Malnutrition and depression are highly prevalent in the institutionalised elderly and can lead to unfavourable outcomes. The aim of the present study was to assess associations between nutritional status and depressive symptoms and to explore their impact on self-caring capacity and quality of life (QoL) in elderly nursing-home residents (NHR). We conducted a cross-sectional study with 114 NHR (eighty-six female) with a mean age of 84·6 (sd 9·1) years. Nutritional status was assessed with the Mini Nutritional Assessment (MNA). Depressive symptoms were rated with the Geriatric Depression Scale (GDS). Self-caring capacity was measured with the Barthel index (BI) and QoL was assessed with the short-form thirty-six-item (SF-36) questionnaire. Of the NHR, twenty-six (22·8 %) were malnourished according to the MNA and sixty-six (57·9 %) were at nutritional risk. Of the residents, seventy-five could be assessed with the GDS, whereof sixteen (21·3 %) had major and twenty-six (34·7 %) had minor depressive symptoms. GDS scores tended to be higher in patients with impaired nutritional status (5·4 (sd 3·6) in well-nourished subjects and 6·9 (sd 3·2) in residents with malnutrition or at risk of malnutrition). The MNA correlated significantly with the GDS (r − 0·313; P = 0·006) and the GDS emerged as the only independent risk factor for malnutrition in a multiple regression analysis, whereas age, sex, care level, number of prescriptions and self-caring capacity had no influence. The BI was not reduced in patients with a high GDS. QoL was affected in malnourished residents as well as in study participants with depressive symptoms. The results of the present study point towards an association between malnutrition and depressive symptoms. However, the relationship is complex and it remains unclear whether depression in NHR is the cause or consequence of impaired nutritional status. Further studies are needed to identify the direction of this relationship and to assess the effect of depression treatment on nutritional and functional status as well as on QoL.

Prior reports suggest that during irinotecan (7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin; CPT-11) chemotherapy in laboratory rats, the anti-tumour efficacy and diarrhoea toxicity could be modulated by n-3 PUFA and glutamine, respectively. We further examined how these two dietary elements, when provided individually and in combination, would affect the efficacy of a cyclical regimen of CPT-11/5-fluorouracil (5-FU), an accepted combination regimen for colorectal cancer. Prior to initiating chemotherapy, diets enriched either with glutamine (2 %, w/w total diet) or n-3 PUFA (0·88 %, w/w total diet) alone, inhibited Ward colon tumour growth (P < 0·05). These diets also completely or partially normalized the changes in peripheral leucocyte counts associated with the tumour-bearing state (e.g. neutrophil proportion/concentration and lymphocyte proportion). During chemotherapy, either glutamine- or n-3 PUFA-enriched diet enhanced tumour chemo-sensitivity, and reduced body weight loss, anorexia and muscle wasting (v. animals fed control diet, P < 0·05). Surprisingly, providing both glutamine and n-3 PUFA together did not confer a greater benefit on tumour inhibition either in the presence or absence of chemotherapy; individual benefits associated with single treatments, particularly in respect to host nutritional status (i.e. body weight, food intake and muscle weight) and immune (peripheral leucocyte counts) features were instead partially or completely lost when these two nutrients were combined. These results draw into question the common assumption that there are additive or synergistic benefits of combinations of nutrients, which are beneficial on an individual basis, and suggest that co-supplementation with glutamine and n-3 PUFA is not indicated during chemotherapy with CPT-11 and 5-FU.

Over a decade ago, the finding of a form of low-grade systemic inflammation (‘metaflammation’) associated with obesity, insulin resistance and chronic disease proffered a causal explanation for the latter. However, recent work has shown that metaflammation is also associated with several modern lifestyle-related and environmental inducers, with or without obesity. Here, we present accumulating data to show a link between metaflammation and a number of non-microbial environmental and lifestyle stimulants, both with and without obesity. This implies that obesity may often be an accomplice to, as much as an offender in, major metabolic disease. The real (albeit distal) cause of such a disease appears to lie in aspects of the modern techno-industrial environment driving unhealthy lifestyle behaviours. If true, this suggests that while individual weight loss may be a component of chronic disease management, it may be neither ‘necessary’ nor ‘sufficient’ to reduce the problem at a population level. Greater multidisciplinary and policy input is needed to modify the economic and political drivers of the modern, obesogenic environment.

