The association of the Mediterranean Adequacy Index with fatal coronary events in an Italian middle-aged male population followed for 40 years.

BACKGROUND AND AIMS: The dietary habits defined as the Mediterranean diet have shown to be protective for coronary heart disease (CHD) and other morbid conditions. The present analysis aims to test the Mediterranean Adequacy Index (MAI), a dietary index derived from the Mediterranean habits, versus the occurrence of fatal CHD events in an Italian male population followed for 40 years. METHODS AND RESULTS: In 1965, at the time of the 5-year follow-up examination of the Italian Rural Areas of the Seven Countries Study, the diet was assessed by the dietary-history method in 1139 men aged 45-64 years, free from previous coronary events, in the rural communities of Crevalcore (Northern Italy) and Montegiorgio (Central Italy). MAI has been computed and its natural log (lnMAI) used for the analysis. Mortality data were collected and coded for the subsequent 40 years. The lnMAI was inversely associated with CHD mortality at 20 and 40 years when entered alone in the Cox proportional hazards model and when adjusted for age, cigarette smoking, systolic blood pressure, serum cholesterol, physical activity and body mass index. The hazard ratio for 1 unit of lnMAI (roughly corresponding to 2.7 units of MAI) was associated with a CHD mortality reduction of 26% in 20 years and 21% in 40 years of follow-up, when adjusted for the covariates. CONCLUSIONS: In an Italian middle-aged male population, MAI showed the protective effect of a healthy Mediterranean Diet pattern versus the occurrence of fatal CHD events at 20 and 40 years.

Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project.

OBJECTIVE: To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality. DESIGN, SETTING AND PARTICIPANTS: The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2,068 men and 1,049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000. RESULTS: During the follow-up period, 1,382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75-0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75-0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81-0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre. CONCLUSIONS: The MDS, the MDI and the HDI were significantly inversely related with mortality. SPONSORSHIP: This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000-00211) to D Kromhout.

Acute effects of lyophilised red wine on total antioxidant capacity in healthy volunteers.

This is an open, cross-over study to examine the acute effects of lyophilised red wine (LYOW) on total antioxidant capacity and some metabolic variables in 10 healthy subjects (age 27.7 +/- 3.9 yr) following a light meal. Each subject was studied on two occasions for a 360-min period, after consumption of a 1.22 MJ (291 kcal) meal; on one occasion without and on another occasion with intake of LYOW with high antioxidant activity [15.4 mM trolox equivalent (eq)]. Plasma oxygen radical absorbance capacity (ORAC) values decreased significantly after meal alone from 4.97 +/- 0.499 to 4.39 +/- 0.383 mM trolox eq. (mean +/- SD; p < 0.05) and remained lower until 360 min compared to basal values (p < 0.05). In contrast, ORAC values after meal with LYOW increased significantly from a baseline of 4.79 +/- 0.356 to the highest value of 6.39 +/- 0.570 mM trolox eq at 90 min; then, it decreased to a plateau of 4.99 +/- 0.316 mM trolox eq (p < 0.05), whose values were still higher than baseline ones until 360 min and also significantly different from the values obtained without LYOW from 90 to 360 min (p < 0.05). No correlations were observed between dietary antioxidant vitamin, fruit and vegetable intakes and plasma antioxidant capacity. No differences were found in plasma insulin and glucose values after meal between the two occasions. We conclude that moderate drinking of red wine (350 ml) with high antioxidant capacity increased and sustained for 360 min plasma antioxidant level of 10 healthy subjects after a meal.

Trace element intake and status of Italian subjects living in the Gubbio area.

Daily intakes of certain trace elements (Pb, Cd, Ni, Hg, and Cr) were assessed using dietary history and weighed record methods and concurrent chemical analysis (CA) of duplicate portions, along with blood levels, in a group (21 M, 23 F) of inhabitants of the Gubbio area (Belvedere, Biscina, Scritto). The evaluation of only intake of trace elements was accomplished in 40 subjects (20 M, 20 F) 1 year later. In both surveys, trace element intakes were generally lower than the potential tolerable weekly intake. However, daily intakes of Pb, Cd, Ni, Hg, and Cr were higher in men compared to women in both surveys (P<0.05). In fact, intakes at the 50th percentile were greater in men by approximately 75% for Pb, 91% for Cd, 20% for Ni, 45% for Hg, and 29% for Cr in the first survey. In the second survey, percentage differences for Pb, Cd, Ni, and Cr were about 12%, 28%, 26%, and 26%, respectively. Blood trace element levels were slightly higher in men in the first survey. Interestingly, no correlation was observed between the intake of trace elements and corresponding blood values. Food basket and total diet, which were computed from the weighed record method for 2 days, showed relevant disagreements with CA of duplicate portion. Moreover, the comparison in content of Pb, Cd, Ni, and Cr obtained by CA of cooked dishes or by calculation using values of raw foods showed significant differences (P<0.05). It was concluded that trace element intake should be assessed by CA of duplicate portion.

