Energy Balance and Risk of Mortality in Spanish Older Adults.

Camille Lassale,Álvaro Hernáez,Helmut Schröder,Estefanía Toledo,José Lapetra,Dolores Corella,Raquel Cueto,Miquel Fiol,Alfredo Gea,Emilio Ros,Jordi Salas-Salvadó,Ángel M Alonso-Gómez,Olga Castañer,Xavier Pinto,Nancy Babio,Ramon Estruch,Montserrat Fitó,Lluis Serra-Majem,José V Sorlí

doi:10.3390/nu13051545

Abstract

Clinical data on the direct health effects of energy deficit or surplus beyond its impact on body weight are scarce. We aimed to assess the association with all-cause, cardiovascular and cancer mortality of (1) sustained energy deficit or surplus, calculated according to each individual’s en-ergy intake (EI) and theoretical energy expenditure (TEE), and (2) mid-term change in total EI in a prospective study. In 7119 participants in the PREDIMED Study (PREvención con DIeta MEDi-terránea) with a mean age of 67 years, energy intake was derived from a 137-item food frequency questionnaire. TEE was calculated as a function of age, sex, height, body weight and physical ac-tivity. The main exposure was the proportion of energy requirement covered by energy intake, cumulative throughout the follow-up. The secondary exposure was the change in energy intake from baseline. Cox proportional hazard models were used to estimate hazard ratios and 95% con-fidence intervals for all-cause, cardiovascular and cancer mortality. Over a median follow-up of 4.8 years, there were 239 deaths (excluding the first 2 years). An energy intake exceeding energy needs was associated with an increase in mortality risk (continuous HR10% over energy needs = 1.10; 95% CI 1.02, 1.18), driven by cardiovascular death (HR = 1.26; 95% CI 1.11, 1.43). However, consum-ing energy below estimated needs was not associated with a lower risk. Increments over time in energy intake were associated with greater all-cause mortality (HR10% increase = 1.09; 95% CI 1.02, 1.17). However, there was no evidence that a substantial negative change in energy intake would reduce mortality risk. To conclude, in an older Mediterranean cohort, energy surplus or increase over a 5-year period was associated with greater risk of mortality, particularly cardiovascular mortality. Energy deficit, or reduction in energy intake over time were not associated with mortal-ity risk.

Highlights

IntroductionLikely a result of energy excess, has been consistently associated with a greater risk of mortality [1] and the development of cardiometabolic diseases [2] and certain cancers [3]
Energy balance is thought to be a key element of health
In this large cohort of Spanish older adults at high cardiovascular risk, we observed that a sustained energy surplus over 5 years and an increase in energy intake compared to baseline are associated with a higher risk of mortality

Summary

Introduction

Likely a result of energy excess, has been consistently associated with a greater risk of mortality [1] and the development of cardiometabolic diseases [2] and certain cancers [3]. At the other end of the spectrum, the direct effects on mortality of long-term calorie restrictions are scarce in human studies. A time series study in Cuba showed that a 35% decrease in energy intake (EI) (together with an increase in the physically active population to twice the baseline number) led to a 50% decline in diabetes-related deaths and a 20–35%. Long-term calorie restrictions have been associated with decreases in the development of cardiovascular risk factors [7,8], and of diabetes [9] and some evidence suggests anti-cancer mechanisms in humans [10,11]

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