poor cognitive performance, especially in the verbal memory domain. Beyond their importance as regards vascular risk, such risk scores may help primary prevention efforts in identifying and targeting middle-aged individuals at high risk of cognitive aging., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background and Aims: The prevention of the metabolic syndrome (MetS) is of major concern and nutrition has been shown to modulate at least partly MetS risk. Our objective was to investigate whether a pro-inflammatory diet was associated with a higher risk of MetS and its components in a large cohort of French adults., Methods and Results: A total of 3726 participants from the Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) cohort were included in this study. The MetS status was identified at baseline and after 13 years of follow-up using self-reported medication, data from clinical investigations and biological measurements. The dietary inflammatory index (DII) was computed using repeated 24 h-dietary records (n = 10.1 ± 3.1). Logistic and linear regression analyses were conducted to assess the prospective association of the DII (as Q, quartiles) with the incidence of MetS and with the traits contributing to the MetS-definition (blood pressure, glycaemia, triglycerides, HDL-cholesterol, waist circumference). A diet with pro-inflammatory properties, as expressed by higher DII scores, was significantly associated with a higher risk of developing the MetS (OR comparing Q4 to Q1: 1.39, 95% confidence interval 1.01-1.92, P = 0.047). Moreover, higher DII scores were associated with higher systolic and diastolic blood pressure (Ptrend across quartiles = 0.03 and 0.05, respectively) and triglycerides (Ptrend = 0.01), and with lower HDL-cholesterol (Ptrend = 0.03)., Conclusion: A higher DII score was prospectively associated with a higher risk of MetS, with associations with blood pressure, triglycerides and HDL-cholesterol. Promotion of a healthy diet exhibiting anti-inflammatory properties may contribute to prevent cardio-metabolic disorders., (Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Very few studies have investigated the determinants of serum vitamin D levels using a set of variables that include simultaneously sun exposure, phototype, dietary intake, sociodemographics, anthropometric, lifestyle data, and genetic polymorphisms. Our objective was to investigate the associations between all these parameters and vitamin D status in a large sample of French adults. This cross-sectional survey was based on 1,828 middle-aged Caucasian adults from the SU.VI.MAX (SUpplémentation en VItamines et Minéraux AntioXydants) study. Plasma 25-hydroxyvitamin D (25OHD) concentration was lower among women (P<0.0001), older subjects (P=0.04), obese/underweight (P<0.0001), those living at higher latitudes (P<0.0001), those whose blood draw occurred in early spring (P<0.0001), less physically active (P<0.0001), with low sun exposure (P<0.0001), and with no-to-low alcohol intake (P=0.0001). Mutant GC rs4588 and rs7041 single nucleotide polymorphisms were associated with lower and higher 25OHD concentrations, respectively (P<0.0001). Dietary intake was not a major determinant of vitamin D status (P=0.7). This study provides an overall picture of determinants of vitamin D status. Several modifiable factors were identified, such as daily-life moderate sun exposure, physical activity, and normal-weight maintenance, which should be targeted by public health policies in order to improve vitamin D status in the general population, while avoiding active/intensive sun exposure, in line with recommendations for skin cancer prevention.

Background and Aims: Benefits of Mediterranean diet on MetS risk have been suggested, but overall prospective evidence in the general population is limited. For the first time, the prospective association of adherence to Mediterranean diet with the 6-y risk of MetS and its components was evaluated in a large cohort in Europe., Methods and Results: Subjects included were participants from the Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) study. Adherence to Mediterranean diet was assessed using traditional Mediterranean diet score (MDS), an updated Mediterranean score (MED) and Mediterranean style-dietary pattern score (MSDPS) calculated from at least three 24-h records. In 3232 subjects, the association between Mediterranean diet scores and 6-y risk of MetS was evaluated. The association between Mediterranean scores and MetS components was also estimated. A lower risk of MetS was observed with increasing MED score (P-trend = 0.001) and MDS (P-trend = 0.03) in multivariate models. The adjusted odds ratios (95% Confidence Interval) for MetS risk were 0.47 (0.32-0.69) and 0.50 (0.32-0.77) in subjects in the highest versus lowest tertile of MED score and MDS, respectively. The MED score was inversely associated with waist circumference, systolic blood pressure and triglycerides, and directly associated with HDL-cholesterol. The MDS was negatively associated with waist circumference and triglycerides, and MSDPS was positively associated with HDL-cholesterol., Conclusions: All Mediterranean diet scores were associated in a potentially beneficial direction with components of MetS or MetS incidence. Our findings support that individuals should be encouraged to follow a Mediterranean dietary pattern for reduction of MetS risk., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Mechanistic data suggest that n-3 PUFAs and endothelial function may interact and play a role in carcinogenesis, but epidemiologic evidence is lacking., Objective: Our objective was to investigate whether the prospective association between soluble intercellular adhesion molecule-1 (sICAM-1) and cancer risk is modulated by n-3 PUFA intake., Design: A nested case-control study was designed to include all first-incident cancer cases diagnosed in the SUpplémentation en VItamines et Minéraux AntioXydants cohort between 1994 and 2007, with available dietary data from 24-h records (n = 408). Cases were matched with 1 or 2 randomly selected controls (n = 760). Conditional logistic regression was used to estimate ORs and 95% CIs for the association between prediagnostic plasma concentrations of sICAM-1 and cancer risk, stratified by n-3 PUFA intake. The interactions between sICAM-1 and n-3 PUFA intake were tested., Results: An interaction was observed between sICAM-1 and n-3 PUFA intake, which was consistent across the studied cancer locations (P-interaction = 0.036 for overall, 0.038 for breast, and 0.020 for prostate cancer risk). sICAM-1 concentrations were positively associated with cancer risk among subjects with n-3 PUFA intakes below the median (multivariate OR(Tertile3vsTertile1): 2.8; 95% CI: 1.5, 5.2; P-trend = 0.001), whereas this association was not observed for subjects with n-3 PUFA intakes above the median (OR(Tertile3vsTertile1): 1.3; 95% CI: 0.8, 2.3; P-trend = 0.3)., Conclusion: These findings suggest that n-3 PUFA intake may counteract the procarcinogenic actions of sICAM-1.

