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The year 2020 celebrated the tenth anniversary of the recognition of the Mediterranean Diet as Intangible Cultural Heritage of Humanity by the UNESCO Intergovernmental Committee. This event represented a milestone in the history of nutrition, as the Mediterranean diet was the first traditional food practice to receive such award. Since then, a lot has been discussed not only on the beneficial aspects of the Mediterranean diet, but also on its complex role as a lifestyle model that includes a set of skills, knowledge and intercultural dialogue. This process ended up with the recognition in 2019 of Mediterranean diet as a possibly universal model of healthy diet from the EAT-Lancet Commission. These concepts were widely debated at the 2019 "Ancel Keys" International Seminar, held in Ascea (Italy) (for more information see: www.mediterraneandietseminar.org) with the aim to stimulate interest and awareness of a young group of participants on the current problems inherent to the effective implementation of the Mediterranean diet. The present article collects the contributions of several lecturers at the Seminar on key issues such as methodological and experimental approach, sustainability, molecular aspects in disease prevention, future exploitation, without neglecting a historical view of the Seven Countries Study. From the Seminar conclusions emerged a still vibrant and modern role of Mediterranean diet. The years to come will see national and international efforts to reduce the barriers that limit adherence to Mediterranean diet in order to plan for multi-factorial and targeted interventions that would guide our populations to a sustainable healthy living. [ABSTRACT FROM AUTHOR]

Background: Although the general importance of diet quality in the prevention of unintentional weight gain is known, it is unknown whether its influence is age or sex dependent.Objective: The aim of this study was to investigate whether the strength of the association between diet quality and 4-y weight change was modified by age and sex.Methods: From the Dutch population-based Lifelines Cohort, 85,618 nonobese adult participants (age 18-93 y), recruited between 2006 and 2013, were included in the study. At baseline, diet was assessed with a 110-item food-frequency questionnaire. The Lifelines Diet Score, based on international evidence for diet-disease relations at the food group level, was calculated to assess diet quality. For analyses, the score was divided in quintiles (Qs). Body weight was objectively measured at baseline and after a median follow-up of 44 mo (25th-75th percentile: 35-51 mo). In between, body weight was self-reported twice. Linear mixed models were used to investigate the association between diet quality and weight change by sex and in 6 age categories (18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 y).Results: Mean 4-y weight change decreased over age categories. Confounder-adjusted linear mixed models showed that the association between diet quality and weight change was modified by sex (P-interaction = 0.001). In women, the association was also modified by age (P-interaction = 0.001). Poor diet quality was most strongly associated with weight gain in the youngest men [Q1 compared with Q5: +0.33 kg/y (95% CI: 0.10, 0.56)] and women [+0.22 kg/y (95% CI: 0.07, 0.37)]. In contrast, in women aged ≥70 y, poor diet quality was associated with greater weight loss [-0.44 kg/y (95% CI: -0.84, -0.05)].Conclusions: Poor diet quality was related to higher weight gain, especially in young adults. Oppositely, among women aged ≥70 y, poor diet quality was related to higher weight loss. Therefore, a healthful diet is a promising target for undesirable weight changes in both directions. [ABSTRACT FROM AUTHOR]

Background: Consumption of coffee, one of the most popular beverages around the world, has been associated with a lower risk of cardiovascular and all-cause mortality in population-based studies. However, little is known about these associations in patient populations. Objective: This prospective study aimed to examine the consumption of caffeinated and decaffeinated coffee in relation to cardiovascular disease (CVD) mortality, ischemic heart disease (IHD) mortality, and all-cause mortality in patients with a prior myocardial infarction (MI). Design: We included 4365 Dutch patients from the Alpha Omega Cohort who were aged 60-80 y (21% female) and had experienced an MI < 10 y before study enrollment. At baseline (2002-2006), dietary data including coffee consumption over the past month was collected with a 203-item validated food-frequency questionnaire. Causes of death were monitored until 1 January 2013. HRs for mortality in categories of coffee consumption were obtained from multivariable Cox proportional hazard models, adjusting for lifestyle and dietary factors. Results: Most patients (96%) drank coffee, and the median total coffee intake was 375 mL/d (~3 cups/d). During a median follow-up of 7.1 y, a total of 945 deaths occurred, including 396 CVD-related and 266 IHD-related deaths. Coffee consumption was inversely associated with CVD mortality, with HRs of 0.69 (95% CI: 0.54, 0.89) for >2-4 cups/d and 0.72 (0.55, 0.95) for >4 cups/d, compared with 0-2 cups/d. Corresponding HRs were 0.77 (95% CI: 0.57, 1.05) and 0.68 (95% CI: 0.48, 0.95) for IHD mortality and 0.84 (95% CI: 0.71, 1.00) and 0.82 (95% CI: 0.68, 0.98) for all-cause mortality, respectively. Similar associations were found for decaffeinated coffee and for coffee with additives. Conclusion: Drinking coffee, either caffeinated or decaffeinated, may lower the risk of CVD and IHD mortality in patients with a prior MI. This study was registered at clinicaltrials.gov as NCT03192410. [ABSTRACT FROM AUTHOR]

Background: Replacement of saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs), especially polyunsaturated fatty acids (PUFAs), has been associated with a lower risk of ischemic heart disease (IHD). Whether this replacement is beneficial for drug-treated patients with cardiac disease is not yet clear.Objective: In a prospective study of Dutch patients with cardiac disease (Alpha Omega Cohort), we examined the risk of cardiovascular disease (CVD) and IHD mortality when the sum of SFAs and trans fatty acids (TFAs) was theoretically replaced by total UFAs, PUFAs, or cis monounsaturated fatty acids (MUFAs).Design: We included 4146 state-of-the-art drug-treated patients aged 60-80 y with a history of myocardial infarction (79% male patients) and reliable dietary data at baseline (2002-2006). Cause-specific mortality was monitored until 1 January 2013. HRs for CVD mortality and IHD mortality for theoretical, isocaloric replacement of dietary fatty acids (FAs) in quintiles (1-5) and continuously (per 5% of energy) were obtained from Cox regression models, adjusting for demographic factors, medication use, and lifestyle and dietary factors.Results: Patients consumed, on average, 17.5% of energy of total UFAs, 13.0% of energy of SFAs, and <1% of energy of TFAs. During ~7 y of follow-up, 372 CVD deaths and 249 IHD deaths occurred. Substitution modeling yielded significantly lower risks of CVD mortality when replacing SFAs plus TFAs with total UFAs [HR in quintile 5 compared with quintile 1: 0.45 (95% CI: 0.28, 0.72)] or PUFAs [HR: 0.66 (95% CI: 0.44, 0.98)], whereas HRs in cis MUFA quintiles were nonsignificant. HRs were similar for IHD mortality. In continuous analyses, replacement of SFAs plus TFAs with total UFAs, PUFAs, or cis MUFAs (per 5% of energy) was associated with significantly lower risks of CVD mortality (HRs between 0.68 and 0.75) and IHD mortality (HRs between 0.55 and 0.70).Conclusion: Shifting the FA composition of the diet toward a higher proportion of UFAs may lower CVD mortality risk in drug-treated patients with cardiac disease. This trial was registered at clinicaltrials.gov as NCT03192410 [ABSTRACT FROM AUTHOR]

