Population dietary habits and physical activity modification with age

Association of dietary phytochemical index with cardiometabolic risk factors

Objective(s): Cardio-metabolic risk factors are becoming a global health concern. To address this problem, one of the proposed ways is to focus on phytochemical-rich foods consumption. Therefore, we aimed to summarize the results of observational studies (cohorts, case-control, and cross-sectional) that investigated the association between dietary phytochemical index (PI) as a new index for evaluating phytochemical-rich food intake and various risk factors of cardio-metabolic disorders. Methods: We conducted a comprehensive systematic review through PubMed, Scopus, and Web of Science databases. The literature search was performed up to August 2021 with no publication year restriction on observational studies investigating the association between PI and cardiometabolic risk factors on adults and children. A random-effect meta-analysis was used. Results: Overall, 16 articles (cross-sectional, case-control, cohort) were eligible for this systematic review and 8 studies with 99771 participants were included in the meta-analysis. Random effect meta-analysis showed that adherence to higher dietary PI decrease the odds of abdominal obesity (OR: 0.73, 95% CI: 0.58, 0.88, I2: 84.90), generalized obesity (OR: 0.84, 95% CI: 0.69, 0.98, I2: 68.10), hypertriglyceridemia (OR: 0.81, 95% CI: 0.73, 0.89, I2: 0.00), hypertension (OR: 0.86, 95% CI: 0.73, 0.99, I2: 7.02), and MetS (OR: 0.79, 95% CI: 0.69, 0.88, I2: 84.90). However, results considering the associations between dietary PI with glycemic indices, and low high-density lipoprotein cholesterol (HDL-C) were not significant (p<0.05). Conclusion: Evidence showed adverse associations between dietary PI and some cardio-metabolic risk factors such as obesity, hypertriglyceridemia, hypertension and metabolic syndrome.

Dietary Intake of Folate and Assessment of the Folate Deficiency Prevalence in Slovenia Using Serum Biomarkers

Folate deficiency is associated with various health issues, including anemia, cardiovascular disease, and birth defects. Low folate intake and suboptimal folate status were found in several countries; however, this topic has not yet been investigated in Slovenia. Dietary folate intake and serum folate status were investigated through the nationally representative food consumption study SI.Menu/Nutrihealth. Folate intake was estimated using a sample of N = 1248 subjects aged 10–74 years, stratified in three age groups (adolescents, adults, elderly population), through two 24 h-dietary recalls and food propensity questionnaire. Data on serum folate and homocysteine was available for 280 participants. Very low folate intake (<300 µg/day) was observed in 59% of adolescents, 58% of adults and 68% of elderlies, and only about 12% achieved the WHO recommended level of 400 µg/day. Major dietary contributors were vegetables and fruit, and cereal products. Living environment, education, employment status and BMI were linked with low folate intake in adults; BMI, and sex in adolescents; and sex in elderlies. Considering low serum folate (<7 nmol/L) and high serum homocysteine (>15 nmol/L), folate deficiency was found in 7.6 and 10.5% in adults and elderlies, respectively. Additional public health strategies should be employed to promote the consumption of folate-rich foods. With current folate intakes, supplementation with folic acid is relevant especially in specific vulnerable populations, particularly in women planning and during pregnancy.

Associations between physical activity levels with nutritional status, physical fitness and biochemical indicators in older adults

BACKGROUND & AIMS

A sedentary lifestyle is one of the major health concerns of all societies that is associated by an increased risk of cardiovascular diseases. In this regard, we compared the anthropometric parameters, physical fitness (PF), lipid profile, and nutritional status of older adults with different levels of physical activity (PA).

METHODS

In this cross sectional study, 220 older people (age: 67.39 ± 2.08 yrs) according to their PA levels had been categorized at high (n = 72), moderate (78) and low (n = 70) PA groups. The International Physical Activity Questionnaires and food frequency questionnaire has been used to determine the PA and nutritional status, respectively. Waist and hip circumference, height, weight, and body mass index of subjects were measured and calculated. Both lower and upper body strength, flexibility, static and dynamic balance, and endurance performance factors were used to determine the level of PF. To assess blood biochemical factors, subjects were asked to visit the laboratory after 12 h of fasting.

RESULTS

The results showed waist circumference, hip circumference, and body fat percent were significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Upper body strength, lower body strength, static balance, dynamic balance flexibility and endurance were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Moreover, triglyceride was significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). According to the post hoc results, high-density lipoprotein, low-density lipoprotein and fasting glucose were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). All participants regardless PA levels showed insufficient consumption of zinc, calcium, vitamin E, and vitamin D (P ≤ 0.05). On the other hand, carbohydrate, sodium, iron, vitamin C and niacin intake significantly above recommended dietary allowance (P ≤ 0.05).

