Alpha Omega Cohort Research Articles

Potato Consumption and Risk of Cardiovascular Mortality and Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort.

BackgroundHigher potato intake, especially French fries, was unfavorably associated with cardiometabolic endpoints in population-based studies. Little is known about this in patients with ischemic heart disease (IHD).ObjectiveTotal and boiled potatoes and French fries intake were examined in relation to cardiovascular disease (CVD) mortality, all-cause mortality, and type 2 diabetes mellitus (T2DM) risk in Dutch post-myocardial infarction (MI) patients of the Alpha Omega Cohort.MethodsWe analyzed 3,401 patients (60–80 years, 78% male), free from T2DM at baseline, with an MI ≤ 10 years before enrolment. Diet was assessed at baseline (2002–2006) using a 203-item validated Food Frequency Questionnaire (FFQ) that includes potato preparation methods. Cause-specific mortality was monitored through December 2018, and T2DM incidence (self-reported physician diagnosis and/or prescribed anti-diabetes medication) was monitored during the first 40 months of follow-up. Multivariable Cox models were used to obtain hazard ratios (HRs) for fatal endpoints and incident T2DM in tertiles of potato intake.ResultsPatients had a median total potato intake (mainly boiled) of 111 g/d, 96% consumed >1 serving (200 g) per week. French fries were consumed by 48% of the patients (median of 6 g/d among consumers). During >12 years of follow-up (38,987 person-years), 1,476 deaths occurred of which 641 were from CVD, 394 were from IHD, and 119 were from a stroke. Total and boiled potatoes were not associated with CVD mortality, but a higher risk of all-cause mortality was observed (HR: 1.07; 95% CI: 1.01, 1.14; per 50 g/d). Potato consumption tended to be positively associated with incident T2DM (186 cases; HR: 1.11, 95% CI: 0.94, 1.32; per 50 g/d). Results for French fries were inconsistent for all outcomes.ConclusionIn Dutch post-MI patients, potatoes (mainly boiled) were not associated with CVD mortality but possibly adversely associated with all-cause mortality and T2DM risk. These findings warrant confirmation in other IHD patient cohorts. The Alpha Omega Cohort is registered at ClinicalTrials.gov as NCT03192410.

Dietary and Circulating Long-Chain Omega-3 Polyunsaturated Fatty Acids and Mortality Risk After Myocardial Infarction: A Long-Term Follow-Up of the Alpha Omega Cohort.

BackgroundHabitual intake of long‐chain omega‐3 fatty acids, especially eicosapentaenoic and docosahexaenoic acid (EPA+DHA) from fish, has been associated with a lower risk of fatal coronary heart disease (CHD) in population‐based studies. Whether that is also the case for patients with CHD is not yet clear. We studied the associations of dietary and circulating EPA+DHA and alpha‐linolenic acid, a plant‐derived omega‐3 fatty acids, with long‐term mortality risk after myocardial infarction.Methods and ResultsWe analyzed data from 4067 Dutch patients with prior myocardial infarction aged 60 to 80 years (79% men, 86% on statins) enrolled in the Alpha Omega Cohort from 2002 to 2006 (baseline) and followed through 2018. Baseline intake of fish and omega‐3 fatty acids were assessed through a validated 203‐item food frequency questionnaire and circulating omega‐3 fatty acids were assessed in plasma cholesteryl esters. Hazard ratios (HRs) with 95% CIs were obtained from Cox regression analyses. During a median follow‐up period of 12 years, 1877 deaths occurred, of which 515 were from CHD and 834 from cardiovascular diseases. Dietary intake of EPA+DHA was significantly inversely associated with only CHD mortality (HR, 0.69 [0.52–0.90] for >200 versus ≤50 mg/d; HR, 0.92 [0.86–0.98] per 100 mg/d). Similar results were obtained for fish consumption (HRCHD, 0.74 [0.53–1.03] for >40 versus ≤5 g/d; P trend: 0.031). Circulating EPA+DHA was inversely associated with CHD mortality (HR, 0.71 [0.53–0.94] for >2.52% versus ≤1.29%; 0.85 [0.77–0.95] per 1‐SD) and also with cardiovascular diseases and all‐cause mortality. Dietary and circulating alpha‐linolenic acid were not significantly associated with mortality end points.ConclusionsIn a cohort of Dutch patients with prior myocardial infarction, higher dietary and circulating EPA+DHA and fish intake were consistently associated with a lower CHD mortality risk.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03192410.

Dairy Consumption and 3-Year Risk of Type 2 Diabetes after Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort.

