Fish consumption, omega-3 fatty acid intake, and risk of pain: the Q5 Seniors-ENRICA-1 cohort

Background & aims: Omega-3 fatty acids have anti-inflammatory and analgesic (anti-nociceptive) actions. However, the relation of habitual omega-3 fatty acidintake andfish consumption -itsmain food source-with pain remains largely unknown.We examined the association offish consumption andmarine omega-3 fatty acid intake with pain incidence and worsening over 5 years among older adults. Methods: Data were taken from the Seniors-ENRICA-1 cohort, which included 950 individuals aged 60 years in Spain. Habitual fish consumption and marine omega-3 fatty acid intake during the previous year were assessed in 2008e2010 and 2012 with a validated diet history. Painwas assessed in 2012 and 2017 with a scale developed from the Survey on Chronic Pain in Europe, ranging from 0 (no pain) to 6 (highest pain), according to its severity, frequency, and number of locations. Analyses on pain incidence were conducted in the 524 participants free of pain at baseline, while those on pain worsening were performed in the overall cohort, and both were adjusted for sociodemographic variables, lifestyle, morbidity, and diet quality. Results: Higher oily fish consumption was associated with reduced pain incidence and worsening over 5 years [fully adjusted odds ratios (95% confidence interval) ¼ 0.68 (0.50,0.94) and 0.70 (0.55,0.88) for every 25 g/day increment (1.5 servings/week), respectively]. Total and white fish consumption were not associated with pain. Higher marine omega-3 fatty acid intake was inversely associated with pain worsening [odds ratio (95% confidence interval) per 0.5 g/day increment ¼ 0.83 (0.72,0.96)]. The corresponding associations for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were 0.53 (0.33,0.87) and 0.73 (0.57,0.94). Conclusions: In this cohort of Spanish older adults, increased oily fish consumption was inversely associated with pain incidence and worsening over 5 years, while higher marine omega-3 fatty acid intake (and that of EPA and DHA) was linked to less pain worseningThe present study was supported by Instituto de Salud Carlos III, State Secretary of RþDþI, and FEDER/FSE (FIS grants 18/287, and 19/ 319), as well as the Funding REACT EU Program (Comunidad de Madrid and the European Regional Development Fund-ERDF, European Union) (FACINGLCOVID-CM project). Adri an Carballo-Casla holds an FPI contract with the Universidad Autonoma de Madrid. The funding agencies played no role in study design, data collection, and analysis, interpretation of results, manuscript preparation, or in the decision to submit this manuscript for publicatio

The role of physical activity in the association between disability and mortality among US older adults: a nationwide prospective cohort study

To examine whether physical activity can mitigate the mortality risk associated with disability in activities of daily living and instrumental activities in daily living among older adults. This analysis comprised 177,360 US participants (104,556 women), aged ≥ 60 years, with valid data from the 1997 through 2018 waves of the US National Health Interview Survey. Participants reported the frequency and duration of leisure-time PA, and their disabilities in activities of daily living and instrumental activities in daily living. Mortality data were obtained from the National Death Index. Over a mean (SD) follow-up of 8.02 (5.43) years, 66,694 deaths occurred from all-cause, 22,673 from cardiovascular disease, and 13,845 from cancer. Among people with disability in activities in daily living, those reaching physical activity recommendations had 25%, 24% and 33% lower risk of all-cause mortality, cardiovascular diseases, and cancer death, respectively, compared with those who do not meet physical activity recommendations. Values were 23%, 22% and 24% for those with disability in instrumental activities in daily living. Risk reductions associated with reaching the recommended physical activity ranged 16% to 29% for people without disability. Combining disability type and compliance with physical activity, individuals with disability in activities of daily living or instrumental activities in daily living who meet the recommended physical activity had moderately higher mortality than those without disability who did not achieve the recommended physical activity. Compliance with physical activity recommendations can partially mitigate excess mortality resulting from disability in activities in daily living or instrumental activities in daily living in older adultsUniversidad de Cádiz/CBUA. The research RIG was supported by a research grant from The Ministry of Universities within the framework of the State program Jose Castillejo Mobility (n.CAS21/00163

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 (ptrend<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 adultsThis 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); Fundacion ´ Soria Melguizo (MITOFUN project); Ministry of Science, Innovation and Universities (RYC 2018-02069I to MSP); Universidad Autonoma ´ 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 (Fundacion ´ de la Universidad Autonoma ´ 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 publicatio

