The inflammatory potential of diet is related to incident frailty and slow walking in older adults

Background: Certain foods and dietary patterns have been associated with both inflammation and frailty. As chronic inflammation may play a role in frailty and disability, we examined the association of the inflammatory potential of diet with these outcomes. Methods: Data were taken from 1948 community-dwelling individuals =60 years old from the Seniors-ENRICA cohort, who were recruited in 2008–2010 and followed-up through 2012. Baseline diet data, obtained with a validated diet history, was used to calculate Shivappa's Dietary Inflammatory Index (DII), an “a priori” pattern score which is based on known associations of foods and nutrients with inflammation, and Tabung's Empirical Dietary Inflammatory Index (EDII), an “a posteriori” pattern score which was statistically derived from an epidemiological study. At follow-up, incident frailty was assessed with Fried's criteria, and incident limitation in instrumental activities of daily living (IADL) with the Lawton-Brody index. Statistical analyses were performed with logistic regression, and adjusted for the main confounders. Results: Compared with individuals in the lowest tertile of DII, those in the highest tertile showed higher risk of frailty (odds ratio [OR] 2.48; 95% confidence interval [CI]: 1.42, 4.44, p-trend = 0.001) and IADL disability (OR: 1.96; 95% CI: 1.03, 3.86, p-trend = 0.035). By contrast, EDII did not show an association with these outcomes. The DII score was associated with slow gait speed, both as a low score in the Short Physical Performance Battery test (OR: 1.82; 95% CI: 1.27, 2.62, p-trend = 0.001) and as a positive Fried's criterion (OR: 1.64; 95% CI: 1.08, 2.51, p-trend = 0.021), which use different thresholds. Conclusions: DII predicted frailty and IADL while EDII did not. DII is able to measure diet healthiness in terms of physical decline in addition to avoidance of inflammation

Prevalence and trends of thinness, overweight and obesity among children and adolescents aged 3-18 years across Europe: a protocol for a systematic review and meta-analysis

Introduction Increasing prevalence of both thinness and excess weight during childhood and adolescence is a significant public health issue because of short-term health consequences and long-term tracking of weight status. Monitoring weight status in Europe may serve to identify countries and regions where rates of these disorders are either slowing down or increasing to evaluate recent policies aimed at appropriate body weight, and to direct future interventions. This study protocol provides a standardised and transparent methodology to improve estimating trends of thinness, overweight and obesity in children aged 3-18 years and adolescents across the European region between 2000 and 2017. Methods and analysis This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane Collaboration Handbook. To identify relevant studies, a search will be conducted in MEDLINE, EMBASE, Cochrane Library, CINAHL and Web of Science databases. From the selected studies, relevant references will be screened as supplemental sources. Finally, open search in websites from health institutions will be conducted to identify weight status data not published in scientific journals. Cross-sectional, follow-up studies and panel surveys reporting weight status (objectively measured height and weight) according to the International Obesity Task Force criteria, and written in English or Spanish will be included. Subgroup analyses will be carried out by gender, age, study year and country or European region. Discussion This study will provide a comprehensive description of weight status of children and adolescents across Europe from 2000 to 2017. The results will be disseminated in a peer-reviewed journal. This study will use data exclusively from published research or institutional literature, so institutional ethical approval is not required

The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk

Objective: The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and Galicia, a region in northwest Spain. The SEAD has been associated with a lower risk of non-fatal acute myocardial infarction, but the mechanisms of this association have not yet been investigated. Thus, we examined the association between the SEAD and numerous biomarkers of coronary risk, blood pressure and anthropometrics. Methods: Cross-sectional study conducted in 2008–2010 among 10,231 individuals representative of the population aged 18 years and older in Spain. Diet was assessed with a validated computerized diet history. SEAD adherence was measured with an index including 9 food components (fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine), which ranges from 0 (lowest adherence) to 9 (highest adherence). C-reactive protein, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose, glycated hemoglobin, insulin, leptin, fibrinogen, were determined in 12-h fasting blood samples, while creatinine and urine albumin were determined in urine. Results: Mean SEAD score was 2.9 points (inter-quartile range 2–4 points). Higher SEAD adherence was associated with a lower level of plasma C-reactive protein (adjusted difference in geometric means between the highest and lowest SEAD quartiles −0.2 mg/l; p for trend <0.001), plasma triglycerides (−3.4 mg/dl; p for trend 0.012), insulin (−0.5 mU/l; p for trend <0.001), HOMA-IR (−0.12; p for trend <0.001), urine albumin (−0.8 mg/l; p for trend <0.001), urine albumin-creatinine ratio (−0.3 mg/g creatinine; p for trend <0.034), and systolic blood pressure (−1.6 mm Hg; p for trend <0.001). Conclusions: This study identifies possible mediators of the effect of SEAD on myocardial infarction, because SEAD is associated with a lower concentration of markers of inflammation and with reduced triglycerides, insulin, insulin resistance, and systolic blood pressure

Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis

Objective: To examine the relationship between glycated haemoglobin A1c (HbA1c) levels and the risk of cardiovascular outcomes and all-cause mortality based on data from observational studies and to determine the optimal levels of HbA1c for preventing cardiovascular events and/or mortality in diabetic and non-diabetic populations. Review methods: We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews and Web of Science databases, from inception to July 2016, for observational studies addressing the association of HbA1c levels with mortality and cardiovascular outcomes. Random effects models were used to compute pooled estimates of HR and respective 95% CI for all-cause mortality, cardiovascular mortality and risk of cardiovascular events, separately for people with and without diabetes. Results: Seventy-four published studies were included in the systematic review, but only 46 studies could be incorporated in the meta-analysis. In both diabetic and non-diabetic populations, there was an increase in the risk of all-cause mortality when HbA1c levels were over 8.0% and 6.0%, respectively. The highest all-cause mortality in people with diabetes was HbA1c above 9.0% (HR=1.69; 95% CI 1.09 to 2.66) and in those without diabetes was HbA1c above 6.0% (HR=1.74; 95% CI 1.38 to 2.20). However, both diabetic and non-diabetic populations with lower HbA1c levels (below 6.0% HR=1.57; 95% CI 1.14 to 2.17 and below 5.0% HR=1.19; 95% CI 1.04 to 1.36, respectively) had higher all-cause mortality. Similar pooled estimates were found when cardiovascular mortality was the outcome variable. Conclusion: HbA1c is a reliable risk factor of all-cause and cardiovascular mortality in both diabetics and non-diabetics. Our findings establish optimal HbA1c levels, for the lowest all-cause and cardiovascular mortality, ranging from 6.0% to 8.0% in people with diabetes and from 5.0% to 6.0% in those without diabetes.ICR is supported by a grant from the Universidad de Castilla-La Mancha (FPU13/01582). CAB is supported by a grant from the Spanish Ministry of Ministry of Education, Culture and Sport (FPU13/03137). BP is supported by a grant from the Portuguese Foundation for Science and Technology (SFRH/BPD/108751/2015)

Glycosylated haemoglobin as a predictor of cardiovascular events and mortality: a protocol for a systematic review and meta-analysis

Introduction Glycosylated haemoglobin level (HbA1c) is an indicator of the average blood glucose concentrations over the preceding 2–3 months and is used as a convenient and well-known biomarker in clinical practice. Currently, epidemiological evidence suggests that HbA1c level is an independent risk factor for cardiovascular events such as myocardial infarction, stroke, coronary heart disease and heart failure. This protocol aim is to conduct a systematic review and meta-analysis to determine relationships of HbA1c levels with cardiovascular outcomes and cause of death, and to analyse the range of HbA1c levels that is a predictor of cardiovascular disease and/or mortality based on data from published observational studies. Methods and analysis The search will be conducted using Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception. Observational studies written in Portuguese, Spanish or English will be included. The Quality In Prognosis Studies tool will be used to assess the risk of bias for the studies included in the systematic review or meta-analysis. HRs for cardiovascular outcomes and causes of death with 95% CIs will be determined as primary outcomes. Subgroup analyses will be performed based on cardiovascular outcomes, cause of death studied, and type of population included in the studies. Ethics and dissemination This systematic review will synthesise evidence on the potential of using HbA1c level as a prognostic marker for cardiovascular disease outcomes and/or mortality. The results will be disseminated by publication in a peer-reviewed journal. Ethics approval will not be needed because the data used for this systematic review will be obtained from published studies and there will be no concerns about privacy

Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study

Aims: Most studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk. Methods and results: This study was conducted with 7641 outpatients aged ≥50 years, free of clinical CVD and with at least one major CVD risk factor, selected from 12 European countries in 2009. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Cholesterol fractions and glycated haemoglobin (HbA1c) were measured in a central laboratory. Cardiovascular disease risk was estimated with the SCORE equation. Patients' mean age was 63 years (48% men), and 40.1% had a high CVD risk. Among treated hypertensives (94.2%), only 38.8% achieved the blood pressure target of <140/90 mmHg [between-country range (BCR): 32.1–47.5%]. Among treated dyslipidaemic patients (74.4%), 41.2% attained both the total- and LDL-cholesterol target of <5 and <3 mmol/L, respectively (BCR: 24.3–68.4%). Among treated type 2 diabetic patients (87.2%), 36.7% achieved the <6.5% HbA1c target (BCR: 23.4–48.4%). Among obese patients on non-pharmacological treatment (92.2%), 24.7% reached the body mass index target of <30 kg/m2 (BCR: 12.7–37.1%). About one-third of controlled patients on treatment were still at high remaining CVD risk. Although most patients were advised to reduce excess weight and to follow a low-calorie diet, less than half received written recommendations. Conclusions: In Europe, a large proportion of patients in primary prevention have CVD risk factors that remain uncontrolled, and lifestyle counselling is not well implemented; moreover, there is substantial between-country variation, which indicates additional room for improvement. Raised residual CVD risk is relatively frequent among patients despite control of their primary risk factors and should be addressed

