EPIC Food Frequency Questionnaire Research Articles

A nutrigenetic precision approach for the management of non-alcoholic fatty liver disease

The Patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 single nucleotide polymorphism (SNP) is one of the major genetic determinant of non-alcoholic fatty liver disease (NAFLD) and is strongly regulated by changes in energy balance and dietary factors. We aimed to investigate the association between the PNPLA3 rs738409 SNP, nutrient intake and NAFLD severity. PNPLA3-rs738409 SNP was genotyped in 181 patients with NAFLD who completed the EPIC Food Frequency Questionnaire. Liver steatosis was evaluated by Controlled Attenuation Parameter (CAP) (Fibroscan®530, Echosens). According to the established cut-off, a CAP value≥300dB/m was used to identify severe steatosis (S3). An independent group of 46 biopsy-proven NAFLD subjects was used as validation cohort. Overall, median age was 53 years (range 44; 62) and 60.2% of patients were male. Most subjects (56.3%) had S3 and showed increased liver stiffness (p<0.001), AST (p=0.003) and ALT levels (p<0.001) compared to those with CAP<300dB/m. At logistic regression analyses we found that the interaction between carbohydrates intake and the carriers of the PNPLA3 G risk allele was significantly associated with S3 (p=0.001). The same result was confirmed in the validation cohort, were the interaction between high carbohydrate intake (48%) and PNPLA3 SNP was significantly associated with steatosis ≥33% (p=0.038). The intake of greater than or equal to 48% carbohydrate in NAFLD patients carriers of the CG/GG allele of PNPLA3 rs738409 may increase the risk of significant steatosis.

How Does Dietary Intake Relate to Dispositional Optimism and Health-Related Quality of Life in Germline BRCA1/2 Mutation Carriers?

Background: The Mediterranean diet (MD) is an anti-inflammatory diet linked to improved health-related quality of life (HRQoL). Germline (g)BRCA1/2 mutation carriers have an increased risk of developing breast cancer and are often exposed to severe cancer treatments, thus the improvement of HRQoL is important. Little is known about the associations between dietary intake and HRQoL in this population. Methods: We included 312 gBRCA1/2 mutation carriers from an ongoing prospective randomized controlled lifestyle intervention trial. Baseline data from the EPIC food frequency questionnaire was used to calculate the dietary inflammatory index (DII), and adherence to MD was captured by the 14-item PREDIMED questionnaire. HRQoL was measured by the EORTC QLQ-C30 and LOT-R questionnaires. The presence of metabolic syndrome (MetS) was determined using anthropometric measurements, blood samples and vital parameters. Linear and logistic regression models were performed to assess the possible impact of diet and metabolic syndrome on HRQoL. Results: Women with a prior history of cancer (59.6%) reported lower DIIs than women without it (p = 0.011). A greater adherence to MD was associated with lower DII scores (p < 0.001) and reduced odds for metabolic syndrome (MetS) (p = 0.024). Women with a more optimistic outlook on life reported greater adherence to MD (p < 0.001), whereas a more pessimistic outlook on life increased the odds for MetS (OR = 1.15; p = 0.023). Conclusions: This is the first study in gBRCA1/2 mutation carriers that has linked MD, DII, and MetS to HRQoL. The long-term clinical implications of these findings are yet to be determined.

Diet quality, sleep and quality of life in Parkinson’s disease: a cross-sectional study

BackgroundParkinson’s disease (PD) is a neurodegenerative disorder characterised by motor and non-motor symptoms that impact quality of daily life, including diet and sleep. However, relatively little is known about dietary intake and quality in people with PD (PwP). Lifestyle factors, and how they relate to diet, are also insufficiently understood.The aims of this study were to investigate dietary intake and quality, sleep and quality of life in PwP, and to explore the relationships between these factors.MethodsForty-five community-dwelling participants with PD (n = 45) were recruited to this cross-sectional study through the Cork Parkinson’s Association, Ireland. Dietary intake was assessed using the EPIC food frequency questionnaire, and diet quality was assessed using the Healthy Diet Indicator. Dietary intakes were compared to Irish RDAs for adults > 65 years. Sleep duration and quality were subjectively measured using the PD Sleep Scale and Pittsburgh sleep quality index and objectively measured by actigraphy in a subset of participants (n = 27). QOL was measured using the validated PDQ-39 questionnaire.ResultsEnergy intake in PwP was significantly higher than that of the general population (2013 vs 1755 kcal/d, p = 0.01), despite their lower mean BMI (25.9 vs 27.7 kg/m2, p = 0.02). Intakes of carbohydrate, protein and fruits and vegetables were significantly higher in PwP compared to recommended and population intakes (all p < 0.01), but fibre intake was significantly lower than recommended (17.3 vs 25 g/d, ple 0.05). Seventy-eight percent of participants had poor dietary quality, and poor sleep quality was associated with poor QOL.ConclusionsCarbohydrates, protein, fruit and vegetable intakes were greater in PwP than population norms, but overall diet quality was low. Interventions to improve dietary and lifestyle factors may improve health and QOL in PwP.