CONCLUSIONS

The results of the current work showed that a higher level of PA improved anthropometric indicators, PF, and lipid profile in Iranian older adults. Moreover, older nutrition should be monitor to maintain their physical health and to prevent them from developing chronic diseases and their malnutrition complications.

Pro-Healthy Diet Properties and Its Determinants among Aging Masters Athletes

Qualitative dietary assessments are not common in aging athletes. Therefore, this study aimed to evaluate diet quality and its determinants among aging masters athletes. Eighty-six participants of the 8th World Masters Indoor Athletics Championships were enrolled in the study (age range 36-65 years). Three subgroups were distinguished to represent countries with different eating habits. Body composition was measured by bioelectrical impedance. Eating habits and diet quality were assessed using the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN®, Warszawa, Poland), and the Pro-healthy Diet Index (pHDI-10). Dietary quality determinants were identified by a multiple regression model conducted for each subgroup separately (Great Britain, France, and Poland). The results showed that none of the subgroups adhered to the reference intake of products with beneficial health outcomes. This was particularly noticeable in the insufficient consumption of whole grain products, dairy, and fish. The fish and vegetables consumption frequency significantly differentiated the eating habits of the studied groups. Diet quality determinants varied depending on the group. However, in each of them, fruit consumption was one of the components of a good-quality diet. The obtained results can be used by institutions providing health education among the elderly to develop an appropriate strategy aimed at changing inappropriate eating habits.

Dietary Diversity and Prostate Cancer in a Spanish Adult Population: CAPLIFE Study

Dietary diversity (DD) is a key component of a high-quality diet, providing the adequate nutrient requirements. However, the role of DD on prostate cancer (PCa) is still uncertain. The aim of this study was to evaluate the relationship between DD, adequate nutrient intake and PCa, according to the aggressiveness of the tumor. The CAPLIFE (CAP: prostate cancer; LIFE: lifestyles) study is a population-based case-control study including a total of 402 incident PCa cases and 302 controls. The DD score (DDS), adjusted by total energy intake, was collected through a validated food frequency questionnaire. Nutrient adequacy was defined according to European Dietary Recommendation Intake for men. The aggressiveness of PCa was determined according to the International Society of Urology Pathology classification. The association between DDS, nutrient intake and PCa was assessed by logistic regression models with adjustment for potential confounding factors. DDS was similar for PCa cases and controls, independent of PCa aggressiveness. According to each food group DDS, the protein group showed the highest mean score in all the subgroups analyzed. However, no differences were observed for each of the DDS components. The DDS, the variety of the group's food intake, and the adequate nutrient intake, were not associated with PCa.

Leisure-Time Physical Activity and Metabolic Syndrome in Older Adults

BACKGROUND

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease, atherosclerosis and diabetes mellitus type 2 which may be reduced by practicing regular physical activity.

OBJECTIVE

To assess the leisure-time physical activity (LTPA) of older adults with MetS and without MetS.

METHODS

Cross-sectional study of older adults (55-80 years old) from Balearic Islands (Spain) with MetS (n = 333; 55% men) and without MetS (n = 144; 43.8% men). LTPA was assessed with the validated Spanish version of the Minnesota LTPA Questionnaire. Two criteria of physically active were used: >150 min/week of moderate physical activity or >75 min/week of vigorous physical activity or a combination of both, and total leisure-time energy expenditure of >300 MET·min/day. Sociodemographic and lifestyle characteristics, anthropometric variables, MetS components, and adherence to the Mediterranean diet (MD) were also measured.

RESULTS

MetS subjects showed lower energy expenditure in LTPA, lower adherence to the MD, higher obesity and waist circumference, and were less active than non-MetS peers. LTPA increased as participants got older and there was higher LTPA intensity as educational level increased. Adherence to MD was as high as LTPA was.

CONCLUSIONS

MetS is associated with physical inactivity and unhealthy diet. To increase LTPA recommendations and raise awareness in the population about the health benefits of PA and high adherence to MD is highly recommended.

Diet quality and nutrient density in subjects with metabolic syndrome: Influence of socioeconomic status and lifestyle factors. A cross-sectional assessment in the PREDIMED-Plus study

BACKGROUND

Socioeconomic disparities and lifestyle factors are likely to determine the overall quality of the diet. In addition, overeating is compatible with inadequate micronutrient intake and it can lead to adverse health outcomes.

OBJECTIVE

To assess adequacy of dietary nutrient intake and to investigate the influence of socioeconomic and lifestyle factors on nutrient density in a large primary cardiovascular prevention trial conducted in healthy participants with metabolic syndrome (MetS) to assess the cardiovascular effects of an energy-restricted Mediterranean diet (PREDIMED-Plus).

