Does food intake mediate the association between mindful eating and change in depressive symptoms?

OBJECTIVE: To examine mediation by (i) diet quality and (ii) diet quantity in the associations of mindful eating domains with 3-year change in depressive symptoms. DESIGN: Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale at baseline and 3-year follow-up. Four mindful eating domains (Focused Eating; Eating in response to Hunger and Satiety Cues; Eating with Awareness; Eating without Distraction) were measured with the Mindful Eating Behavior Scale. Food intake was measured with a 238-item FFQ. Diet quality was defined as the Mediterranean Diet Score (MDS). Diet quantity was defined as total energy intake (kcal/d; 1 kcal = 4·184 kJ). Mediation analyses with percentile-corrected bootstrap confidence intervals were conducted to calculate indirect effects. SETTING: Longitudinal Aging Study Amsterdam. PARTICIPANTS: Adults aged 55 years or above (n 929). RESULTS: Diet quality (MDS) did not mediate associations of any of the four mindful eating domains with change in depressive symptoms. In contrast, total energy intake did mediate the associations with change in depressive symptoms for the mindful eating domains Eating with Awareness (indirect effects fully adjusted models: B = -0·014, 95 % CI -0·037, -0·002) and Eating without Distraction (B = -0·013, 95 % CI -0·033, -0·001), but not for the other two domains. Post hoc multiple mediation analyses showed similar results. CONCLUSIONS: Higher scores on two mindful eating domains were associated with a decrease in depressive symptoms through lower total energy intake. Diet quantity, but not diet quality, could be a possible underlying mechanism in the associations between mindful eating and change in depressive symptoms.

Mindful eating and change in depressive symptoms: Mediation by psychological eating styles.

Earlier cross-sectional research showed that a higher level of mindful eating is associated with less depression. This study investigated associations of attentive mindful eating with change in depressive symptoms, as well as mediation by psychological eating styles, in the Longitudinal Aging Study Amsterdam (n = 946). The mindful eating domains Focused Eating, Eating in response to Hunger and Satiety Cues, Eating with Awareness and Eating without Distraction were measured by the Mindful Eating Behavior Scale. Three-year change in depressive symptoms was measured with the Center for Epidemiologic Studies Depression Scale. Emotional, external and restrained eating were measured by the 20-item version of the Dutch Eating Behaviour Questionnaire. Higher baseline scores on Focused Eating, Eating with Awareness and Eating without Distraction were associated with a 3-year decrease in depressive symptoms. Eating in response to Hunger and Satiety Cues was not associated with a change in depressive symptoms. Multiple mediation models showed mediation by external eating for the domains Eating with Awareness, Eating without Distraction, and Eating in response to Hunger and Satiety Cues, but no mediation by emotional and restrained eating. No mediation by the eating styles was found for Focused Eating. In this study, higher scores on three mindful eating domains were associated with a decrease in depressive symptoms. Mediation analyses suggest that three domains are associated with depression through external eating.

Fish consumption and risk of stroke, coronary heart disease, and cardiovascular mortality in a Dutch population with low fish intake.

BACKGROUND/OBJECTIVES: Fish consumption of at least 1 portion/week is related to lower cardiovascular disease (CVD) risk. It is uncertain whether a less frequent intake is also beneficial and whether the type of fish matters. We investigated associations of very low intakes of total, fatty, and lean fish, compared with no fish intake, with 18-year incidences of stroke, coronary heart disease (CHD), and CVD mortality. METHODS: Data were used from 34,033 participants, aged 20-70 years, of the EPIC-Netherlands cohort. Baseline (1993-1997) fish consumption was estimated using a food frequency questionnaire. We compared any fish consumption, <1 portion/week (<100 g) and ≥1 portion/week to non-fish consumption. RESULTS: During 18 follow-up years, 753 stroke events, 2134 CHD events, and 540 CVD deaths occurred. Among the fish consumers (~92%) median intakes of total, lean, and fatty fish were 57.9, 32.9, and 10.7 g/week, respectively. Any fish consumption compared with non-consumption was not associated with incidences of stroke, CHD, MI, and CVD mortality. Furthermore, consumption of <1 portion/week of total, fatty, or lean fish was not associated with any CVD outcome, as compared with non-consumption. Consumption of ≥1 portion/week of lean fish (HR: 0.70, 95% CI: 0.57-0.86) and of fatty fish (HR: 0.63, 95% CI: 0.39-1.02) were associated with lower incidence of ischaemic stroke. CONCLUSIONS: Baseline fish consumption of <1 portion/week, regardless of the type of fish, was unrelated to incidences of stroke, CHD, and CVD mortality in this Dutch cohort. Consumption of ≥1 portion/week of fatty or of lean fish reduced the incidence of ischaemic stroke.