Fine-grained investigation of the relationship between human nutrition and global DNA methylation patterns.

Nutrition is an important, modifiable, environmental factor affecting human health by modulating epigenetic processes, including DNA methylation (5mC). Numerous studies investigated the association of nutrition with global and gene-specific DNA methylation and evidences on animal models highlighted a role in DNA hydroxymethylation (5hmC) regulation. However, a more comprehensive analysis of different layers of nutrition in association with global levels of 5mC and 5hmC is lacking. We investigated the association between global levels of 5mC and 5hmC and human nutrition, through the stratification and analysis of dietary patterns into different nutritional layers: adherence to Mediterranean diet (MD), main food groups, macronutrients and micronutrients intake. ELISA technique was used to measure global 5mC and 5hmC levels in 1080 subjects from the Moli-sani cohort. Food intake during the 12months before enrolment was assessed using the semi-quantitative EPIC food frequency questionnaire. Complementary approaches involving both classical statistics and supervised machine learning analyses were used to investigate the associations between global 5mC and 5hmC levels and adherence to Mediterranean diet, main food groups, macronutrients and micronutrients intake. We found that global DNA methylation, but not hydroxymethylation, was associated with daily intake of zinc and vitamin B3. Random Forests algorithms predicting 5mC and 5hmC through intakes of food groups, macronutrients and micronutrients revealed a significant contribution of zinc, while vitamin B3 was reported among the most influential features. We found that nutrition may affect global DNA methylation, suggesting a contribution of micronutrients previously implicated as cofactors in methylation pathways.

Relative Validity of an Italian EPIC Food Frequency Questionnaire for Dietary Factors in Children and Adolescents. A Rizzoli Orthopedic Institute Study.

Dietary factors play a major role in the development of non-communicable diseases, however little is known regarding the impact of nutrition on rare diseases like sarcomas. This Rizzoli Orthopedic Institute study aimed to evaluate the relative validity of a Food Frequency Questionnaire (FFQ) to measure the consumption of foods in comparison with a 3-days diary diet in a healthy Italian student population aged between 12 and 17 years. An extended version (including food groups for children) of the semi-quantitative FFQ used in the European Prospective Investigation into Cancer and Nutrition (EPIC) was administered. The validity of the FFQ was assessed by comparing the intakes from the FFQ against the 3-day diary method. 254 Italian subjects were included in the analyses: 128 females; 126 males; 116 from High Secondary School (14–17 years); 138 from Low Secondary School (12–13 years). Mean and median intakes are overall higher in the FFQs than in the food diaries. Spearman correlations adjusted for within-person variability were highest for legumes, vegetables and coffee/tea (>0.5), followed by potatoes, meat, fruits, breakfast cereals, biscuits and candies, and milk/yoghurts (>0.4). Moderate correlations were found for alcoholic drinks, soft drinks, juices, and grains (>0.3). For some food groups, such as fish, potatoes, and bread, correlations tend to become higher when stratifying the analyses for age group. These results demonstrate that the adapted EPIC COS FFQ validated in Italian adults is also appropriate and well understood by Italian children and adolescents.

Do people change their diet after colorectal adenoma diagnosis?