METHODS

Baseline cross-sectional analysis of the PREDIMED-Plus trial with 6646 Spanish participants (aged 55-75 years in men and 60-75 years in women) with overweight/obesity and MetS. Energy and nutrient intake (for 10 nutrients) were calculated using a validated 143-item Food Frequency Questionnaire (FFQ) and nutrient density was estimated dividing the absolute nutrient intake by total energy intake. The prevalence of inadequate intake was estimated according to dietary reference intakes. Multivariable linear regression models were fitted to examine associations between socioeconomic status or lifestyle factors and nutrient density.

RESULTS

A considerable proportion of the screened participants showed a deficient intake of vitamins A, D, E, B₉, calcium, magnesium and dietary fibre. Inadequate intake of four or more of the ten nutrients considered was present in 17% of participants. A higher nutrient density was directly and significantly associated with female sex, higher educational level and a better adherence to the Mediterranean diet. Lifestyle factors such as non-smoking and avoidance of sedentary lifestyles were also independently associated with better nutrient density.

CONCLUSIONS

Patients with MetS, despite being overweight, exhibited suboptimal nutrient intake, especially among men. Low nutrient density diet can be largely explained by differences in socioeconomic and lifestyle factors. These results highlight the importance of focussing on nutritional education in vulnerable populations, taking into account nutrient requirements.

Anorexia of Aging Associated with Nutrients Intake in Brazilian Elderly

This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.

Evaluation of adherence to Mediterranean diet in medical students at Kocaeli University, Turkey

Introduction This study was conducted to evaluate the eating habits of medical students at Kocaeli University in northwest Turkey in terms of their ability to apply their academic knowledge regarding healthy lifestyles to their own lives using the Mediterranean Diet Quality Index (KIDMED). Methods In this cross-sectional study, a questionnaire including demographic information and the KIDMED index was administered to 354 medical school students (206 first-year and 148 third-year students). The students' sex, body mass index, KIDMED score, place of residence, smoking habit, media screen time, and regular exercising variables were evaluated. Results The KIDMED score was -2 to 8 (3.8 ± 1.9) among all students, -1 to 8 (3.9 ± 2.0) among first-year students, and -1 to 8 (3.6 ± 1.9) among third-year students. In total, 59.1% of females and 40.9% of males among first-year students showed moderate adherence to the Mediterranean diet, and female students showed better adherence to the Mediterranean diet than males among third-year students. Conclusion Medical students at Kocaeli University in Turkey showed inadequate application of their academic knowledge about healthy living to their own lives.

Improved muscle function and quality after diet intervention with leucine-enriched whey and antioxidants in antioxidant deficient aged mice

Antioxidant (AOX) deficiencies are commonly observed in older adults and oxidative stress has been suggested to contribute to sarcopenia. Here we investigate if 1) low levels of dietary antioxidants had a negative impact on parameters of muscle mass, function and quality, and 2) to study if nutritional interventions with AOX and/or leucine-enriched whey protein could improve these muscle parameters in aged mice. 18-months-old mice were fed a casein-based antioxidant-deficient (lowox) diet or a casein-based control-diet (CTRL) for 7 months. During the last 3 months, lowox-mice were subjected to either: a) continued lowox, b) supplementation with vitamin A/E, Selenium and Zinc (AOX), c) substitution of casein with leucine-enriched whey protein (PROT) or d) a combination of both AOX and PROT (TOTAL). After 7 months lowox-mice displayed lower muscle strength and more muscle fatigue compared to CTRL. Compared to lowox-mice, PROT-mice showed improved muscle power, grip strength and less muscle fatigue. AOX-mice showed improved oxidative status, less muscle fatigue, improved grip strength and mitochondrial dynamics compared to lowox-mice. The TOTAL-mice showed the combined effects of both interventions compared to lowox-mice. In conclusion, nutritional intervention with AOX and/or leucine-enriched whey protein can play a role in improving muscle health in a AOX-deficient mouse model.

Increased Waist-to-height Ratio May Contribute to Age-related Increase in Cardiovascular Risk Factors

BACKGROUND

The risk of cardiovascular diseases (CVDs) increases with age. The objective was to determine whether lifestyle and dietary behaviors and anthropometric measures, which are affected by these behaviors, contribute to the increase of CVD risk factors across age categories of 20-50-year-old.

METHODS

In a cross-sectional design, 437 adults aged 20-50-year-old were selected from households living in Shiraz. Risk factors of CVD, including body mass index (BMI), waist-to-height ratio (WHtR), blood pressure, fasting blood glucose (FBG), serum triglycerides, total cholesterol, and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) as well as lifestyle behaviors (physical activity and smoking), dietary habits, and food intakes were assessed across the age categories of 20-29, 30-39, and 40-50 years. Linear regression was used to examine the contribution of different variables to the age-related increase of CVD risk factors.