Background: Prospective cohort studies have shown that the consumption of cocoa and tea is associated with lower risk of cardiovascular diseases (CVDs), and cocoa and tea have been shown to improve CVD risk factors in randomized controlled trials. Cocoa and tea are major dietary sources of the flavan-3-ol epicatechin. Objective: We investigated the associations of dietary epicatechin intake with 25-y CVD mortality in elderly Dutch men. Design: We used data from the Zutphen Elderly Study, which was a prospective cohort study of 774 men aged 65-84 y in 1985. Epicatechin intake was estimated 4 times in 15 y with the use of the crosscheck dietary history method. Time-dependent Cox proportional hazards models were used to investigate repeated measures of epicatechin intake in relation to 25-y CVD mortality. Results: Mean intake of epicatechin was 15.2 ± 7.7 mg/d, and the major dietary sources were tea (51%), apples (28%), and cocoa (7%). During 25 y of follow-up, 329 men died from CVD, 148 died from coronary heart disease (CHD), and 72 men died from stroke. Risk of CHD mortality was 38% lower in men in the top tertile of epicatechin intake than in men in the bottom tertile of epicatechin intake (HR: 0.62; 95% CI: 0.39, 0.98). Epicatechin intake was also significantly associated with 46% lower risk of CVD mortality in men with prevalent CVD (HR: 0.54; 95% CI: 0.31, 0.96) but not in men who were free of CVD. Conclusions: We show, for the first time to our knowledge, that epicatechin intake is inversely related to CHD mortality in elderly men and to CVD mortality in prevalent cases of CVD. More studies are needed before conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Objective: Loneliness, defined as the discrepancy between one's desired and actual relationships, is prevalent in the elderly and can be both emotional and social loneliness. We aimed to determine whether loneliness is independently related to higher all-cause, cardiovascular, and noncardiovascular mortality in elderly men.Methods: Using a population-based cohort study with 25 years of follow-up from 1985, the Zutphen Study, 719 of 939 men (76.2%; age range: 64-84 years) who had complete data on loneliness at baseline and at least 2 years of survival were studied. Loneliness was assessed using a validated 11-item questionnaire in 1985, 1990, 1995, and 2000. Time-dependent Cox proportional hazards models were adjusted for sociodemographic characteristics and cardiovascular risk factors.Results: At baseline, point prevalence of moderate and severe loneliness was, respectively, 38.8% (N = 279) and 3.2% (N = 23). Loneliness, especially emotional loneliness, did significantly increase over 15 years with an overall reliability coefficient of 0.50. All-cause, cardiovascular, and noncardiovascular mortality were not higher among moderately lonely participants (hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.84-1.17; HR: 0.99; 95% CI: 0.78-1.25; and HR: 0.99; 95% CI: 0.79-1.24, respectively) and severely lonely participants (HR: 1.40; 95% CI: 0.85-2.31; HR: 1.18; 95% CI: 0.58-2.39; and HR: 1.63; 95% CIH 0.80-3.31, respectively).Conclusion: Loneliness is common and increases during aging, due to the increase in its component emotional loneliness over time. No independent associations with risks of all-cause, cardiovascular, and noncardiovascular death were found. [ABSTRACT FROM AUTHOR]

Background: Little is known about dietary scores and mortality risk in cardiac patients who are well treated with drugs with attendant relatively low risk of cardiovascular diseases (CVDs). Objective: We assessed whether healthy eating lowers the risk of CVD and all-cause mortality in cardiac patients. Design: We included 4307 patients from the Alpha Omega Trial aged 60-80 y with a clinically diagnosed myocardial infarction and monitored mortality for 10 y. Diet was assessed at baseline (2002-2006) with a validated 203-item food-frequency questionnaire. We created 2 dietary scores on the basis of nonoverlapping sets of foods: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). The associations of both dietary scores with CVD and all-cause mortality were assessed by using multivariable-adjusted Cox regression models. Results: The median time after myocardial infarction at baseline was 3.7 y (IQR: 1.7-6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3-7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost to follow-up. A substantially higher average amount of DHNaFS foods (~ 1750 g/d) than DUNaFS foods (~650 g/d) was consumed. Almost all patients received drug treatment: 86% used statins, 90% used antihy-pertensive medication, and 98% used antithrombotic medication. Patients in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55, 0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower all-cause mortality risk than did patients in the first quintile. The DUNaFS was unrelated to both CVD and all-cause mortality. Conclusion: Beyond state-of-the-art drug treatment, healthy eating was associated with a lower risk of CVD and all-cause mortality in cardiac patients. This trial was registered at clinicaltrials.gov as NCT00127452. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prospective cohort studies showed inverse associations between the intake of flavonoid-rich foods (cocoa and tea) and cardiovascular disease (CVD). Intervention studies showed protective effects on intermediate markers of CVD. This may be due to the protective effects of the flavonoids epicatechin (in cocoa and tea) and quercetin (in tea). OBJECTIVE: We investigated the effects of supplementation of pure epicatechin and quercetin on vascular function and cardiometabolic health. DESIGN: Thirty-seven apparently healthy men and women aged 40-80 y with a systolic blood pressure (BP) between 125 and 160 mm Hg at screening were enrolled in a randomized, double-blind, placebo-controlled, crossover trial. CVD risk factors were measured before and after 4 wk of daily flavonoid supplementation. Participants received (-)-epicatechin (100 mg/d), quercetin-3-glucoside (160 mg/d), or placebo capsules for 4 wk in random order. The primary outcome was the change in flow-mediated dilation from pre- to postintervention. Secondary outcomes included other markers of CVD risk and vascular function. RESULTS: Epicatechin supplementation did not change flow-mediated dilation significantly (1.1% absolute; 95% CI: -0.1%, 2.3%; P = 0.07). Epicatechin supplementation improved fasting plasma insulin (Δ insulin: -1.46 mU/L; 95% CI: -2.74, -0.18 mU/L; P = 0.03) and insulin resistance (Δ homeostasis model assessment of insulin resistance: -0.38; 95% CI: -0.74, -0.01; P = 0.04) and had no effect on fasting plasma glucose. Epicatechin did not change BP (office BP and 24-h ambulatory BP), arterial stiffness, nitric oxide, endothelin 1, or blood lipid profile. Quercetin-3-glucoside supplementation had no effect on flow-mediated dilation, insulin resistance, or other CVD risk factors. CONCLUSIONS: Our results suggest that epicatechin may in part contribute to the cardioprotective effects of cocoa and tea by improving insulin resistance. It is unlikely that quercetin plays an important role in the cardioprotective effects of tea. This study was registered at clinicaltrials.gov as NCT01691404. [ABSTRACT FROM AUTHOR]