Diet during pregnancy and total antioxidant capacity in maternal and umbilical cord blood.

OBJECTIVE: To evaluate the longitudinal trend of total antioxidant capacity (ToAC) in a group of pregnant women and the relationship with their food habits and ToAC of their newborns. METHODS: ToAC of 12 pregnant women and of umbilical cord blood was determined by means of the oxygen radical absorbance capacity method; mothers' diet was assessed by the dietary history method. RESULTS: Mothers' oxygen radical absorbance capacity values decreased slightly from the first (5.41 +/- 0.28 mmol/l trolox eq.) to the third (5.23 +/- 0.26 mmol/l trolox eq.) trimester of pregnancy, but significantly at delivery (5.06 +/- 0.17 mmol/l trolox eq., p < 0.05 vs. the first, second and third trimesters). Oxygen radical absorbance capacity values of umbilical cord blood (4.87 +/- 0.24 mmol/l trolox eq.) correlated with mothers' values in the third trimester (r = 0.86; p = 0.004) of pregnancy and at delivery (r = 0.87; p = 0.0002). The mothers' diet was rather poor in fruit and vegetables and did not change throughout pregnancy. CONCLUSIONS: The lowering values of ToAC observed during pregnancy may be a physiological trend or a transient imbalance between higher antioxidant requirements and intake which reflects on newborns' ToAC. Nevertheless, efforts should be made to improve dietary habits in pregnancy in order to optimize the ToAC of mothers and newborns.

Total antioxidant capacity of colostrum, and transitional and mature human milk.

OBJECTIVE: The relationship between antioxidant (pro-)vitamin content of breast milk and diet of pregnant women has been reported. However, the assessment of a complete and reliable antioxidant index, such as the total antioxidant capacity, has never been performed in human milk. METHODS: In the present study, the total antioxidant capacity of colostrum, and transitional and mature milk was determined by the oxygen radical absorbance capacity (ORAC) assay in 29 lactating women and correlated with their food consumption assessed by dietary history during pregnancy and lactation. In addition, the total antioxidant capacity of 12 infant formulas commonly used in Italy was determined by the same method. RESULTS: Mean ORAC values of mature milk (1.01 +/- 0.37 mmol/l trolox eq.) were slightly lower than those of colostrum and transitional milk (1.17 +/- 0.50 and 1.18 +/- 0.38 mmol/l trolox eq., respectively). Correlations were observed between antioxidant (pro-)vitamin intakes during pregnancy (third trimester) and ORAC values of colostrum and transitional milk (both p < 0.05), but not with ORAC values of mature milk. Correlations were also found between antioxidant (pro-)vitamin intakes during lactation and transitional and mature milk ORAC values (both p < 0.05). Term infant formulas (n = 5) showed a total antioxidant capacity of 1.40 +/- 0.23 mmol/l trolox eq., whereas the antioxidant capacity of other formulas (n = 7) oscillated from 1.27 to 2.52 mmol/l trolox eq. CONCLUSIONS: The total antioxidant capacity of breast milk in lactating women was related to a diet in which the food content of antioxidant compounds was inadequate. Efforts should be made to improve women's dietary habits during pregnancy and lactation, in order to optimize the total antioxidant capacity of breast milk.

Dietary studies on two rural italian population groups of the Seven Countries Study. 3. Trend Of food and nutrient intake from 1960 to 1991.

