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  • nutrition  (18)
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  • 1
    Keywords: ASSOCIATION ; ACID ; score ; PATTERNS ; WOMEN ; MEN ; PROSPECTIVE COHORT ; FISH ; REGION ; DIET ; FAT ; INDIVIDUALS ; ALCOHOL ; CONSUMPTION ; FRUIT ; nutrition ; VEGETABLES ; HETEROGENEITY ; REGRESSION ; PRODUCTS ; ENERGY-INTAKE ; ADIPOSITY ; metabolic syndrome ; BODY-MASS INDEX ; USA ; EUROPEAN COUNTRIES ; BMI ; FOODS ; WAIST CIRCUMFERENCE ; DAIRY-PRODUCTS ; EPIC-OXFORD PARTICIPANTS ; WEIGHT-LOSS ; Abdominal ; ABDOMINAL ADIPOSITY ; ELDERLY-PEOPLE ; HEALTH-STATUS ; TO-HIP RATIO
    Abstract: Given the lack of consistent evidence of the relationship between Mediterranean dietary patterns and body fat, we assessed the cross-sectional association between adherence to a modified Mediterranean diet, BMI, and waist circumference (WC). A total of 497,308 individuals (70.7% women) aged 25-70 y from 10 European countries participated in this study. Diet was assessed at baseline using detailed validated country-specific questionnaires, and anthropometrical measurements were collected using standardized procedures. The association between the degree of adherence to the modified-Mediterranean Diet Score (mMDS) (including high consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and unsaturated: saturated fatty acids ratio; moderate alcohol intake; and low consumption of meat and meat products and dairy products) and BMI (kg.m(-2)) or WC (cm was modeled through mixed-effects linear regression, controlling for potential confounders. Overall, the mMDS was not significantly associated with BMI. Higher adherence to the Mediterranean diet was significantly associated with lower WC, for a given BMI, in both men (-0.09; 95% CI -0.14 to -0.04) and women (-0.06; 95% CI -0.10 to -0.01). The association was stronger in men (-0.20; 95% CI -0.23 to -0.17) and women (-0.17; 95% CI -0.21 to -0.13) from Northern European countries. Despite the observed heterogeneity among regions, results of this study suggest that adherence to a modified Mediterranean diet, high in foods of vegetable origin and unsaturated fatty acids, is associated with lower abdominal adiposity measured by WC in European men and women. J. Nutr. 139: 1728-1737, 2009
    Type of Publication: Journal article published
    PubMed ID: 19571036
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  • 2
    Keywords: CANCER ; MODEL ; MODELS ; FOLLOW-UP ; COHORT ; POPULATION ; INTERVENTION ; ASSOCIATION ; PATTERNS ; DESIGN ; ENERGY ; AGE ; WOMEN ; MEN ; OBESITY ; smoking ; COUNTRIES ; DIET ; FAT ; BLOOD-PRESSURE ; ALCOHOL ; PROJECT ; CONSUMPTION ; nutrition ; SMOKERS ; CALIBRATION ; MANAGEMENT ; physical activity ; ASSOCIATIONS ; PATTERN ; WEIGHT ; ENERGY-INTAKE ; LOW-CARBOHYDRATE ; PHYSICAL-ACTIVITY ; dietary patterns ; BODY-MASS INDEX ; prospective ; EUROPEAN COUNTRIES ; WAIST CIRCUMFERENCE ; WEIGHT CHANGE ; RANDOMIZED CLINICAL-TRIAL ; Lead ; Follow up ; weight gain ; OBESE ADULTS ; PLASMA LEPTIN ; PROTEIN DIET
    Abstract: Background: Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies have shown that meat consumption is positively associated with weight gain, but intervention studies have shown mixed results. Objective: Our objective was to assess the association between consumption of total meat, red meat, poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project. Design: A total of 103,455 men and 270,348 women aged 25-70 y were recruited between 1992 and 2000 in 10 European countries. Diet was assessed at baseline with the use of country-specific validated questionnaires. A dietary calibration study was conducted in a representative subsample of the cohort. Weight and height were measured at baseline and