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Background Polyphenols are bioactive compounds widely found in fruit, vegetables and beverages of plant origin. Epidemiological studies have suggested an association between polyphenol intake and health; antioxidant, anti-inflammatory, anti-carcinogenic and other bioactivities may contribute to these beneficially protective effects. To date, most epidemiological studies describing polyphenol intake have been limited by the information available in nutrient databases. The present study aimed to determine the total and individual polyphenol intake among institutionalised elderly people living in Asturias ( North of Spain) and to identify the major dietary sources of polyphenol classes and subclasses. Methods The study sample comprised 304 subjects with a mean age of 73.2 years for men and 76.8 years for women. Dietary intake was assessed by means of a food frequency questionnaire. Phenol content was estimated from the Phenol- Explorer database, as developed at the French National Institute for Agricultural Research. The contribution of each food to the total and subgroup intake of polyphenols was calculated as a percentage. Results Except for flavonones, total polyphenol intake, groups and subgroups, was higher in men than women. The main polyphenol groups contributing to total polyphenol intake were flavonoids (62%) and phenolic acids (35.5%). We identified red wine, coffee, apples, oranges and green beans as the major food sources providing total polyphenol intake. Flavonoid and lignan intake was lower for those aged >80 years. Smoking habit, red wine consumption, physical activity and a Mediterranean diet score were associated with a greater polyphenol intake. Conclusions The present study provides information on polyphenol intake in an elderly Mediterranean population with a level of detail that has not been achieved previously. The identification of age and lifestyle factors associated with the intake of polyphenols may be useful in future studies regarding polyphenols. [ABSTRACT FROM AUTHOR]

Background: The International Agency for Research on Cancer classified processed meats (PM) as "carcinogenic" and red meat as "probably carcinogenic" for humans. The possible relationship between colorectal cancer risk and the mechanisms involved in the carcinogenesis of PMs have not been established yet. Nitrosyl-heme and heme iron have been proposed as potential-related compounds. The aim of this study was to determine the association between nitrosyl-heme and heme iron intake and colorectal cancer risk among participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain study., Methods: This prospective study included 38,262 men and women from the EPIC-Spain study. Food consumption was assessed using diet history and food composition tables. Heme iron and nitrosyl-heme intake were determined by estimating the intake of PM items and conducting laboratory analyses. HR estimates were obtained by proportional hazard models, stratified by age at recruitment and study center and adjusted for sex, total energy intake, education, smoking, body mass index, waist size, physical activity, lifetime alcohol, fibre, calcium, and familiar colorectal cancer history., Results: During a mean follow-up of 16.7 years, 577 participants were diagnosed with colorectal cancer. We found no overall association between nitrosyl-heme [HRT3vsT1, 0.98; 95% confidence interval (CI), 0.79-1.21] or heme iron intakes (HRT3vsT1, 0.88; 95% CI, 0.70-1.10) with colorectal cancer risk, nor according to tumor subtypes., Conclusions: Our study found no evidence supporting a link between nitrosyl-heme or heme iron intake and colorectal cancer risk in Spanish subjects., Impact: As research on nitrosyl-heme is preliminary, more heterogeneous studies are necessary to provide more convincing evidence on their role in colorectal cancer carcinogenesis., (©2024 American Association for Cancer Research.)

