The J-shape association of ethanol intake with total homocysteine concentrations: the ATTICA study

BACKGROUND: Epidemiological studies suggest a non-monotonic effect of alcohol consumption on cardiovascular risk, while there is strong evidence concerning the involvement of homocysteine levels on thrombosis. The aim of this work was to evaluate the association between usual ethanol consumption and homocysteine levels, in cardiovascular disease free adults. METHODS: From May 2001 to December 2002 we randomly enrolled 1514 adult men and 1528 women, without any evidence of cardiovascular disease, stratified by age – gender (census 2001), from the greater area of Athens, Greece. Among the variables ascertained we measured the daily ethanol consumption and plasma homocysteine concentrations. RESULTS: Data analysis revealed a J-shape association between ethanol intake (none, <12 gr, 12 – 24 gr, 25 – 48 gr, >48 gr per day) and total homocysteine levels (mean ± standard deviation) among males (13 ± 3 vs. 11 ± 3 vs. 14 ± 4 vs. 18 ± 5 vs. 19 ± 3 μmol/L, respectively, p < 0.01) and females (10 ± 4 vs. 9 ± 3 vs. 11 ± 3 vs. 15 ± 4 vs. 17 ± 3 μmol/L, respectively, p < 0.01), after controlling for several potential confounders. The lowest homocysteine concentrations were observed with ethanol intake of < 12 gr/day (Bonferroni α* < 0.05). No differences were observed when we stratified our analysis by type of alcoholic beverage consumed. CONCLUSION: We observed a J-shape relationship between homocysteine concentrations and the amount of ethanol usually consumed

Total cholesterol and HDL-cholesterol in relation to socioeconomic status in a sample of 11,645 Greek adults: The EPIC study in Greece

Objective: To examine the relationship between educational level, a powerful indicator of socioeconomic status in Greece, total cholesterol and HDL-cholesterol in a large sample of Greek adults. Methods: The study sample consisted of 11,645 subjects, 4,398 men and 7,247 women, aged 23 - 86 years, who voluntarily participated in the Greek component of the EPIC study during 1994 - 98. Educational attainment was divided into low, medium, and high. Linear regression analyses were performed, in men and women separately, using total and HDL-cholesterol as dependent variables and educational level as independent, while controlling for age. Results: Total blood cholesterol values are inversely associated with educational level in both genders, a pattern contrasting with that found 20 years ago. The association is more prominent among women. HDL-cholesterol values are inversely associated with educational level in men, whereas the association is less consistent in women. © 2000, Sage Publications. All rights reserved

Plasma retinol and tocopherol levels in relation to demographic, lifestyle and nutritional factors of plant origin in Greece

In the context of the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC) we have conducted a cross-sectional study to determine the effect of demographic, lifestyle and nutritional factors of plant origin on retinol, α-tocopherol and γ-tocopherol. Study subjects were a random sample of forty-five men and sixty-eight women, aged 30-82 years, from the Greek EPIC cohort of 27953 volunteers. Analyses were done using linear regression models with the vitamin blood levels as dependent variables, and BMI, the intake of selected food items, total energy intake and a set of demographic factors as independent variables. Women had significantly lower plasma retinol levels (P&lt;0.006) than men. Both α- and γ-tocopherol levels increased by approximately 5% for every additional 5 years of age. Among dietary factors, intake of non-fruity vegetables was associated with increase, while intake of added lipids other than olive oil with decrease, of plasma retinol levels. BMI was positively associated with plasma γ-tocopherol only, while none of the foods or food groups investigated significantly affected the plasma levels of either of the two tocopherols. These findings need to be confirmed before attempts are made to use them in the context of explanatory mechanistic processes

Interaction between Mediterranean diet and methylenetetrahydrofolate reductase C677T mutation on oxidized low density lipoprotein concentrations: The ATTICA study