Associations between Proportion of Plasma Phospholipid Fatty Acids, Depressive Symptoms and Major Depressive Disorder. Cross-Sectional Analyses from the AGES Reykjavik Study.

BACKGROUND: Deficits in n-3 fatty acids may be associated with depression. However, data are scarce from older adults who are at greater risk of poor dietary intake and of developing depression. OBJECTIVE: To investigate proportion of plasma phospholipid fatty acids with respect to depressive symptoms and major depressive disorder in community dwelling older adults. METHODS: Cross-sectional analyses of 1571 participants in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study aged 67-93 years. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). Major depressive disorder was assessed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria using the Mini-International Neuropsychiatric Interview (MINI). RESULTS: Depressive symptoms were observed in 195 (12.4%) subjects and there were 27 (1.7%) cases of major depressive disorder. Participants with depressive symptoms were less educated, more likely to be smokers, less physically active and consumed cod liver oil less frequently. Difference in GDS-15 scores by tertiles of n-3 fatty acid proportion was not significant. Proportion of long chain n-3 fatty acids (Eicosapentaenoic- + Docosahexaenoic acid) were inversely related to major depressive disorder, (tertile 2 vs. tertile 1) OR: 0.31 (95% CI: 0.11, 0.86); tertile 3 vs. tertile 1, OR: 0.45 (95% CI: 0.17, 1.21). CONCLUSION: In our cross sectional analyses low proportions of long chain n-3 fatty acids in plasma phospholipids appear to be associated with increased risk of major depressive disorder. However, the results from this study warrant further investigation in prospective setting with sufficiently long follow-up.

Associations of mindful eating domains with depressive symptoms and depression in three European countries.

OBJECTIVE: To examine associations of mindful eating domains with depressive symptoms and depression in three European countries. Moderation by change in appetite-with increased appetite as marker for depression with atypical features - was also tested. METHODS: Data were collected in Denmark (n = 1522), Spain (n = 1512) and the Netherlands (n = 1439). Multiple linear and logistic regression analyses segregated by country were used to test associations of four mindful eating domains (Mindful Eating Behaviour Scale; MEBS) with depressive symptoms (continuous score on the Center for Epidemiologic Studies Depression Scale; CES-D) and depression (score above the CES-D cut-off value, and/or use of antidepressants, and/or psychological treatment). Moderation by change in appetite was tested with bias-corrected bootstrap confidence intervals. RESULTS: The domains Focused Eating, Eating with Awareness and Eating without Distraction were significantly negatively associated with depressive symptoms and depression in all three countries (e.g. Focused Eating Denmark: B = - 0.71, 95% CI: - 0.87, - 0.54; OR = 0.89, 95% CI: 0.86, 0.93). The domain Hunger and Satiety Cues (only measured in the Netherlands) was significantly positively associated with depressive symptoms in the adjusted models (B = 0.09, 95% CI: 0.02, 0.16), but not with depression (OR = 1.02, 95% CI: 0.98, 1.05). These associations were found for both people with and without increased appetite. LIMITATIONS: The cross-sectional design, which makes it impossible to draw causal conclusions. CONCLUSIONS: The present study indicates that higher scores on three mindful eating domains are consistently associated with a lower level of depressive symptoms and a lower likelihood of having depression in three European countries.