Population-based studies suggest a role for dairy, especially yogurt, in the prevention of type 2 diabetes (T2D). Whether dairy affects T2D risk after myocardial infarction (MI) is unknown. We examined associations of (types of) dairy with T2D incidence in drug-treated, post-MI patients from the Alpha Omega Cohort. The analysis included 3401 patients (80% men) aged 60–80 y who were free of T2D at baseline (2002–2006). Dairy intakes were assessed using a validated food-frequency questionnaire. Incident T2D was ascertained through self-reported physician diagnosis and/or medication use. Multivariable Cox models were used to calculate Hazard ratios (HRs) and 95% confidence intervals (CI) for T2D with dairy intake in categories and per 1-standard deviation (SD) increment. Most patients consumed dairy, and median intakes were 264 g/d for total dairy, 82 g/d for milk and 41 g/d for yogurt. During 40 months of follow-up (10,714 person-years), 186 patients developed T2D. After adjustment for confounders, including diet, HRs per 1-SD were 1.06 (95% CI 0.91–1.22) for total dairy, 1.02 (0.88–1.18) for milk and 1.04 (0.90–1.20) for yogurt. Associations were also absent for other dairy types and in dairy categories (all p-trend > 0.05). Our findings suggest no major role for dairy consumption in T2D prevention after MI.

Dairy consumption and mortality after myocardial infarction: a prospective analysis in the Alpha Omega Cohort

ABSTRACTBackgroundPopulation-based studies generally show neutral associations between dairy consumption and ischemic heart disease (IHD) mortality, whereas weak inverse associations were found for cardiovascular disease (CVD) and stroke mortality. Whether dairy consumption affects long-term survival after myocardial infarction (MI) is unknown.ObjectivesWe studied types of dairy and long-term mortality risk in drug-treated post-MI patients.MethodsWe included 4365 Dutch patients from the Alpha Omega Cohort aged 60–80 y (21% women) with an MI ≤10 y before enrollment. Dietary data were collected at baseline (2002–2006) using a 203-item FFQ and patients were followed for cause-specific mortality through December 2018. HRs of CVD, IHD, stroke, and all-cause mortality for types of dairy were obtained from Cox models, adjusting for age, sex, energy intake, physical activity, smoking, alcohol intake, diabetes, obesity, and dietary factors.ResultsMost patients were Dutch, 24% were obese, 20% had diabetes, and 97% used cardiovascular medication. Median intakes were 39 g/d for plain yogurt, 88 g/d for total nonfermented milk, and 17 g/d for hard cheeses. Of the cohort, 10% consumed high-fat milk. During ∼12 y of follow-up (48,473 person-years) 2035 deaths occurred, including 903 from CVD, 558 from IHD, and 170 from stroke. Yogurt was linearly inversely associated with CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99; per 25 g/d) and nonlinearly inversely associated with all-cause mortality. Milk was not associated with any of the outcomes (HRs: ∼1.0 per 100 g/d), except for a higher mortality risk in high-fat milk consumers (HR: 1.30; 95% CI: 1.13, 1.49). Other dairy groups were not associated with mortality risk.ConclusionsIn Dutch post-MI patients, yogurt consumption was inversely associated with CVD mortality and all-cause mortality. Associations for milk and other dairy products were neutral or inconsistent.This trial was registered at clinicaltrials.gov as NCT03192410.

Abstract P132: Potato Consumption And Risk Of Diabetes And Cardiovascular Mortality In The Alpha Omega Cohort

Introduction: Higher potatoes intake, especially French fries, was unfavorably associated with cardiometabolic endpoints in population-based studies. Little is known about this in coronary heart disease (CHD) patients. Hypothesis: Boiled potatoes and French fries intake might increase the risk of type 2 diabetes (T2D), cardiovascular disease (CVD) mortality and all-cause mortality after myocardial infarction (MI). Methods: We analyzed 3401 Dutch patients (60-80 y, 78% male) from the Alpha Omega Cohort, free from T2D, with an MI ≤ 10 y before enrolment. Diet was assessed at baseline (2002-2006) using a 203-item validated food frequency questionnaire, including potato preparation methods. T2D incidence (self-reported physician diagnosis and/or prescribed anti-diabetes medication) was monitored during the first 40 months of follow-up and cause-specific mortality through December 2018. Multivariable Cox models were used to obtain Hazard Ratios (HRs) for incident T2D and fatal endpoints in potato categories. Results: Patients had a median potato intake (mainly boiled) of 111 g/d (3.8 weekly servings of 200 g), with 6% consuming <1 serving per week. French fries were consumed by 48% of the patients (median: 6 g/d). Total potato intake was non-linearly associated with T2D risk during early follow-up (186 cases). Compared to 0-2 servings, HRs were 1.52 (0.97, 2.39) for 3-4 servings and 1.78 (1.10, 2.89) for ≥5 servings per week. During >12 y of follow-up (38,987 person-years) 1618 deaths occurred, of which 697 from CVD, 431 from CHD and 128 from stroke. HRs for fatal endpoints were non-significant in categories of total and boiled potatoes (Table). For French fries (consumers vs. non-consumers), HRs were 1.23 (0.89, 1.69) for T2D, 1.03 (0.87, 1.22) for fatal CVD and 0.93 (0.83, 1.04) for all-cause mortality. Conclusion: In Dutch post-MI patients, potatoes (mainly boiled) were neutrally associated with CVD and all-cause mortality. An increased risk of T2D was found for French fries, which warrants further study in CHD patient cohorts.

