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Background: High saturated fat consumption, mostly from red meat and sausage meat has been associated with an increase in cardiovascular risk (CVR) in contrast to the effect of high fish consumption.Objective: To get to know the frequency of meat and fish consumption in an elderly high Mediterranean population, their correlations with adherence to the Mediterranean diet (MD) and their association with intermediate CVR phenotypes.Methods: A cross-sectional study was carried out on 945 people (67.4±6.2 years old) with high CVR recruited in primary care centres of Valencia, and participating in the PREDIMED study. The frequency of meat and fish consumption was determined through a validated questionnaire. We analyzed clinical, biochemical and anthropometric variables using standard methods.Results: Mean red meat consumption was high (7.4±4.7 times/week), being higher in men than in women (P=0.031) and was associated with greater weight (P=0.001) and prevalence of obesity (P=0.025). Fish consumption was also high (4.5±2.6 time/week) and was associated with lower concentrations of fasting plasma glucose (P=0.016) as well as with lower prevalence of diabetes (P=0.017).Conclusion: Red meat consumption in this high CVR population is very high and far from the recommendations of MD, needing, therefore, to be reduced. Fish consumption is closer to the recommendations and should be maintained. [ABSTRACT FROM AUTHOR]

Introduction: Coffee and tea consumption recommendations for a healthy diet have been changing in recent years as it has increased the level of evidence on their benefits has increased. Objective: To know the frequency of coffee and tea consumption of in a high cardiovascular risk Mediterranean population (CVR) and to analyze whether there are differences between the consumption of these drinks by cardiovascular risk factors. Methods: A cross-sectional study was carried out on 945 people (340 males, 605 females) (67.4 +/- 6.2 years old) with high CVR recruited in primary care centres of Valencia, included in the PREDIMED study. Coffee and tea consumption has been determined through a validated questionnaire. We analyzed biochemical, clinicaland anthropometric variables by standard methods. Results: Tea consumption is very low in this Mediterranean population (0,4 +/- 1,6 cups/weeks). By contrast, coffee consumption averaged nearly one cup per day (6,5 +/- 5,2 cups/weeks). Hypertensive patients showed a lower overall consumption of coffee than in non-hypertensive patients (6,6 +/- 5,1 vs 7,3 +/- 5,9; P = 0,023 respectively). These differences were greatest when caffeinated coffee consumption is analyzed (2.9 +/- 4.5 vs 4 3 +/- 5.3, P < 0001). Moreover, diabetics consumed significantly less coffee and tea than non-diabetics (P = 0,015 and P = 0,022 respectively), these differences being greater for caffeinatedcoffee (P < 0,025). Conclusions: In conclusion, in this high cardiovascular risk Mediterranean population a coffee consumption pattern, based on traditional recommendations, is observed, that as a result of new scientific evidence should be update. [ABSTRACT FROM AUTHOR]

Introduction: Coffee and tea consumption recommendations for a healthy diet have been changing in recent years as it has increased the level of evidence on their benefits has increased. Objective: To know the frequency of coffee and tea consumption of in a high cardiovascular risk Mediterranean population (CVR) and to analyze whether there are differences between the consumption of these drinks by cardiovascular risk factors Methods: A cross-sectional study was carried out on 945 people (340 males, 605 females) (67.4 ± 6.2 years old) with high CVR recruited in primary care centres of Valencia, included in the PREDIMED study. Coffee and tea consumption has been determined through a validated questionnaire. We analyzed biochemical, clinical and anthropometric variables by standard methods. Results: Tea consumption is very low in this Mediterranean population (0,4 ± 1,6 cups/weeks). By contrast, coffee consumption averaged nearly one cup per day (6,5 ± 5,2 cups/weeks). Hypertensive patients showed a lower overall consumption of coffee than in non-hypertensive patients (6,6 ± 5,1 vs 7,3 ± 5,9; P = 0,023 respectively). These differences were greatest when caffeinated coffee consumption is analyzed (2.9 ± 4.5 vs 4 3 ± 5.3, P < 0001). Moreover, diabetics consumed significantly less coffee and tea than non-diabetics (P = 0,015 and P = 0,022 respectively), these differences being greater for caffeinated coffee (P < 0,025). Conclusions: In conclusion, in this high cardiovascular risk Mediterranean population a coffee consumption pattern, based on traditional recommendations, is observed, that as a result of new scientific evidence should be update. [ABSTRACT FROM AUTHOR]