Limited information is available with respect to the association between age and the plasma phospholipid fatty acid profile. Therefore we investigated the association between plasma phospholipid fatty acid status and age after correction for sex, smoking, alcohol use, BMI and fish intake. Plasma phospholipid fatty acid composition was measured and information on fish intake and other potential covariates was collected in 234 participants of the Maastricht Aging Study. The participants were healthy individuals of both sexes with an age range between 36 and 88 years. Hierarchical linear regression analyses were applied to study the relationship between age and fatty acid concentrations. After correction for fish consumption and other relevant covariates, a significant positive relationship was observed between age of the subjects and their plasma phospholipid concentrations of DHA (22 : 6n-3, P = 0·006) and EPA (20 : 5n-3; P = 0·001). Age contributed 2·3 and 3·9 % to the amount of explained variance, respectively. The higher n-3 long-chain PUFA status at advanced age was confirmed by lower concentrations of their putative ‘shortage marker’ Osbond acid (ObA, 22 : 5n-6; P = 0·022 for the relationship with age after correction for covariates and fish intake, R2 0·022). Concentrations of linoleic acid (LA; 18 : 2n-6) were negatively associated with age (P < 0·001; R2 0·061). In conclusion, DHA and EPA concentrations appeared to be higher in older age groups, partly because of a higher fish intake and partly because of another age-associated mechanism, possibly involving the well-known competition with LA.

The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the risk of type 2 diabetes among an urban adult Asian Indian population. Adult subjects aged >20 years (n 1843) were randomly selected from the Chennai Urban Rural Epidemiology Study, in Chennai city in southern India. Dietary carbohydrates, glycaemic load and food groups were assessed using FFQ. Oral glucose tolerance tests were performed using 75 g glucose in all subjects. Diagnosis of diabetes was based on WHO Consulting Group criteria. OR for newly detected diabetes were calculated for carbohydrates, glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles, after adjustment for potential confounders such as age, sex, BMI, family history of diabetes, physical activity, current smoking, alcohol consumption and relevant dietary factors. We identified 156 (8·5 %) newly diagnosed cases of type 2 diabetes. Refined grain intake was positively associated with the risk of type 2 diabetes (OR 5·31 (95 % CI 2·98, 9·45); P < 0·001). In the multivariate model, after adjustment for potential confounders, total carbohydrate (OR 4·98 (95 % CI 2·69, 9·19), P < 0·001), glycaemic load (OR 4·25 (95 % CI 2·33, 7·77); P < 0·001) and glycaemic index (OR 2·51 (95 % CI 1·42, 4·43); P = 0·006) were associated with type 2 diabetes. Dietary fibre intake was inversely associated with diabetes (OR 0·31 (95 % CI 0·15, 0·62); P < 0·001). In urban south Indians, total dietary carbohydrate and glycaemic load are associated with increased, and dietary fibre with decreased, risk of type 2 diabetes.