Background: Although dietary recommendations have focused on restricting saturated fat (SF) consumption to reduce cardiovascular disease (CVD) risk, evidence from prospective studies has not supported a strong link between total SF intake and CVD events. An understanding of whether food sources of SF influence these relations may provide new insights. Objective: We investigated the association of SF consumption from different food sources and the incidence of CVD events in a multiethnic population. Design: Participants who were 45-84 y old at baseline (n = 5209) were followed from 2000 to 2010. Diet was assessed by using a 120- item food-frequency questionnaire. CVD incidence (316 cases) was assessed during follow-up visits. Results: After adjustment for demographics, lifestyle, and dietary confounders, a higher intake of dairy SF was associated with lower CVD risk [HR (95% CI) for +5 g/d and +5% of energy from dairy SF: 0.79 (0.68, 0.92) and 0.62 (0.47, 0.82), respectively]. In contrast, a higher intake of meat SF was associated with greater CVD risk [HR (95% CI) for +5 g/d and a +5% of energy from meat SF: 1.26 (1.02, 1.54) and 1.48 (0.98, 2.23), respectively]. The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk [HR (95% CI): .0:75 (#.63*- 0.91)]. No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow. Conclusion: Associations of SF with health may depend on food- specific fatty acids or other nutrient constituents in foods that contain SF, in addition to SF. [ABSTRACT FROM AUTHOR]

Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985-2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18-30 y at year 0 (1985-1986)] assessed diet at examinations at study years 0, 7 (1992-1993), and 20 (2005-2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time- specific mean diet scores and servings per day of food groups. Results: In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age- matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups. Conclusions: The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist. [ABSTRACT FROM AUTHOR]

BACKGROUND: In patients who have experienced a myocardial infarction (MI), n-3 (omega-3) PUFA status is low, whereas the risk of depression is increased. OBJECTIVE: The objective was to assess whether the plant-derived [alpha]-linolenic acid (ALA) and the fish fatty acids EPA and DHA would improve affective states. DESIGN: In a secondary analysis of the randomized, double-blind, placebo-controlled Alpha Omega Trial, 4116 of 4837 (85.1%) patients (aged 60-80 y; 79.2% men) who had experienced an MI were included. Margarine spreads were used to deliver 400 mg EPA-DHA/d, 2 g ALA/d, both EPA-DHA and ALA, or a placebo for 40 mo. At 40 mo, the endpoints of depressive symptoms (15-item Geriatric Depression Scale) and dispositional optimism (a 4-item questionnaire and the Life Orientation Test-Revised) were analyzed by using a posttest-only design. RESULTS: The 4 randomly assigned groups did not differ in baseline characteristics. ALA supplementation significantly increased plasma cholesteryl ester concentrations of ALA by 69%, and EPA-DHA supplementation increased plasma cholesteryl ester concentrations of EPA and DHA by 61% and 30%, respectively. Depressive symptoms or dispositional optimism did not differ between groups with the use of n-3 fatty acids compared with placebo at the 40-mo follow-up. The standardized mean (±SE) differences in depressive symptoms were as follows: for EPA-DHA plus ALA (n = 1009) compared with placebo (n = 1030), -0.025 ± 0.044 (P = 0.57); for EPA-DHA (n = 1007) compared with placebo, -0.048 ± 0.044 (P = 0.28); and for ALA (n = 1022) compared with placebo, -0.047 ± 0.044 (P = 0.29). CONCLUSIONS: In patients who had experienced an MI, low-dose EPA-DHA supplementation, ALA supplementation, or a combination of both did not affect depressive symptoms and dispositional optimism. These findings are in accord with those from previous trials in individuals without psychopathology or without severe depressive symptoms. This trial was registered at clinicaltrials.gov as NCT00127452. [ABSTRACT FROM AUTHOR]

We assessed the dose-response relations within a low range of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and fish intake on fatal coronary heart disease (CHD) and nonfatal myocardial infarction (MD. In a Dutch population-based cohort study, EPA+DHA and fish intake were assessed at baseline among 21342 participants aged 20-65 y with no history of Ml or stroke. Hazard ratios were calculated with Cox proportional-hazard models. During 9-14 y of follow-up (mean 11.3 y), 647 participants (3%) died, of which 82 of CHD. Fatal CHD mainly comprised Ml (64 cases). In total, 252 participants survived an MI. Median intakes in quartiles of EPA+DHA were 40, 84, 151, and 234 mg/d. Medians of fish consumption in quartiles were 1.1, 4.2, 10.7, and 17.3 g/d. Compared with the lowest quartile of EPA+DHA, participants in the top quartile had a 49% lower risk of fatal CHD (95% Cl: 6-73%) and a 62% lower risk of fatal MI (95% CI: 23-81 %). We observed inverse dose-response relations for EPA+DHA intake and fatal CHD (P-trend = 0.05) and fatal MI (P-trend = 0.01). Results were similar for fish consumption. Nonfatal Ml was not associated with EPA+DHA or fish intake. In conclusion, in populations with a low fish consumption, EPA+DHA and fish may lower fatal CHD and MI risk in a dose-responsive manner. Low intakes of EPA+DHA or fish do not seem to protect against nonfatal Ml. [ABSTRACT FROM AUTHOR]