Rationale of the association between Mediterranean diet and the risk of frailty in older adults and systematic review and meta-analysis

Frailty is a geriatric syndrome whose frequency is increasing in parallel with population aging and is of great interest due to its dire consequences: increased disability, hospitalizations, falls and fractures, institutionalization, and mortality. Frailty is multifactorial but nutritional factors, which are modifiable, play a crucial role in its pathogenesis. Epidemiologic evidence supports that high-quality dietary patterns can prevent, delay or even reverse the occurrence of frailty. In order to add new knowledge bridging the gap as the main purpose of the present article we performed a comprehensive review of the rationale behind the association of MedDiet with frailty and a systematic review and meta-analysis updating the latest ones published in 2018 specifically examining the relationship of Mediterranean diet (MedDiet) and incident frailty. Adding the updated information, our results confirmed a robust association of a higher adherence to MedDiet with reduced incident frailty. Key components of the MedDiet, i.e., abundant consumption of vegetables and fruit as well as the use of olive oil as the main source of fat, all of which have been associated with a lower incidence of frailty, may help explain the observed benefit. Future well-designed and sufficiently large intervention studies are needed to confirm the encouraging findings of the current observational evidence. Meanwhile, based on the existing evidence, the promotion of MedDiet, a high-quality dietary pattern, adapted to the conditions and traditions of each region, and considering lifelong and person-tailored strategies, is an open opportunity to reduced incident frailty. This could also help counteract the worrying trend towards the spread of unhealthy eating and lifestyle models such as those of Western diets that greatly contribute to the genesis of chronic non-communicable diseases and disability

Fruit, vegetable intake and blood pressure trajectories in older age

Diet rich in fruits and vegetables (F&V) is an established protective factor for hypertension, but the available evidence regarding the impact of F&V consumption on age-related blood pressure change is limited. We examined whether systolic (SBP) and diastolic (DBP) blood pressure trajectories are influenced by F&V intakes in an ageing Russian cohort. Dietary data was available for 8997 men and women in the Health, Alcohol and Psychosocial Factors in Eastern Europe prospective cohort study. Blood pressure measurements were taken at three time-points over 12 years of follow-up, during which time the mean age of the sample changed from 58 to 69 years. The relationships between F&V intake and SBP and DBP were assessed using mixed-effect multilevel models. In the multivariable adjusted models, fruit intake was inversely related to both systolic and diastolic blood pressure at baseline (mean SBP and DBP was 3.5 mmHg and 1.4 mm Hg lower in the highest compared to the lowest intake tertiles, respectively (both p values < 0.001)). However, it was not associated with blood pressure change over time (difference in annual SBP and DBP change was 0.11 mmHg (p value = 0.138) and 0.01 mmHg (p value = 0.894), respectively). We found no significant link between vegetable intake and blood pressure, neither cross-sectionally nor longitudinally. In addition to the association with diet, we observed increasing SBP and mostly steady DBP over age, with deceleration and downward turn after the ages of 55-59 years. On the whole, this analysis found no consistent association between F&V intake and trajectories of blood pressure in older age

Low Rates of Both Lipid-Lowering Therapy Use and Achievement of Low-Density Lipoprotein Cholesterol Targets in Individuals at High-Risk for Cardiovascular Disease across Europe

Aims To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe. Methods and Results Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients’ 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE 5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE 10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels ( 2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as 1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72%and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin 40 mg/day or rosuvastatin 20 mg/day). Among veryhigh- risk patients, this figure was 8.4%. Conclusions There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in EuropeWriting support was provided by Oxford PharmaGenesis Ltd, Oxford, UK, and was funded by AstraZenec

Changes in health behaviors, mental and physical health among older adults under severe lockdown restrictions during the covid-19 pandemic in spain

We used data from 3041 participants in four cohorts of community-dwelling individuals aged =65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If an-other lockdown were imposed during this or future pandemics, public health programs should spe-cially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions. © 2021 by the authors. Licensee MDPI, Basel, Switzerland