Background: Plant-based diets, such as the Planetary Health Diet (PHDI) and the Mediterranean Diet (Med), offer notable advantages for human and planetary health. However, knowledge on the PHDI's benefits is limited, particularly in Southern European countries where the Med is culturally rooted and is an environmentally sustainable dietary pattern., Objective: to evaluate the association of both PHDI and Med with mortality and assess their environmental burden in the adult population of Spain., Methods: Data were taken from the study on Nutrition and Cardiovascular Risk in Spain (ENRICA) comprising 13,105 participants representative of the Spanish adult population. The PHDI score (0-140 points) was based on 15 food groups, while adherence to Med was assessed with the 14-item MEDAS score (0-14 points). Environmental impact was assessed using the SHARP-ID database (including greenhouse gas emissions and land use). Analyses were performed with Cox regression and adjusted for main confounders., Results: During a mean 14.4-year follow-up, 1157 all-cause deaths occurred. The mortality hazard ratio (95 % CI) for the highest vs lowest tertile of the PHDI score was 0.78 (0.66, 0.91) but reached a plateau level at 90 points of PHDI. For the MEDAS, the corresponding results for the highest vs lowest tertile was 0.79 (0.68, 0.93) with a continuous inverse dose-response association. Adherence to some components of the PHDI (fruits, dairy, and unsaturated oils) and of MEDAS (nuts, and low consumption of soda and pastries) was independently and significantly associated with lower mortality. Results remained robust in sensitivity analyses. In terms of environmental impact, both plant-based diets had similar low footprints, with dairy and meat products being the largest contributors., Conclusion: In this large cohort of Spanish adults, higher adherence to the PHDI and MEDAS was similarly associated with lower all-cause mortality and showed comparable low environmental impact., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Objective: To assess whether the role of selenium on pre-diabetes is differential by age, given comorbidities and decreased β-cell function in older adults., Research Design and Methods: We evaluated the cross-sectional association of blood selenium with the homeostatic model assessment for insulin resistance (HOMA-IR) and β-cell function (HOMA-β) in middle-aged (Aragon Workers Health Study [AWHS], N = 1186), and older (Seniors ENRICA [Study on Nutrition and Cardiovascular Risk in Spain]-2 [SEN-2], N = 915) diabetes-free adults. A subsample of participants from AWHS (N = 571) and SEN-2 (N = 603) had glucose and insulin repeated measurements for longitudinal analysis. We validated the cross-sectional dose-response associations in the 2011-2018 National Health and Nutrition Examination Survey (NHANES, N = 1317 middle age and N = 960 older) participants. Selenium was measured in whole blood with ICP-MS in AWHS, SEN-2 and NHANES., Results: The cross-sectional geometric mean ratios (95% confidence intervals) per two-fold selenium increase were 1.09 (1.01, 1.19) for HOMA-IR and 1.15 (1.06, 1.24) for HOMA-β in AWHS; and 1.13 (0.98, 1.31) and 1.03 (0.90, 1.18), in SEN-2. The cross-sectional dose-response associations were consistent in NHANES, with mostly increasingly positive trends for both HOMA endpoints in younger adults and a plateau at levels >~150 μg/L in older adults. The longitudinal dose-response consistently showed positive associations at high selenium dose for both HOMA endpoints in the younger, but not the older, study population., Conclusions: Increased blood selenium was associated with increased insulin resistance and β-cell function in middle-aged, but not in older individuals, especially for β-cell function. The results suggest that selenium-associated insulin resistance might induce compensatory increased β-cell function at younger ages, being this compensatory capacity decreased with aging., Competing Interests: Competing interests: The funding sources did not influence the study’s design, data collection, analysis, interpretation, or paper writing. All authors state that they have not any conflicts of interest. The opinions and views expressed in this editorial are those of the authors and do not necessarily represent the official position of the Instituto de Salud Carlos III (ISCIII) (Spain)., (© 2025. The Author(s).)

