Family History of Premature Coronary Artery Disease (P-CAD)-A Non-Modifiable Risk Factor? Dietary Patterns of Young Healthy Offspring of P-CAD Patients: A Case-Control Study (MAGNETIC Project)

The relationship between nut consumption and premature coronary artery disease in a representative sample of Iranians: Iran-premature coronary artery disease (IPAD) study

OBJECTIVE

The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities.

DESIGN

This case-control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities.

SETTING

This multi-centric case-control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran.

PARTICIPANTS

Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results.

RESULTS

In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); Pfor trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); Pfor trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake.

CONCLUSION

A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.

Is It Feasible to Predict Cardiovascular Risk among Healthy Vegans, Lacto-/Ovo-Vegetarians, Pescatarians, and Omnivores under Forty?

Guidelines for cardiovascular (CV) risk assessment among young adults are uncertain. Researchers are still looking for new tools for earlier diagnosis of cardiovascular diseases (CVD), the leading cause of mortality in the modern world. This study aimed to assess whether CV risk estimation is possible in groups of healthy individuals under the age of 40 on different dietary patterns (vegans-VEGAN (n = 48), lacto-/ovo-vegetarians-VEGE (n = 49), pescatarians-PESCA (n = 23), and omnivores-OMN (n = 35)) during the pandemic period. Four metrics containing selected risk classifiers were created, and participants were assessed using them. Groups including meat consumption showed increased CV risk predictions in the metrics assessment. The next analyzes showed statistically significant relationships between the results from the created metrics and selected non-basic biomarkers for ApoA1 (OMN group, p = 0.028), IL-6 (PESCA group, p = 0.048), HCY (VEGAN group, p = 0.05), and hsCRP (OMN + PESCA groups, p = 0.025). We found that predicting CV risk among healthy people under 40 adhering to different dietary patterns, taking into account basic and non-basic laboratory assessments and created metrics, is challenging but feasible. Furthermore, the OMN group appeared to be at the highest risk of increased CV risk in the future, while risk tended to be the lowest in the VEGAN group.

Nutritional Status and Habits among People on Vegan, Lacto/Ovo-Vegetarian, Pescatarian and Traditional Diets

Background: This study assessed the possible dependencies between nutritional habits and body composition among subjects with different dietary habits. Materials: A total of 196 healthy (aged 18−50 yrs) participants were enrolled in the study and divided into 4 groups according to their diet: vegans-VEGAN (n = 53), lacto/ovo-vegetarians—VEGE (n = 52), pescatarians-PESCA (n = 28), and omnivores-OMN (n = 43). Methods: The Food Frequency Questionnaire (FFQ) was used, and body composition was assessed on the In-Body120 analyzer. Results: Our result revealed in OMN + PESCA groups a higher average consumption frequency of sweets (p = 0.024), cheese/plant cheese (p < 0.001), eggs and egg dishes/egg substitutes (p < 0.001), butter, margarine/plant margarine (p < 0.001), cream /plant cream (p = 0.018), wine and cocktails (p = 0.028), vodka (p = 0.039) and lower of natural cottage cheese/tofu/tempeh (p < 0.001), vegetable oils (p = 0.036), legumes (p < 0.001) and nuts and seeds(p < 0.001) compared to the VEGAN + VEGE groups. The body composition analysis showed significant differences in skeletal muscle mass (SMM) (p = 0.019) and the content of minerals (p = 0.048) between groups. VEGAN disclosed the lowest average values of body fat mass (BFM), percentage body fat (PBF), and visceral adipose tissue (VAT) than other studied groups. Conclusions: The body composition analysis showed mean values within normal ranges in all of the groups, but some average results of OMN, PESCA, and VEGE compared to VEGAN were not highly satisfactory (in addition to eating behavior outcomes).

