F. Zito

Dietary patterns, cardiovascular risk factors and C-reactive protein in a healthy Italian population

BACKGROUND AND AIMSnDietary habits have been associated with cardiovascular disease (CVD) risk factors. This study aimed at evaluating the association of non-predefined dietary patterns with CVD risk profile and C-reactive protein (CRP).nnnMETHODS AND RESULTSnWe analyzed 7646 healthy subjects from the Moli-sani project, an on-going cross-sectional cohort study of men and women aged >or=35, randomly recruited from a general Italian population. The Italian EPIC food frequency questionnaire was used. Food patterns were generated using principal factor analysis (PFA) and reduced rank regression (RRR). Three dietary patterns were identified by PFA. The Olive Oil and Vegetables pattern, characterized by high intake of olive oil, vegetables, legumes, soups, fruits and fish, was associated with relatively lower values of glucose, lipids, CRP, blood pressure and individual global CVD risk score. The Pasta and Meat pattern, characterized by high intake of pasta, tomato sauce, red meat, animal fats and alcohol, was positively associated with glucose, lipids, CRP and CVD risk score. The Eggs and Sweets pattern, characterized by positive loadings of eggs, processed meat, margarines, butter, sugar and sweets, was associated with high values of CRP. The first RRR pattern was similar to the Pasta and Meat pattern both in composition and association with CVD risk profile.nnnCONCLUSIONSnIn a large healthy Italian population, non-predefined dietary patterns including foods considered to be rather unhealthy, were associated with higher levels of cardiovascular risk factors, CRP and individual global CVD risk, whereas a prudent-healthy pattern was associated with lower levels.

Bcl I Polymorphism in the Fibrinogen β-Chain Gene Is Associated With the Risk of Familial Myocardial Infarction by Increasing Plasma Fibrinogen Levels A Case-Control Study in a Sample of GISSI-2 Patients

The aim of this study was to investigate the association of the Bcl I beta-chain fibrinogen polymorphism with the risk of acute myocardial infarction (AMI) and its relationship with fibrinogen levels in the Italian population. We studied 102 AMI patients, selected within the framework of the GISSI-2 trial, who had a familial history of arterial thrombosis (at least one first-degree relative suffering from AMI or stroke before 65 years) and 173 control subjects (with neither AMI nor personal or familial history of arterial thrombosis). All subjects were Italian. Patients showed fibrinogen levels higher than control subjects. There was a highly significant difference in allele frequency in cases versus control subjects, the B2 allele frequencies being respectively 0.28 versus 0.17 (P = .002). In multivariate analysis, adjusted for sex, age, smoking habits, and history of hyperlipidemia, hypertension, or diabetes, the (B1B2 + B2B2) genotype was associated with a higher risk of AMI (odds ratio 2.4, 95% confidence interval, 1.2 to 4.6). The Bcl I genotype was also associated with fibrinogen levels, independently of gender and smoking habits, the (B1B2 + B2B2) subjects showing the highest levels in both cases and control subjects. The difference in fibrinogen levels between cases and control subjects was significantly influenced by the genotype (significant interaction, P = .042). The B2 allele of the Bcl I polymorphism in the beta-chain of the fibrinogen gene is a new factor associated with the risk of familial AMI through its association with fibrinogen levels. These data provide evidence for a causal role of fibrinogen in familial AMI.

Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study

BACKGROUND AND AIMSnAdherence to Mediterranean diet (MD) is reportedly declining in the last decades. We aimed to investigate the adherence to MD over the period 2005-2010 and exploring the possible role of the global economic crisis in accounting for the changing in the dietary habits in Italy.nnnMETHODS AND RESULTSnCross-sectional analysis in a population-based cohort study which randomly recruited 21,001 southern Italian citizens enrolled within the Moli-sani study. Food intake was determined by the Italian EPIC food frequency questionnaire. Adherence to MD was appraised by the Italian Mediterranean Index (IMI). A wealth score was derived to evaluate the economic position and used together with other socioeconomic indicators. Highest prevalence of adherence to MD was observed during the years 2005-2006 (31.3%) while the prevalence dramatically fell down in the years 2007-2010 (18.3%; P<0.0001). The decrease was stronger in the elderly, less affluent groups, and among those living in urban areas. Accordingly, we observed that in 2007-2010 socioeconomic indicators were strongly associated with higher adherence to MD, whereas no association was detected in the years before the economic crisis began; both wealth score and education were major determinants of high adherence to MD with 31% (95%CI: 18-46%) higher adherence to this pattern within the wealthier group compared to the less affluent category.nnnCONCLUSIONnAdherence to MD has considerably decreased over the last few years. In 2007-2010 socioeconomic indicators have become major determinants of adherence to MD, a fact likely linked to the economic downturn.