Objective: To explore the association between three previously identified and validated dietary patterns (Western, Prudent and Mediterranean) and breast cancer risk by tumour subtype and menopausal status., Methods: Data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided epidemiological information (including diet and cancer incidence) from 24,892 women (639 breast cancer cases) recruited between 1992 and 1996. The associations between adherence to the three dietary patterns and breast cancer risk (overall and by tumour subtype) were explored by fitting multivariate Cox proportional hazards regression models stratified by region, among other variables. A possible interaction with menopausal status (changing over time) was explored., Results: No clear association of the Prudent and Mediterranean dietary patterns with breast cancer risk was found. When compared with women with a level of adherence to the Western diet in the first quartile, women with a level of adherence in the third (hazard ratio (95 % confidence interval) (HR(95%CI)):1.37 (1.07;1.77)) and fourth quartiles (1.37 (1.03;1.83)); p for curvature of splines = 0.016) showed a non-linear increased risk, especially postmenopausal women (HR (95 % CI) 1.30 (0.98;1.72) in the third and 1.42 (1.04;1.94) in the fourth quartiles; p for curvature of splines = 0.081) and for estrogen or progesterone receptor positive with human epidermal growth factor receptor 2 negative tumours (HR (95 % CI) 1.62 (1.10;2.38) and 1.71 (1.11;2.63) for the third and fourth quartiles respectively; p for curvature of splines = 0.013)., Conclusions: Intake of foods such as high-fat dairy products, red and processed meats, refined grains, sweets, caloric drinks, convenience food and sauces might be associated with a higher risk of breast cancer., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The nutritional determinants of stroke and, more specifically, the association of frying with the risk of incident stroke have rarely been studied., Objectives: Our aim was to evaluate prospectively the association between the consumption of fried food and the risk of incident stroke in the European Prospective Investigation into Cancer and Nutrition study using the Spanish cohort., Methods: Participants included 40,328 healthy adults (62% women) aged 29-69 y at study entry who were enrolled between 1992 and 1996. Participants were followed up until 31 December, 2017, at which time incident stroke (the main outcome) was measured. The main exposure measure was the percentage of energy obtained from fried-food consumption. Sex-specific quintiles were calculated., Results: During a follow-up period of 23.5 y, 975 cases of stroke occurred (750 ischemic, 185 hemorrhagic, and 40 undetermined). Compared with those in the first (lowest) quintile of fried-food consumption, the multivariate HRs (95% CIs) of incident stroke in the consecutive quintiles were 1.05 (0.86, 1.30), 1.11 (0.90, 1.36), 1.05 (0.84, 1.31), and 0.91 (0.72, 1.15; P-trend = 0.45). There were no differences identified when subtypes of stroke were considered., Conclusions: In this Spanish cohort, whose participants mainly used olive oil or sunflower oil when frying, the consumption of fried food was not associated with an increased risk of incident stroke., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Although total plasma homocysteine (tHcy) has been extensively studied as a risk factor of CVD, longitudinal evidence on its association with mortality is scarce, especially among the elderly. The study cohort consisted of 215 subjects (eighty-eight male and 127 female), aged 60 years or older, recruited in fourteen elderly care institutions from Asturias (Spain). All participants were free of major chronic pathology and took no vitamin and/or mineral supplements. Baseline determinations included tHcy in plasma and folate, vitamin B12 and Se in serum. Survival analyses were performed by quintiles of these factors after 6 years (mean follow-up time 4.3 years) by means of Cox regression models. During follow-up time sixty participants died. tHcy above 16.7 micromol/l was associated with an increased risk of mortality in the sample (relative risk 2.30 (95 % CI 1.02, 5.17)). Among the nutritional determinants of tHcy evaluated, folate and Se were not predictive of death risk of the cohort, while vitamin B12 showed inconsistent results. Nevertheless, mortality was significantly lower at higher serum Se levels (upper quintile), but this effect was restricted to women. Higher tHcy in both sexes and lower serum Se in women were found to be independently associated with an increased risk of death in elderly subjects.

Background/aims: It is becoming apparent that the essential trace element selenium plays a critical role in the maintenance of optimal health status. The objective of this study was to identify the food groups that most contributed to selenium intake and its serum levels in elderly people., Methods: Dietary intake was assessed in 205 institutionalized elderly by means of a 1-year food frequency questionnaire (FFQ). Intake of macronutrients and minerals of the diet were estimated. Selenium was determined in serum and analyzed by graphite-furnace atomic absorption spectrometry., Results: Selenium intake and serum concentration were both within the normal range. The major contributors to selenium intake were cereals and bakery, fish and shellfish, meat and meat products and dairy products. All of them except cereals were also associated to serum selenium. Intake of animal protein, but not the vegetable one, contributed to serum selenium., Conclusion: An adequate intake of fish and meat would be of importance to improve selenium status and health principally in elderly people who are at high risk of mineral deficiency., (Copyright (c) 2006 S. Karger AG, Basel.)

Background and Aim: Total plasma homocysteine (tHcy) is an independent risk factor for cardiovascular diseases. Among other dietary and non-dietary factors, B vitamins, such as folate, riboflavin and cobalamin, are primary determinants of tHcy in the general population. However, research has concentrated on the relationship of these nutrients with tHcy, and little is known about overall eating patterns and tHcy., Methods and Results: In this study, we analysed whether a diet score based on the consumption of folate-, riboflavin- and cobalamin-rich food groups was associated with tHcy in a sample of 140 institutionalised elderly subjects (59 men and 81 women aged 60-80 years) from Northern Spain. The food groups identified as the major contributors to the intake of the three vitamins were vegetables, fruit, fish, meat and milk and dairy products. The mean tHcy level was 13.3+/-5.1 micromol/L (range: 3.9-30.7 micromol/L). None of the food groups predicted tHcy levels individually, but the overall diet score was inversely associated with tHcy in a multiple linear regression analysis. High tHcy levels (>16 micromol/L) were almost twice as prevalent in the groups scoring less than 7 than in those scoring 7 or more (37.5 vs 19.6%, p=0.021)., Conclusions: These data suggest that a dietary pattern characterised by high intakes of B vitamin-rich foods is associated with a lower tHcy concentration and a reduced percentage of high tHcy levels in elderly subjects. They also support the use of dietary pattern approaches to evaluate the relationships between diet and health outcomes that go beyond single nutrient analyses.