AbstractColorectal cancer (CRC) is the fourth most common cancer in the UK; 95% of CRCs develop from colorectal adenomas. Adults in England aged 60–74 years are screened for colorectal cancer through the national Bowel Cancer Screening Programme (BCSP) which aims to detect colorectal cancer early, and also remove colorectal adenomas. However, adenoma recurrence is common. The World Cancer Research Fund (WCRF) estimates that around 45% of CRC cases could be prevented by a healthy lifestyle. There are no specific dietary guidelines to protect against adenoma recurrence and patients do not receive dietary advice in the care pathway. Nonetheless understanding the dietary intake of people with adenoma who are at high-risk of developing CRC and their subsequent dietary behaviour post-diagnosis may design future intervention strategies.This study aims to describe the diet of colorectal adenoma patients and evaluate whether there were elective changes in diet following diagnosis.The data used in this study were obtained from colorectal adenoma patients at high risk of recurrence, recruited to the seAFOod polyp prevention trial through the English BCSP. Dietary intake was assessed using the EPIC Food Frequency Questionnaire at two time points: during the 12 months before and during the 12 months after adenoma diagnosis. FETA dietary analysis software was used to extract data. Paired Sample-T-Tests and Wilcoxon Signed-Rank Test were used to assess change in intake using SPSS version 25.Of the 709 patients recruited to the main study, 526 completed the FFQ on both occasions, of whom 81.7% were males. The mean age was 65 years (SD 4.8), 83.4% were overweight or obese with mean BMI = 29.5 kg/m2 (SD 5.7). The majority of nutrient intakes met UK DRVs, with the exception of low intake of fibre, vitamin D and selenium. Following diagnosis, a significant reduction was detected in daily intake of energy (from 7.7 to 7.5 MJ, p &lt; 0.05) meat and meat products (from 124 to 111 g, p &lt; 0.005), non-alcoholic beverages (from 939 to 898 g, p &lt; 0.05) and nuts (from 5.5 to 4.3 g, p &lt; 0.05). Subgroup analysis revealed that dietary changes were confined to men where the reduction in energy was by 293 kj/day and in meat by 1.5 portions per week.Patients do modify diet following a diagnosis of adenoma and changes correspond to WCRF healthy diet guidelines. Whether detected difference between males and females was due to the sample size or due to actual difference in behavior is not clear.

Influence of the Mediterranean diet on the production of short-chain fatty acids in women at risk for breast cancer (LIBRE)

AbstractBackground: A number of small intervention studies suggested that a Mediterranean diet (MedD) and physical activity can lower the risk for breast cancer. LIBRE is the first large multicenter RCT to test the effect of these lifestyle factors on the incidence of breast cancer in women at risk because of BRCA mutations(1). LIBRE also offers to unravel underlying mechanisms such as the role of short-chain fatty acids (SCFA) for beneficial effects of such lifestyle interventions.Methods: We examined the effect of the lifestyle intervention on the production of SCFA measured in feces by gas chromatography. From the ongoing LIBRE trial we included all complete datasets (171 women; mean age 44 ± 11 years). Both women with and without previous breast cancer diagnosis were recruited (diseased; non-diseased). The participants were randomized into an intervention group (IG) trained for MedD and physical activity, and a usual care control group (CG). Adherence to the MedD was assessed at baseline and after 3 months (V1) using the validated Mediterranean Diet Adherence Screener (MEDAS) and the EPIC food frequency questionnaire (FFQ).Results: At baseline there was no difference in SCFA levels between the groups. In the IG the MEDAS score increased substantially by 2.5 points (p &lt; 0.001), in the CG only mildly by 0.4 points (p &lt; 0.05). Correspondingly, the intake of fibers increased solely in the IG. In the course of the study the amount of caproic acid decreased in the control group (p &lt; 0.001). At V1 non-diseased women showed higher amounts of acetic acid (p = 0.042), n-butyric acid (p = 0.023), n-valeric acid (p = 0.018) and iso-valeric acid (p = 0.031). There were several correlations between the intake of different fibers and fecal SCFA. For example, the sum of poly- and oligosaccharides correlated with acetic acid (p = 0.001; r = 0.316), propionic acid (p = 0.034; r = 0,251), n-butyric acid (p = 0.010; r = 0.316) and iso-valeric acid (p = 0.012; r = 0.306). There was no correlation between the MEDAS and SCFA.Discussion: A lifestyle change towards a MedD and increased physical activity did not change the levels of SCFA in feces, although an increase of fiber intake was documented in the IG. To further analyze SCFA metabolism in this target population, gut microbiota composition and function (metabolites) are currently analyzed.