RESULTS

All CVD risk factors, except for HDL-C, significantly increased across age categories. Older subjects had healthier dietary habits and food intakes, but they possessed nonsignificantly lower physical activity and higher smoking rate compared to younger adults. Adjusting for physical activity, smoking, and BMI did not change the significant positive association between age and CVD risk factors but adjusting for WHtR disappeared associations for blood pressure, triglycerides, and metabolic syndrome although significant associations remained for FBG and total and LDL-C.

CONCLUSIONS

Age-related increase of CVD risk factors occurred independent of lifestyle habits. WHtR, but not BMI, may partially contribute to the age-related increase in CVD risk factors.

High blood pressure and long-term exposure to indoor noise and air pollution from road traffic

BACKGROUND

Traffic noise has been associated with prevalence of hypertension, but reports are inconsistent for blood pressure (BP). To ascertain noise effects and to disentangle them from those suspected to be from traffic-related air pollution, it may be essential to estimate people's noise exposure indoors in bedrooms.

OBJECTIVES

We analyzed associations between long-term exposure to indoor traffic noise in bedrooms and prevalent hypertension and systolic (SBP) and diastolic (DBP) BP, considering long-term exposure to outdoor nitrogen dioxide (NO2).

METHODS

We evaluated 1,926 cohort participants at baseline (years 2003-2006; Girona, Spain). Outdoor annual average levels of nighttime traffic noise (Lnight) and NO2 were estimated at postal addresses with a detailed traffic noise model and a land-use regression model, respectively. Individual indoor traffic Lnight levels were derived from outdoor Lnight with application of insulations provided by reported noise-reducing factors. We assessed associations for hypertension and BP with multi-exposure logistic and linear regression models, respectively.

RESULTS

Median levels were 27.1 dB(A) (indoor Lnight), 56.7 dB(A) (outdoor Lnight), and 26.8 μg/m3 (NO2). Spearman correlations between outdoor and indoor Lnight with NO2 were 0.75 and 0.23, respectively. Indoor Lnight was associated both with hypertension (OR = 1.06; 95% CI: 0.99, 1.13) and SBP (β = 0.72; 95% CI: 0.29, 1.15) per 5 dB(A); and NO2 was associated with hypertension (OR = 1.16; 95% CI: 0.99, 1.36), SBP (β = 1.23; 95% CI: 0.21, 2.25), and DBP (β⊇= 0.56; 95% CI: -0.03, 1.14) per 10 μg/m3. In the outdoor noise model, Lnight was associated only with hypertension and NO2 with BP only. The indoor noise-SBP association was stronger and statistically significant with a threshold at 30 dB(A).

CONCLUSION

Long-term exposure to indoor traffic noise was associated with prevalent hypertension and SBP, independently of NO2. Associations were less consistent for outdoor traffic Lnight and likely affected by collinearity.

Diet quality is associated with leisure-time physical activity in individuals at cardiometabolic risk

OBJECTIVES

We investigated whether diet quality was associated with leisure-time physical activity (LTPA) and television viewing and the associations of these variables with traditional cardiovascular risk factors and novel biomarkers in individuals at cardiometabolic risk.

METHODS

A total of 193 prediabetic adults (63.7% women, mean age 54.1 years), screened for a diabetes prevention program in Brazil, participated in this cross-sectional study. Clinical data and blood samples were collected for several determinations. Twenty-four-hour recalls were used to calculate the Healthy Eating Index (HEI) adapted to Brazilian dietary habits and the International Physical Activity Questionnaire to assess physical activity level. Analysis of covariance with adjustments for age and body mass index (BMI) was employed to test associations across categories of LTPA and television viewing.

RESULTS

Stratifying according to LTPA categories, the most active subset (≥150 minutes/week) showed better HEI scores after adjustments (64.6 ± 11.0, 65.1 ± 10.3, and 68.6 ± 10.8, p = 0.02) and significant higher values of dark green and orange vegetables but not of whole grains (p = 0.06). Active individuals had lower BMI, waist circumference, inflammatory markers, and better insulin sensitivity (p < 0.05). Individuals at the highest category of television viewing had higher age-adjusted BMI (32.0 ± 6.2, 30.7 ± 6.0, and 28.8 ± 4.7 hours/week; p = 0.01) than the others. Time watching television was inversely associated with homeostasis model assessment (HOMA-IR) and C-reactive protein (CRP; p < 0.01) after adjustments but not with lipids and HEI score. Comparisons of individuals with healthy habits (better diet and higher physical activity [PA]), with those with unhealthy habits revealing better anthropometric and cardiometabolic profiles in the former group.