Like in many other countries, few investigations have been carried out in Chile to measure the long-term effects of nutritional status at an early age on scholastic achievement in a multicausal approach. The objectives of the present study were to describe the impact of nutritional, intellectual, family, educational and socio-economic variables at the onset of elementary school in 1987 that may affect achievement on the academic aptitude test (AAT) taken in 1998 at the end of high school, and to quantify the impact of these independent variables on the AAT. The present study comprises two cross-sectional stages: in 1987, a representative sample of 813 elementary school first-grader Chilean children from the Metropolitan Region was randomly chosen; in 1998, 12 years later, 632 school-age children were located and only 351 of them graduated from high school and, from these, 260 students took the AAT. In 1987 nutritional status was assessed through anthropometric parameters, intellectual ability by the Raven's Progressive Matrices Test, scholastic achievement through Spanish language and mathematics tests, and socio-economic status using Graffar's modified scale; family variables were also recorded. Maternal schooling, scholastic achievement, intellectual ability and head circumference-for-age z-score (anthropometric indicator of both nutritional background and brain development) all in 1987 were the independent variables with the greatest explanatory power for AAT variance in 1998 (r2 0·402). These results provide a foundation to identify the risk factors at an early age that affect AAT scores and should be useful to improve nutritional and educational policies.

The impact of variations in current infant feeding practice on bone mineral accrual is not known. We examined the associations between duration of breast-feeding and compliance with infant dietary guidelines and later bone size and density at age 4 years. At total of 599 (318 boys) mother–child pairs were recruited from the Southampton Women's Survey. Duration of breast-feeding was recorded and infant diet was assessed at 6 and 12 months using FFQ. At 6 and 12 months the most important dietary pattern, defined by principal component analysis, was characterised by high consumption of vegetables, fruits and home-prepared foods. As this was consistent with infant feeding recommendations, it was denoted the ‘infant guidelines’ pattern. At age 4 years, children underwent assessment of whole-body bone size and density using a Hologic Discovery dual-energy X-ray absorptiometry instrument. Correlation methods were used to explore the relationships between infant dietary variables and bone mineral. There was no association between duration of breast-feeding in the first year of life and 4-year bone size or density. ‘Infant guidelines’ pattern scores at 6 and 12 months were also unrelated to bone mass at age 4 years. We observed wide variations in current infant feeding practice, but these variations were not associated with differences in childhood bone mass at age 4 years.

Countries worldwide, including the Netherlands, recommend that women planning pregnancy use a folic acid supplement during the periconception period. Some countries even fortify staple foods with folic acid. These recommendations mainly focus on the prevention of neural tube defects, despite increasing evidence that folic acid may also influence birth weight. We examined whether periconception folic acid supplementation affects fetal growth and the risks of low birth weight, small for gestational age (SGA) and preterm birth, in the Generation R Study in Rotterdam, the Netherlands. Main outcome measures were fetal growth measured in mid- and late pregnancy by ultrasound, birth weight, SGA and preterm birth in relation to periconception folic supplementation (0·4–0·5 mg). Data on 6353 pregnancies were available. Periconception folic acid supplementation was positively associated with fetal growth. Preconception folic acid supplementation was associated with 68 g higher birth weight (95 % CI 37·2, 99·0) and 13 g higher placental weight (95 % CI 1·1, 25·5), compared to no folic acid supplementation. In these analyses parity significantly modified the effect estimates. Start of folic acid supplementation after pregnancy confirmation was associated with a reduced risk of low birth weight (OR 0·61, 95 % CI 0·40, 0·94). Similarly, reduced risks for low birth weight and SGA were observed for women who started supplementation preconceptionally, compared to those who did not use folic acid (OR 0·43, 95 % CI 0·28, 0·69 and OR 0·40, 95 % CI 0·22, 0·72). In conclusion, periconception folic acid supplementation is associated with increased fetal growth resulting in higher placental and birth weight, and decreased risks of low birth weight and SGA.