self-reported at follow-up in most centers. Associations between energy from meat (kcal/d) and annual weight change (g/y) were assessed with the use of linear mixed models, controlled for age, sex, total energy intake, physical activity, dietary patterns, and other potential confounders. Results: Total meat consumption was positively associated with weight gain in men and women, in normal-weight and overweight subjects, and in smokers and nonsmokers. With adjustment for estimated energy intake, an increase in meat intake of 250 g/d (eg, one steak at approximate to 450 kcal) would lead to a 2-kg higher weight gain after 5 y (95% CI: 1.5, 2.7 kg). Positive associations were observed for red meat, poultry, and processed meat. Conclusion: Our results suggest that a decrease in meat consumption may improve weight management. Am J Clin Nutr 2010; 92: 398-407
    Type of Publication: Journal article published
    PubMed ID: 20592131
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  • 3
    Keywords: CANCER ; COMBINATION ; Germany ; EPIDEMIOLOGY ; POPULATION ; PROTEIN ; PROTEINS ; PHOSPHORUS ; WOMEN ; COUNTRIES ; FATTY-ACIDS ; DIETARY ; CALCIUM ; ALCOHOL ; CONSUMPTION ; EPIC ; nutrition ; CALIBRATION ; FOOD ; nutrient intake ; BETA-CAROTENE ; NUTRIENTS ; RETINOL ; RECALL ; EPIC PROJECT ; IRON ; dietary patterns ; VITAMINS ; RECALLS ; POTASSIUM ; vitamin D ; 24-h dietary recall ; VEGETABLE-OIL ; magnesium ; nutrient intakes ; food component intakes ; food group combinations ; reduced rank regression
    Abstract: Objective: To identify combinations of food groups that explain as much variation in absolute intakes of 23 key nutrients and food components as possible within the country-specific populations of the European Prospective Investigation into Cancer and Nutrition (EPIC). Subjects/Methods: The analysis covered single 24-h dietary recalls (24-HDR) from 36 034 subjects (13 025 men and 23 009 women), aged 35-74 years, from all 10 countries participating in the EPIC study. In a set of 39 food groups, reduced rank regression (RRR) was used to identify those combinations (RRR factors) that explain the largest proportion of variation in intake of 23 key nutrients and food components, namely, proteins, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, sugars (sum of mono-and disaccharides), starch, fibre, alcohol, calcium, iron, potassium, phosphorus, magnesium, vitamin D, beta-carotene, retinol and vitamins E, B1, B2, B6, B12 and C (RRR responses). Analyses were performed at the country level and for all countries combined. Results: In the country-specific analyses, the first RRR factor explained a considerable proportion of the total nutrient intake variation in all 10 countries (27.4-37.1%). The subsequent RRR factors were much less important in explaining the variation (〈= 6%). Strong similarities were observed for the first country-specific RRR factor between the individual countries, largely characterized by consumption of bread, vegetable oils, red meat, milk, cheese, potatoes, margarine and processed meat. The highest explained variation was seen for protein, potassium, phosphorus and magnesium (50-70%), whereas sugars, beta-carotene, retinol and alcohol were only marginally explained (〈= 5%). The explained proportion of the other nutrients ranged between these extremes. Conclusions: A combination of food groups was identified that explained a considerable proportion of the nutrient intake variation in 24-HDRs in every country-specific EPIC population in a similar manner. This indicates that, despite the large variability in food and nutrient intakes reported in the EPIC, the variance of intake of important nutrients is explained, to a large extent, by similar food group combinations across countries.
