Guidelines for lifestyle and dietary modification in patients with coronary artery disease (CAD) are mainly supported by evidence from general population studies. CAD patients, however, differ from ...the general population in age (older) and treatment with preventive drugs. This review seeks to provide evidence for a prognostic benefit of lifestyle and dietary recommendations from studies in CAD patients.
A literature search was performed on the effect of lifestyle and dietary changes on mortality in CAD patients. Prospective cohort studies and randomized controlled trials of patients with established CAD were included if they reported all-causes mortality and had at least 6 months of follow-up. The effect estimates of smoking cessation (relative risk RR, 0.64; 95% CI, 0.58 to 0.71), increased physical activity (RR, 0.76; 95% CI, 0.59 to 0.98), and moderate alcohol use (RR, 0.80; 95% CI, 0.78 to 0.83) were studied most extensively. For the 6 dietary goals, data were too limited to provide reliable effect size estimates. Combinations of dietary changes were associated with reduced mortality (RR, 0.56; 95% CI, 0.42 to 0.74).
Available studies show convincingly the health benefits of lifestyle changes in CAD patients. Effect estimates of combined dietary changes look promising. Future studies should confirm these findings and assess the contribution of the individual dietary factors.
Social support is important to achieve beneficial changes in risk factors for disease, such as overweight and obesity. This paper presents the theoretical and practical framework for social support, ...and the mechanisms by which social support affects body weight. The theoretical and practical framework is supported with a literature review addressing studies involving a social support intervention for weight loss and weight loss maintenance. A major aspect in social support research and practice is the distinction between structural and functional support. Structural support refers to the availability of potential support-givers, while functional support refers to the perception of support. Interventions often affect structural support, for example, through peer groups, yet functional support shows a stronger correlation with health. Although positive correlations between social support and health have been shown, social support may also counteract health behaviour change. Most interventions discussed in this review showed positive health outcomes. Surprisingly, social support was clearly defined on a practical level in hardly any studies, and social support was assessed as an outcome variable in even fewer studies. Future social support intervention research would benefit from clear definitions of social support, a clear description of the intended mechanism of action and the actual intervention, and the inclusion of perceived social support as a study outcome.
High intake of n-3 polyunsaturated fatty acids may protect against age-related cognitive decline. However, results from epidemiologic studies are inconclusive, and results from randomized trials in ...elderly subjects without dementia are lacking.
To investigate the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on cognitive performance.
Double-blind, placebo-controlled trial involving 302 cognitively healthy (Mini-Mental State Examination score > 21) individuals aged 65 years or older. Participants were randomly assigned to 1,800 mg/d EPA-DHA, 400 mg/d EPA-DHA, or placebo capsules for 26 weeks. Cognitive performance was assessed using an extensive neuropsychological test battery that included the cognitive domains of attention, sensorimotor speed, memory, and executive function.
The mean age of the participants was 70 years, and 55% were male. Plasma concentrations of EPA-DHA increased by 238% in the high-dose and 51% in the low-dose fish oil group compared with placebo, reflecting excellent compliance. Baseline scores on the cognitive tests were comparable in the three groups. Overall, there were no significant differential changes in any of the cognitive domains for either low-dose or high-dose fish oil supplementation compared with placebo.
In this randomized, double-blind, placebo-controlled trial, we observed no overall effect of 26 weeks of eicosapentaenoic acid and docosahexaenoic acid supplementation on cognitive performance.
CONTEXT Dietary patterns and lifestyle factors are associated with mortality
from all causes, coronary heart disease, cardiovascular diseases, and cancer,
but few studies have investigated these ...factors in combination. OBJECTIVE To investigate the single and combined effect of Mediterranean diet,
being physically active, moderate alcohol use, and nonsmoking on all-cause
and cause-specific mortality in European elderly individuals. DESIGN, SETTING, AND PARTICIPANTS The Healthy Ageing: a Longitudinal study in Europe (HALE) population,
comprising individuals enrolled in the Survey in Europe on Nutrition and the
Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands,
Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women,
aged 70 to 90 years in 11 European countries. This cohort study was conducted
between 1988 and 2000. MAIN OUTCOME MEASURES Ten-year mortality from all causes, coronary heart disease, cardiovascular
diseases, and cancer. RESULTS During follow-up, 935 participants died: 371 from cardiovascular diseases,
233 from cancer, and 145 from other causes; for 186, the cause of death was
unknown. Adhering to a Mediterranean diet (hazard ratio HR, 0.77; 95% confidence
interval CI, 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91),
physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65;
95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality
(HRs controlled for age, sex, years of education, body mass index, study,
and other factors). Similar results were observed for mortality from coronary
heart disease, cardiovascular diseases, and cancer. The combination of 4 low
risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44).
In total, lack of adherence to this low-risk pattern was associated with a
population attributable risk of 60% of all deaths, 64% of deaths from coronary
heart disease, 61% from cardiovascular diseases, and 60% from cancer. CONCLUSION Among individuals aged 70 to 90 years, adherence to a Mediterranean
diet and healthful lifestyle is associated with a more than 50% lower rate
of all-causes and cause-specific mortality.
