Coffee consumption and cardiovascular disease: A condensed review of epidemiological evidence and mechanisms

Scientific Journals International : “This is the author’s version of the work. It is posted here by permission of the AAAS for personal use, not for redistribution. The definitive version was published in Journal of Agricultural and Food Chemistry on 66.21 (2018): 5257-5263, DOI: http://doi.org/10.1021/acs.jafc.7b04506"Coffee is one of the most widely consumed beverages, and some studies have suggested it may be related to cardiovascular disease (CVD), the leading cause of poor health in the world. This review evaluates the evidence on the effect of habitual coffee consumption on CVD incidence and mortality. The review is based mostly on observational studies and meta-analyses of the literature. In healthy people, in comparison to not consuming coffee, habitual consumption of 3–5 cups of coffee per day is associated with a 15% reduction in the risk of CVD, and higher consumption has not been linked to elevated CVD risk. Moreover, in comparison to no coffee intake, usual consumption of 1–5 cups/day is associated with a lower risk of death. In people who have already suffered a CVD event, habitual consumption does not increase the risk of a recurrent CVD or death. However, hypertensive patients with uncontrolled blood pressure should avoid consuming large doses of caffeine. In persons with well-controlled blood pressure, coffee consumption is probably safe, but this hypothesis should be confirmed by further investigation

Exposure to secondhand tobacco smoke and the frailty syndrome in US older adults

Exposure to secondhand tobacco smoke (SHS) is a well-established risk factor for cardiovascular disease and lung cancer in non-smoking adults. However, few studies have focused on the health consequences of exposure to SHS in older adults. This is the first study to assess the association between SHS and the frailty syndrome in the non-smoking older adult population. Methods. Cross-sectional study among 2059 non-smoking adults aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had completed a physical examination. Exposure to SHS was assessed by serum cotinine concentrations and by self-reported data from the home questionnaire. Frailty was ascertained with a slight modification of the Fried criteria. Analyses were performed with logistic regression and adjusted for the main confounders. Results. The median (interquartile range) concentration of serum cotinine was 0.095 (IQR: 0.035-0.211) ng/mL. The prevalence of frailty was 6.0%. The odds ratios (95% CI) of frailty comparing the second, third and fourth to the lowest quartile of serum cotinine were, respectively, 1.44 (0.67-3.06), 1.46 (0.75-2.85) and 2.51 (1.06-5.95); p value for trend 0.04. An increased frequency of frailty was also observed in participants reporting to live with ≥2 smokers at home (odds ratio: 5.37; 95% CI: 1.13-25.5). Conclusions. In the US non-smoking older adult population, exposure to SHS was associated with an increased frequency of frailty. More efforts are needed to protect older adults from SHS, especially at home and in other areas not covered by smoke-free regulations.This work was supported by grants from the Instituto de Salud Carlos III, Ministry of Health of Spain (PI12/1166) and from the European Commission (FRAILOMIC Initiative FP7-HEALTH-2012-Proposal No: 305483-2). Dr. Navas-Acien was supported by the Flight Attendant Medical Research Institut

Combined impact of traditional and non-traditional health behaviors on mortality: A national prospective cohort study in Spanish older adults

Background: Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. In this study, we examined the combined impact of three traditional (smoking, physical activity and diet) and three non-traditional health behaviors (sleep duration, sedentary time and social interaction) on mortality among older adults. Methods: A cohort of 3,465 individuals, representative of the Spanish population aged ≥60 years, was established in 2000/2001 and followed-up prospectively through 2011. At baseline, the following positive behaviors were selfreported: never smoking or quitting tobacco >15 years, being very or moderately physically active, having a healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, spending <8 h/d in sitting time, and seeing friends daily. Analyses were performed with Cox regression and adjusted for the main confounders. Results: During an average nine-year follow-up, 1,244 persons died. Hazard ratios (95% confidence interval) for allcause mortality among participants with two, three, four, five and six compared to those with zero to one positive behaviors were, respectively, 0.63 (0.46 to 0.85), 0.41 (0.31 to 0.55), 0.32 (0.24 to 0.42), 0.26 (0.20 to 0.35) and 0.20 (0.15 to 0.28) (P for trend <0.001). The results were similar regardless of age, sex and health status at baseline. Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger. Adding the three non-traditional to the four traditional behaviors improved the model fit (likelihood ratio test, P <0.001) and the accuracy of mortality prediction (c-statistic: + 0.0031, P = 0.040). Conclusions: Adherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults.This work was funded by grants from the FIS (ref. 12/1166) and the ‘Plan Nacional sobre Drogas’ (ref. 06/2010), and by the ‘Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular’. DMG had a “Juan de la Cierva” contract from the Spanish Ministry of Scienc