Polyphenols, and in particular flavonoids, are omnipresent plant-food components displaying biochemical properties possibly beneficial to brain health. We sought to evaluate the long-term association between total and class-specific polyphenol intake and cognitive performance. Polyphenol intake was estimated using the Phenol-Explorer database applied to at least six 24-h dietary records collected in 1994-1996 as part of the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. The cognitive performance of 2574 middle-aged adults participating in the cohort was assessed in 2007-2009 using the following four neuropsychological tests: phonemic and semantic fluency, the RI-48 Cued Recall test, the Trail Making test, and Forward and Backward Digit Span. Inter-correlations among the test scores were estimated with principal component analysis. Associations between polyphenol intake and cognition were assessed by multivariate linear regression and ANCOVA. In multivariate models, high total polyphenol intake was associated with better language and verbal memory (P = 0.01) but not with executive functioning (P = 0.09). More specifically, intake of catechins (P = 0.001), theaflavins (P = 0.002), flavonols (P = 0.01), and hydroxybenzoic acids (P = 0.0004) was positively associated with language and verbal memory, especially with episodic memory assessed by the RI-48 test. In contrast, negative associations between scores on executive functioning and intake of dihydrochalcones (P = 0.01), catechins (P = 0.01), proanthocyanidins (P = 0.01), and flavonols (P = 0.01) were detected. High intake of specific polyphenols, including flavonoids and phenolic acids, may help to preserve verbal memory, which is a salient vulnerable domain in pathological brain aging. Further investigations are needed to clarify the observed negative associations regarding executive functioning.

Background: Antioxidant properties of some vitamins and trace elements may help to prevent cognitive decline., Objective: The aim of the current study was to estimate the long-term effects of antioxidant nutrient supplementation on the cognitive performance of participants in the Supplementation in Vitamins and Mineral Antioxidants (SU.VI.MAX) study 6 y after the end of the trial., Design: This study included 4447 French participants aged 45-60 y who were enrolled in the SU.VI.MAX study (1994-2002), which was a double-blind, placebo-controlled, randomized trial. From 1994 to 2002, participants received daily vitamin C (120 mg), β-carotene (6 mg), vitamin E (30 mg), selenium (100 μg), and zinc (20 mg) in combination or as a placebo. In 2007-2009, the cognitive performance of participants was assessed with 4 neuropsychological tests (6 tasks). Principal components analysis (PCA) was performed to identify cognitive-function summary scores. Associations between antioxidant supplementation and cognitive functions, in the full sample and by subgroups, were estimated through ANOVA and expressed as mean differences and 95% CIs. Subgroup analyses were performed according to baseline characteristics., Results: Subjects receiving active antioxidant supplementation had better episodic memory scores (mean difference: 0.61; 95% CI: 0.02, 1.20). PCA indicated 2 factors that were interpreted as showing verbal memory and executive functioning. Verbal memory was improved by antioxidant supplementation only in subjects who were nonsmokers or who had low serum vitamin C concentrations at baseline., Conclusion: This study supports the role of an adequate antioxidant nutrient status in the preservation of verbal memory under certain conditions. This trial was registered at clinicaltrials.gov as NCT00272428.