Dietary fatty acids (FA) are the major determinants of blood lipids, and measurements of plasma phospholipid FA (PL-FA) composition that reflect the dietary intake of FA may provide insights into the relationships between diet and CHD. We assessed CHD mortality associations with PL-FA (SFA, PUFA and MUFA) levels measured in a nested case–control study of 116 cases of CHD death and 239 controls that were frequency-matched for age and employment grade. The participants had plasma levels of total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol, apo B and apo A1, C-reactive protein (CRP) and fibrinogen recorded. SFA levels were significantly positively correlated with total cholesterol, LDL-C, apo B, CRP protein and fibrinogen. By contrast, phospholipid-PUFA were inversely associated with CRP, but not with any of the lipids. A higher SFA content (top v. bottom quarter) was associated with a 2-fold higher risk of CHD (OR and 95 % CI: OR 2·12; 95 % CI: 1·13, 3·99), and an equivalent difference in PUFA was associated with a halving in CHD risk (OR 0·49; 95 % CI: 0·26, 0·94), but MUFA was unrelated to CHD risk. These associations were substantially attenuated, after additional adjustment for lipids and inflammatory markers. Higher levels of saturated fat and lower levels of polyunsaturated fats were each associated with a higher risk of CHD in elderly men, and these associations were partly explained by their effects on blood lipids and biomarkers of inflammation.

Several components of the metabolic syndrome, particularly diabetes and CVD, are known to be oxidative stress-related conditions and there is research to suggest that antioxidant nutrients may play a protective role in these conditions. Carotenoids are compounds derived primarily from plants and several have been shown to be potent antioxidant nutrients. The aim of the present study was to examine the associations between metabolic syndrome status and major serum carotenoids in adult Australians. Data on the presence of the metabolic syndrome, based on International Diabetes Federation 2005 criteria, were collected from 1523 adults aged 25 years and over in six randomly selected urban centres in Queensland, Australia, using a cross-sectional study design. Weight, height, BMI, waist circumference, blood pressure, fasting and 2 h blood glucose and lipids were determined, as well as five serum carotenoids. Mean serum α-, β-carotenes and the sum of the five carotenoid concentrations were significantly lower (P < 0·05) in persons with the metabolic syndrome (after adjusting for age, sex, education, BMI status, alcohol intake, smoking, physical activity status and vitamin/mineral use) than persons without the syndrome. α-, β- and total carotenoids also decreased significantly (P < 0·05) with increased number of components of the metabolic syndrome, after adjusting for these confounders. These differences were significant among former smokers and non-smokers, but not in present smokers. Low concentrations of serum α-, β-carotenes and the sum of five carotenoids appear to be associated with metabolic syndrome status. Additional research, particularly longitudinal studies, may help to determine whether these associations are causally related to the metabolic syndrome, or are a result of the pathologies of the syndrome.

To evaluate the efficacy of adding cognitive behavioural treatment (CBT) to either a low-carbohydrate (LC) diet or a low-fat (LF) diet in the treatment of weight loss of obese women, a randomised clinical intervention study was performed. A total of 105 healthy non-pregnant obese women (average age and BMI of 45·4 (sd 10·4) years and 36 (sd 4·3) kg/m2) were randomly allocated to the CBT or control (C) groups; within each group, women were randomly selected to receive either the LC or LF diet during 6 months. The pre-planned primary trial end-point was the weight loss. Differences between the groups were assessed using one-way ANOVA. There were three women (2·8 %) who dropped out, all of them in the CBT group. No differences in the anthropometric and laboratory characteristics at baseline were noted between women in the CBT (n 52) and control groups (n 50). Intention-to-treat analysis showed that weight loss in the CBT-LC (90 (sd 12·3) to 82·1 (sd 12·1) kg) and C-LC (89·4 (sd 10·0) to 85·8 (sd 9·8) kg) groups reached 8·7 and 4·0 %, respectively (P < 0·0001), and in the CBT-LF (87·9 (sd 11·4) to 79·4 (sd 11·8) kg) and C-LF (88·8 (sd 14·5) to 85·3 (sd 14·3) kg) groups it was 9·7 and 3·9 %, respectively (P < 0·05). Weight loss was higher in the CBT-LF group than in the CBT-LC groups (P = 0·049). The present results showed that adding CBT to either the LF or LC diet produced significantly greater short-term weight loss in obese women compared with diet alone. These finding support the efficacy of CBT in breaking previous dietary patterns and in developing healthier attitudes that reinforce a healthier lifestyle.

