Prospective studies on diet and coronary heart disease : the role of fatty acids, B-vitamins and arginine

In this thesis, the results of prospective studies on fatty acids, B-vitamins and arginine and the occurrence of coronary heart disease have been described. The results presented are mainly based on the Zutphen Elderly Study. In this study of 939 men aged 64-84 years, detailed information was available on dietary intake, biological risk factors, incidence of major chronic diseases, vital status and causes of death between 1985 and 1995. In addition, data of 5 cohorts from Finland, Italy and the Netherlands, and of all 16 cohorts of the Seven Countries Study were used to investigate specific hypotheses on diet-heart relations in an international setting.Using repeatedly collected data of serum cholesterol, dietary and lifestyle factors in the Zutphen Elderly Study, we observed that changes in intake of saturated fat, polyunsaturated fat, dietary cholesterol and alcohol, and changes in weight were significantly related to changes in total and/or HDL cholesterol concentrations. The strengths of the observed associations are comparable to those obtained in experimental studies performed in younger populations. This indicates that public health strategies on dietary interventions and weight reduction in order to improve cholesterol concentrations are relevant also at old age.The average trans fatty acid intake decreased 2.4% of energy in the Zutphen Elderly Study between 1985 and 1995, mainly due to industrial lowering of the trans fatty acid content in edible fats. Such a decrease in trans fatty acids intake is compatible with a 23% reduction in risk of coronary heart disease. Changes in food composition with respect to the trans fatty acid content are therefore important from a public health perspective.Using the Finnish, Italian and Dutch data of the Seven Countries study, fatty fish consumption was estimated to reduce the relative risk of coronary heart disease mortality with 34%. For total or lean fish consumption no effect was observed. People at risk for coronary heart disease are therefore advised to eat fish, preferably fatty fish at least once a week, to reduce their risk for coronary heart disease.We did not find evidence for a protective effect of intake ofα-linolenic acid on coronary heart disease incidence in the Zutphen Elderly Study. However, the strong association between the intake ofα-linolenic acid and trans fatty acids complicated studying this relationship. Of the B-vitamins, only the intake of folate and vitamin B6 were independently inversely associated with homocysteine in the Zutphen Elderly Study. In this cohort, intake of different B-vitamins did not protect against coronary heart disease, although there is a suggestion for a protective effect of vitamin B2. Arginine intake was not associated with the risk of coronary heart disease mortality, neither in the Seven Countries Study, nor in the Zutphen Elderly Study. Results of prospective and intervention studies are needed before definite statements can be made about the potential protective effect on coronary heart disease of B-vitamins, arginine andα-linolenic acid.</p

Arginine intake and risk of coronary heart disease mortality in elderly men

From experimental studies, the hypothesis is derived that the amino acid arginine, the precursor of NO, could restore the impaired endothelial function and increased platelet activation observed in atherosclerosis. We investigated whether dietary intake of arginine is associated with reduced coronary heart disease risk in elderly persons. The study population consisted of 806 men aged 64 to 84 years at baseline who participated in the Zutphen Elderly Study, a population-based cohort followed up for 10 years. Information about habitual food consumption was collected by use of the cross-check dietary history method. Ninety (11.2€of the 806 men died from coronary heart disease. Mean±SD baseline arginine intake was 4.35±1.07 g/d. Meat was the main source of arginine intake (37.1Œ followed by bread (13.1€and milk and milk products (12.1Ž Arginine intake was not associated with coronary heart disease mortality. After adjustment for age, the relative risk (RR) for the medium tertile of arginine intake was 0.72 (95␌I 0.44 to 1.18), and the RR for the highest tertile was 0.71 (95␌I 0.43 to 1.19, P for trend=0.19) compared with the lowest tertile of arginine intake. After additional adjustment for history of coronary heart disease and diabetes mellitus, energy intake, body mass index, smoking habit, physical activity, and other relevant dietary and biological risk factors, the RR was 1.86 (95␌I 1.06 to 3.27) for the medium intake and 1.56 (95␌I 0.83 to 2.93) for the highest intake (P for trend=0.17). These results do not support the hypothesis that dietary arginine intake lowers the risk of coronary heart disease mortality

Decisional Conflict after Deciding on Potential Participation in Early Phase Clinical Cancer Trials:Dependent on Global Health Status, Satisfaction with Communication, and Timing