CONCLUSION

Diet quality assessed by the HEI adapted for Brazilian eating habits attained significance in differentiating more active from inactive at-risk individuals during leisure time. Time watching television, as a surrogate of sedentary behavior, is not useful to detect unhealthy diet quality. LTPA is indicative of better cardiometabolic profile reflected by lipid and inflammatory markers and index of insulin resistance.

Association of long-term exposure to traffic-related air pollution with blood pressure and hypertension in an adult population-based cohort in Spain (the REGICOR study)

BACKGROUND

Long-term exposure to traffic-related air pollution may increase blood pressure (BP) and induce hypertension. However, evidence supporting these associations is limited, and they may be confounded by exposure to traffic noise and biased due to inappropriate control for use of BP-lowering medications.

OBJECTIVES

We evaluated the associations of long-term traffic-related air pollution with BP and prevalent hypertension, adjusting for transportation noise and assessing different methodologies to control for BP-lowering medications.

METHODS

We measured systolic (SBP) and diastolic BP (DBP) at baseline (years 2003-2005) in 3,700 participants, 35-83 years of age, from a population-based cohort in Spain. We estimated home outdoor annual average concentrations of nitrogen dioxide (NO2) with a land-use regression model. We used multivariate linear and logistic regression.

RESULTS

A 10-μg/m3 increase in NO2 levels was associated with 1.34 mmHg (95% CI: 0.14, 2.55) higher SBP in nonmedicated individuals, after adjusting for transportation noise. Results were similar in the entire population after adjusting for medication, as commonly done, but weaker when other methods were used to account for medication use. For example, when 10 mmHg were added to the measured SBP levels of medicated participants, the association was β = 0.78 (95% CI: -0.43, 2.00). NO2 was not associated with hypertension. Associations of NO2 with SBP and DBP were stronger in participants with cardiovascular disease, and the association with SBP was stronger in those exposed to high traffic density and traffic noise levels ≥ 55 dB(A).

CONCLUSIONS

We observed a positive association between long-term exposure to NO2 and SBP, after adjustment for transportation noise, which was sensitive to the methodology used to account for medication.

Dietary supplement use and health-related behaviors in a Mediterranean population

OBJECTIVE

To determine predictors and health-related motivation for supplement use.

DESIGN

Population-based, cross-sectional survey. Food intake was determined by a validated food frequency questionnaire that included questions on dietary supplement consumption. Physical activity, smoking status, educational level, self-perceived mental and physical health, and medical information and drug treatment of diabetes, hypertension, and hypercholesterolemia were recorded. Weight and height were measured.

SETTING

Girona, Spain.

PARTICIPANTS

Six thousand three hundred fifty-two men and women aged 35-80 years.

ANALYSIS

Multiple logistic regression analysis to evaluate the association between dietary supplement use and the other variables.

RESULTS

Dietary supplements were consumed by 9.3% of the participants. Positive predictors of supplement use were female sex (odds ratio = 2.44, 95% confidence interval 1.96-3.04), higher educational level (P < .001), and a high adherence to the Mediterranean diet pattern (P < .001) and to the nutrient adequacy score (P = .004). A higher body mass index (P < .001) and the awareness of hypertension (odds ratio = 0.69, 95% confidence interval 0.56-0.87) were negatively associated with supplement use.

CONCLUSIONS AND IMPLICATIONS

The relatively small number of dietary supplement users did not show a clustering of healthy lifestyle habits. Self-perception of mental and physical health and awareness of a cardiometabolic disorder were not motivators for supplement use.

Magnesium for alcohol withdrawal

BACKGROUND

Patients have been given magnesium to treat or prevent alcohol withdrawal syndrome (AWS). Evidence to support this practice is limited, and is often based on the controversial link between hypomagnesaemia and AWS.

OBJECTIVES

To assess the effects of magnesium for the prevention or treatment of AWS in hospitalised adults.

SEARCH METHODS

We searched the Cochrane Drugs and Alcohol Group Register of Controlled Trials (August 2012), PubMed (from 1966 to August 2012 ), EMBASE (from 1988 to August 2012), CINAHL (from 1982 to March 2010), Web of Science (1965 to August 2012). We also carried out Internet searches.

SELECTION CRITERIA

Randomised or quasi-randomised trials of magnesium for hospitalised adults with, or at risk for, acute alcohol withdrawal.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data with a standardised data extraction form, contacting the correspondence investigator if the necessary information was not available in the reports. Dichotomous outcomes were analysed by calculating the risk ratio (RR) for each trial, with the uncertainty in each result expressed with a 95% confidence interval (CI). Continuous outcomes were to be analysed by calculating the standardised mean difference (SMD) with 95% CI. For outcomes assessed by scales we compared and pooled the mean score differences from the end of treatment to baseline (post minus pre) in the experimental and control groups.

