Health for life

Coffee is one of the most extensively researched components in the diet. New studies are regularly being added to the already large body of scientific research, which overall suggests that moderate habitual coffee consumption is not associated with detrimental effects on cardiovascular health

Among recent studies, a new review paper1 highlights that for most healthy people, moderate coffee consumption is unlikely to adversely affect cardiovascular health. Furthermore a new paper2 concluded that higher green tea and coffee consumption is inversely associated with risk of CVD and stroke in the general population.

Considerable research has also been devoted to investigating associations between coffee consumption and key risk factors for cardiovascular disease, such as hypertension (high blood pressure) and elevated cholesterol. Most evidence suggests that regular moderate consumption of caffeinated coffee has no long-term effect on blood pressure and does not increase the risk of hypertension.

A recent study suggests that moderate consumption of paper-filtered coffee may have an unfavourable effect on plasma cholesterol3. The wider body of evidence indicates that the impact of coffee on cholesterol is dependent on the brewing method. Unfiltered coffee raises serum cholesterol levels whereas this is not the case with filter coffee because the cholesterol-raising compounds in coffee are retained in the paper filter.

Throughout 2013 coffee and mortality has been a subject of several scientific research papers, which have produced conflicting results. One study4 found a 21% increase in mortality rate in those drinking more than 28 cups of coffee a week. However recent data from a meta-analysis and systematic review5 assessed 23 studies and concluded that coffee consumption is, in fact, inversely related to the risk of mortality.

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More information about this research is available at http://www.coffeeandhealth.org/coffee-and-health-topics/coffee-consumption-and-cardiovascular-health-2/the-latest-research-on-coffee-and-cardiovascular-health/.

References

1 Rebello S.A. & van Dam R.M. (2013) Coffee Consumption and Cardiovascular Health: Getting to the Heart of the Matter. Current Cardiology Reports, 15:403.

2 Kokubo Y. et al. (2013) The Impact of Green Tea and Coffee Consumption on the Reduced Risk of Stroke Incidence in Japanese Population: The Japan Public Health Center-Based Study Cohort. Stroke, published online ahead of print.

3 Correa T.A.F. et al. (2013) Paper filtered coffee increases cholesterol and inflammation biomarkers independent of roasting degree. Nutrition, 29(7-8):977-81.

4 Liu J. et al. (2013) Association of coffee consumtpion with all-cause and cardiovascular disease mortality. Mayo Clinic Proceedings, published online ahead of print.

5 Malerba S. et al. (2013) A meta-analysis of prospective studies of coffee consumtpion and mortality for all causes, cancers and cardiovascular disease. European Journal of Epidemiology, 28(7):527-539.

In a large prospective study published online in the British Journal of Cancer, researchers looked at the association between nut consumption and risk of pancreatic cancer among 75,680 women in the Nurses Health Study, with no previous history of cancer. Consumption of nuts, including tree nuts (such as almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts), was inversely associated with risk of pancreatic cancer, independent of other potential risk factors for pancreatic cancer.

Women who consumed a one-ounce serving of nuts two or more times per week had a significantly reduced risk of pancreatic cancer (RR, 0.65; 95% CI, 0.47-0.92; P=0.007) compared to those who largely abstained from nuts. "This reduction in risk was independent of established or suspected risk factors for pancreatic cancer including age, height, obesity, physical activity, smoking, diabetes and dietary factors," stated lead author, Ying Bao, MD, ScD, from the Department of Medicine, Brigham and Womens Hospital and Harvard Medical School, Boston, MA.

Pancreatic cancer is the fourth most common cause for cancer-related mortality in the U.S., yet very few modifiable risk factors have been identified. According to the 2009 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report, aside from cigarette smoking, body fatness was the only convincing modifiable risk factor for pancreatic cancer.

While there may be concern that frequent nut consumption may result in weight gain and thereby increase the risk of developing pancreatic cancer, the opposite seems to be true. "In our cohort women who consumed the most nuts tended to weigh less," reported Dr. Bao. Moreover, in a recent analysis of this same cohort, higher nut consumption was associated with a slightly lower risk of weight gain and obesity.

Nut intake has also been associated with a reduced risk of diabetes mellitus, which is a risk factor for pancreatic cancer. "Nuts contain a variety of important vitamins, minerals and phytochemicals," states Maureen Ternus, M.S., R.D., Executive Director of the International Tree Nut Council Nutrition Research & Education Foundation (INC NREF). "This exciting, new study provides yet another reason to encourage people to eat a handful—or 1/3 cup—of tree nuts every day."

Risk of dying from heart disease significantly lowered

Older adults who have higher levels of blood omega-3 levels—fatty acids found almost exclusively in fatty fish and seafood—may be able to lower their overall mortality risk by as much as 27% and their mortality risk from heart disease by about 35%, according to a new study from Harvard School of Public Health (HSPH) and the University of Washington. Researchers found that older adults who had the highest blood levels of the fatty acids found in fish lived, on average, 2.2 years longer than those with lower levels.

