OBJECTIVE In this study we investigated the association of the quantity, quality, and timing of carbohydrate intake with all-cause, cardiovascular disease (CVD), and diabetes mortality. RESEARCH DESIGN AND METHODS This secondary data analysis included use of National Health and Nutrition Examination Survey (2003–2014) and National Death Index data from adults (n = 27,623) for examination of the association of total daily and differences in carbohydrate intake with mortality. Participants were categorized into four carbohydrate intake patterns based on the median values of daily high- and low-quality carbohydrate intake. The differences (Δ) in carbohydrate intake between dinner and breakfast were calculated (Δ = dinner − breakfast). Cox regression models were used. RESULTS The participants who consumed more high-quality carbohydrates throughout the day had lower all-cause mortality risk (hazard ratio [HR] 0.88; 95% CI 0.79–0.99), whereas more daily intake of low-quality carbohydrates was related to greater all-cause mortality risk (HR 1.13; 95% CI: 1.01–1.26). Among participants whose daily high- and low-quality carbohydrate intake were both below the median, the participants who consumed more high-quality carbohydrates at dinner had lower CVD (HR 0.70; 95% CI 0.52–0.93) and all-cause mortality (HR 0.82; 95% CI 0.70–0.97) risk; an isocaloric substitution of 1 serving low-quality carbohydrates intake at dinner with high-quality reduced the CVD and all-cause mortality risks by 25% and 19%. There was greater diabetes mortality among the participants who consumed more low-quality carbohydrates at dinner (HR 1.78; 95% CI 1.02–3.11), although their daily high-quality carbohydrate intake was above the median. CONCLUSIONS Consuming more low-quality carbohydrates at dinner was associated with greater diabetes mortality, whereas consuming more high-quality carbohydrates at dinner was associated with lower all-cause and CVD mortality irrespective of the total daily quantity and quality of carbohydrates.

BackgroundCurrent studies on the protective effects of dietary spermidine (SPD) on cardiovascular disease (CVD) are mainly limited to animal studies, and the relationship between dietary SPD and CVD mortality remains inconclusive.ObjectiveThis study aims to evaluate the association between dietary SPD intake and CVD and all-cause mortality.MethodsA total of 23,894 people enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014 were recruited for this study. The dietary intake of SPD from 11 specific food origins and total SPD was categorized into tertiles or quartiles. Cox proportional hazard regression models were developed to evaluate the association of SPD intake with CVD and all-cause mortalities.ResultsAmong the 23,894 participants, 2,365 deaths, including 736 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quartile, participants in the highest quartile of total SPD had a significantly lower risk of CVD mortality (HR = 0.68, 95% CI: 0.51–0.91) and all-cause mortality (HR = 0.70, 95% CI: 0.60–0.82); participants in the highest tertiles or quartiles of vegetable-derived SPD, cereal-derived SPD, legume-derived SPD, nut-derived SPD, and cheese-derived SPD had a lower risk of CVD mortality (HR vegetable − derivedSPD = 0.68, 95% CI: 0.54–0.86; HR cereal − derivedSPD = 0.75, 95% CI: 0.57–0.97; HR legume − derivedSPD = 0.68, 95% CI: 0.52–0.88; HR nut − derivedSPD = 0.66, 95% CI: 0.53–0.80; HR cheese − derivedSPD = 0.68, 95% CI: 0.52–0.88) and all-cause mortality (HR vegetable − derivedSPD = 0.73, 95% CI: 0.64–0.84; HR cereal − derivedSPD = 0.80, 95% CI: 0.69–0.93; HR legume − derivedSPD = 0.70, 95% CI: 0.60–0.80;HR nut − derivedSPD = 0.72, 95% CI: 0.64–0.81; HR cheese − derivedSPD = 0.70, 95% CI: 0.61–0.81) than those in the lowest tertiles or quartiles. Moreover, subgroup analysis showed consistent associations among the people with hypertension and hyperlipidemia.ConclusionHigher intake of dietary SPD is associated with decreased risk of CVD and all-cause mortality, and among specific food origin SPD, SPD derived from vegetables, cereals, legumes, nuts, and cheese was associated with reduced CVD and all-cause mortality.

BackgroundCircadian rhythm plays an essential role in various physiological and pathological processes related to cognitive function. The rest-activity rhythm (RAR) is one of the most prominent outputs of the circadian system. However, little is known about the relationships between RAR and different domains of cognitive function in older adults. The purpose of this study was to examine the relationships between RAR and various fields of cognitive function in older Americans.MethodsThis study included a total of 2090 older adults ≥ 60 years old from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014. RAR parameters were derived from accelerometer recordings. Cognitive function was assessed using the word learning subtest developed by the Consortium to Establish a Registry for Alzheimer’s disease (CERAD W-L), the Animal Fluency Test (AFT) and the Digital Symbol Substitution Test (DSST). Linear regression was used to determine the relationships between RAR parameters (IS, IV, RA, L5, M10) and cognitive function scores (CERAD W-L, AFT, DSST).ResultsAfter adjusting for potential confounders, lower IS and M10 were associated with lower CERAD W-L scores (P=0.033 and P=0.002, respectively). Weaker RA and higher L5 were associated with lower AFT scores (P<0.001 and P=0.001, respectively). And lower IS, RA, and higher L5 were associated with lower DSST scores (P=0.019, P<0.001 and P<0.001, respectively). In addition, the results of sensitivity analysis were similar to those of our main analyses. The main correlation results between the RAR indicators and cognitive function were robust.ConclusionsThis study suggested that the weakened and/or disrupted RAR was associated with cognitive decline in different domains in Americans over the age of 60.

Background The hyperglycemia condition disrupts the metabolism of nitrate/nitrite and nitric oxide, and dietary nitrate intake can restore nitric oxide homeostasis. This study aims to examine whether urinary nitrate is associated with diabetes complications and long-term survival among people with hyperglycemia. Methods A total of 6208 people with hyperglycemia who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 were enrolled. Diabetes complications included congestive heart failure, coronary heart disease, angina, stroke, myocardial infarction, diabetic retinopathy, and nephropathy. Mortality wasobtained from the National Death Index until 2015. Urinary nitrate was measured by ion chromatography coupled with electrospray tandem mass spectrometry, which was log-transformed and categized into tertiles. Logistic regression models and cox proportional hazards models were respectively performed to assess the association of urinary nitrate with the risk of diabetes complications and disease-specific mortalities. Results After adjustment for potential confounders including urinary perchlorate and thiocyanate, compared with the participants in the lowest tertile of nitrate, the participants in the highest tertile had lower risks of congestive heart failure(odd-ratio[OR] = 0.41, 95%CI:0.27-0.60) and diabetic nephropathy(OR = 0.50, 95%CI: 0.41-0.62). Meanwhile, during a total follow-up of 41,463 person-year, the participants in the highest tertile had lower mortality risk of all-cause(hazard-ratio[HR] = 0.78, 95%CI:0.62-0.97), cardiovascular disease(CVD)(HR = 0.56, 95%CI:0.37-0.84) and diabetes(HR = 0.47, 95%CI:0.24-0.90), which showed dose-dependent linear relationships(P for non-linearity > 0.05). Moreover, no association between nitrate and cancer mortality was observed(HR = 1.13, 95%CI:0.71-1.80). Conclusions Higher urinary nitrate is associated with lower risk of congestive heart failure and diabetic nephropathy, and lower risk of all-cause, CVD, and diabetes mortalities. These findings indicated that inorganic nitrate supplementation can be considered as a supplementary treatment for people with hyperglycemia.

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