Background: Given the close relationship between cardiovascular disease (CVD) and malnutrition, we examined whether higher concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), which indicate CVD risk in the general population, were prospectively associated with malnutrition incidence in community-dwelling older adults without CVD., Methods: We used data from 1490 individuals ≥65 years from the Seniors-ENRICA-2 cohort followed up for 2.2 years. Malnutrition was evaluated by the screening Mini Nutritional Assessment-Short Form (MNA-SF) score, which consists of a short questionnaire, and a complete nutritional assessment according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Associations were summarized with odds ratios (OR) and their 95% confidence interval (CI), obtained from logistic regression and adjusted for the main confounders., Results: NT-proBNP was associated with higher malnutrition incidence assessed by the MNA-SF score and the GLIM criteria, with OR (95% CI) of 1.51 (1.09-2.09) and 1.43 (1.04-1.96) per one logarithmic-unit increment, respectively. Malnutrition incidence according to the GLIM criteria was also higher in participants who had elevated NT-proBNP (heart stress age-specific rule-in cutoffs) vs those who did not, with OR (95% CI) of 1.84 (1.05-3.22). hs-cTnT was not associated with higher malnutrition incidence., Conclusions: In this cohort of older adults without CVD, NT-proBNP was associated with higher malnutrition incidence. Further research is needed to validate our findings, uncover the underlying biological mechanisms, and assess whether preventive interventions can reduce NT-proBNP concentrations and, consequently, reduce the risk of malnutrition., (© Association for Diagnostics & Laboratory Medicine 2025. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Only a few studies have investigated the role of diet on the risk of chronic kidney disease (CKD) in European populations and have mainly focused on the Mediterranean diet. This is the first study to evaluate the association between various diet quality indices and CKD incidence in British adults., Objective: To study the relationship between a set of 6 different diet quality indices and CKD incidence among British adults., Methods: A prospective cohort with 106,870 participants from the UK Biobank, followed from 2009 to 2012 through 2021. Food consumption was obtained from ≥2 24-h dietary assessments. Dietary patterns were assessed using previously established indices: Alternate Mediterranean Index (aMED), Alternative Healthy Eating Index 2010, dietary approaches to stop hypertension (DASH), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI), and dietary inflammatory index (DII). Incident CKD was obtained from clinical records, death registries, and self-reports. Analyses were performed with Cox regression models and adjusted for the main confounders., Results: After a median follow-up of 9.27 y, 2934 cases of CKD were ascertained. Hazard ratios (95% confidence interval) of CKD for the highest compared with lowest tertile of adherence to each diet score were 0.84 (0.76, 0.93) for aMED, 0.94 (0.85, 1.03) for alternative healthy eating index 2010, 0.77 (0.70, 0.85) for DASH, 0.79 (0.72, 0.87) for hPDI, 1.27 (1.16, 1.40) for uPDI, and 1.20 (1.18, 1.33) for DII. The results were robust in sensitivity analyses., Conclusions: In British adults, higher adherence to the aMED, DASH, and hPDI patterns was associated with lower risk of CKD, whereas greater adherence to the uPDI and DII patterns was associated with greater risk., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate the long-term, symptomatic recovery of healthcare workers from acute COVID-19 infections up to 3 years after the initial COVID-19 outbreak., Methods: A cross-sectional study was performed among employees of a community-based healthcare system in Massachusetts who had a recorded positive COVID-19 test. Survey responses were collected between September 2022 and January 2023. The survey included validated questionnaires: WHOQOL-BREF, EQ-5D-5 L, DASS-21, FCV-19S, K6+, and the Insomnia Severity Index. We compared the long-COVID (ie, symptoms lasting >28 days) and non-long-COVID groups., Results: Among the 280 respondents (15.2% response rate), those with long COVID (73.4%) reported significantly worse quality of life and greater levels of depression, anxiety, and stress metrics. However, no significant difference was found between the two groups' fear of COVID-19., Conclusions: Targeted support for healthcare workers with prolonged symptoms after COVID-19 is warranted., Competing Interests: Lan, Zalaquett, Lutchman, Iliaki, Buley, Nathan, Prieto, and Kales have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Importance: Physical activity (PA) guidelines recommend the same amount of PA through adulthood to live longer., Objective: To explore whether there is an age-dependent association between PA and all-cause mortality and to investigate the age-dependent associations between other modifiable health factors (high educational level, not smoking, not regularly consuming alcohol, healthy body weight, and living without hypertension and diabetes) and mortality., Design, Setting, and Participants: This cohort study used a pooled analysis of 4 population-based prospective cohorts (National Health Interview Survey, 1997-2018; UK Biobank, 2006-2010; China Kadoorie Biobank, 2004-2008; and Mei Jau, 1997-2016). Data were analyzed from June 2022 to September 2024., Exposures: Self-reported leisure-time PA., Main Outcomes and Measures: The primary outcome was deaths identified through follow-up linkage to national death registries. Analyses were performed for the total sample and by age groups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years). Cox proportional hazards regression models