"Although eating fish has long been considered part of a healthy diet, few studies have assessed blood omega-3 levels and total deaths in older adults," said lead author Dariush Mozaffarian, associate professor in the Department of Epidemiology at HSPH. "Our findings support the importance of adequate blood omega-3 levels for cardiovascular health, and suggest that later in life these benefits could actually extend the years of remaining life."

The study—the first to look at how objectively measured blood biomarkers of fish consumption relate to total mortality and specific causes of mortality in a general population—appears online April 1, 2013 in Annals of Internal Medicine.

Previous studies have found that fish, which is rich in protein and heart-healthy fatty acids, reduces the risk of dying from heart disease. But the effect on other causes of death or on total mortality has been unclear. With this new study, the researchers sought to paint a clearer picture by examining biomarkers in the blood of adults not taking fish oil supplements, in order to provide the best assessments of the potential effects of dietary consumption of fish on multiple causes of death.

The researchers examined 16 years of data from about 2,700 U.S. adults aged 65 or older who participated in the Cardiovascular Health Study (CHS), a long-term study supported by the National Heart, Lung, and Blood Institute. Participants came from four U.S. communities in North Carolina, California, Maryland, and Pennsylvania; and all were generally healthy at baseline. At baseline and regularly during follow-up, participants had blood drawn, underwent physical examinations and diagnostic testing, and were questioned about their health status, medical history, and lifestyle.

The researchers analyzed the total proportion of blood omega-3 fatty acids, including three specific ones, in participants blood samples at baseline. After adjusting for demographic, cardiovascular, lifestyle, and dietary factors, they found that the three fatty acids—both individually and combined—were associated with a significantly lower risk of mortality. One type in particular—docosahexaenoic acid, or DHA—was most strongly related to lower risk of coronary heart disease (CHD) death (40% lower risk), especially CHD death due to arrhythmias (electrical disturbances of the heart rhythm) (45% lower risk). Of the other blood fatty acids measured—eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA)—DPA was most strongly associated with lower risk of stroke death, and EPA most strongly linked with lower risk of nonfatal heart attack. None of these fatty acids were strongly related to other, noncardiovascular causes of death.

Overall, study participants with the highest levels of all three types of fatty acids had a 27% lower risk of total mortality due to all causes.

When the researchers looked at how dietary intake of omega-3 fatty acids related to blood levels, the steepest rise in blood levels occurred when going from very low intake to about 400 mg per day; blood levels rose much more gradually thereafter. "The findings suggest that the biggest bang-for-your-buck is for going from no intake to modest intake, or about two servings of fatty fish per week," said Mozaffarian.

Low levels of vitamin D may be associated with longevity, according to a study involving middle-aged children of people in their 90s published in CMAJ (Canadian Medical Association Journal).

"We found that familial longevity was associated with lower levels of vitamin D and a lower frequency of allelic variation in the CYP2R1 gene, which was associated with higher levels of vitamin D," writes Dr. Diana van Heemst, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands, with coauthors.

Previous studies have shown that low levels of vitamin D are associated with increased rates of death, heart disease, diabetes, cancer, allergies, mental illness and other afflictions. However, it is not known whether low levels are the cause of these diseases or if they are a consequence.

To determine whether there was an association between vitamin D levels and longevity, Dutch researchers looked at data from 380 white families with at least 2 siblings over age 90 (89 years or older for men and 91 year or older for women) in the Leiden Longevity Study. The study involved the siblings, their offspring and their offsprings partners for a total of 1038 offspring and 461 controls. The children of the nonagenarians were included because it is difficult to include controls for the older age group. The partners were included because they were of a similar age and shared similar environmental factors that might influence vitamin D levels.

The researchers measured levels of 25(OH) vitamin D and categorized levels by month as they varied according to season. Tanning bed use, which can affect vitamin D levels, was categorized as never, 1 times per year and 6 times per year. The researchers controlled for age, sex, BMI (body mass index), time of year, vitamin supplementation and kidney function, all factors that can influence vitamin D levels. They also looked at the influence of genetic variation in 3 genes associated with vitamin D levels.

"We found that the offspring of nonagenarians who had at least 1 nonagenarian sibling had lower levels of vitamin D than controls, independent of possible confounding factors and SNPs [single nucleotide polymorphisms] associated with vitamin D levels," write the authors. "We also found that the offspring had a lower frequency of common genetic variants in the CYP2R1 gene; a common genetic variant of this gene predisposes people to high vitamin D levels.