SIMPLE SUMMARY: Early phase clinical trials are an essential part of modern drug development and thus the advance of anti-cancer therapies for patients. However, deciding whether to participate in such trials can be complex and patients have reported decisional conflict (i.e., unresolved decisional needs). The aim of our study was to untangle several factors that contribute to decisional conflict in patients with advanced cancer who have recently been asked to decide whether to participate in early phase clinical trials. We found that patients experienced less decisional conflict if they had a better global health status, higher satisfaction, and made their decision sooner. Other factors, such as the decision to (not) participate, did not prove to be the best indicators for decisional conflict. With these insights, we can start to build hypotheses on how to improve the decision-making process for patients with end-stage cancer, which can ultimately improve their quality of life. ABSTRACT: When standard treatment options are not available anymore, patients with advanced cancer may participate in early phase clinical trials. Improving this complex decision-making process may improve their quality of life. Therefore, this prospective multicenter study with questionnaires untangles several contributing factors to decisional conflict (which reflects the quality of decision-making) in patients with advanced cancer who recently decided upon early phase clinical trial participation (phase I or I/II). We hypothesized that health-related quality of life, health literacy, sense of hope, satisfaction with the consultation, timing of the decision, and the decision explain decisional conflict. Mean decisional conflict in 116 patients was 30.0 (SD = 16.9). Multivariate regression analysis showed that less decisional conflict was reported by patients with better global health status (β = −0.185, p = 0.018), higher satisfaction (β = −0.246, p = 0.002), and who made the decision before (β = −0.543, p < 0.001) or within a week after the consultation (β = −0.427, p < 0.001). These variables explained 37% of the variance in decisional conflict. Healthcare professionals should realize that patients with lower global health status and who need more time to decide may require additional support. Although altering such patient intrinsic characteristics is difficult, oncologists can impact the satisfaction with the consultation. Future research should verify whether effective patient-centered communication could prevent decisional conflict

Prospective studies on diet and coronary heart disease : the role of fatty acids, B-vitamins and arginine

In this thesis, the results of prospective studies on fatty acids, B-vitamins and arginine and the occurrence of coronary heart disease have been described. The results presented are mainly based on the Zutphen Elderly Study. In this study of 939 men aged 64-84 years, detailed information was available on dietary intake, biological risk factors, incidence of major chronic diseases, vital status and causes of death between 1985 and 1995. In addition, data of 5 cohorts from Finland, Italy and the Netherlands, and of all 16 cohorts of the Seven Countries Study were used to investigate specific hypotheses on diet-heart relations in an international setting.Using repeatedly collected data of serum cholesterol, dietary and lifestyle factors in the Zutphen Elderly Study, we observed that changes in intake of saturated fat, polyunsaturated fat, dietary cholesterol and alcohol, and changes in weight were significantly related to changes in total and/or HDL cholesterol concentrations. The strengths of the observed associations are comparable to those obtained in experimental studies performed in younger populations. This indicates that public health strategies on dietary interventions and weight reduction in order to improve cholesterol concentrations are relevant also at old age.The average trans fatty acid intake decreased 2.4% of energy in the Zutphen Elderly Study between 1985 and 1995, mainly due to industrial lowering of the trans fatty acid content in edible fats. Such a decrease in trans fatty acids intake is compatible with a 23% reduction in risk of coronary heart disease. Changes in food composition with respect to the trans fatty acid content are therefore important from a public health perspective.Using the Finnish, Italian and Dutch data of the Seven Countries study, fatty fish consumption was estimated to reduce the relative risk of coronary heart disease mortality with 34%. For total or lean fish consumption no effect was observed. People at risk for coronary heart disease are therefore advised to eat fish, preferably fatty fish at least once a week, to reduce their risk for coronary heart disease.We did not find evidence for a protective effect of intake ofα-linolenic acid on coronary heart disease incidence in the Zutphen Elderly Study. However, the strong association between the intake ofα-linolenic acid and trans fatty acids complicated studying this relationship. Of the B-vitamins, only the intake of folate and vitamin B6 were independently inversely associated with homocysteine in the Zutphen Elderly Study. In this cohort, intake of different B-vitamins did not protect against coronary heart disease, although there is a suggestion for a protective effect of vitamin B2. Arginine intake was not associated with the risk of coronary heart disease mortality, neither in the Seven Countries Study, nor in the Zutphen Elderly Study. Results of prospective and intervention studies are needed before definite statements can be made about the potential protective effect on coronary heart disease of B-vitamins, arginine andα-linolenic acid

Digestion versus composting of straw and hay: effects on composition of biomass residues.

