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      Tea, coffee, caffeine intake and the risk of cardio-metabolic outcomes: findings from a population with low coffee and high tea consumption

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          Abstract

          Background

          This study aimed to assess the potential effects of long-term intake of caffeine and habitual consumption of coffee and tea on the occurrence of cardio-renal events among an Iranian population with low coffee and high tea consumption.

          Methods

          Adult participants of the Tehran Lipid and Glucose Study (2006–2008 to 2012–2014) who met the study inclusion criteria, were recruited. Habitual dietary intakes were assessed using a validated food frequency questionnaire. Demographics, anthropometrics, blood pressure, and biochemical variables were evaluated at baseline and during follow-up examinations. Multivariate Cox proportional hazard and logistic regression models adjusted for potential confounders were used to estimate the risk of cardiovascular disease (CVD), hypertension (HTN) and chronic kidney disease (CKD).

          Results

          During median 6 years of follow-up, the incidence rate of CVD outcomes, HTN, and CKD were 3.3%, 15.5%, and 17.9%, respectively. The risk of CVD was increased more than two-fold in the highest tertile of tea consumption (HR = 2.44, 95% confidence interval, CI = 1.40–4.27; P for trend = 0.001), and caffeine intakes (HR = 2.22, 95% CI = 1.23–4.01; P for trend = 0.005). A 42% lower incidence of CVD was observed in coffee drinkers, compared to non-drinkers (HR = 0.58, 95% CI = 0.36–0.93; P for trend = 0.023). No significant association was observed between tea, coffee or caffeine intakes and the risk of HTN or CKD.

          Conclusions

          Findings of our study support previous data regarding the protective effects of coffee on CVD. Contrary to the previous studies, we found that higher intakes of tea and caffeine, mainly originated from tea in our population, may increase risk of CVD events. It may be related to the type of tea and its preparation methods, additives or artificial colors in tea consumed in Iran, and sweets or sugar that mostly consumed accompanied by tea. Also, genetic variants of the liver enzymes may modify the association of dietary caffeine sources and incidence of CVD. Further prospective studies with incorporation of different population with different dietary habits and genetic backgrounds are needed to clarify the contradictions.

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          Most cited references37

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          Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II

          Background The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software- computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population. Design and methods In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group. Conclusion This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition. Trial registration ISRCTN52588395
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            Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies.

            Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m(2). A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors. The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.
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              Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1).

              Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15,005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1,474 persons by means of two 24-hour dietary recalls. In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8 +/- 6.9, 11.1 +/- 1.8, and 30.9 +/- 7.2, respectively. The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.
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                Author and article information

                Contributors
                zahragn1992@gmail.com
                +98 (21) 224 32 500 , z.bahadoran@endocrine.ac.ir
                +98 (21) 224 32 500 , mirmiran@endocrine.ac.ir
                azizi@endocrine.ac.ir
                Journal
                Nutr Metab (Lond)
                Nutr Metab (Lond)
                Nutrition & Metabolism
                BioMed Central (London )
                1743-7075
                3 May 2019
                3 May 2019
                2019
                : 16
                : 28
                Affiliations
                [1 ]GRID grid.411600.2, Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, , Shahid Beheshti University of Medical Sciences, ; P.O. Box 19395-4763, No. 24, Shahid-Erabi St., Yeman St., Velenjak, Tehran, Iran
                [2 ]GRID grid.411600.2, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, , Shahid Beheshti University of Medical Sciences, ; P.O. Box 1981619573, No.47, Shahid Hafezi St. Farahzadi Blvd. Sharak-e- Ghods., Tehran, Iran
                [3 ]GRID grid.411600.2, Endocrine Research Center, Research Institute for Endocrine Sciences, , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran
                Article
                355
                10.1186/s12986-019-0355-6
                6500051
                31073321
                1d77248e-0632-446c-9628-27a6f7b991e1
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 December 2018
                : 15 April 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Nutrition & Dietetics
                tea,coffee,caffeine,cardiovascular disease,chronic kidney disease,hypertension
                Nutrition & Dietetics
                tea, coffee, caffeine, cardiovascular disease, chronic kidney disease, hypertension

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