OBJECTIVE: To examine the trend of food and nutrient intake from 1960 to 1991 of the subjects of two rural Italian cohorts of the Seven Countries Study. DESIGN: Longitudinal study of dietary patterns from 1960 to 1991. SETTING: Two rural Italian cohorts of Seven Countries Study: Crevalcore in the North near Bologna and Montegiorgio in the Centre near Ancona. SUBJECTS: Men aged 40-59 y in 1960 examined every 5 or 10 y until 1991. METHODS: Food intake was assessed by the dietary history method on all available subjects and by the weighed record method in a statistically selected subsample. RESULTS: A marked decrease of energy intake was observed, due not only to the aging process but also to a remarkable reduction of working activities and life habits. The trend of food group intake as percentage of energy shows an increase for milk, cheese, meat, vegetables, fruit, sweet beverages and cakes, pies and cookies and a decrease for bread and alcoholic beverages, which were more marked in Montegiorgio. The evaluation of the above changes by a Mediterranean Adequacy Index provided the following values: in Crevalcore in 1965 2.9 and in 1991 2.2; in Montegiorgio the corresponding values are 5.6 and 3.9. The Mediterranean Adequacy Index of diet of men from Nicotera (the third rural cohort examined only in 1960), considered the Reference Italian-Mediterranean Diet, is 7.5. Accordingly, in both cohorts dietary habits, different at baseline and rather far from the Reference Italian-Mediterranean type (especially in Crevalcore) became worse with time, particularly in Montegiorgio. CONCLUSIONS: The changes observed in 31 y in the diet of men from Crevalcore and Montegiorgio suggest the necessity in the longitudinal nutritional epidemiology studies particularly in rapidly changing societies to assess the trend of food intakes and the factors related to it. This is in view of the promotion of nutrition intervention programs.

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands.

OBJECTIVE: To relate dietary patterns to cognitive function in elderly men. DESIGN: Cross-sectional study. SETTING: Population based. SUBJECTS: 1049 men aged 70-91 years around 1990 in five cohorts from the Seven Countries Study: Finland (2 cohorts), the Netherlands (1 cohort), and Italy (2 cohorts). INTERVENTIONS: Food intake was estimated by a cross-check dietary history. Based on the WHO guidelines for the prevention of chronic diseases, a healthy diet indicator was calculated (HDI). A higher HDI indicates a diet more in accordance with the WHO guidelines, and previously we showed that HDI predicted reduced all-cause mortality in our cohorts. Cognitive function was measured using the Mini-Mental State Examination (MMSE), and a score of 23 or lower was used to indicate cognitive impairment. RESULTS: The prevalence of cognitive impairment varied from 14.4% in Zutphen (The Netherlands) to 42.1% in Crevalcore (Italy). There was a tendency towards a lower prevalence of cognitive impairment associated with increased HDI in four out of five cohorts (not in East Finland). In Zutphen this association was borderline significant (OR=0.81; 95% CI 0.63-1.04) after adjustment for age, education, cigarette smoking, alcohol consumption and energy intake. In Crevalcore the association was statistically significant (OR = 0.75; 95% CI 0.58-0.97). CONCLUSIONS: A healthy diet might be associated with a better cognitive function in elderly men. However, since the results were not consistent over all five cohorts, further research is needed to confirm this finding and to decide whether this association is causal.

Vitamin intake and status in a group of subjects from the Gubbio area Italy.

beta-Carotene, retinol, niacin, riboflavin, thiamin intake and blood nutritional status beta-carotene, retinol, and alpha-tocopherol) were investigated in a group of 79 subjects (35 males and 44 females) of 30 years and over, living in three rural hamlets in the Gubbio area (Central Italy) to see if there were any differences in nutrient intake using different methods of dietary assessment and if there was a relationship between vitamin intake and status. Vitamin intakes were assessed by three different methods: dietary history, two-day weighed record and two-day duplicate-portion chemical analysis. Vitamin content of duplicate diets was assessed by semiautomated HPLC methods. Plasma vitamin status was assessed by semi-automated isocratic straight-phase HPLC methods. The three methods of dietary assessment were compared using the Student's paired t-test and Wilcoxon-Mann-Whitney test. Between the two days weighed record and diet history, significant differences were observed for beta-carotene and thiamin. Between the two-day weighed record and chemical analysis, significantly differences were found for beta-carotene, riboflavin and thiamin. Between diet history and chemical analysis, significant differences were obtained for beta-carotene, riboflavin and thiamin. The t-test analysis showed different results according to sex and age. Plasma vitamin status using the current cut-off criteria showed some deficiencies for beta-carotene. As on other occasions no correlation was observed between data from diet history, weighed record and chemical analysis of duplicate portions and the corresponding blood vitamin levels for the whole group of subjects.

Gustatory and food habit changes during the menstrual cycle.

