Polyphenol intake and cardiovascular risk in the PREDIMED-Plus trial. A comparison of different risk equations

Prospective association of changes in (poly)phenol intake, body weight and physical activity with inflammatory profile

BACKGROUNDS AND AIM

To prospectively evaluate the associations between changes in (poly)phenol intake, body weight(BW), and physical activity(PA) with changes in an inflammatory score after 1-year.

METHODS AND RESULTS

This is a prospective observational analysis involving 484 participants from the PREDIMED-Plus with available inflammatory measurements. (Poly)phenol intake was estimated using a validated semi-quantitative food frequency questionnaire and the Phenol-Explorer database. An inflammatory score was calculated based on 8 blood biomarkers (IL-6, IL-8, IL-18, MCP-1, C-peptide, hs-CRP, leptin, and RANTES). The association between BW, PA, (poly)phenol intake and inflammatory score was evaluated using structural equations. Mediation analyses were performed to assess the relationship between change in (poly)phenol intake and inflammatory score was mediated by the change in BW. A higher increase in total (poly)phenol intake was related to a decrease in the inflammatory score (β = -0.005mg/1000 Kcal; CI95 % = -0.100,0.000) along with a decrease in BW (β = -0.006mg/1000 Kcal; CI95 % = -0.010,-0.003). Increased PA was associated with a lower inflammatory score (β = -0.129MET-min/d; CI95 % = -0.238,-0.021) and BW (β = -0.248MET-min/d; CI95 % = -0.343,-0.152). Finally, a decrease in BW was associated with a decrease in the inflammatory score (β = 0.240 kg; CI95 % = 0.155,0.325). Mediation analyses revealed that changes in BW explained 22 % of the overall association between changes in (poly)phenol intake and inflammatory score.

CONCLUSIONS

An inverse association between changes in (poly)phenol intake and inflammatory status was observed, with BW playing a significant mediating role, emphasising the impact of BW reduction on inflammation reduction.

Effect of the Mediterranean diet in cardiovascular prevention

The Mediterranean diet is the best evidence-based model for cardiovascular prevention. In addition to 2 major randomized secondary prevention trials (Lyon Heart and CORDIOPREV) and 1 primary prevention trial (PREDIMED) that have demonstrated these benefits, there is an unprecedented body of high-quality prospective epidemiological evidence supporting these beneficial effects. The key elements of this traditional pattern are the abundant use of extra-virgin olive oil and high consumption of foods of natural plant-based origin (fruits, vegetables, nuts, and legumes) and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, with meals is an essential element of this traditional pattern. Although removing wine consumption from the Mediterranean diet has been associated with a reduction in its preventive efficacy, doubts have recently arisen about the possible adverse effect of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, will randomize 10 000 drinkers aged 50 to 75 years to abstention or moderate consumption. UNATI aims to answer these doubts with the best possible evidence.

Health associations of liver enzymes and inflammatory scores with urinary citrus flavonoid metabolites

Background: Dietary flavonoid intake is associated with a reduced risk of some cardiometabolic disorders, attributed in part to their claimed anti-inflammatory activity. Our aim was to investigate the potential association between specific urine flavonoid metabolites, liver enzymes, and inflammatory status in individuals with metabolic syndrome (MetS). Methods: In this cross-sectional study, clinical and dietary data from 267 participants, aged 55 to 75 years, participating in the PREDIMED Plus study (PREvención con DIeta MEDiterránea) were analyzed. At the baseline, spot urine samples were collected and seven urinary flavonoid metabolites were quantified using ultra-performance liquid chromatography coupled to triple quadrupole mass spectrometry (UPLC-Q-q-Q MS). Liver enzymes, inflammatory scores, and urinary flavonoid concentrations were inverse normally transformed. Results: Adjusted linear regression models showed an inverse association between urinary citrus flavanone concentrations and gamma-glutamyl transferase (GGT) (all p-values <0.05). Naringenin 7'-GlcUA was significantly associated with a lower aggregate index of systemic inflammation (AISI) (Bper 1SD = -0.14; 95% CI: -0.27 to -0.02; p-value = 0.025) and systemic inflammation index (SII) (Bper 1SD = -0.14; 95% CI: -0.27 to -0.02; p-value = 0.028). To investigate the relationship between flavanone subclasses and GGT levels, we fitted a score of citrus-flavanones, and subjects were stratified into quartiles. The highest values of the citrus-flavanone score (per 1-SD increase) were associated with lower GGT levels (Bper 1SD = -0.41; 95% CI: -0.74 to -0.07), exhibiting a linear trend across quartiles (p-trend = 0.015). Conclusion: This cross-sectional study showed that higher urinary excretion of citrus-flavanone metabolites was associated with lower GGT levels in subjects diagnosed with MetS and obesity.