Dietary Exposure to Polychlorinated Biphenyls and Dioxins and Its Relationship to Telomere Length in Subjects Older Than 55 Years from the SUN Project

Exposure to persistent organic pollutants (POPs) may influence telomere length (TL), which is considered as a marker of biological age associated with the risk of chronic disease. We hypothesized that dietary exposure to polychlorinated biphenyls (PCBs) and dioxins could affect TL. Our aim was to evaluate the association of dietary exposure to PCBs and dioxins with TL. In this cross-sectional study of 886 subjects older than 55 y (mean age: 67.7; standard deviation (SD): 6.1; 27% women) from the “Seguimiento Universidad de Navarra” (SUN) project. TL was determined by real-time quantitative polymerase chain reaction and dietary PCBs and dioxins exposure was collected using a validated 136-item Food Frequency Questionnaire. Multivariable linear regression models were used to control for potential confounding factors. Shorter TL was associated with dietary total PCBs (SD of T/S ratio/(ng/day) = −0.30 × 10−7; 95% CI, −0.55 × 10−7 to −0.06 × 10−7), dioxin-like PCBs (DL-PCBs) (SD of T/S ratio/(pg WHO TEQ (Toxic Equivalents)/day) = −6.17 × 10−7; 95% CI, −11.30 × 10−7 to −1.03 × 10−7), and total TEQ exposure (SD of T/S ratio/(pg WHO TEQ/day) = −5.02 × 10−7; 95% CI, −9.44 × 10−7 to −0.61 × 10−7), but not with dioxins (SD of T/S ratio/(pg WHO TEQ/day) = −13.90 × 10−7; 95% CI, −37.70 × 10−7 to 9.79 × 10−7). In this sample of middle-aged and older Spanish adults, dietary exposure to total PCBs and DL-PCBs alone and together with dioxins was associated with shorter TL. Further longitudinal studies, preferably with POPs measured in biological samples, are needed to confirm this finding.

Healthy Lifestyle Score and Incidence of Glaucoma: the Sun Project

The relationship between healthy lifestyles, diet, and glaucoma remains controversial. In this study, we analyse the effect of Mediterranean Lifestyle (ML) on glaucoma incidence in the “Seguimiento Universidad de Navarra” (SUN) cohort. Participants (n=18 420) initially free of glaucoma were followed for a mean of 10.8 years. The SUN Healthy Lifestyle Score (SHLS) ranging from 0 to 10 points included 10 healthy habits: never having smoked, moderate to high physical activity (>20 MET-hour/week), Mediterranean diet (≥4/8 adherence points), moderate alcohol consumption (women, 0.1-5.0 g/d; men, 0.1-10.0 g/d), low television exposure (<2 h/day), no binge drinking (≤5 alcoholic drinks at any time), a short afternoon nap (<30 min/day), meeting up with friends (> 1 h/day), working at least 40 h/week and low body mass index (BMI≤22). Information is collected biennially through self-reported questionnaires. The relationship between new cases of glaucoma and the SHLS was assessed by logistic regression using a hazard ratio. Crude, multi-adjusted and sensitivity analysis were performed. During follow-up, we observed 261 (1.42%) new cases of glaucoma. After adjusting for potential confounders, participants in the healthiest category of SHLS (7-10 points) showed a significantly reduced risk of glaucoma compared to those in the lowest SHLS category (0-3 points) (adjusted HR=0.51, 95% CI=0.28-0.93). For each point added to the SHLS the risk of glaucoma relatively dropped by 5%. In conclusion, higher adherence to a ML, measured by the SHLS, was significantly associated with lower risk of developing glaucoma. The ML is a protective factor for glaucoma incidence.

Pre-Gestational Consumption of Ultra-Processed Foods and Risk of Gestational Diabetes in a Mediterranean Cohort. The SUN Project

We aimed to investigate the relationship between the pre-gestational consumption of ultra-processed foods (UPF) and the risk of gestational diabetes (GDM). We carried out a prospective study among 3730 Spanish women of the SUN cohort who reported at least one pregnancy after baseline recruitment. Cases of GDM were identified among women with a confirmed diagnosis of GDM. UPF consumption was assessed through a validated, semi-quantitative food frequency questionnaire and the frequency of UPF consumption was categorized in tertiles. We identified 186 cases of GDM. In the pooled sample, we did not observe a significant association of UPF with the risk of GDM. When we stratified by age, the multivariate OR for the third tertile of UPF consumption compared with the lowest one was 2.05 (95% CI 1.03, 4.07) in women aged ≥30 years at baseline (Ptrend = 0.041). The association remained significant in a sensitivity analysis after changing many of our assumptions and adjusting for additional confounders. No association between a higher UPF consumption and GDM risk was observed in women aged 18–29 years. The pre-gestational UPF consumption may be a risk factor for GDM, especially in women aged 30 years or more. Confirmatory studies are needed to validate these findings.