Dutch food bank recipients have poorer dietary intakes than the general and low-socioeconomic status Dutch adult population.

PURPOSE: Food-assistance program users are a specific group of nutritional concern, as they are often food insufficient and have poorer diet quality compared to non-food-assistance program users. The aim of our study was to assess dietary intake of Dutch food bank recipients (n = 167) and to compare this with dietary intake of a representative sample of the general population (Dutch National Food Consumption Survey (DNFCS-all): n = 1933), including a low-socioeconomic status (SES) sample (DNFCS-low SES: n = 312), using data from the DNFCS 2007-2010. METHODS: In this cross-sectional study, 12 food banks throughout The Netherlands participated. Food bank recipients' characteristics were assessed with a self-administered questionnaire. Dietary intake data were collected through three 24-h recalls. Habitual dietary intake (mean, percentiles, and 95% CI) was estimated for all samples. Differences between samples were determined by comparing the 95% CIs. RESULTS: Mean age of the study population (62.9% female) was 48.6 years (SD:10.1). Mean energy intake was 1986 (95% CI 1830-2089) kcal. The majority of the Dutch food bank recipients had lower intakes than dietary reference intakes for dietary fiber, fruit, vegetables, and fish (range 86.6-99.3%), and a higher intake for saturated fat [88.1% (95% CI 84.1-98.9)]. Furthermore, mean intakes of energy, fiber, fruit, and vegetables were significantly lower in Dutch food bank recipients than in the DNFCS-all and the DNFCS-low-SES [e.g., daily mean fruit intake (g) food bank recipients 62.8 (95% CI 45.5-76.5), DNFCS-all 105.8 (95% CI 105.4-117.9), and DNFCS-low-SES 85.1 (95% CI 78.7-100.2)]. Fish intake was significantly lower compared with the DNFCS-all, but not compared with the DNFCS-low-SES. CONCLUSIONS: Dutch food bank recipients, who largely rely on the content of food parcels, are not able to meet the nutritional guidelines for a healthy diet, and their dietary intake is poorer than the general as well as the low-SES sample of the Dutch adult population. More research is needed on how to improve the dietary intake of this vulnerable population subgroup, by, e.g., revising the content of the food parcels, and to develop effective intervention activities.

Dietary pattern derived by reduced rank regression and depressive symptoms in a multi-ethnic population: the HELIUS study.

BACKGROUND/OBJECTIVES: To investigate the association of dietary patterns derived by reduced rank regression (RRR) with depressive symptoms in a multi-ethnic population. SUBJECTS/METHODS: Cross-sectional data from the HELIUS study were used. In total, 4967 men and women (18-70 years) of Dutch, South-Asian Surinamese, African Surinamese, Turkish and Moroccan origin living in the Netherlands were included. Diet was measured using ethnic-specific food frequency questionnaires. Depressive symptoms were measured with the nine-item patient health questionnaire. RESULTS: By performing RRR in the whole population and per ethnic group, comparable dietary patterns were identified and therefore the dietary pattern for the whole population was used for subsequent analyses. We identified a dietary pattern that was strongly related to eicosapentaenoic acid+docosahexaenoic acid, folate, magnesium and zinc (response variables) and which was characterized by milk products, cheese, whole grains, vegetables, legumes, nuts, potatoes and red meat. After adjustment for confounders, a statistically significant inverse association was observed in the whole population (B: -0.03, 95% CI: -0.06, -0.00, P=0.046) and among Moroccan (B: -0.09, 95% CI: -0.13, -0.04, P=0.027) and South-Asian Surinamese participants (B: -0.05, 95% CI: -0.09, -0.01, P=<0.001), whereas no statistically significant association was found in the remaining ethnic groups. No statistically significant associations were found between the dietary pattern and significant depressed mood in any of the ethnic groups. CONCLUSIONS: No consistent evidence was found that consumption of a dietary pattern, high in nutrients that are hypothesized to protect against depression, was associated with lower depressive symptoms across different ethnic groups.