Abstract P061: Dairy Consumption, Dairy Fat Biomarkers And Type 2 Diabetes Risk After Myocardial Infarction

Introduction: Dairy consumption, especially yogurt, and circulating biomarkers of dairy fat (odd chain fatty acids, OCFAs), have been associated with a lower risk of type 2 diabetes (T2D) in population-based studies. Whether these associations are also present in post-myocardial infarction (MI) patients is unknown. Hypothesis: We hypothesized that dairy consumption and circulating OCFAs (pentadecanoic [15:0] plus heptadecanoic acid [17:0]) may be inversely associated with incident T2D after MI. Methods: We included 3347 Dutch post-MI patients from the Alpha Omega Cohort, who were initially free of T2D. At baseline (2002-2006), dairy consumption was estimated with a 203-item food frequency questionnaire and plasma OCFAs were measured in cholesteryl esters using gas chromatography. Incident T2D was ascertained through self-reported physician diagnosis and medication use. Multivariable Cox models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CI) for incident T2D and dairy types and OCFAs (per 1 standard deviation (SD) increment). Results: At baseline, patients were on average 68.9 years old (± 5.5 SD), 80% were men and 87% used statins (2684 and 2908 of 3347 patients respectively). During a median follow-up time of 40 months (10,550 person-years), 181 patients developed T2D. Almost all patients consumed dairy (3300 of 3347), with a median intake of 273 g/d for total dairy. After multivariable adjustment, dairy and its subtypes consumption was not associated with T2D incidence, with HRs ranging from 1.01 to 1.07 per 1-SD increment (all p> 0.05). When analysed in categories (highest vs lowest intake), HRs (95% CI) were 1.05 (0.73-1.52) for milk and 1.08 (0.77-1.51) for yoghurt intake. In line with these findings, no significant association was found for circulating OCFAs 0.97 (0.83-1.12)( Figure 1 ). Conclusion: Dairy consumption, based on self-report and plasma biomarkers, was neutrally associated with T2D incidence in a population of Dutch post-MI patients with a relatively high habitual dairy intake.

Abstract P039: No Beneficial Associations Between Dairy Products And Kidney Function After Myocardial Infarction

Introduction: Population-based studies showed beneficial associations between (low-fat) dairy products and kidney function. Kidney function declines with age, which is accelerated after myocardial infarction (MI). Little is known about dairy consumption and kidney function in MI patients. Hypothesis: Dairy intake may slow down kidney function decline after MI. Methods: We analysed 2,247 Dutch post-MI patients (60-80 years, 81% men) from the Alpha Omega Cohort. Dietary intakes, including types of dairy, were assessed at baseline (2002-2006) using a validated 203-item food frequency questionnaire. Glomerular filtration rate was estimated at baseline and after ~40 months, using the Chronic Kidney Disease (CKD) Epidemiology Collaboration equations for serum cystatin C alone (eGFR cysC , in ml/min per 1.73m 2 ). Associations between dairy intake and annual eGFR cysC change were obtained using multivariable linear regression models, adjusting for age, sex, lifestyle and dietary factors. Betas (β), with 95% confidence intervals (95% CI), represent additional eGFR cysC changes on top of annual decline, per increment in dairy intake. Results: At baseline, 22% was obese, 18% had diabetes and 15% had CKD (eGFR cysC <60). Median dairy intakes were 70 g/day for milk (62% consumed low-fat milk), 41 g/day for yogurt and 17 g/day for hard cheeses. The mean ± SD eGFR cysC at baseline was 82 ± 19, which on average declined by 3.42 ± 11.04, corresponding to an annual decline of 0.99 ± 3.21. Total milk consumption was not associated with annual eGFR cysC change in the multivariable model (β: 0.01 per 100 g/day, 95% CI: -0.08;0.10; Figure 1). Associations for hard cheeses (per 10 g/day) and yogurt (per 25 g/day) with eGFR cysC decline were also weak and non-significant. Sensitivity analyses in non-diabetic (n=1,843) or non-CKD patients (n=1,910) yielded similar results (Figure 1). Conclusions: Milk, hard cheeses and yogurt consumption were not associated with eGFR cysC decline in Dutch post-MI patients.