Lung Cancer Risk in Men and Compliance with the 2018 WCRF/AICR Cancer Prevention Recommendations

Lung cancer is the most common and deadly form of cancer worldwide, especially in men. The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) updated cancer prevention recommendations, and a standard scoring system (2018 WCRF/AICR Score) was published. The purpose of this study was to develop the adapted version of the 2018 WCRF/AICR Score with respect to lung cancer prevention recommendation (Ad-LC WCRF/AICR Score) and to examine the association between lung cancer risk in men and the Ad-LC WCRF/AICR Score as well as its single components. A case-control study was conducted among 439 men aged 45-80 years (187 controls, 252 primary lung cancer cases). Lifestyle and dietary data were collected with a questionnaire including the 62-item food frequency questionnaire (FFQ-6^®). The Ad-LC WCRF/AICR Score was used as a categorized and continuous variable. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for lung cancer risk were calculated with the partly and fully adjusted model. One component of the score was independently associated with a lower risk of lung cancer in men, regardless of the set of confounders used. In the fully adjusted model following the recommendation "Limit smoking" was associated with a lower risk of lung cancer-in the never smokers by 87% (OR: 0.13; 95% CI: 0.04-0.37; p = 0.0002) and in the moderate smokers by 45% (OR: 0.55; 95% CI: 0.33-0.91; p = 0.0189) compared with the heavy smokers as a reference. By adding the single components making up the Ad-LC WCRF/AICR Score, the combination of three components or more, reducing the risk of lung cancer compared to lower compliance as a reference by 45% to 78% and by 39% to 66% for intermediate compliance (except two models out of seven) and higher compliance, respectively. In the fully adjusted model, the risk of lung cancer for the total Ad-LC WCRF/AICR Score was lower by 47% (OR: 0.53; 95% CI: 0.32-0.88; p = 0.0129) in higher compliance with the score compared to those with the lower compliance. Each one-point increase in the Ad-LC WCRF/AICR Score reduced lung cancer risk by 34% (OR: 0.66; 95% CI: 0.45-0.95; p = 0.0267). The results support previous evidence that limiting smoking reduces the risk of lung cancer in men. It also provides an insight into cancer research by showing that following the combined 2018 cancer prevention recommendations related to diet, lifestyle and body fatness was associated with a lower risk of lung cancer in men.

Design and rationale of a nationwide screening analysis from the LIPIDOGRAM2015 and LIPIDOGEN2015 studies

INTRODUCTION

Cardiovascular disease (CVD) is a major cause of morbidity and mortality throughout the world. The LIPIDOGRAM2015 study was performed to estimate the prevalence of risk factors for atherosclerotic diseases as well as cardiovascular and related disorders in the primary care setting in Poland. The LIPIDOGEN2015 sub-study was designed to include a random cohort of patients in order to analyse parameters related to lipid metabolism, oxidative stress, inflammatory responses, autoimmune disorders, and gene variants that confer susceptibility to cardiometabolic and atherosclerotic diseases.

MATERIAL AND METHODS

The recruitment was carried out by 438 primary care physicians in Poland. The expected number of patients recruited for the LIPIDOGRAM2015 study was 13,000-14,000 with 13-15% (1700-2000) also participating in the LIPIDOGEN2015 sub-study. Each patient had to complete a questionnaire concerning medical and family history, concomitant diseases, and pharmacotherapy. Anthropometric measurements were performed at the doctor's office. For the LIPIDOGEN2015 sub-study, saliva samples for DNA isolation and blood samples for measurement of glycated haemoglobin, oxidative stress parameters, autoantibody levels, and inflammatory cytokine profile and apolipoprotein profile were collected. Follow-up data will be obtained from the National Health Fund in Poland.

RESULTS

The LIPIDOGRAM2015 and LIPIDOGEN2015 study cohort reflects the prevalence of cardiovascular risk factors and concomitant diseases, markers of oxidative stress, the presence of autoantibodies, inflammatory cytokine profile, and apolipoprotein profile, as well as genetic variants potentially conferring susceptibility to cardiometabolic and atherosclerotic diseases.