Flavonols are strong antioxidants in plant foods and tea is a major dietary source. There is evidence from prospective cohort studies that tea and flavonols are inversely related to stroke incidence. We conducted a metaanalysis of prospective cohort studies to assess quantitatively the strength of the association between flavonol intake and stroke incidence. Prospective cohort studies with data from individuals free of cardiovascular diseases (CVD) or stroke at baseline were included in the metaanalysis. Persons were followed for between 6 and 28 y. Data from 6 cohorts involving 111067 persons with at least 2155 nonfatal and fatal cases were pooled. A random effects model was used. In all studies included, adjustments were made for major CVD risk factors except for 2 that did not adjust for alcohol and energy intake. A high intake of flavonols compared with a low intake was inversely associated with nonfatal and fatal stroke with a pooled relative risk of 0.80 (95% Cl: 0.65, 0.98). Visual inspection of Begg's funnel plot and Egger's test (P = 0.01) indicated potential publication bias. We conclude that flavonols may reduce stroke risk. [ABSTRACT FROM AUTHOR]

The role of beta-carotene, alpha-tocopherol, and vitamin C in the prevention of cardiovascular diseases (CVD) is controversial. Prospective studies on gamma-tocopherol and carotenoids other than beta-carotene are sparse. We assessed relations between the intake of different carotenoids, alpha- and gamma-tocopherol, and vitamin C with 15-y CVD mortality in elderly men who participated in the Zutphen Elderly Study. Information on diet and potential confounding factors was collected in 1985, 1990, and 1995. In 1985, 559 men (mean age approximately 72 y) free of chronic diseases were included in the current analysis. After 15 y of follow-up, comprising 5744 person-years, 197 men had died from CVD. After adjustment for age, smoking, and other potential lifestyle and dietary confounders, relative risks (RR) (95% CI) of CVD death for a 1-SD increase in intake were 0.81 (0.66-0.99) for alpha-carotene and 0.80 (0.66-0.97) for beta-carotene. Carrots were the primary source of alpha- and beta-carotene and their consumption was related to a lower risk of death from CVD (adjusted RR, 0.83; 95% CI = 0.68-1.00). Intakes of carotenoids other than alpha- and beta-carotene were not associated with CVD mortality, nor were vitamin C and alpha- and gamma tocopherol. In conclusion, dietary intakes of alpha-carotene and beta-carotene are inversely associated with CVD mortality in elderly men. This study does not indicate an important role for other carotenoids, tocopherols, or vitamin C in lowering the risk of CVD death. [ABSTRACT FROM AUTHOR]

The role of β-carotene, α-tocopherol, and vitamin C in the prevention of cardiovascular diseases (CVD) is controversial. Prospective studies on γ-tocopherol and carotenoids other than β-carotene are sparse. We assessed relations between the intake of different carotenoids, α- and γ-tocopherol, and vitamin C with 15-y CVD mortality in elderly men who participated in the Zutphen Elderly Study. Information on diet and potential confounding factors was collected in 1985, 1990, and 1995. In 1985, 559 men (mean age ∼ 72 y) free of chronic diseases were included in the current analysis. After 15 y of follow-up, comprising 5744 person-years, 197 men had died from CVD. After adjustment for age, smoking, and other potential lifestyle and dietary confounders, relative risks (RR( (95% CI) of CVD death for a 1-SD increase in intake were 0.81 (0.66- 0.99) for α-carotene and 0.80 (0.66-0.97) for β-carotene. Carrots were the primary source of α- and β-carotene and their consumption was related to a lower risk of death from CVD (adjusted RR, 0.83; 95% Cl = 0.68-1.00). Intakes of carotenoids other than α- and β-carotene were not associated with CVD mortality, nor were vitamin C and α- and γ tocopherol. In conclusion, dietary intakes of α-carotene and β-carotene are inversely associated with CVD mortality in elderly men. This study does not indicate an important role for other carotenoids, tocopherols, or vitamin C in lowering the risk of CVD death. [ABSTRACT FROM AUTHOR]

Background: Recent studies indicate that depression plays an important role in the occurrence of cardiovascular diseases (CVDs). The underlying mechanisms are not well understood. Objective: We investigated whether dietary intake of the n-3 fatty acids (FAs) eicosapentaenic acid and docosahexaenoic acid could explain the relation between depressive symptoms and cardiovascular mortality. Design: The Zutphen Elderly Study is a prospective cohort study conducted in the Netherlands. Depressive symptoms were measured in 1990 with the Zung Self-rating Depression Scale in 332 men aged 70-90 y and free from CVD and diabetes. Dietary factors were assessed with a cross-check dietary history method in 1990. Mortality data were collected between 1990 and 2000. Logistic and Cox regression analyses were performed, with adjustment for demographics and CVD risk factors. Results: Compared with a low intake (x: 21 mg/d), a high intake (x: 407 mg/d) of n-3 FAs was associated with fewer depressive symptoms [odds ratio: 0.46; 95% CI: 0.22, 0.95; P for trend = 0.04] at baseline and no significant reduced risk of 10-y CVD mortality [hazard ratio (HR): 0.88; 95% CI: 0.51, 1.50]. The adjusted HR for an increase in depressive symptoms with 1 SD for CVD mortality was 1.28 (95% CI: 1.03, 1.57) and did not change after additional adjustment for the intake of n-3 FAs. Conclusion: An average intake of ≈400 mg n-3 FA/d may reduce the risk of depression. Our results, however, do not support the hypothesis that the intake of n-3 FAs explains the relation between depression and CVD. [ABSTRACT FROM AUTHOR]

Background: Plant lignans are converted to enterolignans that have antioxidant and weak estrogen-like activities, and therefore they may lower cardiovascular disease and cancer risks. Objective: We investigated whether the intakes of 4 plant lignans (lariciresinol, pinoresinol, secoisolariciresinol, and matairesinol) were inversely associated with coronary heart disease (CHD), cardiovascular diseases (CVD), cancer, and all-cause mortality. Design: The Zutphen Elderly Study is a prospective cohort study in which 570 men aged 64-84 y were followed for 15 y. We recently developed a database and used it to estimate the dietary intakes of 4 plant lignans. Lignan intake was related to mortality with the use of Cox proportional hazards analysis. Results: The median total lignan intake in 1985 was 977 μg/d. Tea, vegetables, bread, coffee, fruit, and wine were the major sources of lignan. The total lignan intake was notrelated to mortality. However, the intake of matairesinol was inversely associated with CHD, CVD, and all-cause mortality (P ⩽ 0.05 for all) and cancer (P = 0.06). Multivariate-adjusted rate ratios (95% CI) per 1-SD increase in intake were 0.72 (0.53,0.98) for CHD, 0.83 (0.69,1.00) for CVD, 0.86 (0.76, 0.97) for all-cause mortality, and 0.81 (0.65, 1.00) for cancer. Conclusions: Total lignan intake was not associated with mortality. The intake of matairesinol was inversely associated with mortality due to CHD, CVD, cancer, and all causes. We cannot exclude the possibility that the inverse association between matairesinol intake and mortality is due to an associated factor, such as wine consumption. [ABSTRACT FROM AUTHOR]