Typical breakfast food consumption and risk factors for cardiovascular disease in a large sample of Italian adults.

BACKGROUND AND AIMSnThe overall consumption of foods most frequently consumed in a typical Italian breakfast might be associated with a better cardiovascular risk profile in Italian adults.nnnMETHOD SAND RESULTSn18,177 subjects (53,2% women), aged ≥ 35 yrs, randomly selected from the Moli-sani Project population were studied. The European Prospective Investigation into Cancer and Nutrition (EPIC) FFQ was used for dietary assessment. To derive breakfast pattern, an a priori approach was used: firstly, foods typical of the Italian breakfast were selected: milk, coffee, tea, yogurt, crispbread/rusks, breakfast cereals, brioche, biscuits, honey, sugar and jam. The breakfast score was obtained adding the amounts of all selected foods, expressed in grams/day, previously standardized to mean zero and standard deviation 1. Subjects showing a higher breakfast score appeared to be younger, more frequently women or smokers, with higher social status but less likely practicing physical activity. After multivariable analyses, subjects with a higher breakfast food consumption had a lower risk to have high body mass index, abdominal obesity, systolic and diastolic blood pressure, blood glucose, triglycerides, total cholesterol (P < 0.0001 for all) and C Reactive Protein (P = 0.022). The associations were unrelated to age, sex, smoking, obesity, physical activity and social status. Subjects with a higher food breakfast score also showed a better physical healthy status score, a lower risk of metabolic syndrome (OR = 0.63; 0.55-0.72 95% CI) and of future CVD (P < 0.0001 for both women and men).nnnCONCLUSIONnConsumption of typical Italian breakfast foods positively affects CVD risk profile in an adult Italian population.

Total dietary antioxidant capacity and lung function in an Italian population: a favorable role in premenopausal/never smoker women

Background/Objectives:Antioxidant-rich foods may favorably influence lung function. We examined possible associations between the total dietary antioxidant capacity (TAC) and pulmonary function in a healthy Italian population.Subjects/Methods:Until May 2009, 22u2009300 persons were randomly recruited from the general population in the Moli-sani project. A sample only including healthy women (5824) and men (5848) was analyzed. TAC was measured in foods by three different assays and the ferric reducing-antioxidant power (FRAP) assay was selected as the better indicator of dietary TAC. The European Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary assessment. The association between quintiles of dietary FRAP and pulmonary indexes was assessed using analysis of variance separately for men and women.Results:After adjustment for confounders, women in the highest quintile of FRAP intake had +39u2009ml forced expiratory volume in the first second (FEV1) and +54u2009ml forced vital capacity, compared with those in the lowest quintile (P for trend ⩽0.006). Stratified analysis showed that this relationship only occurred in women who were premenopausal/never smokers. In this subgroup, the observed effect of higher FRAP intake on FEV1 was equivalent to an improvement in pulmonary age of 3.3 years. In men, all significant associations between pulmonary function and TAC were lost after adjustment for confounding.Conclusions:Dietary TAC may have a favorable role in respiratory health, particularly in premenopausal/never smoker women.

Relation between pulmonary function and 10-year risk for cardiovascular disease among healthy men and women in Italy: the Moli-sani Project

Background: Pulmonary dysfunction could influence the onset and the evolution of cardiovascular disorders. This study evaluated whether pulmonary dysfunction based on spirometry, plethysmography and carbon monoxide diffusion test is associated with the estimated risk of cardiovascular disease in 10 years. Design: We performed a cross-sectional general population-based cohort study. Methods: The Moli-sani Project is a population-based cohort study of subjects aged ≥35 years, randomly recruited from the general population in Italy. Cardiovascular risk in 10 years was predicted by the CUORE score which provides an estimate of the probability of a first coronary or cerebrovascular event in the next 10 years, based on a risk equation derived from Italian cohorts. Out of 12,933 subjects with high-quality flow/volume manoeuvre, 8,132 subjects had suitable plethysmography and 3,422 carbon monoxide diffusion (carbon monoxide alveolar diffusion test [DLCO]). Results: In multivariate analyses, reduced pulmonary function expressed by forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and total lung capacity (TLC) were inversely associated with CUORE score both in men and in women, independently of other risk factors such as age, height, smoking habits, total cigarettes exposure (pack-years), pulmonary disease, body mass index, social status and physical activity. In contrast, there was no association between FEV1/FVC ratio, residual volume, DLCO and CUORE risk score. Conclusions: In both genders from an adult general Italian population, pulmonary function decline is associated with increased cardiovascular risk. These results suggest that pulmonary monitoring could be useful to more accurately predict cardiovascular risk.