CONCLUSIONS

This study presents the prevalence of different CV risk factors, with special emphasis on lipid disorders, and it assesses the relationship between inflammation, oxidative stress, and mutations in genes encoding proteins regulating lipid metabolism, as well as genes conferring susceptibility to cardiovascular, cardiometabolic, and related diseases.

Parental health status in relation to the nutrition literacy level of their children: Results from an epidemiological study in 1728 Greek students

BACKGROUND: Children’s dietary behaviors seem tract into adulthood and as a result preventing strategies to establish healthy behaviors from early stages of life are needed. Nutrition knowledge is essential for behavioral change. OBJECTIVE: To examine whether the status of parental health related to their children’s nutrition literacy level through their perceptions mainly of healthy eating attitudes METHODS: A cross-sectional survey was conducted in Greece among 1,728 schoolchildren aged 10–12 years old. The sample was collected in the school setting during the school years of 2014–2016. Children completed anonymously a self-administered questionnaire about their knowledge and perceptions of a healthy diet while their parents completed another suitable questionnaire about family health status. RESULTS: Paternal BMI status and hypertension were inversely associated with the level of nutrition literacy of their children by b = –0.043 (95%CI: (–0.082, –0.003; p = 0.036) and by b = –0.600 (95%CI: –1.181, –0.019; p = 0.043), respectively. Parental health status, specifically, paternal diabetes and maternal dyslipidemia were associated with children’s higher level of nutrition literacy by b = 0.729 (95%CI: 0.002, 1.456; p = 0.049) and by b = 0.730 (95%CI: 0.086, 1.374; p = 0.026), respectively. CONCLUSIONS: Parental health status partially affects, either negatively or positively, the level of nutrition literacy of their children. This impact depends on whether parents follow nutritional recommendations to improve their health.

Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study

Lung cancer is the most commonly diagnosed cancer in men worldwide. Studies regarding dietary patterns (DPs) and lung cancer are limited, with results remaining inconclusive, and the association of DPs with lung cancer in smokers is unclear. This study analyzed the associations between DPs, including the Polish-adapted Mediterranean diet (Polish-aMED) score, and lung cancer risk in Polish adult male smokers. This case-control study involved 439 men aged 45–80 years from northeastern Poland, including 187 newly diagnosed lung cancer cases. Dietary data was collected with a 62-item food frequency questionnaire (FFQ-6). Two approaches were applied to identify dietary patterns. The Polish-aMED score was calculated (hypothesis-driven approach) and a principal component analysis (PCA) was used to identify PCA-driven DPs (data-driven approach). A logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of the lung cancer risk associated with the adherence to DPs overall as well as for moderate (2.5–11 pack-years) and heavy (>11 pack-years) smokers. Among moderate smokers, the risk of lung cancer was lower by 41% (OR: 0.59; 95% CI: 0.39–0.90; p < 0.05; adjusted model) in the higher adherence to the prudent DP when compared to the lower adherence, and by 66% (OR: 0.34; 95% CI: 0.15–0.76; p < 0.05; adjusted model) in the high adherence (7–9 points) to the Polish-aMED score when compared to the low adherence (0–3 points). No significant association between the westernized traditional DP or the sweet dairy DP and lung cancer was revealed. In conclusion, the current study suggests that pro-healthy dietary patterns, including the Mediterranean pattern, may favour lower risk of lung cancer in moderate smokers, although it was not confirmed in heavy smokers.