Personalised nutrition advice delivered online or face-to-face is more effective at motivating healthier dietary choices than generalised advice in Kuwait

AbstractIntroductionThe adoption of poor dietary and lifestyle habits have been associated with the development of non-communicable disease. The majority of strategies implemented to enhance dietary quality of individuals follow a “one size fits all” standardised approach. Results of recent trials have suggested that Personalised Nutrition (PN), tailored to individual requirements, is able to improve dietary intakes, yet limited focus has been given to the effectiveness of face-to-face compared with online methods. The aim of the EatWellQ8 randomised control trial (RCT) was to assess the impact of web-based PN advice, face-to-face PN advice and standardised advice, on adherence to healthy eating in Kuwait.Materials and MethodsFree living adults aged 21–65 years, were recruited for the 12-week study and randomised to; face-to-face PN, web-based PN or generalised (control) advise groups. Dietary intake and self-reported anthropometric measurements were assessed at baseline, 6 and 12 weeks. A validated food frequency questionnaire (FFQ) modified from the EPIC FFQ was used to assess food and nutrient intake. Diet quality was assessed by a 10-component modified Alternative Healthy Eating Index (m-AHEI) which was used to generate the PN advice. At 0 and 12-weeks post FFQ completion, participants randomised to the PN intervention groups were presented with 3 tailored dietary messages based on the m-AHEI components that received the lowest scores.Results320 participants completed the trial. Due to over/underreporting, 100 were included in the analysis (71% female, 29% male) with a mean age of 38.6 years (SD 14.3), and body mass index (BMI) of 25.1 kg/m2 (SD 4.2). After 12-weeks intervention, m-AHEI scores increased significantly in both PN intervention groups (face-to-face PN 19%, web-based 12%) compared to controls (4%) (P &lt; 0.01) and significantly higher intakes of vegetables and fruits, and lower intakes of sugars compared with controls (P &lt; 0.05). The PN intervention groups also significantly increased their intakes of omega 3 fatty acids and total folate compared with the control group (P &lt; 0.05). The Face-to-face PN group significantly reduced weight (-1.9 kg) and BMI (-0.5 kg/m2) compared to web-based PN and control groups(P &lt; 0.01).DiscussionIn adults living in Kuwait, PN advice, delivered face-to-face or online, was more effective at improving dietary quality than population-based advice. Face-to-face PN was found to be more effective at inducing weight-loss in adults compared to web-based PN and population-based advice.

Egg consumption and risk of total and cause-specific mortality in a Mediterranean population

Abstract Background The relation between egg intake and health outcomes is controversial. We aimed to evaluate the association of egg consumption and risk of mortality in a large sample of an adult Mediterranean population. Methods We prospectively analyzed 22,849 men and women aged ≥35 y, recruited within the Moli-sani Study (2005-2010). Dietary data were collected by the EPIC food frequency questionnaire, egg intake was expressed as g/d and used as ordered quintiles. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression and competing risk models. Results Over a median follow up of 8.2 y, a total of 1,237 deaths were ascertained. Mean weekly intake was 1.8 eggs (13 g/d) and regular consumers (27 g/d corresponding to more than 2 eggs per week) were more likely to report less risk factors (e.g. history of cardiovascular disease, diabetes, smoking habit). After adjustment for possible confounders, eating eggs &amp;gt;2 times/week) was associated with increased risk of all-cause mortality (HR = 1.21; 95%CI 1.02-1.44 for Q4 vs Q1) and coronary heart disease/cerebrovascular mortality (HR = 1.51;1.04-2.18, for Q4 vs Q1) in a non-stepwise manner; eating more than three eggs per week increased risk of cardiovascular mortality by 33% (HR = 1.33;95%CI 1.00-1.76 for Q5 vs Q1), while no association was found with cancer death or mortality for other causes. Dietary cholesterol explained up to 37% of the excess of CVD mortality risk associated with the highest egg intake (&amp;gt;3 eggs/week). Conclusions Regular egg intake (&amp;gt;2 times/week) was associated with increased risk of CVD mortality in a general Mediterranean population, and part of this association was likely due to its cholesterol content. Key messages Eating egg regularly is not associated with health benefits, rather it appears to increase CVD mortality risk. High dietary cholesterol content is likely to be on the pathway between egg intake and increased CVD mortality.

