A healthy diet is associated with less endothelial dysfunction and less low-grade inflammation over a 7-year period in adults at risk of cardiovascular disease.
BACKGROUND
A healthy diet rich in fish, fruit, and vegetables, but moderate in alcohol and low in dairy products and meat, has been associated with a lower rate of incident cardiovascular disease (CVD). The underlying mechanisms, however, remain unclear. Endothelial dysfunction and low-grade inflammation play important roles in CVD. A healthy diet might modify these phenomena.


OBJECTIVE
We investigated the associations between the above food groups and overall biomarker scores of endothelial dysfunction and low-grade inflammation in a 7-y longitudinal study.


METHODS
Using longitudinal data from 557 participants at increased CVD risk from the CODAM (Cohort on Diabetes and Atherosclerosis Maastricht) Study, we assessed diet intake by food-frequency questionnaire and measured plasma biomarkers of endothelial dysfunction [von Willebrand factor, soluble vascular cell adhesion molecule 1, soluble endothelial selectin, soluble thrombomodulin, soluble intercellular adhesion molecule 1 (sICAM-1)] and low-grade inflammation [C-reactive protein, serum amyloid A, interleukin (IL)-6, IL-8, tumor necrosis factor α, and sICAM-1]. At baseline, participants were aged 59.6 ± 6.9 y. Measurements were performed then and after 7 y. Biomarkers were combined into overall scores (sum of z scores; higher scores indicating worse function). Longitudinal data were analyzed with generalized estimating equations and adjusted for sex, age, glucose metabolism, energy intake, body mass index, physical activity, alcohol consumption, and smoking.


RESULTS
Higher consumption of fish (per 100 g/wk), but not total consumption of vegetables, fruit, alcohol-containing beverages, dairy products, or meat, was associated with a lower overall endothelial dysfunction score over 7 y (β: -0.027; 95% CI: -0.051, -0.004). No associations were observed with the overall low-grade inflammation score. Further food component analyses indicated that consumption of more lean fish (per 100 g/wk) and raw vegetables (per 100 g/d), and fewer high-fat dairy products (per 100 g/d) was associated with less endothelial dysfunction [(β: -0.038; 95% CI: -0.072, -0.005), (β: -0.095; 95% CI: -0.191, 0.000), and (β: -0.070; 95% CI: -0.131, -0.009), respectively]. Consumption of more fresh fruit (per 100 g/d), wine (per 100 mL/wk), and poultry (per 100 g/d), and fewer high-fat dairy products (per 100 g/d) was associated with less low-grade inflammation [(β: -0.074; 95% CI: -0.133, -0.015), (β:-0.006; 95% CI: -0.013, 0.001), (β:-0.247; 95% CI: -0.479, -0.014), and (β:-0.100; 95% CI: -0.182, -0.019), respectively].


CONCLUSIONS
These data suggest that the dietary modification of endothelial dysfunction and low-grade inflammation, processes that are important in atherothrombosis, is possible.
Department of Medicine School for Nutrition, Toxicology, and Metabolism Top Institute Food and Nutrition, Wageningen, The Netherlands.
Bas C T
BC
van Bussel
Department of Medicine Cardiovascular Research Institute Maastricht Top Institute Food and Nutrition, Wageningen, The Netherlands.
Ronald M A
RM
Henry
Department of Medicine Cardiovascular Research Institute Maastricht School for Public Health and Primary Care, and Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands.
Isabel
I
Ferreira
Department of Medicine Cardiovascular Research Institute Maastricht.
Marleen M J
MM
van Greevenbroek
Department of Medicine Cardiovascular Research Institute Maastricht.
Carla J H
CJ
van der Kallen
The Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Jos W R
JW
Twisk
Top Institute Food and Nutrition, Wageningen, The Netherlands Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
Edith J M
EJ
Feskens
Department of Medicine Cardiovascular Research Institute Maastricht Top Institute Food and Nutrition, Wageningen, The Netherlands.
Casper G
CG
Schalkwijk
Department of Medicine Cardiovascular Research Institute Maastricht Top Institute Food and Nutrition, Wageningen, The Netherlands cda.stehouwer@mumc.nl.
Coen D A
CD
Stehouwer
D000368:Aged; D000428:Alcohol Drinking; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D003611:Dairy Products; D004032:Diet; D004730:Endothelium, Vascular / Q000378:metabolism*; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008460:Meat; D008875:Middle Aged; D009043:Motor Activity; D012307:Risk Factors; D014652:Vascular Diseases / Q000097:blood / Q000517:prevention & control*; D014675:Vegetables
D015415:Biomarkers
diet; endothelial dysfunction; epidemiology; inflammation; longitudinal cohort