    Type of Publication: Journal article published
    PubMed ID: 19888278
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  • 4
    Keywords: CANCER ; RISK ; BODY-WEIGHT ; WOMEN ; nutrition ; LIFE-STYLE ; MIDDLE-AGED WOMEN ; ENERGY-INTAKE ; dietary patterns ; metabolic syndrome ; GAIN ; EPIC-OXFORD ; INTERVENTION TRIAL
    Abstract: BACKGROUND: Fruit and vegetable consumption might prevent weight gain through their low energy density and high dietary fiber content. OBJECTIVE: We assessed the association between the baseline consumption of fruit and vegetables and weight change in participants from 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition study. DESIGN: Diet was assessed at baseline in 373,803 participants by using country-specific validated questionnaires. Weight was measured at baseline and self-reported at follow-up in most centers. Associations between baseline fruit and vegetable intakes (per 100 g/d) and weight change (g/y) after a mean follow-up of 5 y were assessed by using linear mixed-models, with age, sex, total energy intake, and other potential confounders controlled for. RESULTS: After exclusion of subjects with chronic diseases at baseline and subjects who were likely to misreport energy intakes, baseline fruit and vegetable intakes were not associated with weight change overall. However, baseline fruit and vegetable intakes were inversely associated with weight change in men and women who quit smoking during follow-up. We observed weak positive associations between vegetable intake and weight change in women who were overweight, were former smokers, or had high prudent dietary pattern scores and weak inverse associations between fruit intake and weight change in women who were 〉50 y of age, were of normal weight, were never smokers, or had low prudent dietary pattern scores. CONCLUSIONS: In this large study, higher baseline fruit and vegetable intakes, while maintaining total energy intakes constant, did not substantially influence midterm weight change overall but could help to reduce risk of weight gain in persons who stop smoking. The interactions observed in women deserve additional attention.
    Type of Publication: Journal article published
    PubMed ID: 22170373
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  • 5
    Keywords: CANCER ; RISK ; HEALTH ; MEN ; FATTY-ACIDS ; nutrition ; POSTMENOPAUSAL WOMEN ; OLDER-ADULTS ; BONE-MINERAL DENSITY ; OSTEOPOROTIC FRACTURES
    Abstract: Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION: Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS: A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (+/-10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS: Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor. CONCLUSIONS: In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.
    Type of Publication: Journal article published
    PubMed ID: 23085859
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  • 6
    Keywords: COHORT ; BODY-WEIGHT ; BREAST-CANCER ; OBESITY ; PROJECT ; nutrition ; PARTICIPANTS ; survival analysis ; SUBSEQUENT CHANGES ; EPIC-PANACEA
    Abstract: BACKGROUND: Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population. METHODS: We used lifestyle and nutritional data from 53 degrees 758 individuals followed for a median of 5.4 years from six centers of the European Prospective Investigation into Cancer and Nutrition (EPIC) to develop a risk score to predict substantial weight gain (SWG) for the next 5 years (derivation sample). Assuming linear weight gain, SWG was defined as gaining 〉/= 10% of baseline weight during follow-up. Proportional hazards models were used to identify significant predictors of SWG separately by EPIC center. Regression coefficients of predictors were pooled using random-effects meta-analysis. Pooled coefficients were used to assign weights to each predictor. The risk score was calculated as a linear combination of the predictors. External validity of the score was evaluated in nine other centers of the EPIC study (validation sample). RESULTS: Our final model included age, sex, baseline weight, level of education, baseline smoking, sports activity, alcohol use, and intake of six food groups. The model's discriminatory ability measured by the area under a receiver operating characteristic curve was 0.64 (95% CI = 0.63-0.65) in the derivation sample and 0.57 (95% CI = 0.56-0.58) in the validation sample, with variation between centers. Positive and negative predictive values for the optimal cut-off value of 〉/= 200 points were 9% and 96%, respectively. CONCLUSION: The present risk score confidently excluded a large proportion of individuals from being at any appreciable risk to develop SWG within the next 5 years. Future studies, however, may attempt to further refine the positive prediction of the score.