The effect of two decomposition processes, digestion and composting, was compared on the quality of the final residue from two substrates: hay and straw. The digestion was done by using dwarf goats on digestion crates and the composting process was simulated in buckets. Composting was allowed to continue to the same level of organic matter loss as achieved in a digestibility trial. The results indicated that the pattern of biomass decomposition, as measured by the fibre analysis in the Goering and Van Soest method, was similar between both processes and substrates. Absolute amounts of acid detergent lignin (ADL) did not change significantly throughout both decomposition processes, but the quantity of other fibre components decreased. Chemically, the ADL fraction made up a large part of the humus in the soil and though the results were variable, they suggested that the initial ADL content of a substrate indicates its humus building capacity. Concerning the nitrogen fractions, however, there were larger differences between the decomposition processes and substrates. Digestion left less nitrogen in the organic matter than composting, and the composting of straw even resulted in a net increase in nitrogen content

Alpha linolenic acid intake is not beneficially associated with 10-year risk of coronary heart disease. The Zutphen Elderly study

Background: Data on the relation between alpha-linolenic acid intake and coronary artery disease (CAD) are limited. Other dietary components appear to modify the reported relation between alpha-linolenic acid intake and CAD. Objective: We examined whether dietary alpha-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, _-linolenic acid intake was not significantly associated with CAD risk. The relative risk of CAD for the highest compared with the lowest tertile of alpha-linolenic acid intake was 1.68 (95% CI: 0.86, 3.29). alpha-Linolenic acid intake from sources containing trans fatty acids was also nonsignificantly, yet positively, associated with CAD risk. alpha-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 alpha-linolenic acid intake on the risk of 10-y CAD incidence. Investigating this hypothesis was complicated by the association between intakes of alpha-linolenic acid and trans fatty acids. Given the results of current prospective studies, a protective cardiac effect of alpha-linolenic acid is questionable

Fish consumption and coronary heart disease mortality in Finland, Italy, and the Netherlands

Fish consumption seems to protect against death from coronary heart disease (CHD). If this association is due to n-3 polyunsaturated fatty acids, especially fatty fish may be responsible for this protective effect. The association between total, lean, and fatty fish consumption and the risk of CHD mortality was examined in 1,088 Finnish, 1,097 Italian, and 553 Dutch men participants in the Seven Countries Study who were aged 50-69 years and free of CHD around 1970. After 20 years of follow-up, 242 (22.2€men in Finland, 116 (10.6€men in Italy, and 105 (19.0€men in the Netherlands had died of CHD. Cox proportional hazards analysis showed no association between total fish consumption and CHD mortality. After adjustments were made for age, body mass index, smoking, energy intake, and relevant dietary variables, the pooled relative risk for the highest quartile of total fish compared with no fish consumption in the three countries was 1.08 (95␌onfidence interval: 0.76, 1.53). Lean fish consumption also was not associated with CHD mortality in any country. Fatty fish compared with non-fatty-fish consumption was associated with lower CHD mortality; the adjusted, pooled relative risk for fatty fish consumers was 0.66 (95␌onfidence interval: 0.49, 0.90). These data suggest that especially fatty fish is protective against CHD mortality

Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study

Background: Evidence on the relation between trans fatty acid intake and coronary heart disease is limited. We investigated this relation in a Dutch population with a fairly high trans fatty acid intake, including trans fatty acids from partly hydrogenated fish oils. Methods: We prospectively studied 667 men of the Zutphen Elderly Study aged 64-84 years and free of coronary heart disease at baseline. We used dietary surveys to establish the participants' food consumption patterns. Information on risk factors and diet was obtained in 1985, 1990, and 1995. After 10 years of follow-up from 1985-95, there were 98 cases of fatal or non-fatal coronary heart disease. Findings: Between 1985 and 1995, average trans fatty acid intake decreased from 4·3% to 1·9% of energy. After adjustment for age, body mass index, smoking, and dietary covariates, trans fatty acid intake at baseline was positively associated with the 10-year risk of coronary heart disease. The relative risk for a difference of 2% of energy in trans fatty acid intake at baseline was 1·28 (95% CI 1·01-1·61). Interpretation: A high intake of trans fatty acids (all types of isomers) contributes to the risk of coronary heart disease. The substantial decrease in trans fatty acid intake, mainly due to industrial lowering of trans contents in Dutch edible fats, could therefore have had a large public-health impact. Chemicals/CAS: Fatty Acids; Fish Oil

Do depression, stress, sleep disruption, and inflammation alter hippocampal apoptosis and neurogenesis?

We discuss the regulation of cellular plasticity, focusing on neurogenesis and apoptosis in the adult hippocampus, by stress, sleep, inflammation, and depression. This is the fourth of five chapters in this book that present not only clinical data but also experimental evidence from animal models relevant to the role of the hypothalamo-pituitary-adrenal (HPA) in affective disorders, together with Chapters 7, 8, 9, and 26. Moreover, this is the second of four chapters in this book that discuss the role of inflammation in affective disorders, together with Chapters 10, 16, and 17