Data-Driven Dietary Patterns and Diet Quality Scores: Reproducibility and Consistency in Sex and Age Subgroups of Poles Aged 15-65 Years

This study aimed to assess: (i) the test–retest reproducibility of identification of data-driven dietary patterns (DPs) derived using a Principal Component Analysis (PCA) and hypothesis-driven DPs (diet quality scores); (ii) the consistency of data-driven DPs with diet quality scores in sex and age subgroups of Poles aged 15–65 years. The study involved 504 subjects (55.6% of females). Data on food consumption frequency (33 food items) were collected twice with a two-week interval using the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN^®) in a self-administered version (test and retest). Two major data-driven DPs (‘Prudent’ and ‘Western’) were identified in the total sample, sex groups and four age groups separately from test and retest data. Two diet quality scores were analysed: Pro-Healthy-Diet-Index-10 (pHDI-10) and Non-Healthy-Diet-Index-14 (nHDI-14). Tucker’s congruence coefficient indicated fair-to-good similarity of data-driven DPs between test and retest for all study subgroups, except for males. Across study subgroups, the intraclass correlation coefficient (ICC) between the test and retest ranged from 0.56 to 0.86 for ‘Prudent’ DP and 0.57 to 0.82 for ‘Western’ DP, with the lowest values in males. The ICC (test vs. retest) ranged from 0.84 to 0.88 for pHDI-10 and 0.75 to 0.88 for nHDI-14. Comparing the data-driven DPs and diet quality scores, the Spearman’s correlations ranged from 0.63 to 0.93 between ‘Prudent’ DP and pHDI-10, and from 0.60 to 0.81 between ‘Western’ DP and nHDI-14. The test–retest reproducibility of data-driven DPs and diet quality scores and their consistency were acceptable in most of the study subgroups, with a tendency to be higher for pro-health than unhealthy DPs. Data-driven DPs were more reproducible in females than males. The reproducibility of diet quality scores tended to be better in males than females and was the highest in 25–44-year-olds. The KomPAN^® questionnaire can be recommended to use data-driven DPs and diet quality scores to describe the habitual diet in people aged 15–65 years.

Younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature atherosclerosis

BACKGROUND

Premature coronary artery disease is one of the most pressing global issues in modern cardiology. The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients aged < 50 years with myocardial infarction (MI) compared to that in patients aged ≥50 years with MI and to that in young people without MI (no-MI < 50).

METHODS

The studied group (MI < 50) consisted of 240 patients aged 26-49 years with MI. The control groups consisted of 240 patients (MI ≥ 50) with MI aged 50-92 years and 240 healthy people aged 30-49 years without a history of MI (no-MI < 50).

RESULTS

There were statistically significant differences between the MI < 50 and MI ≥ 50 and no-MI < 50 groups regarding the family history of premature MI/ischaemic stroke and the percentage of patients with ≥2 relatives affected (10.8, 2.9, and 3.7%, respectively; p < 0.0001). There was a statistically significant difference in the patient age at the first MI occurrence among patients without a family history of premature CVD, those with 1 affected relative, and those with ≥2 affected first-degree relatives (56.6, 48.6 and 41.8 years, respectively) as well as those with affected first- and second-degree relatives (56.5, 50.7 and 47.0 years, respectively).

CONCLUSIONS

A younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature MI/ischaemic stroke. Thus, the family history of premature atherosclerosis involving not only first- but also second-degree relatives seems to be a valuable factor in CVD risk evaluation in young people.

Regional and socioeconomic variations in dietary patterns in a representative sample of young polish females: a cross-sectional study (GEBaHealth project)

Background

Associations between dietary patterns (DPs) and socioeconomic correlates among adolescents from emerging economy countries are not fully understood. The study analysed variations in DPs adherence depending on country regions and family socioeconomic status (SES) among Polish females.

Methods

Data from a representative sample (n = 1107) of Polish females 13–21-year-old was used. Four DPs were previously identified by principal component analysis. Regions were ranked by Gross Domestic Product. A SES index as an overall measure of family SES was developed. Multiple logistic regression models adjusted for age and body mass index were created.

Results

Higher adherence to ‘Fast-food and sweets’ DP was found in the less affluent (North) region when compared to four other regions (Odds ratio (OR): 1.94 to 1.63). Higher adherence to ‘Fruit and vegetables’ DP was found in more affluent regions when compared to poorer regions: East and North-East (OR 1.71 to 1.81 and 1.69 to 2.23, respectively). Higher adherence to ‘Traditional Polish’ DP was found in 4 out of 5 regions (OR 2.02 to 2.53) when compared to the East. Higher family SES was associated with higher adherence to ‘Fruit and vegetables’ DP (OR 2.06) and lower adherence to ‘Traditional Polish’ DP (OR 0.27).