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

Associations of physical activity type, volume, intensity, and changes over time with all-cause mortality in older adults: The Seniors-ENRICA cohorts

Objective: To assess the association of physical activity (PA) type, volume, intensity, and changes over time with all-cause mortality in older adults. Methods: We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts. PA was assessed with the EPIC questionnaire. Participants reported how many hours they spent a week in walking, cycling, gardening, do-it-yourself (DIY), sports, and housework. Then, time at each intensity (moderate PA [MPA], vigorous PA [VPA], moderate-to-vigorous PA [MVPA] and total PA) was calculated. Changes in PA were calculated from the date of the baseline interview to Wave 1. All-cause mortality was ascertained up January 31, 2022. Analyses were performed with Cox regression models, adjusting for the main confounders. Results: Walking, gardening, sports, and housework was associated with lower mortality (ranged 20%–46%). Also, MPA, VPA, MVPA was associated with lower risk of mortality (ranged 28%–53%). Analyses of PA change showed that, compared no PA participation (at baseline nor Wave 1), maintain walking, sports, and housework (ranged 28%–53%) and maintaining MPA, VPA, and MVPA (ranged 32%–36%) levels was linked to decreased mortality risk. Those who increased, maintained, or even decreased total PA had lower mortality (57%, 52%, and 36%, respectively) than those with consistently very low PA. Conclusions: The lower mortality was observed in those with a high baseline level of total PA. Maintaining PA levels such as walking, gardening, and housework, or at all analyzed intensities, was related to lower mortalit

Plant-based diets and risk of frailty in community-dwelling older adults: the Seniors-ENRICA-1 cohort

Frailty is a geriatric syndrome that leads to increased risk of hospitalization, disability, and death. The effect of plant-based diets defined by the quality of their plant foods is unclear. Our objective is to study the association between two plant-based diet indices and the occurrence of frailty among community-dwelling older adults in Spain. We analyzed data from 1880 individuals aged ≥ 60 years from the Spanish Seniors ENRICA-1 cohort. We used a validated diet history to build two indices: (a) the healthful Plant-based Diet Index (hPDI) where healthy plant foods received positive scores, whereas less-healthy plant foods and animal foods received reverse scores; and (b) the unhealthful Plant-based Diet Index (uPDI), with positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Incident frailty was defined with the Fried phenotype. Study associations were summarized with odds ratios (OR) and 95% confidence intervals (CI) obtained from multivariable logistic models. After 3.3 years of follow-up, 136 incident frailty cases were ascertained. Comparing the highest vs. the lowest tertile of adherence, the OR [95% CI] for frailty was 0.43 (0.25–0.74; p-trend =.003) for the hPDI, and 2.89 (1.73–4.84; p-trend <.001) for the uPDI. Higher consumption of healthy plant foods was inversely associated with frailty (0.39 [0.23–0.66; p-trend < 0.001]); higher consumption of unhealthy plant foods was associated with higher frailty risk (2.40 [1.23–4.71; p-trend =.01]). In older adults, the hPDI was associated with lower risk of frailty, while the opposite was found for the uPDIOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. 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 grant numbers 19/319, 20/896, FI29/00162 to MDV); the National Plan on Drugs (grant number 2020/17); Fundación Soria Melguizo (MITOFUN project); Ministry of Science, Innovation and Universities (grant number RYC 2018- 02069I to MSP); Universidad Autónoma de Madrid (FPI contract to ACC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study

