Consumption of individual saturated fatty acids and the risk of myocardial infarction in a UK and a Danish cohort

Background: The effect of individual saturated fatty acids (SFAs) on serum cholesterol levels depends on their carbon-chain length. Whether the association with myocardial infarction (MI) also differs across individual SFAs is unclear. We examined the association between consumption of individual SFAs, differing in chain lengths ranging from 4 through 18 carbons, and risk of MI. Methods: We used data from 22,050 and 53,375 participants from EPIC-Norfolk (UK) and EPIC-Denmark, respectively. Baseline SFA intakes were assessed through validated, country-specific food frequency questionnaires. Cox regression analysis was used to estimate associations between intakes of individual SFAs and MI risk, for each cohort separately. Results: During median follow-up times of 18.8 years in EPIC-Norfolk and 13.6 years in Denmark, respectively, 1204 and 2260 MI events occurred. Mean (±SD) total SFA intake was 13.3 (±3.5) en% in EPIC-Norfolk, and 12.5 (±2.6) en% in EPIC-Denmark. After multivariable adjustment, intakes of C12:0 (lauric acid) and C14:0 (myristic acid) inversely associated with MI risk in EPIC-Denmark (HR upper versus lowest quintile: 0.80 (95%CI: 0.66, 0.96) for both SFAs). Intakes in the third and fourth quintiles of C4:0–C10:0 also associated with lower MI risk in EPIC-Denmark. Moreover, substitution of C16:0 (palmitic acid) and C18:0 (stearic acid) with plant proteins resulted in a reduction of MI risk in EPIC-Denmark (HR per 1 energy%: 0.86 (95%CI: 0.78, 0.95) and 0.87 (95%CI: 0.79, 0.96) respectively). No such associations were found in EPIC-Norfolk. Conclusion: The results from the present study suggest that the association between SFA and MI risk depends on the carbon chain-length of the SFA

Fascia compared to one-piece composite cartilage-perichondrium grafting for tympanoplasty

OBJECTIVE: To evaluate the effectiveness of type 1 tympanoplasty with one-piece composite cartilage-perichondrium (CCP) grafts compared to temporalis fascia (TF) grafts for tympanic membrane (TM) closure and hearing improvement in adult patients with a subtotal TM perforation and chronic otitis media (COM). DATA SOURCES: PubMed, Embase, Cochrane Library. REVIEW METHODS: A systematic search was conducted. Relevance and validity of selected articles were assessed. Studies that scored moderate or high on relevance were included, and relevant data for both outcomes were extracted. For the outcome of TM closure, absolute risk differences (RD), relative risks, and number needed to treat with their respective 95% confidence intervals were calculated when possible. RESULTS: We retrieved 3,783 unique studies. Ten studies satisfied the eligibility criteria. Four studies of moderate validity showed RD ranging from 0.08 to 0.13 in favor of the CCP graft compared to the TF graft for TM closure 1 year or more postoperatively, but this was not statistically significant. Five studies of moderate to high validity showed no clinically relevant difference in hearing improvement between both intervention groups at a minimum follow-up of 3 months. The relative air-bone gap closure ranged from 5.7 to 11.5 dB in the TF group and from 8.9 to 12.7 dB in the CCP group. CONCLUSIONS: There is no evidence of superiority of one-piece CCP grafting over TF grafting in type 1 tympanoplasty regarding complete closure of a subtotal perforated TM 1 year or more postoperatively or hearing improvement at a minimum of 3 months follow-up. LEVEL OF EVIDENCE: 2A Laryngoscope, 2015

Fatty acids from dairy and meat and their association with risk of coronary heart disease

