Association of eating patterns with blood pressure and body mass index: the INTERMAP study

Background Epidemiologic evidence is sparse on the role of dietary patterns that may be important drivers of high blood pressure (BP) and body mass index (BMI) levels. Additionally, dietary fibre intake in association with BP and BMI yielded inconsistent results. Objective Investigate the relationships of eating frequency, dietary energy density, diet quality, evening energy intake, GI, GL, and dietary fibre to BP, BMI using cross-sectional data from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) of 4680 men and women aged 40–59 y from Japan, China, the United Kingdom, and the United States of America. Methods During 4 visits, eight BP, four weight and height measures, four 24-hour dietary recalls, and two 24-hour urine samples were collected. Consumption of all solid foods was aggregated into eating occasions. Nutrient density is expressed using the Nutrient Rich Food index. Multivariable adjusted linear regression models were used to estimate BP and BMI differences per 2SD higher intakes of eating occasions, dietary energy density, Nutrient Rich Food index, evening energy intake, GI, GL, and dietary fibre. Results Compared to participants with <4 eating occasions/24-hours, those with ≥6 eating occasions/24-hours had lower average: systolic BP: 116.4 vs. 121.4 mm Hg; BMI: 27.3 vs. 29.0 kg/m2; total energy: 2127 vs. 2521 kcal/24-hours; dietary energy density: 1.5 vs. 2.2 kcal/g; and higher Nutrient Rich Food index score: 35.1 vs. 26.8. Additionally, insoluble fibre higher by 4 g/1000 was inversely associated with systolic BP (p<0.05), while soluble fibre and GI, GL showed no associations with BP and BMI. Conclusions Results suggest that higher meal frequency may be associated with improved diet quality and lower BP and BMI. Higher intakes of insoluble fibre may contribute to lower BP and BMI. This may have implications for behavioural approaches to controlling high BP levels and the obesity epidemic.Open Acces

Perspective:The Application of A Priori Diet Quality Scores to Cardiovascular Disease Risk-A Critical Evaluation of Current Scoring Systems

Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. In this perspective, we critically evaluate a priori–defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality. A systematic literature search identified 59 observational studies that applied a priori–defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality. Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk.The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level

Association between plant-based diets and blood pressure in the INTERMAP study.

BACKGROUND: Plant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns - and assessed their associations with BP. DESIGN: We used cross-sectional data including 4,680 men and women ages 40-59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders. RESULTS: Modified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat. CONCLUSION: An hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components. TRIAL REGISTRATION NUMBER: The observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271

Lifestyle Score and Risk of Hypertension in the Airwave Health Monitoring Study of British Police Force Employees

Background: Evidence suggest that promoting a combination of healthy lifestyle behaviors instead of exclusively focusing on a single behavior may have a greater impact on blood pressure (BP). We aimed to evaluate lifestyle factors and their impact on the risk of hypertension and BP. Methods: We analyzed cross-sectional health-screening data from the Airwave Health Monitoring Study of 40,462 British police force staff. A basic lifestyle-score including waist-circumference, smoking and serum total cholesterol was calculated, with a greater value indicating a better lifestyle. Individual/combined scores of other lifestyle factors (sleep duration, physical activity, alcohol intake, and diet quality) were also developed. Results: A 1-point higher basic lifestyle-score was associated with a lower systolic BP (SBP; &minus;2.05 mmHg, 95%CI: &minus;2.15, &minus;1.95); diastolic BP (DBP; &minus;1.98 mmHg, 95%CI: &minus;2.05, &minus;1.91) and was inversely associated with risk of hypertension. Combined scores of other factors showed attenuated but significant associations with the addition of sleep, physical activity, and diet quality to the basic lifestyle-score; however, alcohol intake did not further attenuate results. Conclusions: Modifiable intermediary factors have a stronger contribution to BP, namely, waist-circumference and cholesterol levels and factors that may directly influence them, such as diet, physical activity and sleep. Observed findings suggest that alcohol is a confounder in the BP&ndash;lifestyle score relation

Lauric Acid, a Dietary Saturated Medium-Chain Fatty Acid, Elicits Calcium-Dependent Eryptosis