with stratification by study were used to calculate mortality hazard ratios and their 95% CIs for the pooled dataset and by age group., Results: A heterogeneous sample of 2 011 186 individuals (mean [SD] age, 49.1 [14.3] years; age range, 20-97 years; 1 105 581 women [55.0%]) were included. After a median (IQR) follow-up of 11.5 (9.3-13.5) years, 177 436 deaths occurred. The association between PA and mortality in the total sample showed a nonlinear dose-response pattern, but age modified this association (P for interaction <.001); PA was consistently associated with a lower risk of mortality across all age groups, but the reduction in risk was greater in older vs younger age groups, especially at high levels of PA. The hazard ratio for mortality associated with meeting the recommended PA in the total sample was 0.78 (95% CI, 0.77-0.79). This inverse association between meeting PA recommendations and mortality was somewhat greater as age increased (P for interaction <.001). Age also modified the associations of the other modifiable health factors with mortality (all P for interaction <.001), but the magnitude of associations was greater in younger vs older age groups., Conclusions and Relevance: In this pooled analysis of cohort studies, the association between PA and mortality risk remained consistent across the adult lifespan, which contrasts with other modifiable health factors, for which associations with mortality risk diminished with age. Given these findings, the promotion of regular PA is essential at all stages of adult life.

Background: The Planetary Health Diet index (PHDI) prioritizes the well-being of both individuals and the planet but has yielded mixed results on cardiovascular disease (CVD). Our aim was to assess the association between the PHDI and risk of CVD., Methods: A cohort of 118,469 individuals aged 40-69 years from the UK Biobank, who were free of CVD at 2009-2012 and followed-up to 2021. The PHDI was calculated using at least two 24-h dietary assessments and included 14 food groups, with a possible range from 0 to130 points. CVD incidence was defined as primary myocardial infarction or stroke and obtained from clinical records and death registries., Results: During a 9.4-year follow-up, 5,257 incident cases of CVD were ascertained. When comparing the highest (89.9-128.5 points) versus the lowest quartile (21.1-71.1 points) of PHDI adherence, the multivariable-adjusted hazard ratio (95% confidence interval) was 0.86 (0.79, 0.94) for CVD, 0.88 (0.80, 0.97) for myocardial infarction, and 0.82 (0.70, 0.97) for stroke. The association was linear until a plateau effect was reached at 80 points of adherence to PHDI. Results remained robust when excluding participants with type 2 diabetes, including only those with three or more diet assessments, or excluding CVD cases in the first three years of follow-up. The food group components of the PHDI more strongly associated with reduced CVD risk were higher consumption of whole grains, whole fruits, fish and lower consumption of added sugars and fruit juices., Conclusion: In this large cohort of middle-aged and older British adults, adherence to the PHDI was associated with lower risk of CVD. These results provide empirical evidence that this dietary pattern, thought to be environmentally sustainable, benefits cardiovascular health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: It is unknown whether growth differentiation factor 15 (GDF-15) is associated with chronic musculoskeletal pain (CMP) and whether or not its association with incident cardiovascular disease (CVD) changes according to CMP status., Methods: In total, 1 957 randomly selected adults aged ≥65 years without prior CVD were followed up between 2015 and 2023. CMP was classified according to its intensity, frequency, and interference with daily activities. The association between GDF-15 levels and CMP was assessed using linear models with progressive inclusion of potential confounders, whereas the association between GDF-15 and CVD risk was evaluated with Cox proportional hazard models with similar adjustment and interaction terms between GDF-15 and CMP. The incremental predictive performance of GDF-15 over standard predictors was evaluated using discrimination and risk reclassification metrics., Results: GDF-15 concentrations were 6.90% (95% confidence interval [CI]: 2.56; 11.25) higher in individuals with CMP, and up to 8.89% (4.07; 15.71) and 15.79% (8.43; 23.16) higher in those with ≥3 CMP locations and interfering pain. These increased levels were influenced by a higher prevalence of cardiometabolic risk factors, functional impairments, depressive symptoms, and greater levels of inflammation in individuals with CMP. In fully adjusted models, a twofold increase in GDF-15 was associated with a 1.49 increased risk (95% CI: 1.08; 2.05) of a CVD event in individuals with CMP, but not among those without CMP (1.02 [0.77; 1.35]); p-interaction 0.041. Adding GDF-15 to models including the Framingham Risk Score improved predictive performance among individuals with CMP., Conclusions: We provide evidence that GDF-15 could serve as a biomarker to assess CMP, as well as to predict CVD incidence in individuals with CMP., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors., Objective: To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors., Design, Setting, and Participants: This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024., Exposure: According to their mean alcohol intake in grams per day, participants' drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d)., Main Outcomes and Measures: Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences., Results: A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking., Conclusions and Relevance: In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.