Mediterranean diet and risk of first hospitalization for heart failure and atrial fibrillation

Abstract Background We aimed to explore the association of a traditional Mediterranean diet (MD) with risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) in a population-based cohort from a southern Italian region. Methods Longitudinal analysis on 20,598 men and women (aged≥35 y) free from HF, AF and cardiovascular disease recruited in the Moli-sani Study (2005-2010). First hospital admissions for HF or AF were recorded by direct linkage with hospital discharge form registry. Dietary data were collected by the EPIC food frequency questionnaire, adherence to MD was appraised by the Greek Mediterranean diet score (MDS ranging 0-9). Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 8.2 y, we ascertained 661 HF events and 337 AF cases. A 2-point increase in the MDS was associated with a downward trend in the risk of developing HF (HR = 0.94;0.85-1.04) after adjustment for potential confounders, while no association was found with risk of AF (HR = 1.07;0.94-1.21). Analyses run separately by gender revealed that higher adherence to an MD was associated with lower risk of HF among women (HF = 0.83;0.72-0.95 for 2-point increase in the MDS) but not in men (HR = 1.07;0.93-1.22; p for interaction=0.011). No gender-related difference was observed for AF risk (p for interaction=0.62). Among women, higher intake of monounsaturated over saturated fats was associated with 38% (20% to 52%) lower risk of HF, while in men moderate alcohol intake was likely to reduce HF risk (HR = 0.87;0.70-1.08). Conclusions Closer adherence to a traditional MD is associated with lower risk of first hospitalization for HF among women but not in men. No association was found with risk of AF. Key messages A traditional MD reduces the risk of HF in women but not in men. Minor dietary changes inspired to a traditional MD could be valuable primary prevention measures for risk of HF.

Abstract P224: Chili Pepper Intake and Risk of Total and Cardiovascular Mortality in Italian Adults: Prospective Findings From the Moli-Sani Study

Introduction: Chili pepper, along with other spices, is an integral part of a traditional Mediterranean diet (MD). Yet there is paucity of epidemiological data on the association between chili pepper intake and mortality risk, with lack of studies from Mediterranean populations. Hypothesis: We assessed the hypothesis of an association between chili pepper consumption and total and cardiovascular (CVD) risk of death in a large sample of the Italian general population, and tested different biological mediators of the association. Methods: Longitudinal analysis on 22,811 men and women aged≥35 years enrolled in the Moli-sani Study cohort, Italy (2005-2010). Chili pepper intake was estimated by the EPIC food frequency questionnaire and categorized as none/rare consumption, up to 2 times/week, 2-4 and &gt; 4 times/week. Multivariable hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated by multivariable Cox regression and competing risk models. Results: Over a median follow up of 8.2 years, a total of 1,236 deaths were ascertained, of which 444 from CVD. Multivariable risk estimates for all-cause and CVD mortality among participants in the regular (&gt;4 times/week) relative to the none-rare intake were, respectively, 0.77 (0.66-0.90) and 0.66 (0.50-0.86). Regular intake also lowered ischemic heart disease (0.55;0.35-0.87) and cerebrovascular death risks (0.39;0.20-0.76). Traditional CVD risk factors (e.g. blood cholesterol, triglycerides) only marginally account for such associations (Table). Conclusions: In a large Mediterranean population, regular consumption of chili pepper is associated with lower risk of total and CVD death independent of adherence to MD. Known biomarkers only marginally accounted for the association of chili pepper intake with total mortality.

Dietary fats, olive oil and respiratory diseases in Italian adults: A population‐based study

Fat intake has been associated with respiratory diseases, with conflicting results. We studied the association between asthma and rhinitis with dietary fats, and their food sources in an Italian population. Clinical and nutritional information was collected for 871 subjects (aged 20-84) from the population-based multi-case-control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles. Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR=0.68, 95%CI: 0.48; 0.96; RRR=0.69; 95%CI: 0.49; 0.97, per 10g, respectively) and per-quartile analyses (p for trend=0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR=0.80; 95%CI: 0.65; 0.98 per 10g). An increased risk of rhinitis was associated with moderate total fat and SFA intake. High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.

Sweet and Umami Taste Perception Differs with Habitual Exercise in Males.