Vitamin B12, homocysteine and depressive symptoms: a longitudinal study among older adults.

BACKGROUND/OBJECTIVES: The roles of vitamin B12 and homocysteine concentration in depression are not clear. We investigated cross-sectional and prospective associations of serum vitamin B12 and plasma homocysteine with depressive symptoms in Dutch older adults. SUBJECTS/METHODS: In the Longitudinal Aging Study Amsterdam (LASA), blood was collected in 1995/1996 among 1352 men and women aged ⩾65 years. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D) six times from 1995/1996 to 2011/2012. Multiple linear regression and mixed models were used to assess whether vitamin B12 and homocysteine were associated with severity at baseline and course of depressive symptoms over 16 years. Cox regression analyses were performed for the associations with incidence of depression (CES-D ⩾16 and/or antidepressant use). All analyses were adjusted for sociodemographic characteristics and lifestyle factors. RESULTS: Vitamin B12 was neither cross-sectionally (n=1205) nor prospectively (n=1012) associated with depressive symptoms (adjusted ß for CES-D over time, lowest versus highest quartile: -0.04 (95% confidence interval (CI): -0.15-0.06)). We also found no association with incident depression (n=853), except for a higher risk of depression over time in younger participants (aged 64.8-73.4 years; continuous vitamin B12, adjusted hazard ratio per s.d.: 1.38 (95% CI: 1.10-1.72)). For homocysteine, no associations were found, except for a lower risk of depression in younger participants. CONCLUSIONS: Our study did not confirm earlier shown associations of serum vitamin B12 and plasma homocysteine with severity and course of depressive symptoms and incidence of depression in older adults. Further research into the influence of homocysteine metabolism on mental health is needed.

Polyunsaturated fatty acids in relation to incident mobility disability and decline in gait speed; the Age, Gene/Environment Susceptibility-Reykjavik Study.

BACKGROUND/OBJECTIVES: Low intake of long chain polyunsaturated fatty acids (PUFAs) are associated with physical disability; however, prospective studies of circulating PUFAs are scarce. We examined associations between plasma phospholipid n-3 and n-6 PUFAs with risk of incident mobility disability and gait speed decline. SUBJECTS/METHODS: Data are from a subgroup of the Age, Gene/Environment Susceptibility-Reykjavik Study, a population-based study of risk factors for disease and disability in old age. In this subgroup (n = 556, mean age 75.1 ± 5.0 years, 47.5% men), plasma phospholipid PUFAs were assessed at baseline using gas chromatography. Mobility disability and usual gait speed were assessed at baseline and after 5.2 ± 0.2 years. Mobility disability was defined as the following: having much difficulty, or being unable to walk 500 m or climb up 10 steps; decline in gait speed was defined as change ⩾ 0.10 m/s. Logistic regression analyses were performed to determine associations between sex-specific s.d. increments in PUFAs with risk of incident mobility disability and gait speed decline. Odds ratios (95% confidence intervals) adjusted for demographics, follow-up time, risk factors and serum vitamin D were reported. RESULTS: In women, but not men, every s.d. increment increase of total n-3 PUFAs and docosahexaenoic acid (DHA) was associated with lower mobility disability risk, odds ratio 0.48 (0.25; 0.93) and odds ratio 0.45 (0.24; 0.83), respectively. There was no association between n-6 PUFAs and the risk of incident mobility disability or gait speed decline. CONCLUSIONS: Higher concentrations of n-3 PUFAs and, particularly, DHA may protect women from impaired mobility but does not appear to have such an effect in men.

Misperception of self-reported adherence to the fruit, vegetable and fish guidelines in older Dutch adults.