Conclusions

The study revealed that region’s affluence is strongly reflected in dietary behaviours of young females from a transitioning country. Recognising geographical distribution of dietary patterns within the country and shifting the resources to economically disadvantaged regions might be more effective than current national public health interventions.

Dietary-Lifestyle Patterns Associated with Adiposity and Metabolic Abnormalities in Adult Men under 40 Years Old: A Cross-Sectional Study (MeDiSH Project)

The aim of this study was to examine the associations of dietary-lifestyle patterns (DLPs) with adiposity and metabolic abnormalities in adult Polish men that were under 40. The cross-sectional study included 358 men that were 19–40-year-old. Dietary and lifestyle data were collected with multicomponent food frequency questionnaire (KomPAN^®). DPLs were derived with Principal Component Analysis (PCA) using 25 dietary and six lifestyle as the input variables. Adiposity was determined with the use of: overweight (body mass index 25–29.9 kg/m²), central obesity (waist-to-height ratio ≥ 0.5), general obesity (body fat ≥ 25%), excessive visceral fat tissue (≥ median), and increased skeletal muscle mass (≥ median). The metabolic abnormalities were characterised by elevated: fasting blood glucose (FBG ≥ 100 mg/dL), triglycerides (TG ≥ 150 mg/dL), total cholesterol (TC ≥ 200 mg/dL), or systolic or diastolic blood pressure (≥ 130 or ≥ 85 mmHg, respectively). Four PCA-driven DLPs were derived and labelled accordingly to the most characteristic dietary or lifestyle behaviours that were correlated with each pattern. Multivariate logistic regression revealed that higher adherence (upper vs. bottom tertile as referent) to “Protein food, fried-food, and recreational physical activity” pattern was associated with higher odds of overweight and increased skeletal muscle mass, and lower odds of: general obesity, excessive visceral fat tissue, and elevated TC. Higher adherence to “Healthy diet, active, past smokers” pattern was associated with higher odds of overweight and lower odds of: general obesity, excessive visceral fat tissue, and elevated FBG. Higher adherence to “Sandwiches and convenient diet” pattern was associated with higher odds of: central obesity, general obesity, excessive visceral fat tissue, elevated TC, elevated TG, occurrence at least two metabolic abnormalities, and lower odds of increased skeletal muscle mass. A higher adherence to “Fast foods and stimulants” pattern was associated with higher odds of central obesity, general obesity, excessive visceral fat tissue, and lower odds of increased skeletal muscle mass. The interrelations between diet and lifestyle behaviours were reflected in three out of four patterns. Healthy diet attempts combined with active lifestyle was associated with reduced risk of adiposity and metabolic abnormalities despite some unhealthy components, like former smoking or fried-food consumption. In contrary, patterns that were composed of undesirable dietary behaviours solely, as well as poor diet combined with stimulant use, were associated with higher adiposity and worse metabolic health, despite the relatively young age of the study participants. Accurate mapping of dietary-lifestyle behaviours can serve as a tool for formulating evidence-based recommendations.

Metabolically healthy obese and metabolic syndrome of the lean: the importance of diet quality. Analysis of MAGNETIC cohort

Background

Obesity is considered as an indispensable component of metabolic health assessment and metabolic syndrome diagnosis. The associations between diet quality and metabolic health in lean, young adults have not been yet established whilst data addressing this issue in overweight and obese subjects is scarce. Our analysis aimed to establish the link between diet quality (measured with data-driven dietary patterns and diet quality scores) and metabolic syndrome (MS) in young adults, regardless of their adiposity status.