Study Objective: This study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits., Design, Setting, and Participants: We recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA., Main Outcome Measures: Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants' perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice., Results: Adolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants' median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants' median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits., Conclusion: HerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics., Competing Interests: Conflicts of Interest Melissa J. Kottke has been a consultant for HRA Pharma and has received an investigator-initiated grant from Organon. All other authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Background: Oral vitamin C supplementation has been associated with lower risk of chronic postsurgical pain. However, the effect of dietary vitamin C on pain in a nonsurgical setting is unknown. We aimed to investigate the association between dietary vitamin C intake and changes over time in chronic pain and its characteristics in community-dwelling adults aged 60 + years., Methods: We pooled data from participants of the Seniors-ENRICA-1 (n = 864) and Seniors-ENRICA-2 (n = 862) cohorts who reported pain at baseline or at follow up. Habitual diet was assessed with a face-to-face diet history and dietary vitamin C intake was estimated using standard food composition tables. Pain changes over time were the difference between scores at baseline and follow up obtained from a pain scale that considered the frequency, severity, and number of pain locations. Multivariable-adjusted relative risk ratios were obtained using multinomial logistic regression., Results: After a median follow-up of 2.6 years, pain worsened for 696 (40.3%) participants, improved for 734 (42.5%), and did not change for 296 (17.2%). Compared with the lowest tertile of energy-adjusted vitamin C intake, those in the highest tertile had a higher likelihood of overall pain improvement (RRR 1.61 [95% confidence interval 1.07-2.41], p-trend .02). Higher vitamin C intake was also associated with lower pain frequency (1.57 [1.00-2.47], p-trend = .05) and number of pain locations (1.75 [1.13-2.70], p-trend = .01)., Conclusions: Higher dietary vitamin C intake was associated with improvement of pain and with lower pain frequency and number of pain locations in older adults. Nutritional interventions to increase dietary vitamin C intake with the aim of improving pain management require clinical testing., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Dietary choices play a crucial role in influencing systemic inflammation and the eventual development of cardiovascular diseases (CVD). The Dietary Inflammatory Index (DII®) is a novel tool designed to assess the inflammatory potential of one's diet. Firefighting, which is characterized by high-stress environments and elevated CVD risk, represents an interesting context for exploring the dietary inflammatory-CVD connection., Aim: This study aims to investigate the associations between Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and cardiometabolic risk parameters among US firefighters., Methods: The study analyzed 413 participants from the Indianapolis Fire Department who took part in a Federal Emergency Management Agency (FEMA)-sponsored Mediterranean diet intervention trial. Thorough medical evaluations, encompassing physical examinations, standard laboratory tests, resting electrocardiograms, and submaximal treadmill exercise testing, were carried out. Participants also completed a detailed food frequency questionnaire to evaluate dietary patterns, and E-DII scores were subsequently computed based on the gathered information., Results: Participants had a mean body mass index (BMI) of 30.0 ± 4.5 kg/m 2 and an average body fat percentage of 28.1 ± 6.6%. Regression analyses, adjusted for sex, BMI, maximal oxygen consumption (VO 2 max), max metabolic equivalents (METS), age, and body fat percentage, revealed significant associations between high vs. low E-DII scores and total cholesterol ( β = 10.37, p = 0.04). When comparing low Vs median E-DII scores there is an increase in glucose ( β = 0.91, p = 0.72) and total cholesterol ( β = 5.51, p = 0.26)., Conclusion: Our findings support an association between higher E-DII scores and increasing adiposity, as well as worse lipid profiles., Competing Interests: LZ and JH were employed by Connecting Health Innovations LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Christodoulou, Christophi, Sotos-Prieto, Moffatt, Zhao, Kales and Hébert.)