Gustatory and food habit changes during the menstrual cycle were studied in 8 women, 6 smokers and 2 non-smokers, aged 23-37 years. The following parameters were evaluated during three consecutive menstrual cycles: blood oestradiol and progesterone levels on the 7th, 14th and 21st day of each cycle (radioimmunoassay); detection and recognition thresholds and concentration preferences for sucrose, sodium chloride, citric acid and quinine sulphate on the 1st, 7th, 14th and 21st day of each cycle; food consumption (weighed record) on days 1 and 2, 6-8, 13-15 and 20-22 each cycle. The four basic tastes were influenced differently by blood hormone levels during the menstrual cycle. Sensitivity to sweet taste increased with an increase of oestradiol, while sensitivity to bitter taste increased with an increase of progesterone. No correlations between hormone levels and acid taste, and only a few correlations for salt taste were found. Food habits changed during the cycle particularly for meat and fruit. Vegetables and cereals showed only a tendency to vary. In correspondence with the highest oestradiol values there was a tendency towards lower energy intake, -122 kcal (-0.51 MJ) = 8%, predominantly provided by carbohydrates (as bread).

Dietary intake in five ageing cohorts of men in Finland, Italy and The Netherlands.

OBJECTIVE: To obtain insight into dietary habits of elderly people and how these habits have evolved from middle to old age. DESIGN: Cross-sectional study of dietary patterns around 1990; retrospective cohort study of changes in dietary intake since middle age. SETTING: Five cohorts: East and West Finland, Zutphen (Netherlands), Crevalcore (Italy), and Montegiorgo (Italy). SUBJECTS: Men aged 70-90 years around 1990. METHODS: Food intake was estimated using a cross-check dietary history adjusted to the local situation. RESULTS: (i) Cross-sectional: Significant differences were observed between the countries for all food groups, energy and nutrients (P < 0.05). The Finnish diet was characterised by a high consumption of animal products and potatoes, the Italian diet by a high consumption of cereals, vegetables, fruits and alcohol. The Dutch diet was generally intermediate. (ii) Longitudinal: The decrease in energy intake since middle age varied from 4.2 MJ/day in the Finnish cohorts to 2.1 MJ/day in Italy. Also the consumption of most food groups decreased but the consumption of vegetables and fruits increased. Saturated fatty acid intake decreased by 3 E% in the Finnish cohorts and decreased by < 1 E% in Italy. Alcohol intake decreased by approximately 7 E% in Italy while it increased by 2.5 E% in the Netherlands. CONCLUSIONS: Although the general patterns of dietary intake of the different cultures still can be recognised at old age, the variation between them has become smaller. Compared to their dietary intake at middle age, however, the dietary pattern of the Finnish and Dutch cohorts has changed slightly in the direction of a healthy diet, while the diet of the Italian men remained Mediterranean, and thus more healthy, at old age.

Relationship between mothers' and newborns' nutritional and blood lipid variables.

OBJECTIVE: To study the relation between anthropometry, diet and blood lipids during pregnancy and anthropometry and cord blood lipids in newborns. DESIGN: Longitudinal study during pregnancy. SETTING: Population study. SUBJECTS: A group of 70 volunteer pregnant women attending the Maternity Advisory Service were recruited at the 1st trimester and studied during pregnancy. By the end of the study 17 women had dropped out of anthropometry and diet assessments and 21 had left blood lipid analysis. Anthropometric measurements and cord blood lipid determinations were carried out respectively on 43 and 28 newborns. INTERVENTIONS: Diet history; current methods for anthropometry and blood lipid determinations. RESULTS: The highest values for energy and other nutrient intakes were observed at the 2nd trimester. According to the recommendations usually made, protein and fat intakes were high, and carbohydrate intake too low. This was observed especially at the 3rd trimester. Significant relationships between protein, fat and carbohydrate intake (as a percentage of energy) during pregnancy and anthropometric variables in newborns and cord blood lipids (particularly for boys) were found in the group of mothers and their respective newborns. Few correlations between mothers' and newborns' levels of blood lipids were observed for girls. CONCLUSIONS: The results do not show considerable diet changes during pregnancy. The impact of mothers' diet on fat deposition in newborns and cord blood lipids seems to be sex-linked and more important for boys.

Vitamin and mineral nutritional status and other biochemical data assessed in groups of men from Crevalcore and Montegiorgio (Italy).