PURPOSE: The relationship of total, saturated, mono-unsaturated and poly-unsaturated fatty acids (SFA, MUFA, PUFA) with coronary heart disease (CHD) is debated. We hypothesized that the association of dairy-derived FA with CHD may be different than the association of meat-derived FA with CHD. We therefore aimed to directly compare association of FA intakes from dairy and meat with risk of CHD using substitution models. METHODS: Baseline (1993-1997) FA intake was measured using a validated food frequency questionnaire among 35,767 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort (EPIC-NL). Incident CHD events (n = 2374) were obtained through linkage with national registries during a mean follow-up of 15 years. Association of FA from dairy substituted with FA from meat with CHD risk was estimated through multivariable Cox regression. RESULTS: Participants consumed 81.9 (SD 28.7) grams of FA per day, of which 17.9 (SD 5.2) was from dairy and 15.3 (SD 9.5) from meat. Substituting 1 en% of dairy-derived SFA with meat-derived SFA was associated with higher CHD risk (HR 1.06, 95% CI 1.02-1.10), but substituting dairy-derived MUFA or PUFA did not (HRMUFA 1.03, 95% CI 0.97-1.09; HRPUFA 1.17, 95% CI 0.90-1.53). CONCLUSIONS: Our modelling suggests that substituting dairy SFA with meat SFA is associated with a higher risk of CHD, but substituting dairy MUFA or PUFA with meat FA is not. These results need to be replicated in other cohorts with different fat intakes, preferably with larger variation in the intake of MUFA and PUFA from dairy and meat

Fatty acids from dairy and meat and their association with risk of coronary heart disease

PURPOSE: The relationship of total, saturated, mono-unsaturated and poly-unsaturated fatty acids (SFA, MUFA, PUFA) with coronary heart disease (CHD) is debated. We hypothesized that the association of dairy-derived FA with CHD may be different than the association of meat-derived FA with CHD. We therefore aimed to directly compare association of FA intakes from dairy and meat with risk of CHD using substitution models. METHODS: Baseline (1993-1997) FA intake was measured using a validated food frequency questionnaire among 35,767 participants from the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort (EPIC-NL). Incident CHD events (n = 2374) were obtained through linkage with national registries during a mean follow-up of 15 years. Association of FA from dairy substituted with FA from meat with CHD risk was estimated through multivariable Cox regression. RESULTS: Participants consumed 81.9 (SD 28.7) grams of FA per day, of which 17.9 (SD 5.2) was from dairy and 15.3 (SD 9.5) from meat. Substituting 1 en% of dairy-derived SFA with meat-derived SFA was associated with higher CHD risk (HR 1.06, 95% CI 1.02-1.10), but substituting dairy-derived MUFA or PUFA did not (HRMUFA 1.03, 95% CI 0.97-1.09; HRPUFA 1.17, 95% CI 0.90-1.53). CONCLUSIONS: Our modelling suggests that substituting dairy SFA with meat SFA is associated with a higher risk of CHD, but substituting dairy MUFA or PUFA with meat FA is not. These results need to be replicated in other cohorts with different fat intakes, preferably with larger variation in the intake of MUFA and PUFA from dairy and meat

Consumption of a diet high in dairy leads to higher 15:0 in cholesteryl esters of healthy people when compared to diets high in meat and grain

BACKGROUND AND AIMS: A higher dairy product intake has been associated to higher blood concentrations of 15:0 (pentadecanoic acid), 17:0 (margaric acid), and 14:0 (myristic acid). This study investigates whether a diet high in dairy products influences cholesteryl ester fatty acid concentrations of these specific fatty acids (FA). METHODS AND RESULTS: In a randomized multiple cross-over study, 13 men and 17 women aged 22 ± 4 years with a BMI of 21.6 ± 2.2 kg/m2 received 3 isocaloric intervention diets (dairy, meat or grain) in random order. For this post-hoc analysis, FA in plasma cholesteryl esters were measured using gas chromatography. We performed a linear mixed model per centered log-ratio transformed FA, adjusting for period, and the interaction between diet and period. Consumed total fat intake per controlled intervention diet was 31.0 ± 0.9 en%/day (dairy), 31.5 ± 0.6 en%/day (meat), and 28.4 ± 1.2 en%/day (grain), respectively. The dairy diet led to higher relative concentrations of 15:0 when compared to diets high in meat and grain, (β; 0.27, 95%CI: 0.18,0.37; p = 1.2 × 10-5, and β: 0.15; 95%CI: 0.06,0.24; p = 1.2 × 10-2, respectively). The dairy diet also led to higher 14:0 when compared to the meat diet (β: 0.34; 95%CI: 0.21,0.46; p = 6.0 × 10-5), but not when compared to the grain diet. 17:0 did not differ between diets. CONCLUSION: The plasma cholesteryl ester fraction after a diet high in dairy was characterized by higher 15:0 levels. Concentrations of 14:0 were only higher when comparing the FA profile after a diet high in dairy when compared to a diet high in meat. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01314040