These findings support an association between low vitamin D levels and familial longevity." They postulate that offspring of nonagenarians might have more of a protein that is hypothesized to be an "aging suppressor" protein. More research is needed to understand the link between lower vitamin D levels, genetic variants and familial longevity.

It is the first time that a scientific study associates high polyphenols intake with a 30% reduction in mortality in older adults. The research, published on Journal of Nutrition, is the first to evaluate the total dietary polyphenol intake by using a nutritional biomarker and not only a food frequency questionnaire. Research is signed by Cristina Andrés Lacueva, Montserrat Rabassa and Mireia Urpí Sardà, from the Department of Nutrition and Bromatology of the UB; Raúl Zamora Ros (ICO-IDIBELL), and experts Antonio Cherubini (Italian National Research Centre on Aging), Stefania Bandinelli (Azienda Sanitaria di Firenze, Italy) and Luigi Ferrucci (National Institute on Ageing, United States).

Polyphenols: diet improves health

Polyphenols are naturally occurring compounds found largely in fruits, vegetables, coffee, tea, nuts, legumes and cereals. More than 8,000 different phenolic compounds have been identified in plants. Polyphenols have antioxidant, antiinflammatory, anticarcinogenic, etc. effects.

The research published on Journal of Nutrition is based on a 12-year follow-up of a population sample composed by 807 men and women aged 65 or over from Greve and Bagno (Tuscany, Italy), within the InCHIANTI study. The group of the UB analysed the effect of polyphenol-rich diets by means of a nutritional biomarker -- the total urinary polyphenol (TUP) concentration -- as a proxy measure of intake. To be exact, UB researchers contributes to first literature erences on TUP application to epidemiological or clinical studies.

New biomarkers for nutritional studies

Professor Cristina Andrés Lacueva, head of the Biomarkers and Nutritional & Food Metabolomics Research Group of the UB and coordinator of the study, explains that "the development and use of nutritional biomarkers enables to make a more precise and, particularly, more objective estimation of intake as it is not only based on participants memory when answering questionnaire. Nutritional biomarkers take into account bioavailabity and individual differences. According to the expert, "this methodology makes a more reliable and accurate evaluation of the association between food intake and mortality or disease risk."

In conclusion, the research proves that overall mortality was reduced by 30% in participants who had rich-polyphenol diets (>650 mg/day) in comparison with the participants who had low-polyphenol intakes (<500 mg/day).

Raúl Zamora Ros, first author of the study, points out that "results corroborate scientific evidence suggesting that people consuming diets rich in fruit and vegetables are at lower risk of several chronic diseases and overall mortality." Moreover, the research stresses the importance of evaluating -- if possible -- food intake by using nutritional biomarkers, not only food frequency questionnaires.

The Biomarkers and Nutritional & Food Metabolomics Research Group, which participates in the project Fun-C-Food (Consolider Ingenion), collaborates actively with several national and international research groups. It focuses its activity on the analysis of new more effective and sensitive nutritional biomarkers based on the bioavailabilty of bioactive compounds in food and their activity, in order to associate the intake of certain foods (consumption markers) with their potential effects on peoples health.

People who reported dietary intake that was most consistent with the 2005 Dietary Guidelines for Americans had lower risk of pancreatic cancer, according to a new study published August 15 in the Journal of the National Cancer Institute.

Previous studies investigating the relationship between food and nutrient intake and pancreatic cancer have yielded inconsistent results. The U.S. Government issues evidence-based dietary guidelines that provide the basis for federal nutrition policy and education activities to promote overall health for Americans. The authors evaluated how closely study participants diets matched the 2005 Dietary Guidelines for Americans, as measured by the Healthy Eating Index (HEI-2005), and then compared their risk of pancreatic cancer.

Hannah Arem, Ph.D.,, from the Division of Cancer Epidemiology and Genetics at the National Institutes of Health in Bethesda, MD, and colleagues calculated HEI-2005 scores for 537,218 participants in the NIH-AARP Diet and Health Study (ages 50-71 years), based on responses to food frequency questionnaires. Pancreatic cancer risk was then compared between those with high and low HEI-2005 scores, accounting for the influence of other known pancreatic cancer risk factors.

Among the study participants there were 2,383 new cases of pancreatic cancer. Overall, the investigators observed a 15% lower risk of pancreatic cancer among participants with the highest HEI-2005 score compared to those with the lowest HEI-2005 score. This association was stronger among overweight or obese men compared to men of normal weight, but there was no difference for normal vs. overweight or obese women. While the authors adjusted for known risk factors such as smoking and diabetes status, they caution that other health factors not collected in the questionnaires may be associated with a more healthful diet and might explain some of the observed reduced risk. They also noted that diet is difficult to measure and the HEI-2005 was not designed specifically for the purpose of overall cancer prevention.