Taste is influenced by several factors. However, whether habitual exercise level is associated with differences in taste perception has received little investigation. The aim of this study was to determine if habitual exercise is associated with differences in taste perception in men. Active (n = 16) and inactive (n = 14) males, between ages 18–55, underwent two days of sensory testing, using prototypical taste stimuli of high and low concentrations for sweet, salt, bitter, sour, umami, and carbohydrate (maltodextrin). Mean perceived intensity and hedonic ratings were recorded. Eating behaviour was assessed by the three factor eating questionnaire and food intake by EPIC food frequency questionnaire (FFQ). There were moderate to large differences between the two groups in perceived intensity for sweet taste at the high concentration and umami taste at both high and low concentrations, with active males recording a higher perceived intensity (p < 0.05 for all). The active group also recorded a greater dislike for umami low and carbohydrate low concentration (p < 0.01). Salt, bitter and sour perception did not significantly differ between the two groups. FFQ analysis showed no difference in % energy from macronutrients between the groups. Eating behaviour traits correlated with sweet taste intensity and umami taste liking, independent of activity status. Results indicated that sweet and umami taste perception differ in active compared to inactive males. Habitual exercise level should be considered in taste perception research and in product development. Whether differences in taste perception could be one factor influencing food intake and thus energy balance with habitual exercise warrants further investigation.

Habitual Fructose Intake Relates to Insulin Sensitivity and Fatty Liver Index in Recent-Onset Type 2 Diabetes Patients and Individuals without Diabetes.

The association between the amount and sources of fructose intake with insulin sensitivity and liver fat needs further elucidation. This study aimed at examining whether habitual intake of sucrose plus non-sucrose bound as well as of non-sucrose bound fructose (total fructose, fruit-derived, juice-derived, sugar sweetened beverages (SSB)-derived fructose) is cross-sectionally associated with insulin sensitivity and fatty liver index (FLI). Fructose intake was estimated using the EPIC food frequency questionnaire from 161 participants with type 2 diabetes (T2D) in the ongoing German Diabetes Study (GDS) (age 53 ± 9 years; HbA1c 6.4 ± 0.9%) and 62 individuals without diabetes (CON) (47 ± 14 years; 5.3 ± 0.3%). Peripheral (M-value) and hepatic insulin resistance were assessed by hyperinsulinemic-euglycemic clamps with stable isotope dilution. FLI was calculated based on body mass index, waist circumference, triglyceride and gamma glutamyl transferase concentrations. Multivariable linear regression analyses were performed. A doubling of SSB-derived sucrose plus non-sucrose bound as well as of non-sucrose bound fructose intake was independently associated with a reduction of the M-value by −2.6% (−4.9; −0.2) and −2.7% (−5.2; −0.1) among T2D, respectively, with an increase in the odds of fatty liver by 16% and 17%, respectively among T2D (all p < 0.05). Doubling fruit-derived sucrose plus non-sucrose bound fructose intake independently related to a reduction in the odds of fatty liver by 13% (p = 0.033) among T2D. Moderate SSB-derived fructose intake may detrimentally affect peripheral insulin sensitivity, whereas fruit-derived fructose intake appeared beneficial for liver fat content.

Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study.

The association between diet and inflammation is well documented. Yet, no evidence exists on the relationship between the inflammatory potential of the diet and low-grade inflammation (LGI) as measured by a composite score of plasma and cellular biomarkers. The aim of this study was to assess the association between the Dietary Inflammatory Index (DII®) and LGI in a large population-based cohort. Cross-sectional analyses were conducted on data from 20 823 adults (age ≥35 y; 48% male) without acute inflammation, who were recruited within the general population of the Moli-sani study from 2005 to 2010. LGI was measured by using a composite score (INFLA-score) including platelet and leukocyte counts, the granulocyte to lymphocyte ratio, and C-reactive protein. DII scores were computed based on dietary intake assessed by the EPIC food frequency questionnaire. Multivariable linear regression models were fit to produce adjusted regression coefficients and 95% confidence intervals (CIs). Higher DII scores were associated with increased LGI (β = 0.131; 95% CI, 0.089-0.174 for the highest versus lowest quintile of DII) after adjusting for age, sex, lifestyle, prevalence of chronic diseases, and health conditions. A higher DII score also was positively associated with each single biomarker of inflammation included in the INFLA-score, unhealthy behaviors (smoking, sedentary lifestyle), and insulin. Higher DII scores, indicating greater inflammatory potential of the diet, were directly associated with LGI, as measured by a composite score of plasma and cellular biomarkers of inflammation. These findings are consistent with the contributing role of diet-mediated inflammation in increasing risk for inflammation-related chronic diseases.