Plasma fatty acids and kidney function decline in post-myocardial infarction patients of the Alpha Omega Cohort

Background and aimsAge-related kidney function decline is accelerated in patients with coronary heart disease (CHD). CHD and chronic kidney disease may share common etiologies. We examined plasma fatty acids (FAs) as novel biomarkers of kidney function decline after myocardial infarction (MI). Methods and resultsThe analysis included 2329 Dutch post–MI patients aged 60-80y (Alpha Omega Cohort) most receiving state-of-the-art medications. Plasma FAs (% total FAs) in cholesteryl esters were assessed at baseline (2002–2006), and ∼40 months change in creatinine-cystatin C based glomerular filtration rate was estimated (eGFR, in ml/min per 1.73 m2). Beta coefficients for annual eGFR change in relation to plasma linoleic acid (LA; 50.1% of total FAs in CE), omega-3 FAs (EPA + DHA; 1.7%), odd-chain FAs (C15:0 and C17:0; 0.2%), and C14:0 (0.7%) were obtained from linear regression analyses adjusted for age, sex, smoking, and alcohol intake. Mean baseline eGFR ±SD was 78.5 ± 18.7, which declined by 4.7 ± 13.1 during follow-up, or 1.4 ± 3.9 per year. The annual decline in eGFR was less in patients with higher plasma LA (adjusted beta: 0.40 for LA >47 vs ≤ 47%, 95% CI: 0.01; 0.78; p = 0.046). Associations of plasma LA with annual eGFR decline were stronger in 437 patients with diabetes (1.21, 0.24; 2.19) and in 402 patients with CKD (eGFR<60; 0.90, −0.09; 1.89). Weaker, non-significant associations with kidney function decline were observed for the other plasma FAs. ConclusionHigher plasma LA may be a good predictor of less kidney function decline after MI, particularly in patients with diabetes.The Alpha Omega Cohort is registered with clinicaltrials.gov, NCT03192410.

Plasma fatty acids and kidney function decline: a prospective analysis of the alpha omega cohort

Rationale: Kidney function declines with ∼1.0 ml/min/1.73m2 after age 40y, but is doubled in post-myocardial infarction (MI) patients. Alterations in plasma fatty acid (FA) composition have been observed, therefore we studied wether higher plasma FAs may delay kidney function decline in post-MI patients.

Abstract P522: Alcohol Consumption and Cardiovascular Mortality After Myocardial Infarction

Background: Little is known about alcohol consumption in relation to long-term mortality risk after myocardial infarction (MI). We examined alcohol consumption in relation to total, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality in the Alpha Omega Cohort of Dutch post-MI patients. Methods: We included 4,365 patients (60-80y, 79% male) with MI ≤10y before enrolment. Heavy alcohol users (≥6 glasses/d) were excluded from cohort participation. Dietary intake and alcohol consumption were assessed using a 203-item validated food-frequency questionnaire. Patients were classified as non-drinkers (0 g/d, n=956), very light (&gt;0-≤2 g/d, n=385), light (M: &gt;2-≤10, F: &gt;2-≤5 g/d, n=1,125), moderate (M: &gt;10-≤30, F: &gt;5-≤15 g/d, n=1,207) or heavy drinkers (M :&gt;30, F: &gt;15 g/d, n=692). Hazard ratios (HRs) for total, CHD and CVD mortality were obtained, adjusting for age, sex, education, smoking, BMI, physical activity, energy intake and other dietary factors. Results: Alcohol was consumed by 83% of men and 61% of women. During 11.1y follow up, 2,035 deaths occurred of which 575 from CHD and 801 from CVD. Compared to the reference group of very light drinkers, HRs (95%CI) for total mortality were 1.01 (0.85, 1.19) in non-drinkers, and 0.88 (0.74, 1.04), 0.85 (0.72, 1.01) and 0.91 (0.76, 1.10) in light, moderate and heavy drinkers respectively. Adding non-drinkers to the reference group did not affect HRs: 0.87 (0.78, 0.98), 0.85 (0.76, 0.96) and 0.91 (0.79, 1.05) for light, moderate and heavy drinkers. Associations were slightly stronger but non-significant for CVD and CHD mortality. Findings were roughly similar after exclusion of former drinkers (n=385), diabetics (n=883) and patients with poor health (n=1,010). Conclusion: Light to moderate alcohol consumption was weakly inversely associated with total, CVD and CHD mortality risk in post-MI patients. In this observational study, potential bias and confounding cannot be ruled out and findings should be interpreted cautiously in light of the totality of evidence.

Plasma and Dietary Linoleic Acid and 3-Year Risk of Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort.