The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin. We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18–96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0–15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]. The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patternsThe current analysis of the ENRICA study was supported by Instituto de Salud Carlos III, Secretary of State for Research Development and Innovation, and European Regional Development Fund/European Social Fund (FIS grant 19/319), as well as the Funding REACT EU Programme (Comunidad de Madrid and the European Regional Development Fund European Union) (FACINGLCOVID-CM project). The HAPIEE study was supported by the Wellcome Trust (grant numbers WT064947 and WT081081), the U.S. National Institute on Aging (grant number 1RO1AG23522), and the John D. and Catherine T. MacArthur Foundation Initiative on Social Upheaval and Health. The current analysis was supported by University College London Grand Challenges Small Grant, the European Union’s Horizon 2020 Research and Innovation Programme (ATHLOS Project, grant number 635316) and R-Exposome Chair (grant agreement 857487), and the National Institute for Research of Metabolic and Cardiovascular Disease project (Programme EXCELES, Project ID LX22NPO5104) funded by the European Union Next Generation EU. The Whitehall II Study has been supported by grants from the British Medical Research Council, British Economic and Social Research Council, British Heart foundation (RG/16/11/32334), United Kingdom Health and Safety Executive, United Kingdom Department of Health, National Heart Lung and Blood Institute (HL36310), National Institute on Aging (R01AG056477, RF1AG062553), National Institutes of Health, Agency for Health Care Policy and Research (HS06516), and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health, United Kingdom Stroke Association, and United Kingdom Health and Safety Executive. A.C.-C. was supported by Universidad Autónoma de Madrid (FPI fellowship). Participation of A.P. was supported by the Polish National Science Centre (grant 2018/29/B/NZ7/02118). E.B.’s research was supported by UKRI (ES/T014377/1). The funding sources played no role in the writing of the manuscript or the decision to submit it for publication. Authors were not precluded from accessing data in the study, and they accept responsibility to submit for publicatio

Animal and vegetable protein intake and malnutrition in older adults: a multicohort study

Malnutrition is a global concern in older adults, as it negatively affects morbidity and mortality. While higher animal protein intake may help prevent and treat malnutrition, it might also increase the risk of chronic diseases and death. Conversely, vegetable protein intake might have a lower anabolic effect and not be as effective to improve nutritional status. We studied whether animal and vegetable protein intake are associated with changes in nutritional status in older adults. We used pooled data from two Spanish cohorts: the Seniors-ENRICA 1 and Seniors-ENRICA 2. Settings and participants: 2,965 community-dwelling adults aged 62–92 years. Measurements: Protein intake was estimated at baseline via an electronic, validated diet history. Nutritional status was assessed at baseline and after 2.6 years with the GLIM (Global Leadership Initiative on Malnutrition) phenotypic criteria: weight loss, low body mass index, and reduced muscle mass. The odds of improvements in nutritional status were assessed with logistic regression models, extensively adjusted for potential confounders. Higher animal and vegetable protein intake were associated with improvements in nutritional status [odds ratios (95% confidence intervals) per 0.25 g/kg/day were 1.15 (1.00, 1.32) and 1.77 (1.35, 2.32), respectively]. Cereal protein intake drove most of the latter association [2.07 (1.44, 2.98)]. Replacing 0.25 g/kg/day of total animal protein, meat, or fish protein (but not dairy or egg protein) with vegetable protein was associated with improvements in nutritional status [1.54 (1.13, 2.09), 1.70 (1.20, 2.41), and 1.77 (1.18, 2.64), respectively]. Higher animal and, especially, vegetable protein intake were associated with improvements in nutritional status in older adults. Replacing total animal protein, meat, or fish protein with vegetable protein may help improve malnutritionThis work was supported by FIS grants 19/319 and 22/1111 (funded by the Institute of Health Carlos III; the Secretary of R+D+I; and the European Regional Development Fund/European Social Fund); PLEC2022-009352 grant (funded by MCIN/AEI/10.13039/ 501100011033 and the European Union “NextGenerationEU/PRTR”); FACINGLCOVID-CM project (funded by Comunidad de Madrid and European Regional Development Fund “Funding REACT EU Program”). Adrián Carballo-Casla was supported by Universidad Autónoma de Madrid (FPI fellowship). 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 publicatio

Mediterranean lifestyle index and 24-h systolic blood pressure and heart rate in community-dwelling older adults