Background: Only a few observational studies have related plasma carotene and α-tocopherol to mortality in elderly subjects. Objective: The objective was to study the association of plasma carotene (α-and β-carotene) and α-tocopherol with all-cause and cause-specific mortality in elderly subjects who participated in a European prospective study. Design: Plasma concentrations of carotene and α-tocopherol were measured in 1168 elderly men and women. After a follow-up period of 10 y, 388 persons had died. The association between plasma antioxidants and mortality was analyzed by using Cox proportional hazard models. To put our results in context, we performed a metaanalysis of 5 studies on plasma antioxidants and all-cause mortality in elderly populations. Results: Plasma carotene concentrations were associated with a lower mortality risk [adjusted rate ratio (RR) for an increment of 0.39 μmol/L: 0.79; 95% CI: 0.70, 0.89]. This lower mortality risk was observed for both cancer (RR: 0.59; 95% CI: 0.44, 0.79) and cardiovascular disease (RR: 0.83; 95% CI: 0.70, 1.00). The lower risk of cardiovascular death was confined to those with a body mass index (in kg/m2) <25 (RR: 0.67; 95% CI: 0.49, 0.94). Plasma concentrations of α-tocopherol were not associated with all-cause or cause-specific mortality. The results for both plasma antioxidants and all-cause mortality were confirmed by the meta-analysis. Conclusions: This prospective study suggests that high plasma concentrations of carotene are associated both with lower mortality from all causes and with cancer in the elderly. For cardiovascular mortality, the inverse association was confined to elderly with body mass indexes <25. [ABSTRACT FROM AUTHOR]

Enterolignans (enterolactone and enterodiol) are phytoestrogens that are formed by the colonic microflora from plant lignans. They may reduce the risk of certain types of cancer and cardiovascular diseases. Initially, only secoisolariciresinol and matairesinol were considered to be enterolignan precursors, but recently, new precursors such as lariciresinol and pinoresinol were identified. We recently developed a lignan database including 4 major enterolignan precursors. We used this database to estimate lignan intake in a representative sample of Dutch men and women participating in the Dutch Food Consumption Survey, carried out in 1997–1998. Median total lignan intake among 4660 adults (19–97 y old) was 979 μg/d. Total lignan intake did not differ between men and women; thus, the lignan density of the diet was significantly higher (P < 0.001) in women than in men. Lignan intake was strongly skewed toward higher values (range 43–77584 μg/d, mean 1241 μg/d). Lariciresinol and pinoresinol contributed 75% to lignan intake, whereas secoisolariciresinol and matairesinol contributed only 25%. The major food sources of lignans were beverages (37%), vegetables (24%), nuts and seeds (14%), bread (9%), and fruits (7%). Lignan intake was significantly (P < 0.001) correlated with intake of dietary fiber (r = 0.46), folate (r = 0.39), and vitamin C (r = 0.44). Older persons, nonsmokers, vegetarians, and persons with a low BMI or a high socioeconomic status had higher lignan intakes than their counterparts. In brief, this study shows that the amount of enterolignan precursors in the diet has previously been largely underestimated. [ABSTRACT FROM AUTHOR]

Background: Data on the relation between α-linolenic acid intake and coronary artery disease (CAD) are limited. Other dietary components appear to modify the reported relation between α-linolenic acid intake and CAD. Objective: We examined whether dietary α-linolenic acid intake was inversely associated with risk of CAD. Design: We prospectively studied 667 men aged 64-84 y from the Zutphen Elderly Study who were free of CAD at baseline. Dietary intake was assessed by using a cross-check dietary history method. Results: During the 10-y follow-up, we documented 98 cases of CAD. After adjustment for age, standard coronary risk factors, and intake of trans fatty acids and other nutrients, α-linolenic acid intake was not significantly associated with CAD risk. The relative risk of CAD for the highest compared with the lowest tertile of α-linolenic acid intake was 1.68 (95% CI: 0.86, 3.29). α-Linolenic acid intake from sources containing trans fatty acids was also nonsignificantly, yet positively, associated with CAD risk. α-Linolenic acid intake from foods that did not contain trans fatty acids was not associated with CAD risk, the relative risk of CAD for the highest compared with the lowest tertile was 1.15 (95% CI: 0.63,2.11). Conclusion: We did not observe a beneficial effect of dietary α-linolenic acid intake on the risk of 10-y CAD incidence. Investigating this hypothesis was complicated by the association between intakes of α-linolenic acid and trans fatty acids. Given the results of current prospective studies, a protective cardiac effect of α-linolenic acid is questionable. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies suggest that tea consumption may reduce the risk of cardiovascular diseases, but results are inconsistent. Catechins, which belong to the flavonoid family, are the main components of tea and may be responsible for the alleged protective effect. Taking catechin sources other than tea into account might clarify the reported associations. Objective: The objective was to evaluate the association between catechin intake and the incidence of and mortality from ischemic heart disease and stroke. Design: We evaluated the effect of a high catechin intake by using data from the Zutphen Elderly Study, a prospective cohort study of 806 men aged 65-84 y at baseline in 1985. Results: The mean (±SD) catechin intake at baseline was 72 ± 47.8 mg, mainly from black tea, apples, and chocolate. A total of 90 deaths from ischemic heart disease were documented. Catechin intake was inversely associated with ischemic heart disease mortality; the multivariate-adjusted risk ratio in the highest tertile of intake was 0.49 (95% CI: 0.27, 0.88; P for trend: 0.017). After multivariate adjustment, catechin intake was not associated with the incidence of myocardial infarction (risk ratio in the highest tertile of intake: 0.70; 95% CI: 0.39, 1.26; P for trend: 0.232). After adjustment for tea consumption and flavonol intake, a 7.5-mg increase in catechin intake from sources other than tea was associated with a tendency for a 20% reduction in ischemic heart disease mortality risk (P = 0.114). There was no association between catechin intake and stroke incidence or mortality. Conclusion: Catechins, whether from tea or other sources, may reduce the risk of ischemic heart disease mortality but not of stroke. [ABSTRACT FROM AUTHOR]