The vitamin and mineral nutritional status of 34 elderly (mean age 77.6 +/- 4.7 years) and 39 younger subjects (mean age 41.7 +/- 7.5 years) from Crevalcore and Montegiorgio (the two rural areas of The Seven Countries Study) was studied. Comparisons have been made between centres, between age groups, and with data obtained from similar surveys performed in 1960 and 1970. Levels of thiamin and riboflavin nutritional status were higher in 1991 than in 1970. Plasma retinol values were above levels of deficiency, but vitamin E and beta-carotene tended to be low. The zinc status of the populations, as assessed by leucocyte zinc concentrations, was generally low. A decline in copper intake during the past ten years may be responsible for the low leucocyte copper concentration which was more apparent in the younger subjects. Serum cholesterol was above, and HDL cholesterol below, the European Atherosclerosis Society recommendations.

Dietary studies on two rural Italian population groups of the Seven Countries Study. 1. Food and nutrient intake at the thirty-first year follow-up in 1991.

The food and nutrient intake at the thirty-first follow-up in 1991 of 16 surviving elderly from Crevalcore and Montegiorgio, two Italian rural ares of the Seven Countries Study, are reported. For dietary appraisal the individual weighed record method for 3 and 9 days in three seasons was used. In autumn the dietary history method was also used. Because the number of survivors was small, 15 additional elderly subjects in both areas were surveyed. Then, to detect any change related to age in food intake, 41 younger subjects were assessed with the dietary history method. The results in both areas showed in general a high intra-individual variability and no statistically significant difference in food group and nutrient intake between seasons. Between the two methods for dietary survey no statistically significant difference, in general, was observed (P > 0.05 only for a few items). The diet of the subjects of Crevalcore was characterized by a rather high intake of milk and meat and a low intake of fish and legumes. In Montegiorgio the picture was similar to that of Crevalcore, but at a lower level of intake. In both areas, but particularly in Montegiorgio, these subjects have been abandoning the traditional Mediterranean diet.

Dietary studies on two rural Italian population groups of the Seven Countries Study. 2. Concurrent validation of protein, fat and carbohydrate intake.

On 18 subjects from two rural areas in Italy which were part of the Seven Countries Study (Crevalcore and Montegiorgio), we carried out the concurrent validation of protein, fat, fatty acid and carbohydrate intake in the diet at the thirty-first year follow-up in 1991. The values of the above nutrients obtained using food composition tables from the weighted record method for dietary surveys were compared with the values from chemical analysis of food composites. In both areas for protein, fat and carbohydrate intake the inter-individual variation was large. For protein intake the mean difference was statistically significant but not for fat intake. From 1960 to 1991 protein and fat intake tended to decrease and for protein the means of differences between analysis and calculation were, in general, statistically different. For dietary saturated and polyunsaturated fatty acids, the means of differences were statistically significant in Crevalcore, but this was not the case in Montegiorgio for polyunsaturated fatty acids. The intake of trans fatty acids in both areas was rather low. Available and unavailable carbohydrate intake of both areas showed no statistically significant difference. The mean differences between analysis and calculation for both areas were statistically significant with the exception of cellulose in Crevalcore and sugars in Montegiorgio.

Nutritional status of the elderly. IV. Nutritional knowledge, food preferences and life styles connected with the nutritional process.

On 106 women and 101 men aged 65 and over, elderly pensioners of the city of Perugia (Italy), a survey was carried out to identify their nutritional knowledge, their food preferences and some life styles connected with the nutritional process. The group of elderly people demonstrates a low level of nutritional knowledge. Meat, pasta and soup are the most suitable foods, with no great difference between males and females. Vegetables, fruit, milk and cheese are indicated as important only by low percentages of both sexes, fish, eggs, offal and rice are practically ignored. From the analysis of the sequency with which the various foods are indicated, it appears that a greater importance is attributed to pasta and soup. A higher percentage of women think that meat is a more suitable food for elderly people, and in respect to the men, they have a greater preference for this food. The harmfulness of foods is concentrated in the fatty foods by both sexes, but in particular by the women. Foods which are given up with the greatest sacrifice are mainly cakes, meat and pasta. Women and men show similar percentages of energy expenditure both in time and in frequency in relation to sleep and sedentary activities. For the activities that require a greater energy expenditure, the values are relatively low. This group of elderly people is well integrated into family life. They usually eat their meals with their families. There are frequent occasions when they are at home alone for periods of time that vary from two to four hours of more a day. The percentage of people living alone is small.