Cardiovascular diseases (CVD) are a leading cause of mortality worldwide, and dietary habits represent a major risk factor for dyslipidemia; a hallmark of CVD. Saturated fatty acids contribute to CVD by aggravating dyslipidemia, and, in particular, lauric acid (LA) raises circulating cholesterol levels. The role of red blood cells (RBCs) in CVD is increasingly being appreciated, and eryptosis has recently been identified as a novel mechanism in CVD. However, the effect of LA on RBC physiology has not been thoroughly investigated. RBCs were isolated from heparin-anticoagulated whole blood (WB) and exposed to 50&ndash;250 &mu;M of LA for 24 h at 37 &deg;C. Hemoglobin was photometrically examined as an indicator of hemolysis, whereas eryptosis was assessed by Annexin V-FITC for phosphatidylserine (PS) exposure, Fluo4/AM for Ca2+, light scatter for cellular morphology, H2DCFDA for oxidative stress, and BODIPY 581/591 C11 for lipid peroxidation. WB was also examined for RBC, leukocyte, and platelet viability and indices. LA caused dose-responsive hemolysis, and Ca2+-dependent PS exposure, elevated erythrocyte sedimentation rate (ESR), cytosolic Ca2+ overload, cell shrinkage and granularity, oxidative stress, accumulation of lipid peroxides, and stimulation of casein kinase 1&alpha; (CK1&alpha;). In WB, LA disrupted leukocyte distribution with elevated neutrophil-lymphocyte ratio (NLR) due to selective toxicity to lymphocytes. In conclusion, this report provides the first evidence of the pro-eryptotic potential of LA and associated mechanisms, which informs dietary interventions aimed at CVD prevention and management

Associations of Systematic Inflammatory Markers with Diet Quality, Blood Pressure, and Obesity in the AIRWAVE Health Monitoring Study

Introduction: Chronic low-grade inflammation is a characteristic feature of obesity, and elevated levels of inflammation are associated with pathophysiologic consequences and a constellation of metabolic disturbances, such as hypertension. The relationships of inflammation with diet, obesity, and hypertension are complex, hence, this study aimed to assess cross-sectional relationships between inflammatory scores, diet quality, obesity, high blood pressure (BP), and hypertension in the Airwave Health Monitoring Study cohort, a large cohort of police officers and police staff in the United Kingdom. Methods: Data from 5198 men and 3347 women who completed health screening measurements and dietary assessment between 2007 and 2012 were included (n=8545 adults). Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lympho-cyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII) were calculated. Diet quality was evaluated using the Nutrient-Rich Food 9.3 (NRF9.3) index score. Results: Results show that a 1SD higher diet quality score, waist circumference, and systolic/diastolic BP were significantly associated with SII differences of −33.3 (95% confidence interval (CI): −49.0, −17.6), 8.2 (95% CI: 0.2, 16.6), 17.9 (95% CI: 10.1, 25.8), and 18.3 (95% CI: 10.8, 25.7) (Model 2; P&lt;0.0001), respectively. A 1SD higher diet quality score, waist circumference, and BMI were also significantly associated with PLR (P&lt;0.0001). The odds of elevated PLR were higher in those with higher systolic and diastolic BP (P&lt;0.0001, P=0.0006, respectively). Conclusion: In conclusion, the findings of this analysis add to the existing knowledge indicating a link between inflammation and conditions such as obesity, hypertension, and behavioral factors including diet quality. Of the various inflammatory scores evaluated, SII and PLR were consistently significantly associated with diet quality and these conditions.</p

Associations of Systematic Inflammatory Markers with Diet Quality, Blood Pressure, and Obesity in the AIRWAVE Health Monitoring Study.