Background: An elevated plasma total homocysteine (tHcy) concentration is associated with an increased risk of cardiovascular diseases. Folate, riboflavin, vitamin B-6, and vitamin B-12 are essential in homocysteine metabolism. Objective: The objective was to describe the association between dietary intakes of folate, riboflavin, vitamin B-6, and vitamin B-12 and the nonfasting plasma tHcy concentration. Design: A random sample of 2435 men and women aged 20-65 y from a population-based Dutch cohort examined in 1993-1996 was analyzed cross-sectionally. Results: Univariately, intakes of all B vitamins were inversely related to the plasma tHcy concentration. In multivariate models, only folate intake remained inversely associated with the plasma tHcy concentration. Mean plasma tHcy concentrations (adjusted for intakes of riboflavin, vitamin B-6, vitamin B-12, and methio-nine and for age, smoking, and alcohol consumption) in men with low (first quintile: 161 µg/d) and high (fifth quintile: 254 µg/d) folate intakes were 15.4 and 13.2 µmol/L, respectively; in women, plasma tHcy concentrations were 13.7 and 12.4 µmol/L at folate intakes of 160 and 262 µg/d, respectively. In men, the difference in the mean plasma tHcy concentration between men with low and high folate intakes was greater in smokers than in nonsmok-ers (2.8 compared with 1.6 µmol/L) and greater in nondrinkers than in drinkers of >2 alcoholic drinks/d (3.5 compared with 1.4 µmol/L). In women, the association between folate intake and plasma tHcy was not modified by smoking or alcohol consumption. Conclusions: In this Dutch population, folate was the only B vitamin independently inversely associated with the plasma tHcy concentration. Changing dietary habits may substantially influence the plasma tHcy concentration in the general population. [ABSTRACT FROM AUTHOR]

At the end of the 1950s the Seven Countries Study was designed to investigate the relations between diet and cardiovascular diseases. Sixteen cohorts were selected in Finland, Greece, Italy, Japan, The Netherlands, United States, and Yugoslavia. During the 1960s food consumption data were collected from random samples of these cohorts by use of the record method. In Finland the intake of milk, potatoes, edible fats, and sugar products was very high. A similar but lower intake pattern was observed in The Netherlands. Fruit, meat, and pastry consumption was high in the United States; cereal and alcoholic drink consumption was high in Italy; and bread consumption high in Yugoslavians except for those in Belgrade. In Greece the intake of olive oil and fruit was high and the Japanese cohorts were characterized by a high consumption offish, rice, and soy products. These differences in food consumption patterns have lessened during the past 25 y. [ABSTRACT FROM AUTHOR]

In 1965 within the Zutphen Study information on several possible determinants of body fatness (eg, energy intake, energy expenditure, alcohol intake, coffee consumption, tea consumption, and smoking) was collected. Univariate analyses showed that for 525 men aged 45-64 y and free from cardiovascular diseases, indicators of body fatness were inversely related to the difference between energy intake and expenditure, physical activity per kilogram body weight, smoking, and coffee consumption. Alcohol intake was directly related to Quetelet index, and tea consumption was not related to indicators of body fatness. Inverse associations between indicators of body fatness and the difference between energy intake and expenditure, physical activity per kilogram body weight, and smoking were confirmed in multivariate analyses. The inverse association between body fatness and the difference between energy intake and expenditure may be due to the underestimation of energy intake by obese subjects. In lean people this association may be explained by a thermogenic effect of smoking. [ABSTRACT FROM AUTHOR]

The article discusses various epidemiologic studies that depict relations between diet and chronic diseases. Topics discussed include relations between the intake of beta-carotene, vitamin C, selenium, and mortality from lung cancer and total cancer, essential micronutrients commonly related to carcinogenesis and a significant inverse association vitamin C intake in 1960 and 25-yr lung-cancer mortality.

The response by Jolien Julsing and colleagues to a letter to the editor about their article "Loneliness and all-cause, cardiovascular, and noncardiovascular mortality in older men: the Zutphen Elderly Study," published in a previous issue is presented.

A response by the authors of the article "Effects of the pure flavonoids epicatechin and quercetin on vascular function and cardiometabolic health: A randomized, double-blind, placebo-controlled, crossover trial" which was published in a previous issue is presented.

Background: Weekly fish consumption has been related to a lower risk of fatal coronary heart disease (CHD) and incident stroke in populations with a low fish intake. This relation has mainly been attributed to n-3 fatty acids in fish, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is at present unclear whether α-linolenic acid (ALA), a n-3 fatty acid from vegetable origin, could also be protective against cardiovascular diseases (CVDs). There is a need for food-based trials to establish the efficacy of low doses of n-3 fatty acids in CVD prevention. Objectives: The aim of the study was to evaluate the effect of an additional daily intake of 400 mg of EPA + DHA and 2 g of ALA on CVD morbidity and mortality in free-living subjects with a history of myocardial infarction. Design: The multicenter Alpha Omega Trial is a randomized, double-blind, placebo-controlled trial with a 2 × 2 factorial design. Between May 2002 and December 2006, we enrolled a total of 4,837 men and women aged 60 through 80 who experienced a myocardial infarction within 10 years before entering the study. Subjects were randomized to 1 of 4 margarine spreads that were enriched with EPA + DHA and/or ALA, or placebo. Compliance was monitored via tub counts and assessment of n-3 fatty acids in plasma. Subjects were observed for 40 months for the occurrence of fatal and nonfatal CVD. Results: The cohort was on average 69 years old at the start of the study and comprised 22% women. Subjects had their (last) myocardial infarction approximately 4 years before enrolment. Mean body mass index was 27.7 kg/m2, and 17% smoked. Average serum total and high-density lipoprotein cholesterol were 4.7 and 1.3 mmol/L, respectively, and 85% used statins. Mean blood pressure was 142/80 mm Hg, and most subjects were on antihypertensive medication (88%). Diabetes mellitus was reported by 17% of the subjects, and 7% reported a history of stroke. The overall mortality rate during the trial period was 23 per 1,000 person-years, with approximately 40% due to CVD. Current status: Follow-up of the patients was completed in November 2009, and findings will be reported in the second part of 2010. [Copyright &y& Elsevier]

