Vitamin E intake and cardiovascular diseases in the EPIC-Potsdam Study [Elektronische Ressource] / Zorabel Cordero Gonzalez. Betreuer: Heiner Boeing

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• Gesundheit

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• Publié par: technische_universitat_berlin
• Publié le: 01 janvier 2011
• Nombre de lectures: 15
• Langue: Deutsch

Extrait

VITAMIN E INTAKE AND CARDIOVASCULAR DISEASES
IN THE EPIC-POTSDAM STUDY


vorgelegt von der
Ärztin und Chirurgin, Magister in Ernährung



Zorabel Cordero Gonzalez
aus der Bolivarischen Republik Venezuela



von der Fakultät VII – Wirtschaft und Management der Technischen Universität Berlin
zur Erlangung des akademischen Grades



Doktorin der Gesundheitswissenschaften/Public Health
-Dr. P.H.-
Genehmigte Dissertation



Promotionsausschuss:

Vorsitzende: Prof. Dr. Ulf Stahl
Gutachter: Prof. Dr. Heiner Boeing
Gutachter: Prof. Dr. Reinhard Busse



Tag der wissenschaftlichen Aussprache: 31.03.2010


Berlin 2011

D83 CONTENT

TABLE OF CONTENT


INDEX OF TABLES................................................................................................................5
INDEX OF FIGURES..............................................................................................................8
INDEX OF ABBREVIATIONS..............................................................................................9
1. INTRODUCTION ............................................................................................. 11
1.1 Cardiovascular diseases and public health relevance .......................................... 11
1.1.1 Definition and global epidemic ........................................................................... 11
1.1.2 Impact of cardiovascular diseases in Europe on the economy ............................ 12
1.1.3 Cardiovascular diseases, atherosclerosis and antioxidants ................................. 13
1.2 Vitamin E, properties and relevance of vitamin E .............................................. 14
1.2.1 From chemical structures to physiological implications ...................................... 14
1.2.2 Vitamin E against atherosclerosis ........................................................................ 15
1.2.2.1 Antioxidant vs. Prooxidant function ............................................................ 15
1.2.2.2 Non-antioxidant functions ............................................................................ 16
1.2.3 Vitamin E metabolism .......................................................................................... 17
1.2.4 Vitamin E and antioxidant network ..................................................................... 18
1.3 Assessing of vitamin E intake ............................................................................. 19
1.3.1 Correlations with biological measures ................................................................. 19
1.3.2 Food sources of vitamin E .................................................................................... 22
1.4 Epidemiological evidences of relationship between vitamin E intake and
cardiovascular diseases ....................................................................................... 24
1.4.1 Cohort studies ....................................................................................................... 25
1.4.2 Metaanalysis of cohort studies and pooling of cohort studies ............................. 26
1.4.3 Randomized clinical trials .................................................................................... 30
1.5 What do we eat? Single nutrients vs. dietary patterns ......................................... 34
1.6 Aims and research questions ............................................................................... 36
2. MATERIAL AND METHODS ........................................................................ 37
2.1. The EPIC-Potsdam Study .................................................................................... 37
2.1.1 The EPIC-Study and the EPIC-Potsdam Study, a general description ................ 37
2.1.2 Baseline examination ........................................................................................... 38
2.1.2.1 Dietary assessment ....................................................................................... 38
2.1.2.2 Assessment of other characteristics .............................................................. 39
2
CONTENT
2.1.2.2.1 Socio-demographic, lifestyle and medical history ................................... 39
2.1.2.2.2 Anthropometry ......................................................................................... 39
2.1.3 Follow-up and case ascertainment ....................................................................... 40
2.2 Study design ........................................................................................................ 40
2.2.1 Exclusion criteria .................................................................................................. 40
2.2.2 Outcomes: case ascertainment and verified-cases ............................................... 41
2.2.3 Definition of nutrient variables ............................................................................ 41
2.3. Statistical analysis ............................................................................................... 42
2.3.1 Descriptive analysis .............................................................................................. 42
2.3.2 Energy adjustment and categorization ................................................................. 43
2.3.3 Stepwise linear regression deriving food groups to explain the variance in the
vitamin E intake .................................................................................................. 44
2.3.4 Stepwise linear regression deriving fat components to explain the variance in the
vitamin E intake .................................................................................................. 45
2.3.5 Reduced rank regression model deriving food groups rich in antioxidants ......... 45
2.3.6 Constructing food patterns ................................................................................... 46
2.3.7 Cox’s Proportional Hazard Model ....................................................................... 47
2.3.8 Covariates of the multivariate model ................................................................... 49
3. RESULTS ........................................................................................................... 51
3.1. Baseline description ............................................................................................ 51
3.1.1. Vitamin E intake distribution ............................................................................... 51
3.1.2. General characteristics of the study population across energy-adjusted vitamin E
intake ................................................................................................................... 53
3.1.3. Vitamin E and fat ................................................................................................. 58
3.1.4. Vitamin E and antioxidants .................................................................................. 59
3.1.5. Food sources of vitamin E .................................................................................... 60
3.1.6. Food patterns ........................................................................................................ 63
3.1.7. Characterization of the EPIC-Potsdam cohort across quintiles of food patterns . 72
3.2 Incidence of cardiovascular outcomes ................................................................ 79
3.3 Evaluation of risk for cardiovascular outcomes .................................................. 80
3.3.1 Association between vitamin E intake and cardiovascular outcomes .................. 80
3.3.1.1 Myocardial infarction ................................................................................... 80
3.3.1.2 Stroke ........................................................................................................... 82
3.3.1.3 Transient ischemic attack ............................................................................. 83
3
CONTENT
3.3.2 Association between the food pattern rich in vitamin E and cardiovascular
outcomes .............................................................................................................. 84
3.3.2.1 Myocardial infarction ................................................................................... 84
3.3.2.2 Stroke ........................................................................................................... 85
3.3.2.3 Transient ischemic attack ............................................................................. 86
3.3.2.4 All cardiovascular events ............................................................................. 87
3.3.3 Association between the food pattern rich in antioxidant nutrients and
cardiovascular outcomes ..................................................................................... 89
3.3.3.1 Myocardial infarction ................................................................................... 89
3.3.3.2 Stroke ........................................................................................................... 90
3.3.3.3 Transient ischemic attack ......................................................................