Specifc foods, nutrients, dietary patterns, and physical activity are associated with lower blood pressure (BP) and heart rate (HR), but little is known about the joint efect of lifestyle factors captured in a multidimensional score. We assessed the association of a validated Mediterranean-lifestyle (MEDLIFE) index with 24-h-ambulatory BP and HR in everyday life among community-living older adults. Data were taken from 2,184 individuals (51% females, mean age: 71.4 years) from the SeniorsENRICA-2 cohort. The MEDLIFE index consisted of 29 items arranged in three blocks: 1) Food consumption; 2) Dietary habits; and 3) Physical activity, rest, and conviviality. A higher MEDLIFE score (0–29 points) represented a better Mediterranean lifestyle adherence. 24-h-ambulatory BP and HR were obtained with validated oscillometric devices. Analyses were performed with linear regression adjusted for the main confounders. The MEDLIFEhighest quintile (vs Q1) was associated with lower nighttime systolic BP (SBP) (-3.17 mmHg [95% CI: -5.25, -1.08]; p-trend=0.011), greater nocturnal-SBP fall (1.67% [0.51, 2.83]; p-trend=0.052), and lower HR (-2.04 bpm [daytime], -2.33 bpm [nighttime], and -1.93 bpm [24-h]; all p-trend<0.001). Results were similar for each of the three blocks of MEDLIFE and by hypertension status (yes/no). Among older adults, higher adherence to MEDLIFE was associated with lower nighttime SBP, greater nocturnal-SBP fall, and lower HR in their everyday life. These results suggest a synergistic BP-related protection from the components of the Mediterranean lifestyle. Future studies should determine whether these results replicate in older adults from other Mediterranean and non-Mediterranean countriesThis work was supported by FIS grants 19/319, 20/00896, and 22/1164 from the Carlos III Health Institute, the Secretary of R+D+I, and the European Regional Development Fund/European Social Fund; and by International; REACT EU Program. Comunidad de Madrid and European Regional Development Fund (ERDF), European Union: FACINGLCOVID-CM project, Comunidad de Madrid and European Regional Development Fund (ERDF), European Union. MSP holds a Ramón y Cajal contract (RYC2018–025069-I) from the Spanish Ministry of Science, Innovation and Universitie

Alcohol consumption patterns and unhealthy aging among older lifetime drinkers from Spain

Background: The protective health effects of light alcohol consumption are debated due to potential selection biases, reverse causation and confounding. We examined cross-sectional and prospective associations of alcohol consumption patterns with unhealthy aging among older drinkers addressing these methodological issues. Methods: 2081 lifetime drinkers aged 65 + years from the Seniors-ENRICA-2 cohort followed-up for 2.4 years were classified as occasional (average lifetime alcohol intake [g/day] ≤1.43), low-risk (men: >1.43–20; women: >1.43–10), moderate-risk (men: >20–40; women: >10–20) and high-risk drinkers (men: >40; women: >20; or binge drinkers). A Mediterranean drinking pattern (MDP) was defined as occasional/low-risk drinking, wine preference and drinking only with meals. Unhealthy aging was measured with a 52-item health deficit accumulation index (DAI), with higher values indicating more health deficits. Results: A 10-g/day increment in lifetime average alcohol intake was cross-sectionally associated with a higher DAI among all drinkers (mean difference [95% confidence interval] = 0.35 [0.16, 0.53]) and moderate-/high-risk drinkers (0.41 [0.17, 0.65]), but not among occasional/low-risk drinkers. Also, the DAI was 1.35 (0.06, 2.65) points higher in high-risk versus low-risk drinkers and 2.07 (0.59, 3.60) points higher in non-adherers versus adherers to the MDP. Most associations strengthened when restricting analyses to individuals with lower disease burden and did not generally remain after 2.4 years. Conclusions: We found no evidence of a beneficial association between low-risk alcohol consumption and unhealthy aging, but a detrimental one for high-risk drinking, which strengthened when accounting for reverse causation, although attenuated over the follow-up likely due to selective attrition of those less resilient to the harmful effects of alcoholThis work was supported by the Plan Nacional sobre Drogas, Ministry of Health of Spain, Spain (grant 2020/17), Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE, Spain (FIS grants 18/287, 19/319), the Fundacion ´ Francisco Soria Melguizo, Spain (MITOFUN project grant) and the REACT EU Program, Comunidad de Madrid, Spain and the European Regional Development Fund (ERDF), European Union (FACINGLCOVID-CM project). Adrian ´ Carballo-Casla has an FPI contract from the Universidad Autonoma ´ de Madrid. Mercedes Sotos-Prieto holds a Ramon ´ y Cajal contract (RYC-2018–025069-I) from the Ministry of Science, Innovation and Universities. Reagents for measuring Growth Differentiation Factor 15 have been provided by Roche Diagnostics International through a Research Agreement with the FUAM (Fundacion ´ de la Universidad Autonoma ´ 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 publicatio