Associação entre capital social e autopercepção de saúde em adultos brasileiros

OBJECTIVE To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship.METHODS A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR) and confidence intervals (CI) 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test.RESULTS Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80), those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68), who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74) and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80) had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable) and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship.CONCLUSIONS Lifestyle seems to only partially explain the relationship between social capital and self-perceived health. Among the investigated behaviors, physical activity during leisure time is what seems to have the most important role as a mediator of this relationship.OBJETIVO Analisar a associação entre indicadores de capital social e autopercepção de saúde com base em comportamentos relacionados à saúde como possíveis mediadores dessa relação.MÉTODOS Realizou-se estudo transversal com 1.081 sujeitos, representativos da população de 40 anos ou mais de município da região Sul do Brasil. Os sujeitos que percebiam sua saúde como regular, ruim ou muito ruim foram considerados com autopercepção negativa. Os indicadores de capital social foram: número de amigos; pessoas que emprestariam dinheiro em caso de necessidade; confiança nas pessoas do bairro; frequência de ajuda entre as pessoas do bairro; segurança no bairro; e participação comunitária. Os comportamentos investigados foram prática de atividade física no lazer, consumo de frutas e verduras, tabagismo e consumo abusivo de álcool. A razão de odds (OR) e seus intervalos de confiança (IC) 95% foram calculados por regressão logística binária, em diferentes modelos. A significância da mediação foi verificada pelo teste de Sobel.RESULTADOS Na análise ajustada pelas variáveis demográficas e clínicas, maior autopercepção negativa de saúde foi apresentada por pessoas com menor número de amigos (OR = 1,39; IC95% 1,08;1,80), que percebiam menor frequência de ajuda entre as pessoas no bairro (OR = 1,30; IC95% 1,01;1,68), que consideravam o bairro violento (OR = 1,33; IC95% 1,01;1,74) e que não haviam participado de atividade comunitária (OR = 1,39; IC95% 1,07;1,80). A atividade física no lazer foi um mediador significativo na relação entre todos os indicadores de capital social, e a autopercepção de saúde. O consumo de frutas e verduras foi um mediador significativo da relação entre a participação comunitária e a autopercepção de saúde. Tabagismo e consumo abusivo de álcool não mediaram nenhuma relação.CONCLUSÕES O estilo de vida parece explicar parcialmente a relação entre capital social e autopercepção de saúde. Dos comportamentos investigados, a atividade física no lazer parece ter papel mais importante como mediador dessa relação

Physical activity and diabetes mortality in people with type 2 diabetes: a prospective cohort study of 0.5 million US people

Aim To examine the association between physical activity and the cause of death with the greatest risk related to type 2 diabetes mellitus (T2DM) in a large population-based cohort representative of the general US adult population. Methods A total of 41,726 adults suffering from T2DM (age 62 ± 14 years) and 459,660 adults without diabetes (age 46 ± 18 years) who participated in the National Health Interview Survey from 1997 to 2014 were included in this prospective cohort study. Self-reported moderate-to-vigorous physical activity (MVPA) was categorized into inactive, insufficiently active, active and very active. Mortality data was obtained from the National Death Index. Cox regression models adjusted for potential confounders were performed to estimate hazard ratio (HR) and 95% confidence interval (CI). Results Diabetes mortality cause showed the highest relative risk of death among adults with T2DM compared to adults without diabetes (HR 5.72 [3.15;10.39]). There was a non-linear inverse dose-response association between MVPA and diabetes mortality among adults with T2DM, up to a plateau in risk reduction at approximately 500 min/week. Any level of activity was inversely associated with a significantly lower risk of diabetes mortality compared with being inactive (insufficiently active HR 0.71[0.54;0.97], active HR 0.68 [0.49;0.95], very active HR 0.44 [0.32;0.60]). Compared to adults without diabetes, the risk of diabetes mortality decreased from HR 7.38 [4.00;13.58] for inactive people with T2DM to HR 3.34 [1.76;6.32] for very active people with T2DM. Conclusions Higher levels of MVPA were associated with lower risk of diabetes mortality among adults with T2DM