To study the relationship between body fat percentage and body mass index (BMI) in three different ethnic groups in Singapore (Chinese, Malays and Indians) in order to evaluate the validity of the ...BMI cut-off points for obesity.
Cross-sectional study.
Two-hundred and ninety-one subjects, purposively selected to ensure adequate representation of range of age and BMI of the general adult population, with almost equal numbers from each ethnic and gender group.
Body weight, body height, sitting height, wrist and femoral widths, skinfold thicknesses, total body water by deuterium oxide dilution, densitometry with Bodpod(R) and bone mineral content with Hologic(R) QDR-4500. Body fat percentage was calculated using a four-compartment model.
Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.
The results show that the relationship between BF% and BMI is different between Singaporeans and Caucasians and also among the three ethnic groups in Singapore. If obesity is regarded as an excess of body fat and not as an excess of weight (increased BMI), the cut-off points for obesity in Singapore based on the BMI would need to be lowered. This would have immense public health implications in terms of policy related to obesity prevention and management.
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 2068 men and 1049 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, 1382 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.
The authors investigated the role of food frequency questionnaire (FFQ) design, including length, use of portion-size questions, and FFQ origin, in ranking subjects according to their nutrient ...intake. They also studied the ability of the FFQ to detect differences in energy intake between subgroups and to assess energy and protein intake. In a meta-analysis of 40 validation studies, FFQs with longer food lists (200 items) were better than shorter FFQs at ranking subjects for most nutrients; results were statistically significant for protein, energy-adjusted total fat, and energy-adjusted vitamin C. The authors found that FFQs that included standard portions had higher correlation coefficients for energy-adjusted vitamin C (0.80 vs. 0.60, p < 0.0001) and protein (0.69 vs. 0.61, p = 0.03) than FFQs with portion-size questions. However, it remained difficult from this review to analyze the effects of using portion-size questions. FFQs slightly underestimated gender differences in energy intake, although level of energy intake was underreported by 23% and level of protein intake by 17%. The authors concluded that FFQs with more items are better able to rank people according to their intake and that they are able to distinguish between subpopulations, even though they underestimated the magnitude of these differences.
This article provides an overview of the longitudinal Survey in Europe on Nutrition and the Elderly: a Concerted Action (SENECA) study, which was designed to assess differences in dietary and ...lifestyle factors among elderly Europeans, and to identify the factors that contribute to healthy aging. Elderly people from Belgium, Denmark, France, Italy, Portugal, Spain, Switzerland, and The Netherlands participated in the SENECA study. Standardized measurements were conducted at baseline in 1988–1989 and were repeated in 1993 and 1999. Diet, physical activity, and smoking, as well as maintenance of health and survival, were assessed. At baseline, considerable differences in lifestyle factors existed among elderly people. Mealtime patterns as well as dietary intake varied across Europe, and geographical patterns were apparent. Similar results were found for engagement in sport or professional activities. The smoking prevalence among women was generally low. Distinct geographical differences were also observed in percentages of deaths during the SENECA study and in overall survival time. A healthy lifestyle was related to stable self-perceived health, a delay in functional dependence, and mortality. Inactivity and smoking, and to a lesser extent a low-quality diet, increased mortality risk. A combined effect of multiple unhealthy lifestyle factors was also observed. The SENECA study showed that a healthy lifestyle at older ages is related to a delay in the deterioration of health status and a reduced mortality risk. Improving and maintaining a healthy lifestyle in elderly people across Europe is a great challenge for the European Community.
BACKGROUND: It is suggested that a low intake of fish and/or n-3 PUFA is associated with depressed mood. However, results from epidemiologic studies are mixed, and randomized trials have mainly been ...performed in depressed patients, yielding conflicting results. OBJECTIVE: We investigated the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on mental well-being in a double-blind, placebo-controlled trial. DESIGN: Independently living individuals (n = 302) aged >=65 y were randomly assigned to consume 1800 mg/d EPA+DHA, 400 mg/d EPA+DHA, or placebo capsules for 26 wk. Changes in mental well-being were assessed as the primary outcome with the Center for Epidemiologic Studies Depression Scale (CES-D), Montgomery-Åsberg Rating Scale (MADRS), Geriatric Depression Scale (GDS-15), and Hospital Anxiety and Depression Scale (HADS-A). RESULTS: Plasma concentrations of EPA+DHA increased by 238% in the high-dose and 51% in the low-dose fish-oil group compared with the placebo group, reflecting excellent compliance. Baseline CES-D scores ranged from 5.9 to 6.8 in the 3 groups and were not significantly different between groups. Mean changes in CES-D scores after 26 wk were -0.2, 0.2, and -0.4 (P = 0.87) in the high-dose fish oil, low-dose fish oil, and placebo groups, respectively. Treatment with neither 1800 mg nor 400 mg EPA+DHA differentially affected any of the measures of mental well-being after 13 or 26 wk of intervention compared with placebo. CONCLUSIONS: In this randomized, double-blind, placebo-controlled trial we observed no effect of EPA+DHA supplementation for 26 wk on mental well-being in the general older population studied. This trial was registered at clinicaltrials.gov as NCT00124852.
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