    Type of Publication: Journal article published
    PubMed ID: 23874419
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  • 7
    Keywords: CANCER ; SURVIVAL ; MODEL ; FOLLOW-UP ; INFORMATION ; COHORT ; DEATH ; DISEASE ; incidence ; MORTALITY ; POPULATION ; RISK ; HEART ; PATIENT ; prognosis ; REDUCTION ; ASSOCIATION ; NO ; TRIAL ; TRIALS ; HEALTH ; AGE ; COUNTRIES ; POPULATIONS ; DIET ; DIETARY ; NETHERLANDS ; MYOCARDIAL-INFARCTION ; ALCOHOL ; IMPROVES ; EPIC ; European Prospective Investigation into Cancer and Nutrition ; nutrition ; FOOD ; HEART-DISEASE ; Mediterranean diet ; HETEROGENEITY ; REGRESSION ; ASSOCIATIONS ; PATTERN ; CORONARY-HEART-DISEASE ; INTERVAL ; elderly ; prospective ; PEOPLE ; UNIT ; COMMUNITY ; myocardial infarction ; coronary heart disease ; DEATHS
    Abstract: Mediterranean diet is associated with lower incidence of coronary heart disease, and two randomised trials indicated that it improves prognosis of coronary patients. These trials, however, relied on a total of 100 deaths and evaluated designer diets in the clinical context. We have evaluated the association of adherence to the modified Mediterranean diet, in which unsaturates were substituted for monounsaturates, with survival among elderly with previous myocardial infarction within the European Prospective Investigation into Cancer and nutrition (EPIC) study. As of December 2003, after a median follow-up of 6.7 years, 2671 EPIC participants from nine countries were 60 years or older and had prevalent myocardial infarction but no stroke or cancer at enrolment, complete information on dietary intakes and important covariates and known survival status. Adherence to the modified Mediterranean diet was assessed through a 10-unit-scale. Mortality ratio in relation to modified Mediterranean diet was estimated through Cox regression controlling for possible confounding. Increased adherence to modified Mediterranean diet by two units was associated with 18% lower overall mortality rate (95% confidence interval 7-27%, fixed effects model). There was no significant heterogeneity by sex, age at enrolment, or country, although the association tended to be less evident among northern Europeans. Associations between food groups contributing to the modified Mediterranean diet and mortality were generally weak. A diet inspired by the Mediterranean pattern that can be easily adopted by Western populations is associated with substantial reduction of total mortality of coronary patients in the community
    Type of Publication: Journal article published
    PubMed ID: 17926134
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  • 8
    Keywords: CANCER ; MODEL ; MODELS ; COHORT ; BODY-WEIGHT ; ASSOCIATION ; WOMEN ; MEN ; OBESITY ; smoking ; EPIC ; nutrition ; EUROPE ; LEISURE-TIME ; physical activity ; ADULTS ; REGRESSION ; WEIGHT ; fat distribution ; ADIPOSITY ; OVERWEIGHT ; prospective ; EUROPEAN COUNTRIES ; BMI ; WAIST CIRCUMFERENCE ; ENERGY-EXPENDITURE ; BODY-COMPOSITION ; INVESTIGATE ; cross-sectional analysis ; OXFORD PARTICIPANTS ; WEIGHT-GAIN
    Abstract: Objectives: Cross-sectional data suggest a strong association between low levels of physical activity and obesity. The EPIC-PANACEA ( European Prospective Investigation into Cancer-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating out of home And obesity) project was designed to investigate the associations between physical activity and body mass index (BMI) and waist circumference based on individual data collected across nine European countries. Methods: In the European Prospective Investigation into Cancer and Nutrition ( EPIC), 519 931 volunteers were recruited between 1992 and 2000, of whom 405 819 had data on main variables of interest. Height, body weight and waist circumference were measured using standardized procedures. Physical activity was assessed using a validated four-category index reflecting a self-reported usual activity during work and leisure time. The associations between physical activity and BMI and waist circumference were estimated using multilevel mixed effects linear regression models, adjusted for age, total energy intake, smoking status, alcohol consumption and educational level. Results: A total of 125 629 men and 280 190 women with a mean age of 52.9 (s.d. 9.7) and 51.5 (s.d. 10.0) years, respectively were included. The mean BMI was 26.6 kg/m(2) (s.d. 3.6) in men and 25.0 kg/m(2) (s.d. 4.5) in women. Fifty percent of men and 30% of women were categorized as being active or moderately active. A one-category difference in the physical activity index was inversely associated with a difference of 0.18 kg/m(2) in the mean BMI (95% confidence interval, CI, 0.11, 0.24) and 1.04-cm (95% CI 0.82, 1.26) difference in waist circumference in men. The equivalent figures for women were 0.31 kg/m(2) (95% CI 0.23, 0.38) and 0.90 cm ( 95% CI 0.71, 1.08), respectively. Conclusions: Physical activity is inversely associated with both BMI and waist circumference across nine European countries. Although we cannot interpret the association causally, our results were observed in a large and diverse cohort independently from many potential confounders