To study plasma and dietary linoleic acid (LA) in relation to type 2 diabetes risk in post-myocardial infarction (MI) patients. We included 3,257 patients aged 60-80 years (80% male) with a median time since MI of 3.5 years from the Alpha Omega Cohort and who were initially free of type 2 diabetes. At baseline (2002-2006), plasma LA was measured in cholesteryl esters, and dietary LA was estimated with a 203-item food-frequency questionnaire. Incident type 2 diabetes was ascertained through self-reported physician diagnosis and medication use. Hazard ratios (with 95% CIs) were calculated by Cox regressions, in which dietary LA isocalorically replaced the sum of saturated (SFA) and trans fatty acids (TFA). Mean ± SD circulating and dietary LA was 50.1 ± 4.9% and 5.9 ± 2.1% energy, respectively. Plasma and dietary LA were weakly correlated (Spearman r = 0.13, P < 0.001). During a median follow-up of 41 months, 171 patients developed type 2 diabetes. Plasma LA was inversely associated with type 2 diabetes risk (quintile [Q]5 vs. Q1: 0.44 [0.26, 0.75]; per 5%: 0.73 [0.62, 0.86]). Substitution of dietary LA for SFA+TFA showed no association with type 2 diabetes risk (Q5 vs. Q1: 0.78 [0.36, 1.72]; per 5% energy: 1.18 [0.59, 2.35]). Adjustment for markers of de novo lipogenesis attenuated plasma LA associations. In our cohort of post-MI patients, plasma LA was inversely related to type 2 diabetes risk, whereas dietary LA was not related. Further research is needed to assess whether plasma LA indicates metabolic state rather than dietary LA in these patients.

Associations of dairy and fiber intake with circulating odd-chain fatty acids in post-myocardial infarction patients

BackgroundCirculating odd-chain fatty acids pentadecanoic (15:0) and heptadecanoic acid (17:0) are considered to reflect dairy intake. In cohort studies, higher circulating 15:0 and 17:0 were associated with lower type 2 diabetes risk. A recent randomized controlled trial in humans suggested that fiber intake also increased circulating 15:0 and 17:0, potentially resulting from fermentation by gut microbes. We examined the associations of dairy and fiber intake with circulating 15:0 and 17:0 in patients with a history of myocardial infarction (MI).MethodsWe performed cross-sectional analyses in a subsample of 869 Dutch post-MI patients of the Alpha Omega Cohort who had data on dietary intake and circulating fatty acids. Dietary intakes (g/d) were assessed using a 203-item food frequency questionnaire. Circulating 15:0 and 17:0 (as % of total fatty acids) were measured in plasma phospholipids (PL) and cholesteryl esters (CE). Spearman correlations (rs) were computed between intakes of total dairy, dairy fat, fiber, and circulating 15:0 and 17:0.ResultsPatients were on average 69 years old, 78% was male and 21% had diabetes. Total dairy intake comprised predominantly milk and yogurt (69%). Dairy fat was mainly derived from cheese (47%) and milk (15%), and fiber was mainly from grains (43%). Circulating 15:0 in PL was significantly correlated with total dairy and dairy fat intake (both rs = 0.19, p < 0.001), but not with dietary fiber intake (rs = 0.05, p = 0.11). Circulating 17:0 in PL was correlated both with dairy intake (rs = 0.14 for total dairy and 0.11 for dairy fat, p < 0.001), and fiber intake (rs = 0.19, p < 0.001). Results in CE were roughly similar, except for a weaker correlation of CE 17:0 with fiber (rs = 0.11, p = 0.001). Circulating 15:0 was highest in those with high dairy intake irrespective of fiber intake, while circulating 17:0 was highest in those with high dairy and fiber intake.ConclusionsIn our cohort of post-MI patients, circulating 15:0 was associated with dairy intake but not fiber intake, whereas circulating 17:0 was associated with both dairy and fiber intake. These data suggest that cardiometabolic health benefits previously attributed to 17:0 as a biomarker of dairy intake may partly be explained by fiber intake.

Abstract P034: Circulating Odd-Chain Fatty Acids in Relation to Intake of Dairy and Fiber in Post-Myocardial Infarction Patients

Background: Odd-chain fatty acids (OCFA) pentadecanoic (15:0) and heptadecanoic acid (17:0) are considered to reflect dairy intakes in studies on cardiometabolic outcomes. A recent randomized controlled trial on dietary fiber showed that circulating proportions of these OCFA may also be related to fiber intake, which may result from fermentation by gut microbes. Objective: To examine the associations between circulating OCFA and dairy and fiber intake in patients with a history of myocardial infarction. Methods: We performed cross-sectional analyses in a subsample of 896 Dutch post-MI patients of the Alpha Omega Cohort. Proportions of OCFA (as % of total fatty acids) were measured in plasma phospholipids (PL) and cholesterol esters (CE). Dietary intakes (g/d) were assessed using a 203-item validated food frequency questionnaire. Spearman correlations ( r ) were computed between circulating OCFA in PL and CE and intakes of total dairy, types of dairy products, dietary fiber and total meat. Results: Patients were on average 69 years old, 78% was male and 89% used statins. Dairy intake was predominantly from milk and yogurt. PL 15:0 was positively correlated with total dairy intake ( r =0.16, p&lt;0.001; Table 1), especially yogurt. PL 15:0 was not correlated with dietary fiber ( r =0.01, p=0.75). For CE 15:0, correlations were similar. PL 17:0 was positively correlated with total dairy ( r =0.15, p&lt;0.001), but also with dietary fiber ( r =0.13, p&lt;0.001). For CE 17:0 similar correlations were observed, although somewhat weaker (dairy: r =0.10, p=0.003; fiber: r =0.09, p=0.009). OCFA were not significantly correlated with meat intake. Conclusions: Plasma PL 15:0 and CE 15:0 were related to dairy and not to fiber intake. PL 17:0 and CE 17:0 were equally related to dairy and fiber intake. Cardiometabolic health benefits attributed to biomarkers of dairy intake, especially 17:0, may be (partly) attributable to fiber intake. Further research is needed into endogenous OCFA synthesis as a result of fermentation of dietary fiber by gut microbes.