Associations Between an Overall, Healthful and Unhealthful Low-Fat Dietary Patterns and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project

Objectives Dietary patterns may have a greater influence on human health than individual foods or nutrients and they are also being widely studied in the field of breast cancer prevention. Beyond the adequate balance of macronutrients, evidence shows that the quality of fat sources may play an important role in health outcomes. Our aim was to assess the relationship between healthful and less healthful low-fat dietary patterns in relation to breast cancer in a Mediterranean cohort (the SUN project). Methods The SUN Project is a Mediterranean dynamic prospective follow-up cohort study assessing participants every 2 years. We evaluated 10,930 middle-aged women initially free of breast cancer during a median of follow-up of 12.1 years. Dietary variables were evaluated through a previously validated 136-item FFQ. We calculated an overall, an unhealthful, and a healthful low-fat-diet score (rang: 0–30 points) based on the percentage of energy from total and subtypes of carbohydrate, fat, and protein. Participants were then categorized into tertiles. Incident breast cancer was de primary outcome. We fitted Cox regression models adjusted for potential confounders to investigate the relationship between baseline categories of low-fat-diet scores and the incidence of breast cancer- overall and stratified by menopausal status-. Results During 123,297 person-years of follow-up, 119 cases of incident breast cancer were confirmed. Among postmenopausal women, a significant direct association with postmenopausal breast cancer (comparing tertile 2 vs. tertile 1, HR = 2.60; 95% CI 1.24–5.45, P value = 0.012) was found. None of the other associations was statistically significant. Conclusions In this Mediterranean prospective cohort study, a moderate adherence to an unhealthy low-fat-diet-score might increase the risk of postmenopausal breast cancer. These results must be further confirmed in future studies. Funding Sources The SUN project received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund, the Navarra Regional Government and the University of Navarra.

Low Dietary Magnesium and Overweight/Obesity in a Mediterranean Population: A Detrimental Synergy for the Development of Hypertension. The SUN Project

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index (BMI). We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake < 200 mg/d, which was greater among those with a BMI > 27 kg/m2. Lean participants with magnesium intake < 200 mg/d vs. >200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension.

Higher adherence to an empirically derived Mediterranean dietary pattern is positively associated with telomere length: the Seguimiento Universidad de Navarra (SUN) project

Telomere integrity is influenced by oxidative stress. Also, inflammation-related factors, including nutritional factors, could modulate telomere integrity. The relationship between a posteriori-derived dietary patterns and telomere length (TL) has been scarcely investigated. Thus, our objective was to examine the association between empirically derived dietary patterns ascertained through principal component analysis (PCA) and TL in an older adult Spanish population. A total of 886 older adults (>55 years old; 645 males and 241 females) from the Seguimiento Universidad de Navarra (SUN) cohort were included in the study. TL was measured by monochrome multiplex real-time quantitative PCR. Age-adjusted TL was used for all analyses. Dietary patterns were identified by PCA based on thirty predefined candidate food groups collected from a validated 136-food items frequency questionnaire. Generalised linear models were fitted to obtain β-coefficients and their 95 % CI evaluating differences in TL between each of the four upper quintiles of adherence to dietary patterns and the lowest quintile. Sensitivity analyses by rerunning all multiple linear models under different stratifications were performed to evaluate the robustness of our results. Two major dietary patterns were empirically identified, Western dietary pattern (WDP) and Mediterranean dietary pattern (MDP). After adjustment for potential confounders, longer TL was found among subjects in the highest quintile of MDP (β = 0·064; 95 % CI 0·004, 0·123). The WDP showed no significant association with TL. In conclusion, higher adherence to a posteriori-derived MDP was independently associated with longer telomeres in an older adult Spanish population of the SUN project.

Polyphenol intake and cognitive decline in the Seguimiento Universidad de Navarra (SUN) Project

The global growing rates of cognitive decline and dementia, together with the absence of curative therapies for these conditions, support the interest in researching potential primary prevention interventions, with particular focus on dietary habits. The aim was to assess the association between polyphenol intake and 6-year change in cognitive function in the ‘Seguimiento Universidad de Navarra’ (SUN) Project, a Spanish prospective cohort study. Changes (final – initial) in cognitive function were evaluated in a subsample of 806 participants (mean age 66 (sd 5) years, 69·7 % male) of the SUN Project using the validated Spanish Telephone Interview for Cognitive Status-modified score. Polyphenol intake was derived from a validated semi-quantitative FFQ and matching food composition data from the Phenol-Explorer database. Multivariable linear regression models were used to evaluate the association between total polyphenol intake, polyphenol subclasses and cognitive changes. No significant association between total polyphenol intake and changes in cognitive function was found. However, a higher intake of lignans (βQuintile (Q) 5 v. Q1 0·81; 95 % CI 0·12, 1·51; Ptrend = 0·020) and stilbenes (βQ5 v. Q1 0·82; 95 % CI 0·15, 1·49; Ptrend = 0·028) was associated with more favourable changes in cognitive function over time, particularly with respect to immediate memory and language domains. Olive oil and nuts were the major sources of variability in lignan intake, and wine in stilbene intake. The results suggest that lignan and stilbene intake was associated with improvements in cognitive function.