MAIN RESULTS

Four trials involving 317 people met the inclusion criteria. Three trials studied oral magnesium, with doses ranging from 12.5 mmol/day to 20 mmol/day. One trial studied parenteral magnesium (16.24 mEq q6h for 24 hours). Each trial demonstrated a high risk of bias in at least one domain. There was significant clinical and methodological variation between trials.We found no study that measured all of the identified primary outcomes and met the objectives of this review. Only one trial measured clinical symptoms of seizure, delirium tremens or components of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score. A single outcome (handgrip strength) in three trials (113 people), was amenable to meta-analysis. There was no significant increase in handgrip strength in the magnesium group (SMD 0.04; 95% CI -0.22 to 0.30). No clinically important changes in adverse events were reported.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether magnesium is beneficial or harmful for the treatment or prevention of alcohol withdrawal syndrome.

Association between dietary phytochemical index and 3-year changes in weight, waist circumference and body adiposity index in adults: Tehran Lipid and Glucose study

Background

High intakes of phytochemical-rich foods have favorable effects on the prevention of chronic diseases. In this study we assessed the dietary phytochemical index (PI) in relation to 3-year change in weight, waist circumference (WC), body adiposity index (BAI) among Tehranian adults.

Methods

This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study, between 2006–2008 and 2009–2011, on 1938 adults, aged 19–70 y. The usual intake of participants was measured at baseline using a validated semi-quantitative food frequency questionnaire and dietary PI was calculated. Anthropometric measures were assessed both at baseline and 3 years later. Multiple regression models were used to estimate mean difference changes in anthropometrics associated with various dietary PI.

Results

The mean age of participants was 40.4 ± 13.0 y, at baseline, respectively. Mean weight gain was 1.49 ± 5.06 kg (1.65 ± 5.3 kg in men and 1.34 ± 4.9 kg in women) during 3-year period. After adjustment for potential confounding variables including age at baseline, sex, BMI, educational levels, smoking, physical activity, total energy intake, dietary intake of carbohydrate, fat and protein, dietary intakes of whole grains in the highest quartile category of PI were inversely associated with 3-year changes in weight and WC (P for trend <0.05). Dietary intake of fruits in the highest quartile was also associated with lower weight gain during the study period (P for trend <0.05). There was significant inverse association between the highest quartile category of dietary PI with the 3-year changes in weight and BAI (P for trend <0.05).

Conclusion

Higher dietary PI could have favorable effects on prevention of weight gain and reduction of body adiposity in adults.

Influência do exercício físico na qualidade de vida de mulheres na pós-menopausa: um estudo caso-controle

OBJETIVO: Avaliar a influência de atividade física na qualidade de vida e sintomas referidos por um grupo de mulheres pós-menopáusicas. METODOLOGIA: estudo caso-controle envolvendo de 197 mulheres na pós- menopausa com idade entre 50-65 anos: 132 sedentárias e 65 praticantes de exercícios físicos aeróbicos de intensidade leve a moderada. A qualidade de vida e a sintomatologia climatérica foram avaliadas pela Menopause Rating Scale (MRS). Na análise estatística, procedeu-se à análise multivariada por regressão linear múltipla. RESULTADOS: O grupo fisicamente apresentou índices de qualidade de vida significativamente melhores em todos os domínios do instrumento MRS: sintomas sômato-vegetativos (p<0,01), sintomas psicológicos (p<0,01) e geniturinários e sexuais (p<0,01); 63,6% do grupo sedentário e 33,4% do fisicamente ativo referiram sintomas de intensidade moderada a severa. A capacidade cardiorrespiratória se mostrou também significativamente maior entre as mulheres fisicamente ativas (26,5±7,0 ml/Kg/min and 20,2±7,8 ml/kg/min, respectivamente). Através da análise multivariada, mostraram-se fatores preditores da qualidade de vida no presente estudo, a confirmação de atividade física regular (p<0,01) e a renda familiar per capita (p<0,01), de modo que as mulheres fisicamente ativas ou com melhor renda tenderam a referir menor sintomatologia climatérica e melhor qualidade de vida. CONCLUSÕES: No presente estudo, a atividade física regular de intensidade leve a moderada e a renda familiar per capita influenciaram positivamente a qualidade de vida e a intensidade da sintomatologia climatérica.

Leisure-time physical activity in a southern European mediterranean country: adherence to recommendations and determining factors

INTRODUCTION AND OBJECTIVES

To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence.

METHODS

A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity >or=150 min/week or vigorous activity >or=60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis.

RESULTS

The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34).

CONCLUSIONS

The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity.

How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83·9 %) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8·0 %) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25 % of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75 % had inadequate intakes when compared against the estimated average requirement cut-point value of 320 μg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequacy.