Abstract: Objective: It is unclear whether the personality trait of dispositional optimism, defined in terms of generalized positive outcome expectancies, life engagement, and a future orientation, has a protective effect on the development of depression in community-dwelling elderly men. Methods: We included 464 men aged 64 to 84 years (mean 70.8; SD 4.6) with complete data at baseline and at 5 years of follow-up in a prospective cohort study with a follow-up period of 15 years. In 1985, 1990, 1995 and 2000 dispositional optimism was assessed using a 4-item questionnaire, and in 1990, 1995 and 2000 depressive symptoms were assessed by the Zung self-rating depression scale (SDS). Logistic regression was used to estimate odds ratios for the development of depressive symptoms (i.e., Zung SDS≥50). Results: The cumulative incidence for depressive symptoms was 44% (n =202) after 15 years follow-up. Dispositional optimism predicted for a lower cumulative incidence of depressive symptoms with an odds ratio of 0.23 (95% confidence interval 0.15–0.36; high vs. low optimism). The protective effect remained unaffected after multivariate adjustment for age, self-rated health, cardiovascular disease, education, and physical activity. In men free of depressive symptoms in 1990, the protective effect of dispositional optimism persisted. Limitation: The dispositional optimism scale has not been validated against the ‘Life Orientation Test’. Conclusions: Dispositional optimism protects against the development of depressive symptoms during 15 years of follow-up in elderly community-dwelling men. [Copyright &y& Elsevier]

The relationship between the Gly972Arg polymorphism in the insulin receptor substrate-1 (IRS-1) gene and metabolic risk markers is not clear, possibly due to small sample sizes. Modification by body mass index (BMI) has also been suggested. Our aim was therefore to quantify the association of this 972Arg-variant with insulin, glucose and lipid levels in overweight and non-overweight subjects with oversampling of subjects with the 972Arg-variant. We first genotyped 3684 subjects selected from a large population-based cohort (n∼23,000) according to BMI (26–40 or 18–24 kg/m2). Next, we examined 600 of these subjects for fasting metabolic risk markers according to BMI-group and genotype. Subjects with the 972Arg-variant had significantly higher insulin concentrations (4.09 pmol/l or 9.6%, P=0.024) and lower triglyceride levels (0.13 mmol/l or 11%, P=0.001) compared with non-carriers when adjusted for age, sex, waist-to-hip ratio, BMI, alcohol consumption, physical activity and cigarette smoking. These associations were more pronounced in the high BMI-group, although the interactions were not statistically significant. Our large population-based sample shows that the IRS-1 Gly972Arg polymorphism relates to higher fasting insulin levels and lower triglyceride levels. The impact of this genotype and its modification by overweight may be smaller than suggested previously. [Copyright &y& Elsevier]

Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The relationships were explored of some cardiovascular risk factors to typical (TYP) and atypical (ATYP) fatal coronary events (CHD). Material and methods: Thirteen cohorts of 40–59year-old men of the Seven Countries Study were followed-up for 40years (N=9704 heart disease free subjects). Fatal TYP-CHD were classified when manifested as myocardial infarction, other acute coronary syndromes, angina pectoris and sudden death; and as ATYP-CHD when manifested only as heart failure or arrhythmia in the absence of other clear etiologies. Death rates were computed for single countries separately for TYP and ATYP and for different lengths of follow-up. Cox models included: age, smoking habits, systolic blood pressure (SBP), serum cholesterol (CHOL), forced expiratory volume in ¾sec (FEV) and diabetes. Results: TYP-CHD was more common in North American and Northern European countries, while ATYP-CHD were more common in Southern and Eastern Europe. Age at death was 5years greater for ATYP-CHD than for TYP-CHD. Cox models in the pool of 13 cohorts showed that coefficient for age was significantly larger for ATYP-CHD (hazard ratio, HR: 2.36; confidence intervals CI: 2.18 – 2.26) versus TYP-CHD (HR 1.50, CI 1.43-1.58) while coefficients for CHOL was larger and significant for TYP-CHD (HR 1.29, CI 1.22-1.35) but not for ATYP-CHD (HR 0.93, CI 0.85-1.03). SBP, smoking habits, FEV and diabetes all predicted both conditions almost equally. Conclusion: The different relationships of CHOL and age with the two types of fatal CHD suggest that the two groups of manifestations may belong to different diseases. [Copyright &y& Elsevier]

Background: Prospective cohort studies on biological risk factors of completed suicide are scarce. We aimed to test which biological risk factors independently identify subjects at increased risk of suicidal death.Methods: In the prospective cohort of the Seven Countries Study, 5,321 middle-aged men from Finland, Serbia, Italy, and Greece were included. Completed suicide (ICD-8 codes E950-959) was assessed during 40 years of follow-up. Biological cardiovascular risk factors (including forced vital capacity [FVC] and height) were tested for their role as predictors in multivariable Cox models stratified by country.Results: There were 4518 deaths during follow-up, with 64 from suicide (1.4%). In univariable models, only FVC and height were strongly inversely related with suicide. Socio-economic status and being unmarried were potential confounders. In multivariable models taking these confounders into account, both a low FVC (0.30 for top vs. lowest quartile; 95% CI: 0.12-0.76; P=0.006 for trend) and a low FVC/height ratio (0.37 for top vs. lowest quartile; 95% CI: 0.17-0.82; P=0.004 for trend) were strongly inversely related with completed suicide.Limitations: Information on proximal causes, such as prior suicidal ideation, emotional distress and depression, was lacking at baseline.Conclusions: Poor respiratory function in middle-aged men was an independent risk factor for completed suicide. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cohort and case-control studies found that lower serum total cholesterol is associated with depression. It is, however, unclear whether low cholesterol or its lipoprotein fractions are causally related to depression. Using a Mendelian randomization design, the potential association between apolipoprotein E (APOE) genotype (affecting lifetime cholesterol levels) and depressive symptoms was studied. Methods: In the longitudinal Finland, Italy, the Netherlands Elderly (FINE) Study 1089 men were included in 1985. The 435 men from Finland, 418 men from The Netherlands, and 236 men from Italy (aged 65–84 years) were free of myocardial infarction, stroke, diabetes mellitus and cancer at all time points. They were prospectively studied around 1985 (n =658), 1990 (n =668), 1995 (n =327), and 2000 (n =82). Associations between serum cholesterol, lipoprotein fractions and APOE genotype, with depressive symptoms (by Zung self-rating depression scale [SDS]) were analyzed using multilevel regression models. Results: Serum total cholesterol was inversely associated with the Zung SDS (−0.61 points per 1 mmol/L increase in cholesterol; 95% confidence interval: −1.05 to −0.17; P =0.007), after adjustment for country, age, body mass index, smoking, and alcohol intake. However, none of the cholesterol lipoprotein fractions were associated with the Zung SDS. The APOE genotypes ε4/4, ε4/3; ε3/3; ε4/2, and ε3/2 or ε2/2 were associated with decreasing levels of serum total and LDL cholesterol (Ps<0.001), but not with increasing depressive symptoms (P =0.67). Limitations: APOE genotype was assessed through protein isoforms and not actual DNA-based typing. Conclusions: There was a modest inverse relationship between depression scores and serum total cholesterol in elderly men, but no associations with lipoprotein fractions or with the APOE genotype. [Copyright &y& Elsevier]

