Association Between an Oxidative Balance Score and Mortality: A Prospective Analysis in the SUN Cohort

Abstract Objectives Whether oxidative balance impacts mortality risk requires accounting not only for dietary patterns but also for lifestyle exposures. We aimed to investigate the association between an overall oxidative balance with all-cause, cardiovascular, and cancer mortality risk among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of middle-aged Spanish graduate students. Methods Using baseline information from 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures — vitamins C and E, betacarotenes, minerals (Se, Zn, heme-Fe), polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity — we constructed an oxidative balance score (OBS) categorized in equal-weighting quartiles, with higher scores meaning greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality risk. Cases were ascertained through consultation of the National Death Index. Results A total of 19,083 participants (mean [SD] age, 38.5 [12.4] years; 59.2% females) were included in the analysis. During a median follow-up of 12.2 years (interquartile range, 8.1–14.9), 421 deaths were identified, including 80 cardiovascular (CV) deaths and 215 cancer deaths. After adjustment for potential confounders, the hazard ratio between the highest quartile (predominance of antioxidant) vs. the lowest quartile (reference category) was 0.43 (95% confidence interval [CI], 0.29–0.66, P-trend < 0.001) for all-cause mortality; 0.19 (95% CI 0.07–0.50, P-trend = 0.012) for CV mortality; 0.47 (95% CI 0.26–0.84, P-trend = 0.012) for cancer mortality. The antioxidant balance of dietary exposures and lifestyle exposures contributed towards reducing mortality risk, however, the individual effects were smaller than the combination of both exposures, suggesting the utility of the OBS to reflect the synergistic effect between the individual components. Conclusions Our findings suggest a strong inverse association between OBS score and decreased all-cause, CV, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk. Funding Sources Instituto de Salud Carlos III, FEDER, Navarra Regional Government and University of Navarra.

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Oxidative Balance Score and Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000441623 ◽

2015 ◽

Vol 42 (4) ◽

pp. 320-327 ◽

Cited By ~ 10

Author(s):

Titilayo O. Ilori ◽

Young Sun Ro ◽

So Yeon Kong ◽

Orlando M. Gutierrez ◽

Akinlolu O. Ojo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Racial Differences ◽

Proportional Hazards ◽

A Priori ◽

Cox Proportional Hazards ◽

Lower Prevalence ◽

Oxidative Balance ◽

Oxidative Balance Score

Background: The oxidative balance score (OBS) is a composite estimate of the overall pro- and antioxidant exposure status in an individual. The aim of this study was to determine the association between OBS and renal disease. Methods: Using the Reasons for Geographic and Racial Differences in Stroke cohort study, OBS was calculated by combining 13 a priori-defined pro- and antioxidant factors by using baseline dietary and lifestyle assessment. OBS was divided into quartiles (Q1-Q4) with the lowest quartile, Q1 (predominance of pro-oxidants), as the reference. Multivariable logistic regression and Cox proportional hazards models were used to estimate adjusted ORs for albuminuria defined as urine albumin/creatinine ratio (ACR) >30 mg/g, macroalbuminuria defined as ACR >300 mg/g and chronic kidney disease (CKD) defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration and hazards ratios for end-stage renal disease (ESRD), respectively. Results: Of the 19,461 participants analyzed, 12.9% had albuminuria and 10.1% had CKD at baseline; over a median follow-up of 3.5 years (range 2.14-4.32 years), 0.46% developed ESRD. Higher OBS quartiles were associated with lower prevalence of CKD (OR vs. Q1: Q2 = 0.93 [95% CI 0.80-1.08]; Q3 = 0.90 [95% CI 0.77-1.04] and Q4 = 0.79 [95% CI 0.67-0.92], p for trend <0.01). The associations between OBS and albuminuria (p for trend 0.31) and incident ESRD (p for trend 0.56) were not significant in the fully adjusted models. Conclusions: These findings suggest that higher OBS is associated with lower prevalence of CKD. Lack of association with ESRD incidence in the multivariable analyses indicates that temporal relation between OBS and renal damage remains unclear.