Consumption of 'extra' foods by Australian adults: types, quantities and contribution to energy and nutrient intakes

OBJECTIVES

To identify the types and quantities of 'extra' foods, or energy-dense, nutrient-poor foods, consumed by Australian adults, and assess their contribution to total energy and nutrient intakes.

SUBJECT/METHODS

We used 24-h recall data from 10 851 adults, aged 19 years and over, who participated in the nationally representative 1995 National Nutrition Survey. 'Extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating and by applying cut points for maximum amounts of fat and sugar within each food category.

RESULTS

'Extra' foods contributed to 36% of daily energy intake with the highest contributors being fried potatoes (2.8%), margarine (2.6%), cakes and muffins (2.5%), beer (2.4%), sugar-sweetened soft drinks (2.4%), and meat pies (2.2%). Both age and sex were important determinants of 'extra' foods intake; younger adults were more likely to consume sugar-sweetened soft drinks, fried potatoes, meat pies and savoury pastries, pizza, crisps, lollies and chocolate; whereas older adults were more likely to consume sweet and savoury biscuits, cakes and muffins, margarine and butter. In all age groups, 'extra' foods contributed more to energy intake for men than women. Overall, 'extra' foods contributed 16% protein, 41% total fat, 41% saturated fat, 47% sugar and approximately 20% of selected micronutrients to the diet.

CONCLUSIONS

'Extra' foods contribute excessively to the energy, fat and sugar intakes of Australian adults, while providing relatively few micronutrients. This is of concern for the increasing risk of overweight and chronic disease and poor micronutrient status.

Intake of fruits and vegetables in relation to 10-year weight gain among Spanish adults

OBJECTIVE

Despite the alarming increase in the prevalence of obesity, epidemiologic studies that prospectively examine the fruit and vegetable consumption and other lifestyle factors in relation to weight gain (WG) are still insufficient. We explored the associations between fruit and vegetable intake and WG over a 10-year period in an adult Mediterranean population.

METHODS AND PROCEDURES

We performed a 10-year follow-up study with healthy participants (n = 206) aged 15-80 years at baseline in 1994, who participated in a nutrition survey in Valencia, Spain. Data on diet, lifestyle factors, and body weight were obtained in 1994 and 2004 using a food frequency questionnaire (FFQ) and direct measurements.

RESULTS

The average WG over the study period was 3.41 (s.d. 6.9) kg. In multivariate analyses, participants in the third quartile of fruit intake at baseline in 1994 had lower risk of WG> or =3.41 kg compared to those in the lowest quartile (oddsratio (OR) = 0.31, 95% confidence interval (CI), 0.11-0.85; P trend = 0.044). Regarding vegetable intake, the risk of WG was lowest in participants of the fourth quartile (>333 g/day), which had an 84% reduced risk of gaining 3.41 kg weight (OR = 0.18, 95% CI, 0.05-0.66; P trend = 0.017). When the intake of fruits and vegetables was combined, the risk of WG decreased across quartiles, with the lowest risk among those in the fourth quartile (OR = 0.22, 95% CI, 0.06-0.81; P trend = 0.022). Further adjustment for an increased intake of fruits and vegetables over the past 10 years reported by participants in 2004 did not appreciably alter the observed ORs.

DISCUSSION

Dietary patterns associated with a high intake of fruits and vegetables in Mediterranean populations may reduce long-term risk of subsequent WG and obesity among adults.

Dietary intake and status of folate and vitamin B12 and their association with homocysteine and cardiovascular disease in European populations

BACKGROUND/OBJECTIVES

Folate and vitamin B12 have been suggested to play a role in chronic diseases like cardiovascular diseases. The objectives are to give an overview of the actual intake and status of folate and vitamin B12 in general populations in Europe, and to evaluate these in view of the current vitamin recommendations and the homocysteine concentration.

METHODS

Searches in Medline with 'folic acid', 'folate' and 'vitamin B12', 'B12' or 'cobalamin' as key words were combined with the names of the European countries. Populations between 18 and 65 years were included.

RESULTS

Sixty-three articles reporting on studies from 15 European countries were selected. Low folate intakes were observed in Norway, Sweden, Denmark and the Netherlands. Low intakes of vitamin B12 were not common and only seen in one small Greek study. In the countries with a low intake of folate, the recommended levels were generally not achieved, which was also reflected in the folate status. Vitamin B12 intake was not strongly associated with the vitamin B12 status, which can explain why in the Netherlands and Germany the vitamin B12 status was inadequate, despite sufficient intake levels. In countries with a low folate intake in particular, the Hcy concentration was higher than ideal.

CONCLUSIONS

Populations from the Nordic countries, the Netherlands, Germany and Greece may need to improve their intakes of folic acid, B12 or both to either meet the recommendations or to optimize their statuses. This could be achieved via a food-based approach, food fortification or supplements.