Dietary protein intake and kidney function decline after myocardial infarction: the Alpha Omega Cohort.

BackgroundPost-myocardial infarction (MI) patients have a doubled rate of kidney function decline compared with the general population. We investigated the extent to which high intake of total, animal and plant protein are risk factors for accelerated kidney function decline in older stable post-MI patients.MethodsWe analysed 2255 post-MI patients (aged 60–80 years, 80% men) of the Alpha Omega Cohort. Dietary data were collected with a biomarker-validated 203-item food frequency questionnaire. At baseline and 41 months, we estimated glomerular filtration rate based on the Chronic Kidney Disease Epidemiology Collaboration equations for serum cystatin C [estimated glomerular filtration rate (eGFRcysC)] alone and both creatinine and cystatin C (eGFRcr–cysC).ResultsMean [standard deviation (SD)] baseline eGFRcysC and eGFRcr–cysC were 82 (20) and 79 (19) mL/min/1.73 m2. Of all patients, 16% were current smokers and 19% had diabetes. Mean (SD) total protein intake was 71 (19) g/day, of which two-thirds was animal and one-third plant protein. After multivariable adjustment, including age, sex, total energy intake, smoking, diabetes, systolic blood pressure, renin–angiotensin system blocking drugs and fat intake, each incremental total daily protein intake of 0.1 g/kg ideal body weight was associated with an additional annual eGFRcysC decline of −0.12 (95% confidence interval −0.19 to −0.04) mL/min/1.73 m2, and was similar for animal and plant protein. Patients with a daily total protein intake of ≥1.20 compared with <0.80 g/kg ideal body weight had a 2-fold faster annual eGFRcysC decline of −1.60 versus −0.84 mL/min/1.73 m2. Taking eGFRcr–cysC as outcome showed similar results. Strong linear associations were confirmed by restricted cubic spline analyses.ConclusionA higher protein intake was significantly associated with a more rapid kidney function decline in post-MI patients.

Circulating n-3 fatty acids and linoleic acid as indicators of dietary fatty acid intake in post-myocardial infarction patients

Background and aimsPopulation-based studies often use plasma fatty acids (FAs) as objective indicators of FA intake, especially for n-3 FA and linoleic acid (LA). The relation between dietary and circulating FA in cardiometabolic patients is largely unknown. We examined whether dietary n-3 FA and LA were reflected in plasma lipid pools in post-myocardial infarction (MI) patients. Methods and resultsPatients in Alpha Omega Cohort filled out a 203-item food-frequency questionnaire from which eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), and LA intake were calculated. Circulating individual FA (% total FA) were assessed in cholesteryl esters (CE; n = 4066), phospholipids (PL; n = 838), and additionally in total plasma for DHA and LA (n = 739). Spearman correlation coefficients (rs) were calculated for dietary vs. circulating FA. Circulating FA were also compared across dietary FA quintiles, overall and in subgroups by sex, obesity, diabetes, statin use, and high alcohol intake.Patients were on average 69 years old and 79% was male. Moderate correlations between dietary and circulating levels were observed for EPA (rs∼0.4 in CE and PL) and DHA (rs ∼0.5 in CE and PL, ∼0.4 in total plasma), but not for ALA (rs ∼0.0). Weak correlations were observed for LA (rs 0.1 to 0.2). Plasma LA was significantly lower in statin users and in patients with a high alcohol intake. ConclusionsIn post-MI patients, dietary EPA and DHA were well reflected in circulating levels. This was not the case for LA, which may partly be influenced by alcohol use and statins.