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Association of Happiness and Life Satisfaction with Cancer Mortality in the United States: A Longitudinal Analysis

International Journal of Translational Medical Research and Public Health ◽

10.21106/ijtmrph.206 ◽

2020 ◽

Vol 4 (2) ◽

pp. 162-169

Author(s):

Hyunjung Lee ◽

Gopal K. Singh

Keyword(s):

United States ◽

Life Satisfaction ◽

Mortality Risk ◽

Cancer Mortality ◽

Proportional Hazards ◽

The United States ◽

Cox Proportional Hazards ◽

Cox Models ◽

Creative Commons ◽

Cancer Mortality Risk

Background: Theimpact of happiness and life satisfaction on cancer mortality is not well studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and cancer mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, cancer mortality risk was 78% higher (hazard ratio [HR]=1.78; 95% CI=1.42,2.23) in adults with little or no happiness, controlling for age, and 53% higher (HR=1.53; 95% CI=1.19,1.97) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Age-adjusted cancer mortality risk increased by 41% (HR=1.41; 95% CI=1.21,1.77) in adults who were very dissatisfied with their life. Cancer mortality did not vary by life satisfaction after adjusting for all covariates. Conclusions and Implications for Translation: Adults with lower happiness levels had significantly higher cancer mortality risks than those with higher happiness levels. Excess mortality was substantially accounted for by sociodemographic, behavioral, and health risk factors. Key words: • Happiness • Life satisfaction • Cancer • Mortality • Longitudinal • Social determinants Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Nutrients ◽

10.3390/nu13031034 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1034

Author(s):

Vincenza Gianfredi ◽

Annemarie Koster ◽

Anna Odone ◽

Andrea Amerio ◽

Carlo Signorelli ◽

...

Keyword(s):

Depressive Symptoms ◽

Dietary Patterns ◽

Proportional Hazards ◽

A Priori ◽

Preventive Measure ◽

Population Based ◽

Cox Proportional Hazards ◽

Healthy Diet ◽

Patient Health

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

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High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

Innovation in Aging ◽

10.1093/geroni/igaa057.1632 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 505-506

Author(s):

Dominika Seblova ◽

Kelly Peters ◽

Susan Lapham ◽

Laura Zahodne ◽

Tara Gruenewald ◽

...

Keyword(s):

High School ◽

Mortality Risk ◽

Race And Ethnicity ◽

Proportional Hazards ◽

School Quality ◽

Cox Proportional Hazards ◽

School Level ◽

Lower Mortality ◽

All Cause Mortality ◽

Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

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The Joint Effects of Loneliness and Depression on Mortality: Does Gender Matter?

Innovation in Aging ◽

10.1093/geroni/igaa057.1034 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 323-323

Author(s):

Ted Kheng Siang Ng ◽

Abhijit Visaria ◽

Angelique W M Chan ◽

Kheng Siang Ted Ng

Keyword(s):

Los Angeles ◽

Mortality Risk ◽

Proportional Hazards ◽

Depression Scale ◽

Well Being ◽

Joint Effect ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Increased Risk

Abstract Loneliness and depression are both associated with an increased risk of all-cause mortality among older adults. However, the evidence on the joint effect of loneliness and depression is scarce. Furthermore, previous research has rarely examined the modifying effects of gender. We investigated these questions using the Panel on Health and Aging of Singaporean Elderly, a nationally-representative cohort study of community-dwelling older Singaporean adults aged 60 and above, conducted in 2009 with two follow-up waves in 2011 and 2015 (N=4536). We operationalized six groups based on three categories of loneliness measured using the 3-item University of California, Los Angeles (UCLA) loneliness scale: always lonely, sometimes lonely, and never lonely; Two categories of depressive symptom scores were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D) scale: depressed and not depressed. Cox proportional hazards models were employed to estimate the mortality risks for each group, with an extensive set of covariates. Due to significant differences in the prevalence of loneliness and depression in different genders, we conducted gender-stratified analyses. Compared to being not depressed and never lonely, women who were depressed and sometimes lonely and who were not depressed but always lonely had a higher mortality risk. Men who were not depressed but sometimes lonely had a higher mortality risk. We conclude that loneliness appears to be the predominant construct in conferring excess mortality risk. Health policies and interventions addressing the factors common and unique to each gender may improve psychological well-being at older ages, thereby extending the lifespan.