Association between a Mediterranean lifestyle and growth differentiation factor 15: The seniors ENRICA-2 cohort

Background: Growth Differentiation Factor 15 (GDF-15) is a marker of inflammation and oxidative stress that has been associated with multiple age-related chronic diseases. Since lifestyle is key for preventing these adverse health outcomes, we examined the association between a Mediterranean lifestyle and GDF-15 serum concentrations in Spanish older adults. Methods: We used cross-sectional data from 2502 older adults participating in the Seniors ENRICA-2 cohort. Adherence to the Mediterranean lifestyle was assessed with the 27-item MEDLIFE index, divided into three blocks: 1) "Mediterranean food consumption, 2) Mediterranean dietary habits, 3) Physical activity, rest, social habits, and conviviality". Analyses of the association between the MEFLIFE index and GDF-15 concentrations were performed using multivariable linear regression models adjusting for the main potential confounders. Results: The MEDLIFE index was inversely associated with GDF-15. Compared with participants in the lowest quartile of the MEDLIFE score, GDF-15 mean percentage differences (95% CI) were -3.0% (-8.0, 2.3) for the second quartile, -8.7% (-13.0, -4.1) for the third quartile, and -10.1% (-15.0, -4.9) for the fourth quartile (p-trend<0.001). Block 3 of MEDLIFE, and particularly doing sufficient physical activity, adequate sleep duration, and participating in collective sports, was individually linked to lower concentrations of GDF-15. Results remained similar after excluding participants with cardiovascular disease, type 2 diabetes, or obesity. Conclusions: A Mediterranean lifestyle was associated with reduced levels of GDF-15, suggesting that a combination of multiple lifestyles may be an integral approach to reduce chronic inflammation and disease burden in older adults.This work was supported by the Institute of Health Carlos III; the Secretary of R+D+I; the European Regional Development Fund/European Social Fund (FIS grants 19/319, 20/00896); the National Plan on Drugs (grant 2020/17); Fundación Soria Melguizo (MITOFUN project); Ministry of Science, Innovation and Universities (RYC 2018-02069I to MSP); Universidad Autonóma de Madrid (FPI contract to JMR); FACINGLCOVID-CM project, Funding REACT EU Program (Comunidad de Madrid, European Regional Development Fund). Reagents for measuring Growth Differentiation Factor 15 have been provided by Roche Diagnostics International through a Research Agreement with the FUAM (Fundación de la Universidad Autonóma de Madrid). The funding agencies had no role in study design, data collection and analysis, interpretation of results, manuscript preparation or the decision to submit this manuscript for publication.S

Impact of ambulatory blood pressure monitoring on reclassification of hypertension prevalence and control in older people in Spain

This is the submitted version of the following article: Impact of ambulatory blood pressure monitoring on reclassification of hypertension prevalence and control in older people in Spain, Journal of Clinical Hypertension 17.6:453-61 which has been published in final form at http://dx.doi.org/10.1111/jch.12525. This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving Policy wiley.com/WileyCDA/Section/id- 820227.htmlAmbulatory blood pressure monitoring (ABPM) accurately classifies blood pressure (BP) status but its impact on the prevalence and control of hypertension is little known. The authors conducted a cross-sectional study in 2012 among 1047 individuals 60 years and older from the follow-up of a population cohort in Spain. Three casual BP measurements and 24-hour ABPM were performed under standardized conditions. Approximately 68.8% patients were hypertensive based on casual BP (≥140/90 mm Hg or current BP medication use) and 62.1% based on 24-hour ABPM (≥130/80 mm Hg or current BP medication use) (P=.009). The proportion of patients with treatment-eligible hypertension who met BP goals increased from 37.4% based on the casual BP target to 54.1% based on the 24-hour BP target (absolute difference, 16.7%; P<.01). These results were consistent across alternative BP thresholds. Therefore, compared with casual BP, 24-hour ABPM led to a reduction in the proportion of older patients recommended for hypertension treatment and a substantial increase in the proportion of those with hypertension controlData collection was funded by Fondo de Investigación Sanitaria (FIS) grants 09/1626 and 12/1166 (Ministry of Health of Spain) and by the ‘Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular’. Specific funding for this analysis was obtained from FIS grant PI13/02321