Abstract P215: Plasma and Dietary Linoleic Acid and Diabetes Incidence After Myocardial Infarction

Background: Plasma linoleic acid (C18:2n-6, LA) has been associated with a lower risk of type 2 diabetes mellitus (T2DM) in prospective cohort studies, but associations of dietary LA with T2DM risk are inconsistent. Objective: To study both plasma and dietary LA in relation to incident T2DM in post-myocardial infarction (MI) patients who received state-of-the-art drug treatment. Methods: We included 3,377 patients (80% male) from the Alpha Omega Cohort aged 60-80 y who had an MI &lt;10 y before study enrollment and who were initially free of T2DM. At baseline, LA was measured in plasma cholesterol esters as a proportion of total fatty acids. Dietary LA intake was estimated from a validated 203-item food-frequency questionnaire that had been specifically designed for measuring fatty acid intake. Incident T2DM was ascertained through self-reported physician diagnosis and medication use. HRs for incident T2DM in quintiles of plasma LA and dietary LA were obtained from multivariable Cox models that included age, sex, lifestyle and dietary factors. For dietary LA, we used a substitution model in which LA was iso-calorically replaced with the sum of saturated plus trans fatty acids. Results: From the lowest to the highest quintile, dietary LA ranged from 3.5 to 8.8 percent of energy and the proportion of plasma LA ranged from 43.7 to 56.3%. Plasma and dietary LA were weakly correlated (Spearman r = 0.14, P &lt;.0001). During a median follow-up of 3.4 years, 171 cases of T2DM occurred. Plasma LA was associated with a significantly lower risk of T2DM (HR Q5vsQ1 : 0.45; 95% CI: 0.27 - 0.76; P for trend = 0.002). Dietary LA was not associated with T2DM risk (HR Q5vsQ1: 0.97; 95% CI: 0.53 - 1.76; P for trend = 0.85). Conclusion: Plasma LA but not dietary LA was associated with lower T2DM risk in post-MI patients. The utility of plasma LA as a biomarker of dietary LA warrants further investigation.

Abstract P227: Circulating and Dietary Linoleic Acid and Prevalent Diabetes in Post-Myocardial Infarction Patients

Background: Circulating linoleic acid 18:2n-6 (LA) has been considered to reflect LA intake, but its utility as a dietary biomarker could be affected by metabolism. Objective: To study the associations of plasma and dietary LA with T2D prevalence in drug-treated patients with a history of myocardial infarction (MI). Methods: Cross-sectional analysis of baseline data in 4,072 Dutch post-MI patients of the Alpha Omega Cohort. Circulating LA (as % of total fatty acids) was assessed in plasma cholesterol esters (CE) in the total cohort and in plasma phospholipids (PL) in a random subset of 833 patients. LA intake was assessed by a 203-item validated food frequency questionnaire. Prevalence ratios of T2D and associations with metabolic parameters were estimated in plasma and dietary LA quintiles using multivariable generalized linear models adjusted for demographic, lifestyle and dietary factors. Results: Patients were on average 69 years old, 79% was male and 77% were overweight or obese. Most patients used statins (86%), antihypertensive drugs (90%) and antiplatelet drugs (84%). A total of 813 patients (20%) had T2D. Mean LA intake (±SD) was 5.7±2.2 energy%, and circulating LA was 49.9±5.0% in CE and 18.7±3.0% in PL. Spearman’s correlations of dietary LA with circulating LA in CE and PL were 0.16 and 0.10, respectively. Higher plasma LA, but not dietary LA, was significantly associated with a lower diabetes prevalence (Table 1). BMI (β= -0.07, p&lt;0.001), log non-fasting triglycerides (β= -0.01, p&lt;0.001), log non-fasting glucose (β= -0.01, p&lt;0.001), and log alcohol intake (β= -0.03, p&lt;0.001) were significantly associated with circulating LA in plasma CE. Similar associations were found for LA in plasma PL. Dietary LA was not significantly associated with T2D prevalence and metabolic parameters (all p&gt;0.05). Conclusions: Circulating LA may reflect both LA intake and metabolic state in drug-treated post-MI patients. This bears restrictions for its use as a biomarker of dietary LA intake in epidemiological studies.

Cardiovascular Risk Factors Accelerate Kidney Function Decline in Post−Myocardial Infarction Patients: The Alpha Omega Cohort Study