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Theoretical substitutions between dairy products and all-cause and cause-specific mortality. Results from the Danish diet, cancer and health cohort

British Journal Of Nutrition ◽

10.1017/s0007114521002464 ◽

2021 ◽

pp. 1-10

Author(s):

Anne Sofie D. Laursen ◽

Anne L. Thomsen ◽

Anne Beck ◽

Kim Overvad ◽

Marianne U. Jakobsen

Keyword(s):

Cancer Mortality ◽

Dairy Products ◽

Proportional Hazards ◽

Dairy Product ◽

Daily Intake ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Low Fat ◽

Specific Mortality ◽

Optimal Health

Abstract A daily intake of dairy products is recommended in many countries in order to maintain optimal health throughout life. However, evidence regarding the association between intake of individual dairy products and mortality is limited. We therfore, explored associations between intake of different dairy products and all-cause and cause-specific mortality using specified theoretical substitution analyses. We analysed data from 55 775 Danish men and women aged 50–64 years between 1993 and 1997. Information about dairy product intake at baseline was collected using a validated food frequency questionnaire. Information about vital status and causes of death was obtained through national registers. Measures of associations were calculated using Cox proportional hazards regression. During a median follow-up of 19·0 years, 11 586 participants died. For all-cause mortality, we observed that the intake of low-fat milk, whole-fat milk or low-fat yogurt products in place of cheese was associated with a higher rate of death (hazard ratios between 1·03 and 1·12 per serving/d substituted). The same pattern was present for CVD mortality. For cancer mortality, whole-fat milk and low-fat yogurt products in place of cheese were also associated with a higher rate of death for men while for women, whole-fat milk in place of buttermilk was associated with a higher cancer mortality rate. The results appeared robust in several sensitivity analyses. Our results suggest that intake of low-fat milk, whole-fat milk or low-fat yogurt products in place of cheese is associated with a higher rate of all-cause and cause-specific mortality.

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Abstract P030: Variations in Cardiovascular Risk Among Different Clinical Presentations of Metabolic Syndrome in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.125.suppl_10.ap030 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Todd M Brown ◽

Joshua Richman ◽

Vera Bittner ◽

Cora E Lewis ◽

Jenifer Voeks ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Racial Differences ◽

Central Obesity ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Next Of Kin ◽

Cox Proportional Hazards Models ◽

Chd Risk ◽

The Individual

Background: Some individuals classified as having metabolic syndrome (MetSyn) are centrally obese while others are not with unclear implications for cardiovascular (CV) risk. Methods: REGARDS is following 30,239 individuals ≥45 years of age living in 48 states recruited from 2003-7. MetSyn risk factors were defined using the AHA/NHLBI/IDF harmonized criteria with central obesity being defined as ≥88 cm in women and ≥102 cm in men. Participants with and without central obesity were stratified by whether they met >2 or ≤2 of the other 4 MetSyn criteria, resulting in the creation of 4 groups. To ascertain CV events, participants are telephoned every 6 months with expert adjudication of potential events following national consensus recommendations and based on medical records, death certificates, and interviews with next-of-kin or proxies. Acute coronary heart disease (CHD) was defined as definite or probable myocardial infarction or acute CHD death. To determine the association between these 4 groups and incident acute CHD, we constructed Cox proportional hazards models in those free of CHD at baseline by race/gender group, adjusting for sociodemographic variables. Results: A total of 20,018 individuals with complete data on MetSyn components were free of baseline CHD. Mean age was 64+/−9 years, 58% were women, and 42% were African American. Over a mean follow-up of 3.4 (maximum 5.9) years, there were 442 acute CHD events. In the non-centrally obese with>2 other risk factors, risk for CHD was higher for all but AA men, though significant only for white men. In contrast, in the centrally obese with >2 other risk factors, risk was doubled for women, but only non-significantly and modestly increased for men. Only AA women with central obesity and ≤2 other risk factors had increased CHD risk (Table). Conclusion: The CHD risk associated with the MetSyn varies by the presence of central obesity as well as the race and gender of the individual.