Food advertisements on mainstream television have received less research attention than those on children's television. Little is known about how television food advertisements vary internationally or if there have been changes over recent years. We describe food-related television advertisements and the nutrient content of foods advertised during prime-time television in Ontario, Canada and the UK in 1991 and 2006. Information on what advertisements were broadcast were obtained from video recordings and audience research bureaux. Data on nutrient content of foods advertised were obtained from manufacturers and standard food tables. The proportion of advertisements that were food related decreased between 1991 and 2006 in both countries. The frequency of food-related advertisements was relatively constant in Canada but decreased between 1991 and 2006 in the UK. In 1991, advertisements for beverages and meals predominated in both countries. By 2006, food-related advertisements in Canada were dominated by meals and restaurants. In the UK advisements for food stores and beverages predominated. The ‘TV diet’ in Canada in 1991 was relatively high in fat, high in alcohol and low in fibre, compared to current recommendations. By 2006, this had changed to high in fat and sodium and low in fibre. The ‘TV diet’ in the UK in 1991 was high in fat, sodium, sugar and alcohol and low in fibre compared to current recommendations. By 2006, the UK ‘TV diet’ was high in sodium, sugar and alcohol and low in fibre. Foods advertised on ‘prime-time’ television do not reflect a healthful diet.

The objective of the present study was to investigate the relationship between plasma n-3 PUFA composition and weight status. A total of 124 adults, stratified by weight status: healthy weight (n 21), overweight (n 40) and obese (n 63) were recruited. Fasting blood samples, anthropometric measures and body composition were collected. Plasma fatty acid composition was determined by GC. BMI, waist circumference and hip circumference were inversely correlated with n-3 PUFA, EPA and DHA (P < 0·05 for all) in the obese group. Obese individuals had significantly lower plasma concentrations of total n-3 PUFA, compared with healthy-weight individuals (4·53 (sd 1·11) v. 5·25 (sd 1·43) %). When subjects were pooled and stratified into quartiles of total n-3 PUFA, a significant inverse trend was found for BMI (P = 0·002), waist circumference and hip circumference (P = 0·01 and P < 0·001 respectively). Higher plasma levels of total n-3 PUFA are associated with a healthier BMI, waist circumference and hip circumference. Our findings suggest that n-3 PUFA may play an important role in weight status and abdominal adiposity.

The diet of pre-school children is determined by the parents and carers. The aim of the present study was to describe dietary clusters of pre-school children and their mothers in Finland, and analyse the similarity of dietary clusters within child–mother pairs. The present study comprised the mothers (n 4862) whose child was recruited in the Type 1 Diabetes Prediction and Prevention Nutrition Study and the children belonging to selected, cross-sectional age groups of 1 year (n 719), 3 years (n 708) and 6 years (n 841). The dietary data were collected from children by 3-d food records and from mothers by a FFQ validated for pregnant women. The food consumption data were analysed for patterns by hierarchical cluster analysis. Three main dietary clusters were identified in children: ‘healthy’ and ‘traditional’ in all three age groups, and ‘ready-to-eat baby foods’ in 1-year-olds and ‘fast foods, sweet’ in the older children. Six main clusters were identified among the mothers who completed a FFQ for their diet during pregnancy. Some familial dependence between dietary clusters of mother–child pairs was observed in 6-year-old children but not in younger children. Younger age and lower educational level of the mother were associated with the cluster ‘fast food, sweet’ only at the age of 3 years. The diets of pre-school children vary by age and only a slight similarity within dietary clusters of mother–child pairs was observed.