In this study we investigated (the degree of) misperception of adherence to the fruit, vegetable and fish guidelines in older Dutch adults and examined to what extent misperception is associated with socio-economic position (SEP) and other demographic, lifestyle and nutrition-related characteristics. The sample included 1057 community dwelling adults, aged 55-85 years, who participated in the Longitudinal Aging Study Amsterdam. Respondents completed a lifestyle questionnaire which included a food frequency questionnaire to calculate fruit, vegetable and fish intake. After current dietary guidelines were explained, respondents were asked to indicate whether they believed they adhered to the fruit, vegetable and fish guidelines. Characteristics potentially associated with misperception included level of income and education, lifestyle factors, nutritional knowledge, as well as attitude, social support and self-efficacy toward healthy eating. In the total sample, 69.1% of the older adults reported to adhere to the fruit guideline, 77.5% to the vegetable guideline, and 36.4% to the fish guideline. Based on the calculated intake data, 82.6% adhered to the fruit guideline, 65.5% to the vegetable guideline and 33.8% to the fish guideline. Overestimation of adherence was most common for the vegetable guideline (18.7%). Multivariate analysis, adjusted for level of income as well as for attitude and self-efficacy toward healthy eating, showed that lower educated respondents were more likely to overestimate their adherence to the vegetable guideline (relative index of inequality (RII): 2.97 (95% CI: 1.47-6.01)). Overestimation rates for fish (3.4%) and fruit (2.3%) were lower and not associated with any of the characteristics. This study showed that overestimation in older adults was common for adherence to the vegetable guideline and especially in those with a lower education level, but not for adherence to the fruit and fish guideline.

Adherence to dietary guidelines for fruit, vegetables and fish among older Dutch adults; the role of education, income and job prestige.

OBJECTIVES: Little is known about socio-economic differences in dietary intake among older adults. In this study we describe self-reported dietary adherence to the fruit, vegetables and fish guidelines among older Dutch adults and investigate the independent associations of three socio-economic status (SES) indicators with adherence to these guidelines. DESIGN: Cross sectional data-analyses. SETTINGS: The Longitudinal Aging Study Amsterdam (LASA), the Netherlands. SUBJECTS: 1057 community dwelling older adults, aged 55-85 years. MEASUREMENTS: Fruit, vegetable and fish intake was assessed using a short food frequency questionnaire. We measured SES using self-reported levels of education, household income and occupational prestige. RESULTS: 82.5% of the respondents reported to adhere to the fruit guideline, 65.1% to the vegetables guideline, and 31.7% to the fish guideline. After adjustment for confounders and the other two SES indicators, respondents in the lowest education group adhered less often to the vegetables guideline (OR 0.39 (95% CI 0.22-0.70)) compared to those in the highest education group. Respondents in the lowest income group adhered less often to the fruit (0.44 (95 % CI 0.22-0.91) and fish guideline (OR 0.55 (95% CI 0.33-0.91) compared to those in the highest groups. Occupational prestige was not independently associated with adherence any the guidelines. CONCLUSION: Self-reported adherence to the fruit, vegetables and fish guidelines among older adults can be improved and particularly in those with a low SES. Education and income have independent and unique contributions to dietary adherence. Future research should investigate potential pathways through which these specific SES indicators influence dietary adherence.

Associations of serum n-3 and n-6 polyunsaturated fatty acids with echocardiographic measures among older adults: the Hoorn Study.