IntroductionImpaired kidney function is a robust risk factor for cardiovascular mortality. Age-related annual kidney function decline of 1.0 ml/min per 1.73 m2 after age 40 years is doubled in post−myocardial infarction (MI) patients.MethodsWe investigated the impact of the number of cardiovascular risk factors (including unhealthy lifestyle) on annual kidney function decline, in 2426 post-MI patients (60−80 years) of the prospective Alpha Omega Cohort study. Glomerular filtration rate was estimated by serum cystatin C (eGFRcysC) and combined creatinine−cystatin C (eGFRcr-cysC), using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations from 2012. Data were analyzed by multivariable linear and logistic regression.ResultsAt baseline, mean (SD) eGFRcysC and eGFRcr-cysC were 81.5 (19.6) and 78.5 (18.7) ml/min per 1.73 m2, respectively. Of all patients, 79% were men, 19% had diabetes, 56% had high blood pressure (≥140/90 mm Hg), 16% were current smokers, 56% had high serum low-density lipoprotein (LDL of ≥2.5 mmol/l), and 23% were obese (body mass index of ≥30.0 kg/m2). After multivariable adjustment, the additional annual eGFRcysC decline (95% confidence interval) was as follows: in patients with versus without diabetes, −0.90 (−1.23 to −0.57) ml/min per 1.73 m2; in patients with high versus normal blood pressure, −0.50 (−0.76 to −0.24) ml/min per 1.73 m2; in obese versus nonobese patients, −0.31 (−0.61 to 0.01) ml/min per 1.73 m2; and in current smokers versus nonsmokers, −0.19 (−0.54 to 0.16) ml/min per 1.73 m2. High LDL was not associated with accelerated eGFRcysC decline. Similar results were obtained with eGFRcr-cysC.ConclusionIn older, stable post-MI patients without cardiovascular risk factors, the annual kidney function decline was −0.90 (−1.16 to −0.65) ml/min per 1.73 m2. In contrast, in post-MI patients with ≥3 cardiovascular risk factors, the annual kidney function decline was 2.5-fold faster, at −2.37 (−2.85 to −1.89) ml/min per 1.73 m2.

Body-fat indicators and kidney function decline in older post-myocardial infarction patients: The Alpha Omega Cohort Study.

BackgroundObesity increases risk of hypertension and diabetes, the leading causes of end-stage renal disease. The effect of obesity on kidney function decline in stable post-myocardial infarction patients is poorly documented. This relation was investigated in a large cohort of older post-myocardial infarction patients.DesignData were analysed from 2410 post-myocardial infarction patients in the Alpha Omega Trial, aged 60–80 years receiving optimal pharmacotherapy treatment (79% men, 18% diabetes).MethodsCystatin C based estimated glomerular filtration rate (eGFRcysC) was calculated at baseline and after 41 months, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Obesity was defined as body mass index ≥ 30 kg/m2 and high waist circumference as ≥102 and ≥88 cm for men and women. The relation between body mass index, waist circumference and annual eGFRcysC decline was evaluated by linear regression.ResultsAt baseline, mean (standard deviation) eGFRcysC was 81.5 (19.6) ml/min/1.73 m2, 23% of all patients were obese. After multivariable adjustment, the annual mean (95% confidence interval) eGFRcysC decline in men and women was –1.45 (–1.59 to –1.31) and –0.92 (–1.20 to –0.63) ml/min/1.73 m2, respectively (p = 0.001). Obese versus non-obese patients and patients with high versus normal waist circumference experienced greater annual eGFRcysC decline. Men and women showed an additional annual eGFRcysC decline of –0.35 (–0.56 to –0.14) and –0.21 (–0.55 to 0.14) ml/min/1.73 m2 per 5 kg/m2 body mass index increment (p for interaction 0.3).ConclusionsHigh compared to normal body mass index or waist circumference were associated with more rapid kidney function decline in older stable post-myocardial infarction patients receiving optimal drug therapy.

Dietary patterns and mental health after myocardial infarction.

BackgroundDiet has been associated with better mental health in general populations, but less is known on this association in patients with a history of coronary heart disease.The objective of this study is to examine the cross-sectional associations between dietary patterns and mental health in elderly patients with a history of myocardial infarction.MethodsData were drawn from the final assessment of the Alpha Omega cohort that monitored patients with a history of myocardial infarction (age range 60–80 years). 2171 patients with complete data for diet and mental health were included in this study. Diet was assessed with the 203-item Food Frequency Questionnaire, and subsequently categorized into two scores: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). Depressive symptoms, assessed with the Geriatric Depression Scale (GDS-15), and dispositional optimism, assessed with the 4-item questionnaire (4Q), were cross-sectionally analyzed in relation to dietary patterns using linear regression analysis.ResultsPatients were on average 72.2 years old and 79.5% were male. The DHNaFS score was associated with less depressive symptoms and higher dispositional optimism (β = -0.108; P<0.001; and β = 0.074; P<0.001), whereas no associations were found with the DUNaFS score. Particularly, consumption of vegetables, fruits, whole grains, fish, and low fat-dairy were associated with less depressive symptoms and higher optimism. Similar associations were found when analyzing the association between average DHNaFS score over the preceding 41 months with depression β = -0.085; P<0.001) and higher dispositional optimism (β = 0.084; P<0.001).ConclusionsA healthy dietary pattern, in particular a higher consumption of vegetables, fruit, whole grains, fish and low-fat dairy, was associated with less depressive symptoms and higher optimism. However, given the cross-sectional nature of our analyses, our findings may also be explained by more optimistic participants making healthier food choices. Therefore, future prospective or interventions studies are needed to establish the direction of causality of this association.Trial registrationClinicalTrials.gov NCT03192410.