According to Arem and colleagues "the Dietary Guidelines for Americans are issued to promote overall health, including the maintenance of a healthy weight and disease prevention. Our findings support the hypothesis that a high-quality diet may also play a role in reducing pancreatic cancer risk." Future studies are needed to confirm these findings.

In an accompanying editorial, Rachel Ballard-Barbash, M.D., and Susan M. Krebs-Smith, Ph.D., from the Applied Research Program at the National Cancer Institute (Bethesda, MD), and Marian L. Neuhouser, Ph.D., from the Cancer Prevention Program in the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center (Seattle, WA) discuss that progress has been made in understanding associations between diet and cancer risk, but they have not resulted in noticeable changes in cancer incidence in the US. They conclude, "Practical and actionable dietary recommendations that are based on sound research should ultimately reduce patient suffering and treatment-related expenditures from preventable cancers."

The authors of this study aimed to examine the conclusions, statistical significance, and reproducibility in the literature on associations between specific foods and cancer risk.

Design: We selected 50 common ingredients from random recipes in a cookbook. PubMed queries identified recent studies that evaluated the relation of each ingredient to cancer risk. Information regarding author conclusions and relevant effect estimates were extracted. When >10 articles were found, we focused on the 10 most recent articles.

Results: Forty ingredients (80%) had articles reporting on their cancer risk. Of 264 single-study assessments, 191 (72%) concluded that the tested food was associated with an increased (n = 103) or a decreased (n = 88) risk; 75% of the risk estimates had weak (0.05 > P ≥ 0.001) or no statistical (P > 0.05) significance. Statistically significant results were more likely than nonsignificant findings to be published in the study abstract than in only the full text (P < 0.0001). Meta-analyses (n = 36) presented more conservative results; only 13 (26%) reported an increased (n = 4) or a decreased (n = 9) risk (6 had more than weak statistical support). The median RRs (IQRs) for studies that concluded an increased or a decreased risk were 2.20 (1.60, 3.44) and 0.52 (0.39, 0.66), respectively. The RRs from the meta-analyses were on average null (median: 0.96; IQR: 0.85, 1.10). Conclusions: Associations with cancer risk or benefits have been claimed for most food ingredients. Many single studies highlight implausibly large effects, even though evidence is weak. Effect sizes shrink in meta-analyses.
Related article

A healthy diet may reduce the risk of severe depression, according to a prospective follow-up study of more than 2,000 men conducted at the University of Eastern Finland. In addition, weight loss in the context of a lifestyle intervention was associated with a reduction in depressive symptoms.

"The study reinforces the hypothesis that a healthy diet has potential not only in the warding off of depression, but also in its prevention," says Ms Anu Ruusunen, MSc, who presented the results in her doctoral thesis in the field of nutritional epidemiology.

Depressed individuals often have a poor quality of diet and decreased intake of nutrients. However, it has been unclear whether the diet and the intake of foods and nutrients are associated with the risk of depression in healthy individuals.

Those following a healthy diet are less at risk

A healthy diet characterized by vegetables, fruits, berries, whole-grains, poultry, fish and low-fat cheese was associated with a lower prevalence of depressive symptoms and a lower risk of depression during the follow-up period.

Increased intake of folate was also associated with a decreased risk of depression. Vegetables, fruits, berries, whole-grains, meat and liver are the most important dietary sources of folate. In addition, increased coffee consumption was non-linearly associated with a decreased risk of depression.

In addition, participation in a three-year lifestyle intervention study improved depression scores with no specific group effect. Furthermore, a reduction in the body weight was associated with a greater reduction in depressive symptoms.

Junk food, sugar and processed meats may increase depressive symptoms

Adherence to an unhealthy diet characterized by a high consumption of sausages, processed meats, sugar-containing desserts and snacks, sugary drinks, manufactured foods, French rolls and baked or processed potatoes was associated with an increased prevalence of elevated depressive symptoms.

Contrary to some earlier observations, vitamin B12 intake, serum concentrations of n-3 PUFAs, serum ratio of n-6 to n-3 PUFAs, tea drinking and total caffeine intake were not related to the risk of depression in this study.

The study was based on the population-based Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. The participants, over 2,000 middle-aged or older Finnish men were followed-up for an average of 13󈞀 years. Their diet was measured by food records and food frequency questionnaires, and information on cases of depression was obtained from the National Hospital Discharge Register. The effects of the three-year lifestyle intervention on depressive symptoms were investigated in the Finnish Diabetes Prevention Study (DPS) with 140 middle-aged men and women randomized to intervention and control groups.

Depression is one of the leading health challenges in the world and its effects on public health, economics and quality of life are enormous. Not only treatment of depression, but also prevention of depression needs new approaches. Diet and other lifestyle factors may be one possibility.

The original articles were published in Psychotherapy and Psychosomatics, European Journal of Nutrition, Public Health Nutrition and Diabetic Medicine. One submitted article was also presented.