BACKGROUND/OBJECTIVES: Lower circulating polyunsaturated fatty acids (PUFAs) may induce loss of heart function. We investigated whether lower concentrations of n-3 and n-6 PUFAs were associated with less favourable echocardiographic measures and higher heart rate in older Caucasians, cross-sectionally and after 7 years of follow-up. SUBJECTS/METHODS: We used data from the Hoorn Study, a population-based cohort. Cross-sectional data were available for 621 participants and longitudinal data for 336 participants. Mean age was 68.6±6.8 years at baseline. We performed linear regression analyses using n-3 and n-6 PUFAs quartiles-assayed by gas liquid chromatography-with left ventricular ejection fraction (LVEF), left ventricular mass index, left atrial volume index and heart rate. RESULTS: In multivariable analyses (regression coefficient (95% confidence interval)), the lowest eicosapentaenoic acid and docosahexaenoic acid quartiles compared with the highest quartiles were cross-sectionally associated with lower LVEF. Lower eicosapentaenoic acid and docosahexaenoic acid concentrations were associated with higher heart rate: 3.7 b.p.m. (1.5, 6.0; P for trend <0.001) and 3.4 b.p.m. (1.2, 5.6; P for trend 0.001), respectively. Multivariate longitudinal analyses showed a significant trend across quartiles for alpha-linolenic acid in relation to LVEF. The lowest linoleic acid quartile was significantly associated with a decreased LVEF of -4.0% compared with the highest quartile. CONCLUSIONS: This study found no strong evidence of longitudinal associations of eicosapentaenoic acid and docosahexaenoic acid with echocardiographic measures, however, lower concentrations of alpha-linolenic acid and linoleic acid were associated with decreased LVEF. These results provide evidence for a potential protective role of alpha-linolenic acid and linoleic acid in relation to systolic function.

Serum vitamin D and parathyroid hormone in relation to cardiac structure and function: the ICELAND-MI substudy of AGES-Reykjavik.

CONTEXT: Emerging evidence suggests that vitamin D and PTH may play a role in the development of cardiac diseases. OBJECTIVE: We investigated whether 25-hydroxyvitamin D (25OHD) and PTH concentrations are cross-sectionally associated with cardiac structure and function using magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: ICELAND-MI is a substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study, an older-aged community-dwelling cohort with oversampling of participants with diabetes (29%) and measurements between 2004 and 2007. Serum 25OHD concentrations were measured using an immunoassay (n = 992). Intact PTH concentrations were measured using a 2-site immunoassay (n = 203). We included 969 participants for this cross-sectional analysis (mean age 76 ± 5.3 years, 51% female). Mean 25OHD was 54.2 ± 25.5 nmol/L and the median PTH was 4.5 pmol/L (range 1.5-18). MAIN OUTCOMES: MRI to measure cardiac structure and function was the main outcome. RESULTS: The lowest 25OHD category (<25 nmol/L) compared with the highest category (≥75 nmol/L) was associated with a smaller left and right atrial area in unadjusted analyses; however, the associations became nonsignificant after adjustment for covariates. The highest PTH quartile compared with the lowest quartile was significantly associated with a 7.3 g (95% confidence interval 0.8, 13.8) greater left ventricular (LV) mass and a 5.1% (-9.1, -1.1) lower LV ejection fraction compared with the lowest PTH quartile in the fully adjusted model. CONCLUSIONS: Serum 25OHD concentrations were not associated with MRI measures in an older white population. Higher PTH concentrations were associated with greater LV mass and lower systolic function and may point to a potential role for PTH as a determinant of cardiac remodeling.

Trans fatty acids and cardiovascular health: research completed?

This review asks the question if further research on trans fatty acids and cardiovascular health is needed. We therefore review the evidence from human studies on trans fatty acids and cardiovascular health, and provide a quantitative review of effects of trans fatty acid intake on lipoproteins. The results show that the effect of industrially produced trans fatty acids on heart health seen in observational studies is larger than predicted from changes in lipoprotein concentrations. There is debate on the effect of ruminant trans fatty acids and cardiovascular disease. Of special interest is conjugated linoleic acid (CLA), which is produced industrially for sale as supplements. Observational studies do not show higher risks of cardiovascular disease with higher intakes of ruminant trans fatty acids. However, CLA, industrial and ruminant trans fatty acids all raise plasma low-density lipoprotein and the total to high-density lipoprotein ratio. Gram for gram, all trans fatty acids have largely the same effect on blood lipoproteins. In conclusion, the detrimental effects of industrial trans fatty acids on heart health are beyond dispute. The exact size of effect will remain hard to determine. Further research is warranted on the effects of ruminant trans fatty acids and CLA on cardiovascular disease and its risk factors.