Methods

A total of 797 participants aged 18–35 years old were included in the study. Participants were assigned into metabolic syndrome (MS) group if at least two abnormalities within the following parameters were present: blood pressure, triglycerides, total cholesterol, HDL cholesterol, blood glucose. Participants with one or none abnormalities were considered as metabolically healthy subjects (MH), Diet quality was assessed with two approaches: 1) a posteriori by drawing dietary patterns (DPs) with principal component analysis (PCA) and 2) a priori by establishing diet quality scores and the adherence to pro-Healthy-Diet-Index (pHDI) and non-Healthy-Diet-Index (nHDI). Logistic regression with backward selection based on Akaike information criterion was carried out, to identify factors independently associated with metabolic health.

Results

Within the MS group, 31% were of normal weight. Three PCA-driven DPs were identified, in total explaining 30.0% of the variance: “Western” (11.8%), “Prudent” (11.2%) and “Dairy, breakfast cereals & treats” (7.0%). In the multivariate models which included PCA-driven DPs, higher adherence to middle and upper tertiles of “Western” DP (Odds Ratios [OR] and 95% Confidence Intervals [95% CI]: 1.72, 1.07–2.79 and 1.74, 1.07–2.84, respectively), was associated with MS independently of clinical characteristics including BMI and waist-hip ratio (WHR). Similar results were obtained in the multivariate model with diet quality scores - MS was independently associated with higher scores within nHDI (2.2, 0.92–5.28).

Conclusions

Individuals with MS were more likely to adhere to the western dietary pattern and have a poor diet quality in comparison to metabolically healthy peers, independently of BMI and WHR. It may imply that diet composition, as independent factor, plays a pivotal role in increasing metabolic risk. Professional dietary advice should be offered to all metabolically unhealthy patients, regardless of their body mass status.

Reproducibility of A Non-Quantitative Food Frequency Questionnaire (62-Item FFQ-6) and PCA-Driven Dietary Pattern Identification in 13-21-Year-Old Females

The aim of this study was to evaluate the test-retest reproducibility of a non-quantitative food frequency questionnaire (acronym: 62-item FFQ-6) and the possibility of identifying dietary patterns (DPs) in 13-21-year-old females. The study involved 97 females within three age groups: 13-15, 16-18, and 19-21 years, including 31, 38, and 28 subjects, respectively. The questionnaire was completed twice with a two-week interval (test and retest). For the total sample, using a principal component analysis (PCA), two similar PCA-driven DPs (DP1 and DP2) were identified separately from test data and retest data, considering two sets of input variables. 60-item-DP1 and 60-item-DP2 were identified after excluding two items-vegetables and fruits in general-due to including single items of various kinds of vegetables and fruits. After an aggregation of some items of the questionnaire, 25-item-DP1 and 25-item-DP2 were identified. The kappa statistic (test vs. retest) in the total sample averaged at 0.52 (0.32-0.72 for food items), while within age groups, it averaged at 0.41, 0.53, and 0.65, respectively. The percentage of subjects classified into the same food frequency category (test vs. retest) in the total sample averaged at 68% (51%-89% for food items), while within age groups, it averaged at 60%, 68%, and 77%, respectively. The Spearman correlations between dietary pattern scores (test vs. retest) in the total sample were: 0.84 (within age groups 0.83, 0.81, and 0.78, respectively) for 60-item-DP1, 0.68 (within age groups 0.24, 0.79, and 0.76, respectively) for 60-item-DP2, 0.76 (within age groups 0.56, 0.82, and 0.89, respectively) for 25-item-DP1, and 0.48 (within age groups 0.40, 0.57, and 0.53, respectively) for 25-item-DP2 (p < 0.05 for all). In conclusion, the test-retest reproducibility of the 62-item FFQ-6 was good or very good for most food items, with a tendency to be higher in older age groups of females under study. Due to the acceptable-to-good reproducibility of dietary pattern identification, the use of a 62-item FFQ-6 to describe the overall diet of young Polish females can be recommended.