PurposeMediterranean-type dietary pattern has been associated with lower risk of cardiovascular (CVD) and other chronic diseases, primarily in Southern European populations. We examined whether Mediterranean diet score (MDS) is associated with total, CVD, coronary heart disease (CHD) and stroke mortality in a prospective cohort study in three Eastern European populations.MethodsA total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study in the Czech Republic, Poland and the Russian Federation were included in the analysis. Diet was assessed by food frequency questionnaire, and MDS was derived from consumption of nine groups of food using absolute cut-offs. Mortality was ascertained by linkage with death registers.ResultsOver the median follow-up time of 7 years, 1314 participants died. The proportion of participants with high adherence to Mediterranean diet was low (25 %). One standard deviation (SD) increase in the MDS (equivalent to 2.2 point increase in the score) was found to be inversely associated with death from all causes (HR, 95 % CI 0.93, 0.88–0.98) and CVD (0.90, 0.81–0.99) even after multivariable adjustment. Inverse but statistically not significant link was found for CHD (0.90, 0.78–1.03) and stroke (0.87, 0.71–1.07). The MDS effects were similar in each country cohort.ConclusionHigher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban populations. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean populations.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-015-1092-x) contains supplementary material, which is available to authorized users.

PurposeThe aim of this study was to evaluate the association between total and individual classes and subclasses of dietary polyphenol intake and prevalence of metabolic syndrome (MetS) in the Polish arm of the Health, Alcohol and Psychosocial factors In Eastern Europe cohort study.MethodsA cross-sectional population-based survey including 8821 adults (51.4 % female) was conducted in Kraków, Poland. Dietary polyphenol intake was evaluated using food frequency questionnaires and matching food consumption data with the Phenol-Explorer database. MetS was defined according to the International Diabetes Federation definition. Linear and logistic regression models were performed to estimate odds ratios (ORs) and confidence intervals (CIs).ResultsSignificant differences in age and energy intake among different categories of total dietary polyphenol intake were found. Body mass index (BMI), waist circumference (WC), blood pressure, and triglycerides were significantly lower among individuals in the higher quartiles of polyphenol intake, but a linear association was found only for BMI and WC. After adjusting for potential confounding factors, individuals in the highest quartile of polyphenol intake were less likely to have MetS (OR 0.80; 95 % CI 0.64, 0.98 and OR 0.70; 95 % CI 0.56, 0.86 for both men and women, respectively). High total polyphenol intake was negatively associated with WC, blood pressure, high lipoprotein cholesterol, and triglycerides in women, and fasting plasma glucose in both genders. Among individual classes of polyphenols, phenolic acids and stilbenes were significantly associated with MetS; lignans and stilbenes with WC; phenolic acids with blood pressure and triglycerides; and flavonoids with fasting plasma glucose. Among specific subclasses of polyphenols, hydroxycinnamic acids, flavanols, and dihydrochalcones had the most relevant role.ConclusionsTotal and individual classes and subclasses of dietary polyphenols were inversely associated with MetS and some of its components.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-016-1187-z) contains supplementary material, which is available to authorized users.

Background The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories.Methods This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study.Findings We used data from 141 214 participants, with a mean age of 62•9 years (SD 10•1) and an age range of 45-106 years, of whom 76 484 (54•2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10•54 points, 95% CI 10•31-10•77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8•98 points (95% CI 8•74-9•22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA.Interpretation The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies.

PurposeDietary polyphenols have been studied for their potential effects on metabolic disorders, but studies on risk of hypertension are scarce. This study aimed to test the association between total and individual classes of dietary polyphenols and incidence of hypertension in the Polish arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study.MethodsA total of 2725 participants free of hypertension at baseline were tested for blood pressure or taking hypertensive medication within the last 2 weeks at 2–4-year follow-up visit. A 148-item food frequency questionnaire and the Phenol-Explorer database were used to estimate dietary polyphenol intake. Odds ratios (ORs) and 95% confidence intervals (CIs) of hypertension comparing the various categories of exposure (total and individual classes of polyphenol intake) with the lowest one (reference category) were calculated by performing age- and energy-adjusted and multivariate-adjusted logistic regression models.ResultsDuring follow-up, 1735 incident cases of hypertension occurred. The highest quartile of total polyphenol intake was associated with 31% decreased risk of hypertension compared with the lowest intake (OR 0.69, 95% CI 0.48, 0.98) in women. There was no significant association in men. Among main classes of polyphenols, flavonoids and phenolic acids were independent contributors to this association. The analysis of individual subclasses of polyphenol revealed that, among phenolic acids, hydroxycynnamic acids were independently associated to lower odds of hypertension (OR 0.66, 95% CI 0.47, 0.93), while among flavonoids, most of the association was driven by flavanols (OR 0.56, 95% CI 0.36, 0.87).ConclusionCertain classes of dietary polyphenols were associated with lower risk of hypertension, but potential differences between men and women should be further investigated.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-017-1438-7) contains supplementary material, which is available to authorized users.

This study aimed to test the association between dietary content of total and individual classes of polyphenols and incident cases of type 2 diabetes in Polish adults participating to the Health, Alcohol and Psychosocial factors In Eastern Europe study. At baseline, diet by 148-item FFQ and health information were collected from 5806 participants free of diabetes. Self-reported incident type 2 diabetes was ascertained at 2–4-year follow-up visit. OR and 95 % CI of type 2 diabetes comparing the various categories of polyphenol intake to the lowest one (reference category) and as 1 sd increase modelled as continuous variable were calculated by performing age-, energy-, and multivariate-adjusted logistic regression models. During the follow-up, 456 incident cases of type 2 diabetes occurred. When comparing extreme quartiles, intake of total polyphenol was inversely associated with the risk of type 2 diabetes (OR 0·43; 95 % CI 0·30, 0·61); 1 sd increase was associated with a reduced risk of diabetes (OR 0·68; 95 % CI 0·59, 0·79). Among the main classes of polyphenols, flavonoids, phenolic acids, and stilbenes were independent contributors to this association. Both subclasses of phenolic acids were associated with decreased risk of type 2 diabetes, whereas among subclasses of flavonoids, high intake of flavanols, flavanones, flavones and anthocyanins was significantly associated with decreased risk of type 2 diabetes. Total dietary polyphenols and some classes of dietary polyphenols were associated with lower risk of type 2 diabetes.