Serum parathyroid hormone in relation to all-cause and cardiovascular mortality: the Hoorn study.

CONTEXT: Higher PTH concentrations have been associated with fatal cardiovascular diseases (CVDs), but data in the general population are scarce. OBJECTIVE: We investigated whether higher PTH concentrations are prospectively associated with all-cause and CVD mortality. DESIGN, SETTING, PARTICIPANTS: This study used data from the Hoorn Study, a prospective population-based cohort with baseline measurements between 2000 and 2001. We included 633 participants, mean age 70.1 ± 6.6 years, 51% female. Serum intact PTH was measured using a 2-site immunoassay. MAIN OUTCOME MEASURES: Outcomes were all-cause and CVD mortality based on clinical files and coded according to the International Classification of Diseases, ninth revision. We used Kaplan-Meier plots to estimate survival curves and Cox regression to estimate hazard ratios (HRs) using season-specific PTH quartiles. RESULTS: During a median follow-up of 7.8 years, 112 participants died, of which 26 deaths (23%) were cardiovascular. Survival curves by PTH quartiles differed for all-cause mortality (log-rank P = .054) and CVD mortality (log-rank P = .022). In a multivariate model, the highest PTH quartile was associated with all-cause mortality; HR = 1.98 (1.08, 3.64). Kidney function slightly attenuated the PTH risk association, but risk persisted; HR = 1.93 (1.04, 3.58). The results for CVD mortality showed a similar pattern, although the association was significant only in a threshold model (quartile 4 vs quartile 1-3); HR = 2.56 (1.11, 5.94). CONCLUSIONS: Among a general older population, higher PTH concentrations were associated with higher all-cause mortality risk, mostly explained by fatal CVD events. We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations.

Determinants of adherence to heart failure medication: a systematic literature review.

A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization's (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients' educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions.

Vitamin D in relation to myocardial structure and function after eight years of follow-up: the Hoorn study.

BACKGROUND AND AIMS: To investigate associations between baseline serum 25-hydroxyvitamin D [25(OH)D] levels and myocardial structure and function after 8 years of follow-up in older Dutch subjects. METHODS: We included 256 subjects of the Hoorn Study, a population-based cohort. They underwent a standardized 2-dimensional echocardiogram at baseline between 2000 and 2001, and again between 2007 and 2009. We studied the association of 25(OH)D quartiles with echocardiographic measures of the left ventricular mass index (LVMI), left ventricular systolic function and markers of diastolic function using linear regression analyses. RESULTS: At baseline, subjects had a mean age of 67.4 ± 5.2 years and 41.4% had prior cardiovascular disease (CVD). Low serum 25(OH)D levels were only associated with higher LVMI at 8-year follow-up in subjects without prior CVD and in subjects with low kidney function (median estimated glomerular filtration rate ≤77.5 ml/min/1.73m(2)). The associations attenuated after adjustments for parathyroid hormone (PTH), which was associated with higher LVMI (g/m(2.7)) in subjects with low kidney function (regression coefficient highest quartile 6.3, 95% CI: 0.2, 12.5). CONCLUSION: This study showed no strong associations of 25(OH)D with myocardial structure and function. However, PTH - a possible modifiable mediator in the relation between 25(OH)D and myocardial structure - was positively associated with LVMI in subjects with low kidney function.

Association of serum n-3 polyunsaturated fatty acids with C-reactive protein in men.