Mediterranean-type diet is associated with higher psychological resilience in a general adult population: findings from the Moli-sani study.

Psychological resilience is a measure of stress coping ability and has been associated with favourable health outcomes. While evidence on the relationship of dietary habits with a number of psychosocial conditions is available, there is lack of studies on their association with psychological resilience in a general adult population. Cross-sectional analysis on 10 812 subjects recruited within the cohort of the Moli-sani study (2005-2010). Psychological resilience was measured by the 25-item Connor-Davidson Psychological Resilience Scale. Food intake was recorded by the EPIC food frequency questionnaire and adherence to Mediterranean diet was appraised by both a Greek Mediterranean diet score and an Italian Mediterranean Index. Empirically derived dietary patterns were obtained by principal factor analysis. Multivariable linear regression analysis (95%CI) was used to test the association between dietary scores and psychological resilience. Higher adherence to Mediterranean-type diets or consumption of a vegetable-based dietary pattern (obtained from principal factor analysis) were positively associated with psychological resilience (β=0.43; 95%CI: 0.19-0.66, β=0.92; 0.69-1.16, and β=1.18; 0.93-1.44, for Greek Mediterranean diet score, Italian Mediterranean Index and the 'Olive oil and vegetables pattern', respectively). Dietary polyphenol or antioxidant intakes and greater variety in fruit and vegetable consumption were also positively associated with psychological resilience, while the associations with Western-like diets were weak. In conclusion, Mediterranean diet, vegetable-based dietary patterns and better diet quality were all positively associated with higher psychological resilience, whereas Western-type diets were not.

Fish intake is associated with lower cardiovascular risk in a Mediterranean population: Prospective results from the Moli-sani study

Background and aimsFish consumption reportedly reduces the risk of heart disease, but the evidence of cardiovascular advantages associated with fish intake within Mediterranean cohorts is limited. The aim of this study was to test the association between fish intake and risk of composite coronary heart disease (CHD) and stroke in a large population-based cohort adhering to Mediterranean Diet. Methods and resultsProspective analysis on 20,969 subjects free from cardiovascular disease at baseline, enrolled in the Moli-sani study (2005–2010). Food intake was recorded by the Italian version of the EPIC food frequency questionnaire. Hazard ratios were calculated by using multivariable Cox-proportional hazard models. During a median follow-up of 4.3 years, a total of 352 events occurred (n of CHD = 287 and n of stroke = 66). After adjustment for a large panel of covariates, fish intake ≥4 times per week was associated with 40% reduced risk of composite CHD and stroke (HR = 0.60; 95%CI 0.40–0.90), and with 40% lower risk of CHD (HR = 0.60; 95%CI 0.38–0.94) as compared with subjects in the lowest category of intake (<2 times/week). A similar trend of protection was found for stroke risk although results were not significant (HR = 0.62; 95%CI 0.26–1.51). When fish types were considered, protection against the composite outcome and CHD was confined to fatty fish intake. ConclusionsFish intake was associated with reduced risk of composite fatal and non-fatal CHD and stroke in a general Mediterranean population. The favourable association was likely to be driven by fatty fish.

Abstract P214: Mediterranean Diet, Vegetable-based Dietary Patterns and Diet Quality are Associated With Higher Resilience: Findings From the Moli-sani Study