INTRODUCTION: Chronic low-grade inflammation is a characteristic feature of obesity, and elevated levels of inflammation are associated with pathophysiologic consequences and a constellation of metabolic disturbances, such as hypertension. The relationships of inflammation with diet, obesity, and hypertension are complex, hence, this study aimed to assess cross-sectional relationships between inflammatory scores, diet quality, obesity, high blood pressure (BP), and hypertension in the Airwave Health Monitoring Study cohort, a large cohort of police officers and police staff in the United Kingdom. METHODS: Data from 5198 men and 3347 women who completed health screening measurements and dietary assessment between 2007 and 2012 were included (n=8545 adults). Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII) were calculated. Diet quality was evaluated using the Nutrient-Rich Food 9.3 (NRF9.3) index score. RESULTS: Results show that a 1SD higher diet quality score, waist circumference, and systolic/diastolic BP were significantly associated with SII differences of -33.3 (95% confidence interval (CI): -49.0, -17.6), 8.2 (95% CI: 0.2, 16.6), 17.9 (95% CI: 10.1, 25.8), and 18.3 (95% CI: 10.8, 25.7) (Model 2; P<0.0001), respectively. A 1SD higher diet quality score, waist circumference, and BMI were also significantly associated with PLR (P<0.0001). The odds of elevated PLR were higher in those with higher systolic and diastolic BP (P<0.0001, P=0.0006, respectively). CONCLUSION: In conclusion, the findings of this analysis add to the existing knowledge indicating a link between inflammation and conditions such as obesity, hypertension, and behavioral factors including diet quality. Of the various inflammatory scores evaluated, SII and PLR were consistently significantly associated with diet quality and these conditions

The Relationships between Various Factors and Sleep Status: A Cross-Sectional Study among Healthy Saudi Adults

Impaired sleep can adversely affect daily life. This study assesses the association between different factors and sleep status among apparently healthy Saudi adults. In total, 478 adults were included in this study. Data on anthropometrics, body composition, stress scales, physical activity, and dietary habits were collected. Fasting blood glucose and lipid profile were measured. Sleep quality and duration were assessed using the Pittsburgh Sleep Quality Index. Larger neck circumference (NC) was associated with short sleep duration (odds ratio (OR) 1.23; 95% confidence interval (CI) [1.08, 1.41]; p = 0.002). Higher triglyceride levels were associated with poor sleep quality (OR 1.01; 95% CI [1.002, 1.02]; p = 0.019) and short sleep duration (OR 1.01; 95% CI [1.004, 1.02]; p = 0.005). Stress was a risk factor for poor sleep quality (OR 1.15; 95% CI [1.09, 1.22]; p p = 0.009), while being single was correlated with longer sleep duration (OR 0.46; 95% CI [0.22, 0.96]; p = 0.039). Other factors such as having a larger waist circumference and more muscle mass were protective factors against poor sleep quality and/or short sleep duration. In conclusion, a larger NC is suggested as a risk factor for short sleep duration and a higher triglyceride level for both short and poor sleep among healthy Saudis. Investigating the factors associated with sleep status may help alleviate sleep disturbances and improve overall health. Further studies are needed to confirm causality using objective sleep measures

Nutritional Biomarkers and Factors Correlated with Poor Sleep Status among Young Females: A Case-Control Study

Poor sleep status is associated with several health problems. Nutritional biomarkers and factors related to poor sleep are understudied. This study aimed to identify nutrition biomarkers and factors related to sleep status in healthy young Saudi females. The study included 92 normal-weight and obese Saudi females aged 19&ndash;25. Fasting blood glucose, insulin, and lipid profiles were measured. Insulin resistance was calculated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR) method. Anthropometric, stress, physical activity, and dietary data were collected. Data on the polyphenol content in foods were retrieved from the Phenol-Explorer database. The sleep status was assessed using the Pittsburgh sleep quality index (PSQI). Associations between variables were assessed using the multiple logistic regression model. Around 76% of the participants had poor sleep status (PSQI &gt; 5). Multiple logistic regression reported high polyphenol intake as a protective factor against poor sleep (OR 0.24; 95% CI 0.07&ndash;0.83; p = 0.03) and HOMA-IR as an independent risk for poor sleep (OR 4.97; 95% CI 1.11&ndash;22.31; p = 0.04). Other nutritional biomarkers and factors, such as BMI, lipid profile, and vitamins, revealed a trend but were not significant. In conclusion, poor sleep status is associated with insulin resistance and low polyphenol intake among women of reproductive age