Background: Substantial evidence supports the inverse association between adherence to healthy dietary patterns and frailty risk. However, the role of plant-based diets, particularly their quality, is poorly known., Objective: To examine the association of two plant-based diets with incidence of physical frailty in middle-aged and older adults., Design: Prospective cohort., Setting: United Kingdom., Subjects: 24,996 individuals aged 40-70 years, followed from 2009-12 to 2019-22., Methods: Based on at least two 24-h diet assessments, we built two diet indices: (i) the healthful Plant-based Diet Index (hPDI) and (ii) the unhealthful Plant-based Diet Index (uPDI). Incident frailty was defined as developing ≥3 out of 5 of the Fried criteria. We used Cox models to estimate relative risks (RR), and their 95% confidence interval (CI), of incident frailty adjusted for the main potential confounders., Results: After a median follow-up of 6.72 years, 428 cases of frailty were ascertained. The RR (95% CI) of frailty was 0.62 (0.48-0.80) for the highest versus lowest tertile of the hPDI and 1.61 (1.26-2.05) for the uPDI. The consumption of healthy plant foods was associated with lower frailty risk (RR per serving 0.93 (0.90-0.96)). The hPDI was directly, and the uPDI inversely, associated with higher risk of low physical activity, slow walking speed and weak hand grip, and the uPDI with higher risk of exhaustion., Conclusions: In British middle-age and older adults, greater adherence to the hPDI was associated with lower risk of frailty, whereas greater adherence to the uPDI was associated with higher risk., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction and Objectives: The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death., Methods: We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression., Results: In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89)., Conclusions: A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population., Patients and Methods: We studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) "Mediterranean food consumption," (2) "Mediterranean dietary habits," and (3) "physical activity, rest, social habits, and conviviality." Death information was retrieved from death register records. Cox regression models were used to analyze the study associations., Results: During a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality., Conclusion: Higher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle., (Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Introduction: The impact of residential green spaces on cardiovascular health in older adults remains uncertain., Methods: Cohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF-15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92)., Results: After adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of -5.56 % (95 %CI: -9.77; -1.35), -5.05 % (-9.58; -0.53), -4.24 % (-8.19, -0.19), and -4.16 % (-7.59; -0.74), respectively; and mean differences in hs-TnT among diabetic participants of -8.03 % (95 %CI: -13.30; -2.77), -9.52 % (-16.08; -2.96), -8.05 % (-13.94, -2.16) and -5.56 % (-10.75; -0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes., Conclusion: Increased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To examine the independent relationships of lifestyle and social and economic factors with all-cause and cardiovascular disease (CVD) mortality in a large representative sample of the US adult population. Furthermore, the association between the combination of lifestyle and social and economic factors with mortality was analyzed in detail., Methods: The sample included 103,314 participants with valid records and eligible for mortality follow-up, and information on lifestyle factors and social and economic disadvantages (NHIS waves 2000, 2005, 2010, and 2015). An unhealthy lifestyle score was constructed using information on physical activity, alcohol consumption, diet, and smoking status. Social and economic disadvantages were assessed using information on education, receipt of dividends, employment, family's home, and access to private health. Information on mortality data was determined by the National Death Index records., Results: Compared with favorable lifestyle, unfavorable lifestyle was associated with higher all-cause (HR 2.07; 95% CI 1.97-2.19) and CVD (HR 1.84; 95% CI 1.68-2.02) mortality. Higher social and economic disadvantages were also associated with higher all-cause (HR 2.44; 95% CI 2.30-2.59) and CVD mortality (HR 2.44; 95% CI 2.16-2.77), compared to low social and economic disadvantages. In joint associations, participants in the high social and economic disadvantage and unfavorable lifestyle showed a greater risk of all-cause (HR 4.06; 95% CI 3.69-4.47) and CVD mortality (HR 3.98; 95% CI 3.31-4.79)., Conclusion: Lifestyle and social and economic disadvantages are associated with all-cause and CVD mortality. The risk of mortality increases as the number of social and economic disadvantages and unhealthy lifestyles increases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Duarte Junior, Pintos Carrillo, Martínez-Gómez, Sotos Prieto, Rodríguez-Artalejo and Cabanas Sánchez.)