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Association of Antioxidants Use with All-Cause and Cause-Specific Mortality: A Prospective Study of the UK Biobank

Antioxidants ◽

10.3390/antiox9121287 ◽

2020 ◽

Vol 9 (12) ◽

pp. 1287

Author(s):

Inken Behrendt ◽

Gerrit Eichner ◽

Mathias Fasshauer

Keyword(s):

Respiratory Disease ◽

Mortality Risk ◽

Cancer Mortality ◽

Primary Objective ◽

Inverse Association ◽

Uk Biobank ◽

Cancer Subtypes ◽

Specific Mortality ◽

The Uk ◽

The Impact

Prospective studies and randomized controlled trials elucidating the impact of antioxidants supplementation on mortality risk are inconclusive. The present analysis determined association between regular antioxidants use and all-cause (primary objective), as well as cause-specific, mortality in 345,626 participants of the UK Biobank cohort using Cox proportional hazard models. All models were adjusted for confounders and multiple testing. Antioxidants users were defined as participants who indicated to regularly use at least one of the following: multivitamins, vitamin C, vitamin E, selenium, and zinc. Median age of antioxidants users (n = 101,159) and non-users (n = 244,467) at baseline was 57 years. During 3.9 million person-years and a median follow-up of 11.5 years, 19,491 deaths occurred. Antioxidants use was not significantly associated with all-cause, cancer, and non-cancer mortality including several cancer and non-cancer subtypes. Interestingly, mortality risk from respiratory disease was significantly 21% lower among antioxidants users as compared to non-users (hazard ratio: 0.79; 95% confidence interval: 0.67, 0.92). In conclusion, the present study findings do not support recommendations for antioxidants supplementation to prevent all-cause, cancer, or non-cancer mortality on a population level. The significant inverse association between antioxidants use and respiratory disease mortality needs further study.

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Eosinophil count and mortality risk in incident hemodialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz296 ◽

2020 ◽

Vol 35 (6) ◽

pp. 1032-1042

Author(s):

Duk-Hee Kang ◽

Yuji Lee ◽

Carola Ellen Kleine ◽

Yong Kyu Lee ◽

Christina Park ◽

...

Keyword(s):

Mortality Risk ◽

Eosinophil Count ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Time Varying ◽

Cox Proportional Hazards Models ◽

Lower Baseline ◽

All Cause Mortality ◽

Relationship Of ◽

The Relationship

Abstract Background Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown. Methods In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment. Results Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (>350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (<100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk. Conclusions Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.

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Relationship of lycopene intake and consumption of tomato products to incident CVD

British Journal Of Nutrition ◽

10.1017/s0007114512005417 ◽

2013 ◽

Vol 110 (3) ◽

pp. 545-551 ◽

Cited By ~ 54

Author(s):

Paul F. Jacques ◽

Asya Lyass ◽

Joseph M. Massaro ◽

Ramachandran S. Vasan ◽

Ralph B. D'Agostino Sr

Keyword(s):

Repeated Measures ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Supporting Evidence ◽

Inverse Association ◽

Cvd Risk ◽

Stroke Incidence ◽

Hazard Ratios ◽

Increased Risk

Evidence for cardioprotective effects of lycopene is inconsistent. Studies of circulating lycopene generally report inverse associations with CVD risk, but studies based on lycopene intake do not. The failure of dietary studies to support the findings based on biomarkers may be due in part to misclassification of lycopene intakes. To address this potential misclassification, we used repeated measures of intake obtained over 10 years to characterise the relationship between lycopene intake and the incidence of CVD (n314), CHD (n171) and stroke (n99) in the Framingham Offspring Study. Hazard ratios (HR) for incident outcomes were derived from Cox proportional hazards regression models using logarithmically transformed lycopene intake adjusted for CVD risk factors and correlates of lycopene intake. HR were interpreted as the increased risk for a 2·7-fold difference in lycopene intake, a difference approximately equal to its interquartile range. Using an average of three intake measures with a 9-year follow-up, lycopene intake was inversely associated with CVD incidence (HR 0·83, 95 % CI 0·70, 0·98). Using an average of two intake measures and 11 years of follow-up, lycopene intake was inversely associated with CHD incidence (HR 0·74, 95 % CI 0·58, 0·94). Lycopene intake was unrelated to stroke incidence. The present study of lycopene intake and CVD provides supporting evidence for an inverse association between lycopene and CVD risk; however, additional research is needed to determine whether lycopene or other components of tomatoes, the major dietary source of lycopene, are responsible for the observed association.

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