Introduction: Resilience is a measure of stress coping ability and has been favourably associated with cardiovascular health. Yet little is known on the likely association between diet and resilience. Hypothesis: We tested the hypothesis that diet quality is associated with resilience. Methods: Cross-sectional analysis on 10,812 subjects (mean age 52.7±10.8, 50.5% men) recruited within the cohort of the Moli-sani study from 2005 to 2010. Resilience was measured by the 25-item Connor-Davidson Resilience Scale ranging from 0-100 with the higher score reflecting greater resilience. Food intake was recorded by the EPIC food frequency questionnaire and adherence to the Mediterranean diet was appraised by both a Greek and an Italian dietary score. Empirically-derived dietary patterns were obtained by principal components analysis (PCA), while dietary polyphenol and antioxidant intakes and fruit and vegetables variety were assessed by specific holistic scoring. Multivariable linear regression analysis (95%CI) was used to test the association between dietary scores and resilience. Results: As compared to those below the median value of resilience (score=67), more resilient subjects had higher educational status (19.4% vs 13.5% for university or postgraduate education) and were more likely to report favourable health behaviours (leisure-time physical activity and less prevalence of smoking habit) . In a multivariable model, greater adherence to Mediterranean-type diets or vegetables-based dietary pattern obtained from PCA, as well as dietary polyphenol or antioxidant intakes and greater variety in fruit and vegetables consumption were all positively associated with resilience (Table) . No association with Western-like diets was found. Conclusions: Diet quality, as measured by a number of dietary scores, was positively associated with higher resilience, whereas western-type diets were not. Modulation of stress coping ability may be a factor in considering healthy effect of high quality diet.

Zinc Deficiency Is associated With Depressive Symptoms-Results From the Berlin Aging Study II.

Zinc plays an important role for behavioral and mental function, maintaining the correct functions of intracellular signal transduction, cellular and trans-membrane transport, protein synthesis, and antioxidant system. We investigated both dietary zinc intake and plasma zinc levels and the correlation with depressive symptoms in a large sample of community-dwelling old. One thousand five hundred fourteen older people (aged 60-84 years, 772 women) from the Berlin Aging Study II were included. Zinc intake was assessed by the EPIC Food Frequency Questionnaire. Plasma zinc levels were assessed with atomic-absorption spectrophotometry. Depressive symptoms were assessed with the "Center for Epidemiological Studies Depression Scale" and the "Geriatric Depression Scale." Zinc deficiency in blood plasma was found in 18.7% of participants, and depressive symptoms in 15.7%. Participants with depressive symptoms had lower energy-adjusted zinc intake (median 11.1 vs 11.6 µmol/L; p = .048) and lower plasma zinc levels (median 12.2 vs12.3 mg/dL; p = .037). Even after adjustment for known predictors of depression, plasma zinc deficiency remained significantly associated with depressive symptoms (odds ratio: 1.490, 95% confidence interval: 1.027-2.164; p = .036). In the multiple logistic regression model stratified by sex, we found that plasma zinc deficiency was strongly associated with a higher risk for depressive symptoms in women (odds ratio: 1.739, 95% confidence interval: 1.068-2.833; p = .026). Plasma zinc deficiency was common in our old study population. An increase in dietary zinc and higher plasma zinc levels may reduce the risk of depressive symptoms. A screening for reduced dietary zinc intake or plasma zinc deficiency might be beneficial in older people at risk of depressive symptoms.

Prototypical versus contemporary Mediterranean Diet

To investigate the evolution of the Mediterranean Diet (MD) in a delimited area of Southern Italy, by comparing the diet adopted 60-70 years ago (Prototypical Mediterranean Diet, PMD) with the contemporary one (Contemporary Mediterranean Diet, CMD), and to verify to what extent they fitted the recommendations of the Italian and the USDA dietary guidelines. We recruited a total of 106 participants, divided in two groups. PMD group included 52 women aged >80 years, with a good cognitive function and full independence in basic and instrumental activities of daily living. CMD group included 20 men and 34 women aged 50-60 years. Food intake was assessed by administering the EPIC food frequency questionnaire to each participant, and an additional survey to the PMD subjects only. Both PMD and CMD showed adequate intakes of macronutrients, although some deficiencies related to micronutrient requirements were evident. CMD showed a slightly greater use of animal products, processed and sugary foods, and higher intakes of simple sugars, animal proteins (49.6 vs 28.3g/day), animal lipids (37.8 vs 20.1g/day), saturated fats (25.0 vs 15.8g/day) and cholesterol (305.0 vs 258.5g/day). PMD showed many similarities to the original version of the MD in terms of macronutrients distribution and food choices. The documented evolution of the dietary habits over a 70 years timespan suggests that nowadays Mediterranean regions adhere less strictly to the original MD, although nutrients intakes are adequate to LARN and USDA recommendations.