Importance: Previous research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods., Objective: To examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses' Health Study., Design, Setting, and Participants: This cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses' Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023., Main Outcomes and Measures: Hip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture., Results: In total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend)., Conclusions and Relevance: Findings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.

Background: Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown., Methods: Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces., Results: At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities., Conclusions: Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age., (© 2024. The Author(s).)

Specific foods, nutrients, dietary patterns, and physical activity are associated with lower blood pressure (BP) and heart rate (HR), but little is known about the joint effect of lifestyle factors captured in a multidimensional score. We assessed the association of a validated Mediterranean-lifestyle (MEDLIFE) index with 24-h-ambulatory BP and HR in everyday life among community-living older adults. Data were taken from 2,184 individuals (51% females, mean age: 71.4 years) from the Seniors-ENRICA-2 cohort. The MEDLIFE index consisted of 29 items arranged in three blocks: 1) Food consumption; 2) Dietary habits; and 3) Physical activity, rest, and conviviality. A higher MEDLIFE score (0-29 points) represented a better Mediterranean lifestyle adherence. 24-h-ambulatory BP and HR were obtained with validated oscillometric devices. Analyses were performed with linear regression adjusted for the main confounders. The MEDLIFE-highest quintile (vs Q1) was associated with lower nighttime systolic BP (SBP) (-3.17 mmHg [95% CI: -5.25, -1.08]; p-trend = 0.011), greater nocturnal-SBP fall (1.67% [0.51, 2.83]; p-trend = 0.052), and lower HR (-2.04 bpm [daytime], -2.33 bpm [nighttime], and -1.93 bpm [24-h]; all p-trend < 0.001). Results were similar for each of the three blocks of MEDLIFE and by hypertension status (yes/no). Among older adults, higher adherence to MEDLIFE was associated with lower nighttime SBP, greater nocturnal-SBP fall, and lower HR in their everyday life. These results suggest a synergistic BP-related protection from the components of the Mediterranean lifestyle. Future studies should determine whether these results replicate in older adults from other Mediterranean and non-Mediterranean countries., (© 2023. The Author(s).)

Objective: To assess the association of physical activity (PA) type, volume, intensity, and changes over time with all-cause mortality in older adults., Methods: We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts. PA was assessed with the EPIC questionnaire. Participants reported how many hours they spent a week in walking, cycling, gardening, do-it-yourself (DIY), sports, and housework. Then, time at each intensity (moderate PA [MPA], vigorous PA [VPA], moderate-to-vigorous PA [MVPA] and total PA) was calculated. Changes in PA were calculated from the date of the baseline interview to Wave 1. All-cause mortality was ascertained up January 31, 2022. Analyses were performed with Cox regression models, adjusting for the main confounders., Results: Walking, gardening, sports, and housework was associated with lower mortality (ranged 20%-46%). Also, MPA, VPA, MVPA was associated with lower risk of mortality (ranged 28%-53%). Analyses of PA change showed that, compared no PA participation (at baseline nor Wave 1), maintain walking, sports, and housework (ranged 28%-53%) and maintaining MPA, VPA, and MVPA (ranged 32%-36%) levels was linked to decreased mortality risk. Those who increased, maintained, or even decreased total PA had lower mortality (57%, 52%, and 36%, respectively) than those with consistently very low PA., Conclusions: The lower mortality was observed in those with a high baseline level of total PA. Maintaining PA levels such as walking, gardening, and housework, or at all analyzed intensities, was related to lower mortality., (© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)