    Type of Publication: Journal article published
    PubMed ID: 19223851
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  • 9
    Keywords: CANCER ; OBESITY ; body mass index ; nutrition ; ENERGY-INTAKE ; PHYSICAL-ACTIVITY ; BODY-MASS INDEX ; weight gain ; 10 EUROPEAN COUNTRIES ; eating at restaurants ; eating at work ; EPIC-PANACEA ; FAST-FOOD CONSUMPTION ; OUT-OF-HOME ; RESTAURANT USE
    Abstract: Objective: The aim of this study was to examine the association of body mass index (BMI) and weight gain with eating at restaurants and similar establishments or eating at work among 10 European countries of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Subjects: This study included a representative sample of 24 310 randomly selected EPIC participants. Methods: Single 24-h dietary recalls with information on the place of consumption were collected using standardized procedures between 1995 and 2000. Eating at restaurants was defined to include all eating and drinking occasions at restaurants, cafeterias, bars and fast food outlets. Eating at work included all eating and drinking occasions at the workplace. Associations between eating at restaurants or eating at work and BMI or annual weight changes were assessed using sex-specific linear mixed-effects models, controlling for potential confounders. Results: In southern Europe energy intake at restaurants was higher than intake at work, whereas in northern Europe eating at work appeared to contribute more to the mean daily intake than eating at restaurants. Cross-sectionally, eating at restaurants was found to be positively associated with BMI only among men (beta = +0.24, P = 0.003). Essentially no association was found between BMI and eating at work among both genders. In a prospective analysis among men, eating at restaurants was found to be positively, albeit nonsignificantly, associated with weight gain (beta = +0.05, P = 0.368). No association was detected between energy intake at restaurants and weight changes, controlling for total energy intake. Conclusion: Among men, eating at restaurants and similar establishments was associated with higher BMI and possibly weight gain.
    Type of Publication: Journal article published
    PubMed ID: 20661252
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  • 10
    Keywords: CANCER ; EXPOSURE ; validation ; MEASUREMENT ERROR ; nutrition ; CALIBRATION ; MULTICENTER ; FOOD ; HEMOGLOBIN ADDUCTS ; glycidamide
    Abstract: BACKGROUND: Acrylamide is a chemical compound present in tobacco smoke and food, classified as a probable human carcinogen and a known human neurotoxin. Acrylamide is formed in foods, typically carbohydrate-rich and protein-poor plant foods, during high-temperature cooking or other thermal processing. The objectives of this study were to compare dietary estimates of acrylamide from questionnaires (DQ) and 24-h recalls (R) with levels of acrylamide adduct (AA) in haemoglobin. METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC) study, acrylamide exposure was assessed in 510 participants from 9 European countries, randomly selected and stratified by age, sex, with equal numbers of never and current smokers. After adjusting for country, alcohol intake, smoking status, number of cigarettes and energy intake, correlation coefficients between various acrylamide measurements were computed, both at the individual and at the aggregate (centre) level. RESULTS: Individual level correlation coefficient between DQ and R measurements (r DQ,R) was 0.17, while r DQ,AA and r R,AA were 0.08 and 0.06, respectively. In never smokers, r DQ,R, r DQ,AA and r R,AA were 0.19, 0.09 and 0.02, respectively. The correlation coefficients between means of DQ, R and AA measurements at the centre level were larger (r 〉 0.4). CONCLUSIONS: These findings suggest that estimates of total acrylamide intake based on self-reported diet correlate weakly with biomarker AA Hb levels. Possible explanations are the lack of AA levels to capture dietary acrylamide due to individual differences in the absorption and metabolism of acrylamide, and/or measurement errors in acrylamide from self-reported dietary assessments, thus limiting the possibility to validate acrylamide DQ measurements.
    Type of Publication: Journal article published
    PubMed ID: 23114503
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