C reactive protein and its determinants in healthy men and women from European regions at different risk of coronary disease: the IMMIDIET Project

Aim:u2002Differences in C‐reactive protein (CRP) levels and its determinants in three European populations at different risk of coronary artery disease (CAD) were studied.Methods:u2002Subjects were recruited randomly in Limburg (Belgium), Abruzzo (Italy) and south‐west (SW) London (England).Results:u2002Ten‐year risk of fatal coronary events (estimated using risk equations provided by the SCORE Project) was lower both in men and women from Abruzzo, intermediate in people from Limburg and higher in subjects from SW London. Within each country, high sensitivity (hs)‐CRP levels were higher in the high‐risk class in men but not in women. Men from Abruzzo had higher hs‐CRP levels than those from Limburg and SW London. Women always had higher hs‐CRP levels than men. The strongest hs‐CRP determinant was body mass index (BMI, R2u2003=u20030.14) in women and waist circumference (WC, R2u2003=u20030.046) in men. The highest hs‐CRP levels were observed in subjects with both high BMI and high WC. Metabolic syndrome was associated with high levels of CRP both in men and women, even after adjustment for confounders. Discussion:u2002Difference in CRP levels cannot explain the European gradient of CVD risk, although CRP levels are associated with the calculated SCORE risk of fatal coronary events within each country.

Genes, coagulation and cardiovascular risk.

Coronary artery disease (CAD) is a multifactorial disease influenced by both genetic and environmental determinants. Coagulation activation plays a key role in thrombus formation and variation in its factors has been associated with the risk of CAD. The levels of these factors are genetically determined and polymorphisms in their genes can also be responsible for disease development. Three polymorphic alleles of coagulation factor VII (FVII) gene have been associated with a protective effect on the risk of familial myocardial infarction. Their distribution in Europe covaries across populations with the rate of myocardial infarction mortality, being higher in countries (like Italy, Spain, Greece) at low risk. These polymorphisms are major determinants of FVII variability in humans. They can also determine the response of FVII to environmental stimuli. Indeed, they modulate the association between triglycerides or smoking and FVII, while a gender-dependent regulation of FVII, probably related to sexual hormones, has also been described. Interestingly, lowering the plasma levels of FVII with low dose warfarin to the same low normal range as that associated with the ‘protective’ genotypes, results in protection against ischaemic heart disease, reducing mortality in high risk men.

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

BACKGROUND AND AIMSnFish 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.nnnMETHODS AND RESULTSnProspective 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 CHDxa0=xa0287 and n of strokexa0=xa066). 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 (HRxa0=xa00.60; 95%CI 0.40-0.90), and with 40% lower risk of CHD (HRxa0=xa00.60; 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 (HRxa0=xa00.62; 95%CI 0.26-1.51). When fish types were considered, protection against the composite outcome and CHD was confined to fatty fish intake.nnnCONCLUSIONSnFish 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.

Moderate Alcohol Consumption Is Associated With Lower Risk for Heart Failure But Not Atrial Fibrillation

OBJECTIVESnThe aim of this study was to assess the hypothesis that alcohol consumption is associated with onset of atrial fibrillation (AF) and/or heart failure (HF).nnnBACKGROUNDnThe connection between ethanol intake and AF or HF remains controversial.nnnMETHODSnThe study population was 22,824 AF- or HF-free subjects (48% men, agexa0≥35 years) randomly recruited from the general population included in the Moli-sani study, for whom complete data on HF, AF, and alcohol consumption were available. The cohort was followed up to December 31, 2015, for a median of 8.2 years (183,912 person-years). Incident cases were identified through linkage to the Molise regional archive of hospital discharges. Hazard ratios were calculated using Cox proportional hazard models and cubic spline regression.nnnRESULTSnA total of 943 incident cases of HF and 554 of AF were identified. In comparison with never drinkers, both former and occasional drinkers showed comparable risk for developing HF. Drinking alcohol in the range of 1 to 4xa0drinks/day was associated with a lower risk for HF, with a 22% maximum risk reduction at 20 g/day, independent of common confounders. In contrast, no association of alcohol consumption with onset of AF was observed. Very similar results were obtained after restriction of the analyses to regular or only wine drinkers or according to sex, age, socialxa0status, or adherence to the Mediterranean diet.nnnCONCLUSIONSnConsumption of alcohol in moderation was associated with a lower incidence of HF but not with development of AF.