In nutritional epidemiology, it is often assumed that nutrient absorption is proportional to nutrient intake. For several nutrients, including non-haem Fe, this assumption may not hold. Depending on the nutrients ingested with non-haem Fe, its availability for absorption varies greatly. Therefore, using Fe intake to examine associations between Fe and health can impact upon the validity of findings. Previous algorithms that adjust Fe intakes for dietary factors known to affect absorption have been found to underestimate Fe absorption and, in the present study, perform poorly on independent dietary data. We have designed a new algorithm to adjust Fe intakes for the effects of ascorbic acid, meat, fish and poultry, phytate, polyphenols and Ca, incorporating not only absorption data from test meals but also current understanding of Fe absorption. In so doing, we have created a robust and universal Fe algorithm with potential for use in large cohorts. The algorithm described aims not to predict Fe absorption but available Fe in the gut, a measure we believe to be of greater use in epidemiological research. Available Fe is Fe available for absorption from the gastrointestinal tract, taking into account enhancing or inhibiting effects of dietary modifiers. Our algorithm successfully estimated average Fe availability in test meal data used to construct the algorithm and, unlike other algorithms tested, also provided plausible predictions when applied to independent dietary data. Future research is needed to evaluate the extent to which this algorithm is useful in epidemiological research to relate Fe to health outcomes.

The ‘iron hypothesis’ claims that Fe depletion protects against IHD. The objective of the present study was to investigate the associations between serum ferritin levels and the risk of CVD and IHD in a population-based sample. A total of 2874 subjects with serum ferritin levels between 15 and 300 μg/l from the Danish part of the ‘Monitoring of Trends and Determinants in Cardiovascular Disease’ (DAN-MONICA) I study and the 1914 Cohort survey were followed for 10 years. Information on behavioural and socio-demographic characteristics were collected and serum ferritin levels measured. Non-fatal and fatal CVD and IHD were identified by the International Classification of Diseases diagnoses numbers. Multivariable Cox proportional hazard regression models with restricted cubic splines were performed. During the follow-up period, 310 subjects (201 men; 109 women) and 161 subjects (117 men; forty-four women) experienced CVD and IHD, respectively. Our analyses revealed no statistically significant associations between serum ferritin levels and the risk of CVD or IHD in both sexes. However, in women, the results argue for a U-shaped relationship between serum ferritin levels and CVD as well as IHD. In concordance with former prospective studies, the present results do not support the hypothesis that normal body Fe stores should play a significant role in the development of CVD.

We sought to identify the sex-specific cut-off in waist circumference which best identifies those with metabolic abnormalities consistent with the metabolic syndrome (MS) among Maori, the indigenous people of New Zealand of Polynesian origin. In 3816 self-identified Maori (2742 women, 1344 men) a 75 g oral glucose tolerance test, fasting lipid, anthropometric and blood pressure measurements were made. MS components were defined by Adult Treatment Panel (ATP) III criteria. Waist cut-off was defined using receiver operating characteristic (ROC) curve analysis to define the presence of at least two of the other MS components ( ≥ 2MS). Prevalence of ≥ 2MS was high (42·1 %). In males and females, waist was as good, or better, a predictor of ≥ 2MS (area under ROC 0·73 women, 0·68 men) as waist:hip ratio (0·66, 0·67), BMI (0·72, 0·68) or percentage body fat (0·70, 0·68). The prediction of dysglycaemia using anthropometric variables followed a similar pattern to ≥ 2MS. Waist circumference to predict ≥ 2MS or dysglycaemia in Maori women and men was 98 cm and 103 cm. Applying this cut-off to the International Diabetes Federation (IDF) criteria would identify 27·8 % (34·0 % males, 25·5 % females) with the MS with an OR for ≥ 2MS (adjusted for sex, smoking and age) of 3·5 (95 % CI 3·1, 4·0). Age >48 years, smoking and being male increased the odds of the MS. These waist cut-offs should be considered in both clinical practice and to optimise the definition of the MS for Maori. The validity of these criteria in other Polynesian groups should be confirmed.