Diet quality and lifestyle associated with free selected low-energy density diets in a representative Spanish population

OBJECTIVE

Dietary intake is strongly influenced by the energy density of the diet. The purpose of this study was to determine the association of energy density with diet quality, dietary reference intake (DRI) for energy and lifestyle characteristics in free-living people.

SUBJECTS

The subjects were Spanish men (n=1491) and women (n=1563) selected in between 1999 and 2000 among the general population according to the 1996 census.

RESULTS

A low-energy density diet was significantly associated (P<0.001) with a higher consumption of vegetables, fruits, legumes, fish and white meat as compared to high-energy density diets. More subjects (P<0.001) with a high adherence to low-energy density diets meet DRI for energy intake and tended to be closer (P<0.05) to the recommendations of dietary intakes, established by the Spanish Society of Community Nutrition than those following a high-energy density diet. Alcohol consumption, the prevalence of a sedentary lifestyle and smoking significantly increased (P<0.01) across quartile distribution of energy density.

CONCLUSION

Low-energy density diets of the present population were associated with a healthier lifestyle. Furthermore, our data suggest that adherence to low-energy density diets, with similar characteristics to those found in the present population, promote adequate energy intakes and increase overall diet quality.

Dietary Intake of Free-Living Elderly in Northern Greece

The aim of the present study was to investigate the nutrient intake of a non-institutionalized Greek elderly population. Dietary intake and anthropometric data were investigated in 100 elderly subjects from Grevena, Greece, all belonging to the race of "Hasiotes." According to BMI classification, 48% of the subjects are considered overweight and 20% obese. WHR for women and men was 0.91 and 0.98, respectively. Both genders presented insufficient energy intake (7.27 +/- 3.49MJ/d) in 3 +/- 0.9 feeding sessions daily. Mean protein and fiber intake was 0.82 +/- 0.43 and 0.29 +/- 0.2g/kg BW, respectively. The diet presented insufficient amounts of vitamins A, B6, D, E, K, Biotin, Pantothenic acid, Cu, I, Mg, Mn, and Zn. Female subjects exhibited low dietary intake of vitamins B2, B3 and Ca. The diet had many characteristics of the traditional Mediterranean diet and comprised of a high intake of goat-milk yoghurt, olive oil, goat cheese, traditional alcohol drinks, pies, legumes, fruits and meat. The majority of the sample (70%), reported fasting on Orthodox celebrations. Further research should assess adherence to the Mediterranean diet with the use of scores and compare diet characteristics to other regions in Greece, in order to present regional differences in Greek diet variations.

Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort

INTRODUCTION

Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases. We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly (> or =60 years) Italians participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

METHODS AND RESULTS

Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food questionnaires. Individual participants were assigned factor scores, indicating the extent to which their diet conformed to each of the four dietary patterns identified: prudent (cooked vegetables, pulses, cabbage, seed oil and fish); pasta & meat (pasta, tomato sauce, red meat, processed meat, bread and wine); olive oil & salad (raw vegetables, olive oil, soup and chicken); and sweet & dairy (sugar, cakes, ice cream, coffee and dairy). Highly educated people had high scores on prudent and low scores on pasta & meat. The pasta & meat and prudent patterns were strongly positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) in men and women. Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids. The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year, suggesting awareness of the health consequences of these patterns.

CONCLUSIONS

Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people, and can be used to provide tangible dietary advice to elderly people.

Epidemiology of heavy alcohol use in Ukraine: findings from the world mental health survey

AIMS

To describe the epidemiology of heavy alcohol use in Ukraine, using data from the world mental health (WMH) survey in Ukraine.

METHODS

The WMH composite international diagnostic interview was administered in 2002 to a national probability sample of Ukrainian adults (n=4725). An algorithm for classifying heavy use in the past year was developed from self-reports about the quantity and frequency of drinking, and its convergent validity was demonstrated. Prevalence rates and socio-demographic risk factors were examined separately for men and women.

RESULTS

The 12-month rates of heavy alcohol use were 38.7% in men and 8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of women consumed at least 80 g of ethanol in a typical drinking day on a monthly basis in the year before the interview. The most significant risk factors in men and women were age (26-54 years for men; 18-25 years for women), living in the Southeast region, being in the labour force whether employed or unemployed, and for men, low education and being the father of a young child. A highly significant linear relationship of number of risk factors with heavy alcohol use was found for both sexes.

CONCLUSIONS

The rates for men were similar to those reported in a Russian national survey with the exception of Southeast Ukraine where the rate was >10% higher. The highest rates were among men who were middle-aged, fathers and unemployed. Future prospective studies are needed to assess the impact of heavy alcohol use on Ukrainian health, mental health and occupational and social functioning.