Background: Rapid aging of the population worldwide necessitates a heightened concern about preventing cognitive decline., Objective: We investigated the effects of B vitamins and omega-3 (n-3) fatty acid supplementation on cognition in a high-risk population., Design: This was an ancillary study of the SU.FOL.OM3 (SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids) secondary prevention trial conducted in France between 2003 and 2009. The present sample included 1748 men and women aged 45-80 y with a history of myocardial infarction, unstable angina, or ischemic stroke and who were recruited via a network of 417 physicians. With the use of block randomization with stratification by sex, age, prior cardiovascular disease, and city of residence, participants were assigned in a 2 × 2 factorial design to 1 of 4 groups: 1) 5-methyltetrahydrofolate (folate, 0.56 mg) and vitamins B-6 (3 mg) and B-12 (0.02 mg), 2) eicosapentaenoic and docosahexaenoic acids (600 mg) in a 2:1 ratio, 3) B vitamins and omega-3 fatty acids, or 4) placebo. Cognitive function after 4 y of supplementation was assessed with the French version of the modified Telephone Interview for Cognitive Status., Results: No significant main effects of group assignment on cognitive function were found; however, we found some evidence of disease history- and age-specific effects. In the subgroup with prior stroke, for example, participants assigned to receive B vitamins plus omega-3 fatty acids were significantly less likely to have a decreased score on the temporal orientation task than were those assigned to receive placebo (odds ratio: 0.43; 95% CI: 0.21, 0.86)., Conclusions: If present, dietary effects on cognition are likely group-specific. These results could be useful in interventions aimed at preventing cognitive decline in high-risk individuals. This trial is registered at controlled-trials.com as ISRCTN41926726.

Background: Epidemiologic studies have suggested an association between polyphenol intake and health. These studies have been limited to ≤40 flavonoid and lignan aglycones., Objective: We estimated intakes of all known individual polyphenols in the French cohort SUpplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) by using the recently developed database Phenol-Explorer, which contains content values for 502 polyphenols in 452 foods., Design: A total of 4942 men and women, who were aged 45-60 y and who had completed at least six 24-h dietary records, participated in this study. Foods documented in 24-h dietary records and the Phenol-Explorer database were matched, and intakes of all individual polyphenols were calculated., Results: A total of 337 polyphenols were consumed by SU.VI.MAX subjects, including 258 polyphenols consumed by at least one-half of the population and 98 polyphenols consumed in an amount >1 mg/d. Mean total polyphenol intake was estimated at 1193 ± 510 mg/d (or 820 ± 335 mg/d when expressed as aglycone equivalents), with hydroxycinnamic acid esters and proanthocyanidins being the most largely consumed polyphenols. These values may have been underestimated because of insufficient data or lack of accurate data on the content in foods for proanthocyanidins and thearubigins. Nonalcoholic beverages and fruit were the most important contributors to polyphenol intakes., Conclusions: The current study provides intake data for all individual polyphenols known to be present in the diet of a cohort. This information will be essential to characterize the health effects of individual phenolic compounds that differ widely in their bioavailability and physiologic properties. The SU.VI.MAX study was registered at clinicaltrials.gov as NCT00272428.

A decrease in metabolic syndrome (MetS) prevalence may lower the cardiovascular disease (CVD) burden. The predictive value of nutritional recommendations for the incidence of MetS has not yet been evaluated. We assessed, in a population-based study, the association between the French National Nutrition and Health Program Guideline Score (PNNS-GS) and 6-y risk of MetS. Participants in the Supplémentation en Vitamines et Minéraux Antioxydants study were followed-up from 1994-1996 to 2001-2002. MetS was defined according to International Diabetes Federation criteria. We also defined "mild" and "severe" MetS as waist criteria plus 2, or more than 2, other criteria. Prospective associations between the PNNS-GS at baseline (either as a continuous variable or in quartiles) and incident MetS were assessed using binary or multinomial logistic regression to provide OR and 95% CI in participants free of MetS at baseline (n = 2763). In multivariate models, each unit increase in the PNNS-GS score was associated with a 9% lower risk of MetS (OR = 0.91; 95% CI = 0.83-1.00). This association was even stronger with the risk of severe MetS (OR = 0.76; 95% CI = 0.63-0.91). After adjustment for baseline and change in BMI, this association remained significant for severe MetS but did not reach significance for overall MetS. These findings support a potential beneficial impact of nutritional guidelines upon primary prevention of MetS. Improvement in compliance with nutritional recommendations may help to reduce the burden of CVD disease in the general population.

Aims: To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon., Methods: We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits., Results: The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight., Conclusions: Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.

Objectives: To determine, in a rural and urban population in Cameroon, the prevalence of the metabolic syndrome (MS) using three definitions and to assess the association between components of the MS, central obesity and HOMA insulin resistance (HOMA-IR) index., Methods: A representative sample of 1573 adults (638 rural, 935 urban) were interviewed on their personal medical history. Blood pressure and anthropometric measures used standardised methods. After an overnight fast, blood samples were collected before and 2h after an OGTT and plasma glucose, plasma insulin and blood lipids determined. Modified WHO, NCEP-ATP III, and IDF definitions of the MS were used., Results: Central obesity was the most prevalent component of the syndrome, but prevalence varied widely according to the definition used. Hypertriglyceridemia was almost non-existent. The highest prevalence of the MS was with the WHO definition and the lowest with the NCEP-ATP III definition. Central obesity was more tightly associated with components of the MS than was HOMA-IR., Conclusions: The prevalence of the MS varied greatly by rural/urban residence with the various definitions used. Central obesity appears to be the key determinant of the prevalence of the MS in sub Saharan Africa. Many MS definitions may not be appropriate for African populations.