Do dietary patterns in older men influence change in homocysteine through folate fortification? The Normative Aging Study

Objective We aimed to describe the difference in B-vitamin intake and in plasma B-vitamin and homocysteine concentrations before and after folic acid fortification, in relation to dietary patterns. Design The Normative Aging Study (NAS) is a longitudinal study on ageing. Between 1961 and 1970, 2280 male volunteers aged 21¿80 years (mean 42 years) were recruited. Dietary intake data have been collected since 1987 and assessment of plasma B vitamins and homocysteine was added in 1993. Setting Boston, Massachusetts, USA. Subjects In the present study, 354 men who had completed at least one FFQ and one measurement of homocysteine, both before and after the fortification period, were included. Results Three dietary patterns were identified by cluster analysis: (i) a prudent pattern, with relatively high intakes of fruit, vegetables, low-fat milk and breakfast cereals; (ii) an unhealthy pattern, with high intakes of baked products, sweets and added fats; and (iii) a low fruit and vegetable but relatively high alcohol intake pattern. Dietary intake and plasma concentrations of folate increased significantly (P <0·05) among all dietary patterns after the fortification period. Homocysteine tended to decrease in supplement non-users and in subjects in the high alcohol, low fruit and vegetable dietary pattern (both P = 0·08). Conclusions After fortification with folic acid, folate intake and plasma folate concentration increased significantly in all dietary patterns. There was a trend towards greatest homocysteine lowering in the high alcohol, low fruit and vegetable grou

Dietary patterns, biological risk factors and survival in elderly European men and women

Background: The percentage of the population aged 65 and over, which started to rise sharply in the last decades of the past century, is continuing to rise. However, up until now, little is known about dietary factors and diet-related biological factors in elderly in relation to survival in old age. Aim: The aim of this thesis is to investigate the associations between dietary patterns, diet-related biological risk factors and survival. Study population: Data from two prospective studies were used, the Healthy Ageing: a longitudinal study in Europe (HALE) and the Normative Aging Study (NAS). The HALE project which involves individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women in 11 European Countries, aged 70 to 90 years at baseline and who were followed for 10 years. The NAS is a longitudinal study which started in 1963 by recruiting men, 21 to 80 years of age and free of heart disease and other major health problems, around Boston. Data collected in 1993 and later were used. Results: We observed that after fortification with folic acid, folate intake and plasma folate concentration increased significantly in three groups with different dietary patterns, derived by cluster analysis. Homocysteine tended to decrease in the group with a relatively high alcohol consumption, low fruit and vegetable dietary pattern in the NAS study. Dietary patterns defined by three European indexes were significantly associated with all-cause mortality in the HALE project. A Mediterranean type of diet was associated with an approximately 20 % lower mortality rates in both apparently healthy elderly and in post-myocardial infarction patients. Healthy lifestyle factors (moderate alcohol consumption, being physically active and non-smoking) were also inversely associated with all-cause mortality. Weight loss was significantly associated with increased all-cause mortality in the study centres of Northern Europe while weight gain was weakly associated with increased mortality in these centres in the FINE study. HDL-cholesterol was inversely associated with mortality from cardiovascular diseases and all-causes in the HALE project. Associations between HDL and mortality were strongest in women. Conclusion: A healthy diet is associated with lower mortality risk in elderly. Besides a healthy diet, it is important for elderly people to be physically active, use alcohol in moderation and quit smoking. It is also important to maintain constant body weight and to keep blood cholesterol at a desirable level, especially to keep HDL-cholesterol high

Supplement use and mortality: the SENECA study

Background It is hypothesis that in relatively healthy older people supplement usage can be consider as healthy life style habit and as such can positively influence longevity. Aim of the study To determine whether supplement use was associated with all-cause mortality in the participants of the SENECA study. Methods Baseline measurements were carried out in 1988/1989 among 75 to 80-year-old people living in 15 European small towns. All-cause mortality was followed up to April 30, 1999. Data from 920 men and 980 women who were ischemic heart diseases-, stroke- and cancer-free at baseline were included. The multivariate adjusted (for sex, age, years of education, physical activity, BMI, chronic diseases, Mediterranean Diet Score, alcohol use and the place of living) hazard ratio (HRs) and 95% confidence intervals (CIs) of mortality by use of any type of nutrient supplement and by particular nutrient supplement use were estimated by Cox proportional hazards regression models. Results At baseline, 13% of participants used nutritional supplements, 19% of subjects were smokers. During 10 years of follow-up 445 men and 252 women died. Among non-smokers no significant associations between total supplement use and particular nutrient supplement use were observed. Among smokers use of any type of supplements (Multivariate HR: 1.52; 95%CI: 1.02¿2.28), use of vitamin B1 (Multivariate HR: 1.57; 95%CI: 1.00¿2.48) and vitamin B2 supplements (Multivariate HR: 1.60; 95%CI: 1.00¿2.56) were associated with a significantly higher risk of all-cause mortality. The similar tendencies were observed among vitamin B6 and vitamin C supplement users who were smoker

Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project

Objective: To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality. Design, Setting and Participants: The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2068 men and 1049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000. Results: During the follow-up period, 1382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75¿0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75¿0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81¿0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre. Conclusions: The MDS, the MDI and the HDI were significantly inversely related with mortality. Sponsorship: This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000¿00211) to D Kromhout