Shorter than average adults are at a higher risk for obesity and are also more susceptible to diabetes and CVD, independent of BMI. In contrast, taller children have a higher risk of obesity. We hypothesised that short stature is related to adverse body composition and that the association between stature and obesity differs between generations. In a cross-sectional German database of 213 804 adults and 12 411 children and adolescents, the prevalence of overweight and obesity was compared between percentiles of height. The association between stature and percentage of fat mass (%FM), lean BMI (LBMI; kg/m2) or waist:hip ratio (in children only) was analysed within BMI groups. In adults, the prevalence of BMI >30 kg/m2 gradually increased with decreasing percentile of height whereas in children and adolescents, a positive association between height and weight status was observed. Short-stature women and girls had a 0·8–3·2 % lower %FM than tall subjects (P < 0·05), whereas no trend for %FM was observed in males. When compared with tall subjects, LBMI was 0·2–0·6 kg/m2 lower in short-stature men, as well as obese women (P < 0·05). There was a non-significant trend for a lower LBMI and a higher waist:hip ratio in shorter children. In conclusion, short stature is associated with an increased risk of obesity in adults. Cardiometabolic risk in short stature is not explained by an adverse body composition.

A whole-diet approach has proven useful for characterising dietary exposure in cardiovascular epidemiology research. In our previous analyses, we found dietary patterns to be significant determinants of CVD risk factor levels among the Cardiovascular Risk in Young Finns cohort. We investigated the associations of major dietary patterns with carotid intima media thickness (IMT), a subclinical predictor of CVD, in healthy adults. The Young Finns Study is an ongoing, prospective cohort study with a 21-year follow-up to date. The subjects were children and adolescents at baseline in 1980 (aged 3–18 years), and all had reached adulthood by the latest follow-up in 2001 (aged 24–39 years). Complete dietary data from the years 1980, 1986 and 2001 and outcome data from the year 2001 were obtained from 785 subjects. The long-term average pattern score for a traditional dietary pattern (characterised by high consumption of rye, potatoes, butter, sausages, milk and coffee) was associated with IMT especially among subjects with a low score for the health-conscious dietary pattern (characterised by high consumption of vegetables, legumes and nuts, rye, tea, cheese and other dairy products). In multivariable regression analyses using long-term pattern scores as predictors, the traditional dietary pattern was independently associated with IMT in men (P < 0·01), but not in women (P = 0·66). Long-term adherence to traditional food choices seems to increase the risk of developing subclinical atherosclerosis among Finnish men.

Regular consumption of flavonoids may reduce the risk for CVD. However, the effects of individual flavonoids, for example, quercetin, remain unclear. The present study was undertaken to examine the effects of quercetin supplementation on blood pressure, lipid metabolism, markers of oxidative stress, inflammation, and body composition in an at-risk population of ninety-three overweight or obese subjects aged 25–65 years with metabolic syndrome traits. Subjects were randomised to receive 150 mg quercetin/d in a double-blinded, placebo-controlled cross-over trial with 6-week treatment periods separated by a 5-week washout period. Mean fasting plasma quercetin concentrations increased from 71 to 269 nmol/l (P < 0·001) during quercetin treatment. In contrast to placebo, quercetin decreased systolic blood pressure (SBP) by 2·6 mmHg (P < 0·01) in the entire study group, by 2·9 mmHg (P < 0·01) in the subgroup of hypertensive subjects and by 3·7 mmHg (P < 0·001) in the subgroup of younger adults aged 25–50 years. Quercetin decreased serum HDL-cholesterol concentrations (P < 0·001), while total cholesterol, TAG and the LDL:HDL-cholesterol and TAG:HDL-cholesterol ratios were unaltered. Quercetin significantly decreased plasma concentrations of atherogenic oxidised LDL, but did not affect TNF-α and C-reactive protein when compared with placebo. Quercetin supplementation had no effects on nutritional status. Blood parameters of liver and kidney function, haematology and serum electrolytes did not reveal any adverse effects of quercetin. In conclusion, quercetin reduced SBP and plasma oxidised LDL concentrations in overweight subjects with a high-CVD risk phenotype. Our findings provide further evidence that quercetin may provide protection against CVD.