Background: The oxidative modification of low-density lipoprotein (LDL) has been suggested to be a key element in atherogenesis, while methylenetetrahydrofolate reductase (MTHFR) C677T mutation has been associated with the development of coronary heart disease. We evaluated whether adoption of a Mediterranean type of diet is associated with oxidized LDL levels, as well as the role of MTHFR C677T mutation in this relationship. Methods: We studied demographics, lifestyle, clinical, biochemical and genetic data from 322 men (46 ± 13 years) and 252 women (45 ± 14 years), without any clinical evidence of cardiovascular disease, from the Attica region, Greece (i.e. the ATTICA study). Among the other parameters we also measured oxidized (ox)-LDL levels, and the distribution of MTHFR. Adherence to the Mediterranean diet was evaluated by a special diet score. Results: The distribution of MTHFR genotypes was: 41% for homozygous normal (CC) genotype, 48% for heterozygous (CT) and 11% for homozygous mutant (TT) genotype. Ox-LDL levels were higher in TT as compared to CC and CT (70.8 + 26 vs. 51.0 ± 26 vs. 63.7 ± 24 mg/dl, p &lt; 0.001). Greater adherence to the Mediterranean diet was inversely associated with ox-LDL levels (standardized beta = -0.34, p &lt; 0.001), after controlling for several confounding variables; however, stratified analysis revealed that adherence to the Mediterranean diet was associated with lower ox-LDL levels in TT and CT individuals (standardized beta = -0.67, p = 0.001 and standardized beta = -0.66, p = 0.025, respectively), but not in CC (standardized beta = -0.18, p = 0.10), after controlling for several potential confounders. Conclusion: The observed gene-to-diet interaction on ox-LDL concentrations may provide a pathophysiological explanation by which a Mediterranean type of diet could influence coronary risk in people with increased oxidative stress. © 2005 Elsevier B.V. All rights reserved

Long-term fish consumption is associated with protection against arrhythmia in healthy persons in a Mediterranean region - The ATTICA study

Background: Dietary habits have long been associated with many manifestations of cardiovascular disease. Objective: We sought to investigate whether a diet enriched with fish and n-3 fatty acid consumption are associated with changes in the potential duration of the electrical action, as represented by the QT duration on a resting electrocardiogram, in a population-based sample of Greek adults. Design: During 2001 and 2002, we randomly enrolled 1514 men (18-87 y old) and 1528 women (18-89 y old) stratified by age and sex distribution (in the 2001 Greek census) from the Attica area, Greece. We studied several demographic, anthropometric, lifestyle, dietary, and bioclinical factors of the participants. Dietary habits (including fish consumption) were evaluated by using a validated food-frequency questionnaire. All subjects underwent electrocardiography with a 12-lead surface, in which, along with several other indexes, QT duration was measured, and the heart rate-corrected QT (QTc) was calculated (corrected by using Bazett&apos;s rate). The tested hypothesis was evaluated through multiple linear regression analysis, after control for physical activity status, sex, age, medication intake, and several other potential confounders. Results: Compared with fish nonconsumers, those who consumed &gt;300 g fish/wk had a mean 13.6% lower QTc (P &lt; 0.01). These findings were confirmed after adjustment for age, sex, physical activity status, BMI, smoking habits, intake of nuts, and other confounders. Moreover, compared with fish nonconsumers, those who consumed ≥300 g fish/wk had a 29.2% lower likelihood of having QTc intervals &gt;0.45 s (P = 0.03). Conclusions: Long-term consumption of fish is associated with lower QTc interval in free-eating people without any evidence of cardiovascular disease. Thus, fish intake seems to provide antiarrhythmic protection at a population level. © 2007 American Society for Nutrition

The J-shape association of ethanol intake with total homocysteine concentrations: The ATTICA study

Background: Epidemiological studies suggest a non-monotonic effect of alcohol consumption on cardiovascular risk, while there is strong evidence concerning the involvement of homocysteine levels on thrombosis. The aim of this work was to evaluate the association between usual ethanol consumption and homocysteine levels, in cardiovascular disease free adults. Methods: From May 2001 to December 2002 we randomly enrolled 1514 adult men and 1528 women, without any evidence of cardiovascular disease, stratified by age - gender (census 2001), from the greater area of Athens, Greece. Among the variables ascertained we measured the daily ethanol consumption and plasma homocysteine concentrations. Results: Data analysis revealed a J-shape association between ethanol intake (none, &lt;12 gr, 12 - 24 gr, 25 - 48 gr, &gt;48 gr per day) and total homocysteine levels (mean ± standard deviation) among males (13 ± 3 vs. 11 ± 3 vs. 14 ± 4 vs. 18 ± 5 vs. 19 ± 3 μmol/L, respectively, p &lt; 0.01) and females (10 ± 4 vs. 9 ± 3 vs. 11 ± 3 vs. 15 ± 4 vs. 17 ± 3 μmol/L, respectively, p &lt; 0.01), after controlling for several potential confounders. The lowest homocysteine concentrations were observed with ethanol intake of &lt; 12 gr/day (Bonferroni α* &lt; 0.05). No differences were observed when we stratified our analysis by type of alcoholic beverage consumed. Conclusion: We observed a J-shape relationship between homocysteine concentrations and the amount of ethanol usually consumed. © 2004 Pitsavos et al; licensee BioMed Central Ltd