Abstract: Background: Depression is associated with an increased risk of cardiovascular diseases (CVD) and cardiovascular mortality. We investigated to what extent subjective health status explained the apparent association between depressive symptoms and cardiovascular mortality in older European men. Methods: Data were used from the population-based prospective Finland, Italy and the Netherlands Elderly (FINE) Study. Depressive symptoms were measured with the Zung Self-rating Depression Scale in 909 men, aged 70–90 years, free of CVD and diabetes in 1990. Subjective health status was estimated with a single question on self-rated health and with a standardized questionnaire about activities of daily living. Cardiovascular mortality was determined during ten years of follow-up. Results: At baseline, poor self-rated health and more disability in activities of daily living were both associated with more depressive symptoms using multiple linear regression analysis. Prospectively men who reported to be unhealthy or with moderate to severe disability had an approximately 2.5 times higher risk of cardiovascular mortality using Cox regression analysis. An increase in depressive symptoms by one standard deviation was associated with an increased risk of cardiovascular mortality (HR 1.37; 95% CI 1.21–1.56). A substantial part of this association was explained by self-rated health and disability (proportion explained 0.32; 95% CI 0.09–0.55). However, a significant risk of depressive symptoms on cardiovascular mortality remained (HR 1.25; 95% CI 1.09–1.43) after adjustment for subjective health status. Limitations: Health status is based on subjective measures. Conclusions: In older men, subjective health status explains a considerable part of the association between depression and risk of cardiovascular mortality. [Copyright &y& Elsevier]

Abstract: Studies have shown that depression relates to biomarkers of both short-term and long-term polyunsaturated fatty acid intake. However, it is not known which of these two biomarkers is more closely related to depression. The aim of this study was to examine the relationship of depression with both adipose tissue and serum phospholipid polyunsaturated fatty acids and to assess the importance of each of these two biomarkers in relating to depression. This is a cross-sectional study of healthy adults from the island of Crete. Subjects were examined by the Preventive Medicine and Nutrition Clinic of the University of Crete. Subjects were 394 healthy adults (175 males, 219 females) aged 18–60. The sample consisted of farmers from a number of rural communities of Crete. Fatty acids were determined by gas chromatography in adipose tissue and serum phospholipids. Information about depression was obtained through the Beck Depression Inventory (BDI) and Zung Self-rating Depression Scale (ZSRDS). Adipose tissue alpha-linolenic acid (ALA) (C18:3n-3) was inversely correlated to BDI (r =−0.17, p <0.02). Multiple linear regression analysis taking into account the possible confounding effect of age, gender, body mass index (BMI), smoking and educational level did not confirm this association. The other polyunsaturated fatty acids in adipose tissue were not related to depression. Serum phospholipid polyunsaturated fatty acids did not correlate with depression. This study did not show that the polyunsaturated fatty acids in the adipose tissue are better predictors of depression than those in serum phospholipids. [Copyright &y& Elsevier]

Objective: Dispositional optimism has been associated with a lower risk of cardiovascular mortality, but the underlying mechanisms are still largely unknown. We therefore studied whether dispositional optimism was associated with healthy lifestyle and dietary habits.Methods: In 773 (87.1%) of 887 Dutch elderly community-living men with complete data in 1985, the associations of dispositional optimism with lifestyle and dietary factors were assessed at baseline and during follow-up every 5 years up to 15 years using multilevel regression models.Measurements: Dispositional optimism was assessed using a four-item questionnaire, and the participants' food consumption was assessed by a cross-check dietary history method that estimates the usual food consumption pattern of the participants. Lifestyle factors were assessed by questionnaires, while weight and height were measured to calculate body mass index.Results: A high level of dispositional optimism was associated with more physical activity (P<.001), nonsmoking (P=.02), and higher intakes of alcohol (P=.046), fruit (P=.01), vegetables (P=.01), and whole-grain bread (P=.01), independently from age, education, living arrangement, self-rated health, cardiovascular disease, diabetes mellitus, cancer, and body mass index, as well as total energy intake (for dietary factors).Conclusion: Dispositional optimism in elderly men is associated with healthy lifestyle and dietary habits. A low level of optimism may indirectly affect proneness to cardiovascular death via unhealthy behavioral choices. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore whether “typical” coronary heart disease (CHD) such as fatal myocardial infarction and sudden death relate to major cardiovascular risk factors in the same way as the “atypical” CHD, such as fatal heart failure and chronic arrhythmias. Design and setting: Ten cohorts (6633 cardiovascular disease-free men, aged 40–59) in five European countries were examined, age and three major risk factors were measured (systolic blood pressure, serum cholesterol, and smoking habits) and 35-year mortality data were collected. Proportional hazard models were solved with typical and atypical CHD deaths treated separately. Results: Death rates from typical and atypical CHD were inversely related among the five countries. Mean age at death was significantly higher for atypical than typical (75.8 versus 71.6 years; p <0.001). In the multivariate analysis conducted on pools of 5 countries (adjusted for countries), the relationship of risk factors with typical CHD was direct and significant for age (hazard ratio—HR—for 5 years of age 1.44 (95% CI 1.36–1.52)), systolic blood pressure (HR for 20 mm Hg, 1.39 (95% CI 1.32–1.47)), serum cholesterol (HR for 1 mmol/l of 1.22 (95% CI 1.16–1.27)) and smoking habits (HR smokers versus non-smokers of 1.39 (95% CI 1.24–1.57)). For atypical CHD, age had a larger HR of 2.27 (95% CI 2.05–2.52), systolic blood pressure had a smaller HR of 1.28 (95% CI 1.16–1.41), serum cholesterol had an inverse non-significant HR of 0.90 (0.58–1.58) and smoking habits had a larger HR of 1.54 (95% CI 1.26–1.89). Conclusions: Age and serum cholesterol were differently related with typical and atypical CHD deaths, suggesting different etiologies for these coronary diseases. [Copyright &y& Elsevier]