An inverse relation between education and health has been reported, suggesting the importance of examining the underlying mechanism of this association. We examined whether cardiovascular risk factors, diet, and indicators of quality of life (mood, self-perceived health, social relationships, self-rated sensory, and dental adequacy) vary according to educational level among 352 old people (65-95 years old) in the city of Oviedo (Northern Spain). Lower educational level (LE) was associated with unhappiness, poor social relationships, poor self-assessed health, and sensory, and masticatory problems. LE elderly consumed less vegetables and meat products and more carbohydrates. LE women had a lower contribution of proteins and lipids to their total energy intake as well as a lower vitamin A intake. Except for hypercholesterolemia, no differences were found for the cardiovascular risk factors studied. The educational level of old people has a strong influence on their quality of life, nutrient intake and food consumption. These findings may provide part of the explanation for the social gradient in mortality.

Background: Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity., Objective: To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil., Subjects: The study was carried out in Spain among 23 289 women and 14 374 men, aged 29-69 years, who were participants of a large European prospective cohort., Methods: : Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI >/= 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting., Results: The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men., Conclusions: The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

Background: In studies from Italy and Greece, a Mediterranean dietary pattern was shown to favorably affect life expectancy in the elderly population. This pattern is thought to reduce the risk of cancer in addition to being cardioprotective., Objective: The objective of this study was to evaluate the interactive effects of the Mediterranean diet and age with respect to survival after controlling for several other variables that could be considered as confounders: age, sex, body mass index, albumin concentration, physical activity, self-assessment of health, and dieting in response to chronic conditions., Design: This was a cohort study involving 161 nonsmoking elderly subjects (74 subjects aged <80 y and 87 subjects aged > or =80 y) living in Spain. The subjects were followed up for > or =9 y. Diet was assessed with a semiquantitative food-frequency questionnaire., Results: A diet score based on 8 characteristics of the traditional diet in the Mediterranean region was associated with a significant reduction in overall mortality in elderly subjects aged <80 y but not in subjects aged > or =80 y. A unit increase in the diet score predicted a 31% reduction in mortality in subjects aged <80 y (95% CI: 7%, 57%)., Conclusion: Efforts to promote adherence to the Mediterranean dietary pattern appear to be worthwhile in persons aged <80 y, in whom the diet predicts survival, but we do not have any available evidence that such a diet benefits subjects aged > or =80 y.

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.

Objective: To assess the consumption of vegetables and fruits (V&F) in adults from five regions in Spain according to sex, age and educational level., Design: Cross-sectional study within the members of the EPIC cohort in Spain., Setting: Three regions of the north of Spain (Asturias, Guipúzcoa and Navarra) and two regions of the south of Spain (Granada and Murcia)., Subjects: 41448 healthy volunteers (15365 men, 25813 women), aged 29-69 y., Interventions: Information on habitual diet during the previous year was collected by means of a computerised version of a diet history questionnaire., Results: Among men, the mean daily consumption of vegetables and of fruits was 273.7 g (3.4 servings) and 348.3 g (4.4 servings) respectively. Among women, the corresponding vegetables and fruit intakes per day were 244.4g (3.1 servings) and 349.4g (4.4 servings). The total V&F intake tended to increase with age and educational level. Overall, 74% of subjects consumed 400 g/d (5 servings) of vegetables and fruit., Conclusions: Consumption of vegetables and fruits in healthy adults in Spain is considerably higher than in most European countries and the United States; this complies with what is considered to be the Mediterranean diet. Despite some regional differences, there were no clearly differentiated patterns of V&F intake between southern and northern regions within Spain.

Background: Stroke, with a rate of 121/100,000 was the second cause of death in Asturias, Spain. Here we communicate the results of a population based stroke register in the oriental health districts of Asturias., Method: The study took place between October 1, 1990 and May 30, 1991, covering a population of 652,549. Surveillance was both active and passive and included the public and private hospitals, and the primary health care. Death certificates could not be checked due to legal reasons. We defined case following the WHO criteria., Results: During the eight months of study 708 case occurred. The crude incidence rate of first stroke was 132.4/100,000 and that of any stroke, 162.7/100,000. The age adjusted incidence to the world population was, respectively, 61.3/100,000 and 73.6/100,000. There were no differences in the incidence across sexes. Age showed a strong effect in cerebral infarctation and less marked in intracerebral hemorrhage Infarcts are very rare in women before 50. Distribution of stroke type was: infarct: 77%; intracerebral hemorrhages: 14%: subarachnoid hemorrhage: 4% and unspecified stroke: 4%. Almost 50% of the strokes occurred in the morning hours, from 6:00 am to 12:00 am also during the cold season, winter and fall, the proportion of stroke was higher than during the warm season., Conclusion: Stroke is an important cause of morbi-mortality in Asturias. The magnitude of mortality is larger than the expected from the incidence. It maybe explained by a high case/fatality ratio in Asturias due to proportion of hemorrhagic stroke, the ageing of the population and the distribution of competing causes of death. However, we cannot rule out a small incomplete registration of cases, mostly in patients over 85. We estimated the incidence of any stroke, given underegistration, to be 176/100,000 for any stroke.