BACKGROUND/OBJECTIVES: N-3 polyunsaturated fatty acids (PUFAs) have been associated with reduced inflammation. We tested the hypothesis that high serum concentrations of the n-3 PUFAs are associated with lower serum C-reactive protein (CRP) concentrations in healthy middle-aged Finnish men. We also examined whether exposure to mercury, an environmental contaminant in fish, which is also a major source of long-chain n-3 PUFA, was associated with CRP. SUBJECTS/METHODS: Data from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study were analyzed cross-sectionally to determine the associations between serum n-3 PUFAs, hair mercury and serum CRP in 1395 healthy men, aged 42-60 years. Linear regression analyses were performed to analyze the associations. RESULTS: In the multivariate models, the mean serum CRP in quartiles of serum total n-3 PUFA concentration was 1.23, 1.27, 1.18 and 1.08 mg/l, P for trend = 0.01. Statistically significant inverse associations were also observed with the total serum long-chain n-3 PUFA concentration and with the individual long-chain n-3 PUFAs docosapentaenoic acid and docosahexaenoic acid, but not with eicosapentaenoic acid or with the intermediate-chain n-3 PUFA alpha-linolenic acid. Hair methylmercury content was not associated with serum CRP levels and it did not modify the associations between serum n-3 PUFAs and CRP either. CONCLUSIONS: Serum n-3 PUFAs and especially the long-chain n-3 PUFA concentration, a marker of fish or fish oil consumption, were inversely associated with serum CRP in men. Exposure to mercury was not associated with serum CRP.

The effect of conjugated linoleic acid, a natural trans fat from milk and meat, on human blood pressure: results from a randomized crossover feeding study.

Cis-9, trans-11 conjugated linoleic acid (CLA) is a natural trans fatty acid that is largely restricted to ruminant fats and consumed in foods and supplements. Its role in blood pressure (BP) regulation is still unclear. We examined the effect of cis-9, trans-11 CLA on BP compared with oleic acid. A total of 61 healthy volunteers were sequentially fed each of 3 diets for 3 weeks, in random order, for a total of 9 weeks. The diets were identical except for 7% of energy (18.9 g in a diet of 10 MJ day(-1)) that was provided either by oleic acid, by industrial trans fatty acids or by cis-9, trans-11 CLA. We measured BP on two separate days at the end of each intervention period. At baseline, mean BP was 113.8±14.4 mm Hg systolic and 66.3±9.6 mm Hg diastolic. The effect of the CLA diet compared with the oleic acid diet was 0.11 mm Hg (95% confidence interval: -1.27, 1.49) systolic and -0.45 mm Hg (-1.63, 0.73) diastolic. After the industrial trans fatty acid diet, the effect was 1.13 mm Hg (-0.25, 2.51) systolic and -0.44 mm Hg (-1.62, 0.73) diastolic compared with the oleic acid diet. Our study suggests that short-term high intakes of cis-9,trans-11 CLA do not affect BP in healthy volunteers.

Determinants of heart failure self-care: a systematic literature review.

Self-care is an important aspect of heart failure (HF) management. Information on the determinants of self-care is necessary for the development of self-care promotion interventions. HF self-care includes self-care management, self-care maintenance, sodium, fluid and alcohol intake restriction, physical activity, smoking cessation, monitoring signs and symptoms and keeping follow-up appointments. To assess the evidence regarding presumed determinants of HF self-care and make recommendations for interventions to promote self-care behavior among HF patients, a systematic literature review was conducted. Based on inclusion and exclusion criteria and a quality assessment, twenty-six articles were included. A best evidence synthesis was used. Results showed that the length of time since patients' diagnosis with HF is positively related to their performance of self-care maintenance. Moreover, it was found that HF patients' perceived benefits and barriers are related to their restriction of sodium intake, and that patients with type-D personality are less likely to consult medical professionals. There was also evidence for a few non-significant relationships. All other evidence was inconsistent, mainly due to insufficient evidence. Interventions that aim to increase the performance of self-care maintenance can teach newly diagnosed patients the skills that are usually attained with experience acquired as a result of living with HF for a longer time. Perceived benefits and barriers of restricting sodium intake could be targeted in interventions for sodium intake reduction among HF patients. Finally, interventions for the promotion of adequate consulting of medical professionals can specifically target HF patients with a type-D personality.