The relationship between vitamin K and peripheral arterial disease

Background and aims A high dietary intake of vitamin K1 (phylloquinone) and vitamin K2 (menaquinones) is thought to decrease cardiovascular disease risk by reducing vascular calcification. The objective of this study is to explore if there is a relationship between phylloquinone and menaquinones intake and risk of PAD. Methods We investigated the association between intake of phylloquinone and menaquinones with PAD in a prospective cohort with 36,629 participants. Occurrence of PAD was obtained by linkage to national registries. Baseline intake of phylloquinone and menaquinones was estimated using a validated food-frequency questionnaire. Multivariate Cox regression was used to estimate adjusted hazard ratio's for the association. Results During 12.1 years (standard deviation 2.1 years) of follow-up, 489 incident cases of PAD were documented. Menaquinones intake was associated with a reduced risk of PAD with a hazard ratio (HR) of 0.71, 95% CI; 0.53–0.95 for the highest versus lowest quartile. A stronger association was observed (p interaction 0.0001) in participants with hypertension (HRQ4 versus Q1 0.59; 95% CI 0.39–0.87) or diabetes (HRQ4 versus Q1 0.56; 95% CI 0.18–1.91), though confidence intervals were wide in the small (n = 530) diabetes stratum. Phylloquinone intake was not associated with PAD risk. Conclusions High intake of menaquinones was associated with a reduced risk of PAD, at least in hypertensive participants. High intake of phylloquinone was not associated with a reduced risk of PAD

The relationship between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease and cerebrovascular disease : Findings from an Australian population-based prospective cohort study of women

BACKGROUND AND AIMS: Recently, a pro-inflammatory diet based on a dietary inflammatory index (DII) has been related to higher CVD risk in general population, but this has not been investigated among women. METHODS: We investigated the relationship between DII and risk of total CVD and CVD subgroups (myocardial infarction, ischemic heart disease, stroke and cerebrovascular disease) in a prospective cohort of 6972 Australian women aged 50-55 years at baseline in 2001. We used clinical and procedure information from inpatient hospital separation registries, information on use of health care services, and from the causes-of-death registry to ascertain CVD outcomes during 11-year follow up. The association between baseline DII score and cardiovascular endpoints was analysed through cox-regression, with correction for demographic and cardiovascular risk factors. RESULTS: We identified 335 incident cases of CVD and 191 cases of ischaemic heart disease (including 69 myocardial infarctions) and 59 cases of cerebrovascular disease (including 40 cases of stroke). A statistically significant higher risk of myocardial infarction was observed in analyses using DII scores as a continuous variable with a hazard ratio of 1.46 (95% confidence interval 1.12-1.89), but this was attenuated by further adjustment for other known cardiovascular risk factors. No association was found for total CVD, ischaemic heart diseases, or cerebrovascular disease. CONCLUSIONS: There was no statistically significant association between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease, myocardial infarction, cerebrovascular disease or stroke in this population of mid-aged Australian women. Associations were not different for postmenopausal women

The relationship between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease and cerebrovascular disease: findings from an Australian population-based prospective cohort study of women

Background and aims Recently, a pro-inflammatory diet based on a dietary inflammatory index (DII) has been related to higher CVD risk in general population, but this has not been investigated among women. Methods We investigated the relationship between DII and risk of total CVD and CVD subgroups (myocardial infarction, ischemic heart disease, stroke and cerebrovascular disease) in a prospective cohort of 6972 Australian women aged 50–55 years at baseline in 2001. We used clinical and procedure information from inpatient hospital separation registries, information on use of health care services, and from the causes-of-death registry to ascertain CVD outcomes during 11-year follow up. The association between baseline DII score and cardiovascular endpoints was analysed through cox-regression, with correction for demographic and cardiovascular risk factors. Results We identified 335 incident cases of CVD and 191 cases of ischaemic heart disease (including 69 myocardial infarctions) and 59 cases of cerebrovascular disease (including 40 cases of stroke). A statistically significant higher risk of myocardial infarction was observed in analyses using DII scores as a continuous variable with a hazard ratio of 1.46 (95% confidence interval 1.12–1.89), but this was attenuated by further adjustment for other known cardiovascular risk factors. No association was found for total CVD, ischaemic heart diseases, or cerebrovascular disease. Conclusions There was no statistically significant association between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease, myocardial infarction, cerebrovascular disease or stroke in this population of mid-aged Australian women. Associations were not different for postmenopausal women