Social support and ambulatory blood pressure in older people

This is a non-final version of an article published in final form in Journal of Hypertension 34.10 (2016): 2045-2052. http://dx.doi.org/10.1097/HJH.0000000000001036Objective: Social support has been associated with greater nocturnal decline (dipping) in blood pressure (BP) in younger and middle-Aged individuals. However, it is uncertain if aggregated measures of social support are related to ambulatory SBP in older adults, where high SBP is frequent and clinically challenging. Methods: We studied 1047 community-living individuals aged at least 60 years in Spain. Twenty-four-hour ambulatory BP was determined under standardized conditions. Social support was assessed with a seven-item questionnaire on marital status, cohabitation, frequency of contact with relatives, or with friends and neighbors, emotional support, instrumental support, and outdoor companionship. A social support score was built by summing the values of the items that were significantly associated with SBP variables, such that the higher the score, the better the support. Results: Participants' mean age was 71.7 years (50.8% men). Being married, cohabiting, and being accompanied when out of home were the support items significantly associated with SBP variables. After adjustment for sociodemographic (age, sex, education), behavioral (BMI, alcohol, tobacco, salt consumption, physical activity, Mediterranean diet score), and clinical variables [sleep quality, mental stress, comorbidity, BP medication, and ambulatory BP levels and heart rate (HR)], one additional point in the social support score built with the abovementioned three support variables, was associated with a decrease of 0.93mmHg in night-Time SBP (P=0.039), totaling 2.8mmHg decrease for a score of 3 vs. 0. The three-item social support score was also inversely associated with the night/day SBP ratio (β=-0.006, P=0.010). Conclusion: In older adults, social support is independently associated with lower nocturnal SBP and greater SBP dipping. Further research is needed in prospective studies to confirm these resultsData collection was funded by Fondo de Investigacion Sanitaria (FIS) grants 09/1626 and 12/1166 (Ministry of Health of Spain and FEDER/FSE) and by the Catedra UAM de Epidemiologia y Control del Riesgo Cardiovascular. Specific funding for this analysis was obtained from FIS grant PI13/0232

The inflammatory potential of diet and pain incidence: a cohort study in older adults

This article has been accepted for publication in The Journals of Gerontology: Series A Published by Oxford University PressBackground: Pain is a highly prevalent and on-the-rise symptom with heavy associated healthcare and social burdens among older adults, yet evidence regarding its prevention is inadequate. The growing knowledge on how diet regulates inflammation may be utilized for pain prevention. Objective: To examine the association of 3-year changes in the inflammatory potential of diet (2008-2010 to 2012) with pain incidence over the subsequent 3 years (2012 to 2014-2015) among older adults. Methods: We used data from 820 individuals aged ≥60 years and free of pain in 2012, drawn from the Seniors-ENRICA cohort study in Spain. Food consumption was collected with a validated diet history, and the inflammatory potential of diet was estimated via the a priori empirical dietary inflammatory index (EDII) and the a posteriori dietary inflammatory index (DII). The frequency, severity (impact on daily activities), and number of locations of incident pain were combined into a scale that classified subjects as suffering from no pain, intermediate pain, and highest pain. The associations were summarized with relative risk ratios (RRR) and their 95% confidence interval (CI), estimated with multinomial logistic regression, and adjusted for potential sociodemographic, lifestyle, and morbidity confounders. Results: Shifting the diet towards a higher inflammatory potential was associated with a subsequent increased risk of intermediate pain [fully adjusted RRR (95% CI) per 1-point increment in the EDII=1.30 (1.03,1.65)] and highest pain [DII=1.14 (1.03,1.26)]. The three components of the pain scale followed similar trends, the most consistent one being with moderate-to-severe pain [EDII=1.26 (1.04,1.54); DII=1.12 (1.01,1.24)]. The association of increasing DII with highest incident pain was only apparent among the least physically active subjects [1.35 (1.17,1.56) vs 0.96 (0.83,1.10); p for interaction <0.001]. Conclusions: An increase in the inflammatory potential of diet was associated with higher pain incidence over the following years. Future studies in older adults should assess the efficacy of pain prevention interventions targeting the inflammatory potential of dietThe present study was supported by Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE (FIS grants 16/1512, 18/287, and 19/319

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

Background: The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. Methods: MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. Results: In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. Conclusion: Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.European Regional Development FundConsejería de Educación, Cultura y Deportes-JCCMFondo Europeo de Desarrollo Regional funds (grant no. SBPLY/17/180501/000533)Grant from the University of Castilla-La Mancha (2020-PREDUCLM-15596)Grant from the Universidad de Castilla-La Mancha co-financed by the European Social Fund (2020-PREDUCLM-16746