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      Total volume and composition of fluid intake and mortality in older women: a cohort study

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          Abstract

          Objectives

          The health benefits of ‘drinking at least 8 glasses of water a day” in healthy individuals are largely unproven. We aimed to examine the relationship between total fluid and the sources of fluid consumption, risk of rapid renal decline, cardiovascular disease (CVD) mortality and all-cause mortality in elderly women.

          Design, setting and participants

          We conducted a longitudinal analysis of a population-based cohort study of 1055 women aged ≥70 years residing in Australia.

          Main outcome measures

          The associations between total daily fluid intake (defined as total volume of beverage excluding alcohol and milk) and the types of fluid (water, black tea, coffee, milk and other fluids) measured as cups per day and rapid renal decline, CVD and all-cause mortality were assessed using adjusted logistic and Cox regression analyses.

          Results

          Over a follow-up period of 10 years, 70 (6.6%) experienced rapid renal decline and 362 (34.4%) died, of which 142 (13.5%) deaths were attributed to CVD. The median (IQR) intake of total fluid was 10.4 (8.5–12.5) cups per day, with water (median (IQR) 4 (2–6) cups per day) and black tea (median (IQR) 3 (1–4) cups per day) being the most frequent type of fluid consumed. Every cup per day higher intake of black tea was associated with adjusted HRs of 0.90 (95% CI 0.81 to 0.99) and 0.92 (95% CI 0.86 to 0.98) for CVD mortality and all-cause mortality, respectively. There were no associations between black tea intake and rapid renal decline, or between the quantity or type of other fluids, including water intake, and any clinical outcomes.

          Conclusions

          Habitual higher intake of black tea may potentially improve long-term health outcomes, independent of treating traditional CVD risk factors, but validation of our study findings is essential.

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          Most cited references19

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          The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation.

          To assess the validity of the Anti Cancer Council of Victoria food frequency questionnaire (ACCVFFQ) relative to seven-day weighed food records (WFRs) in 63 women of child-bearing age. 63 women completed WFRs to assess iron intake as part of a study on iron deficiency. These women also completed the ACCVFFQ. Nutrient intakes were computed independently for the WFRs and FFQs. Intakes were compared as group means, by correlation and by quintile classification, adjusting for day-to-day variation in intakes, and for energy intake. Individual differences in results were also examined. The strongest associations between WFR and FFQ results were energy-adjusted, log-transformed and adjusted for day-to-day variability in intake. Correlation coefficients ranged from 0.28 for vitamin A to 0.78 for carbohydrate. Mean intakes from the WFRs and FFQs were within +/- 20% for 21 of 27 nutrients. Poor agreement between FFQs and WFRs for retinol intake was due to the inclusion of liver in two WFRs, an item which is not included in the FFQ. The ACCVFFQ performs as well as other FFQs for which validation data are available. The relatively poor measurement of retinol is consistent with other data, and with the limited number of foods in which this nutrient is abundant. The availability of an optically scannable valid instrument for assessing dietary intake will facilitate epidemiological studies of diet and disease, an area of current research priority.
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            Flavonoids as anti-inflammatory agents.

            Epidemiological evidence suggests that a high intake of plant foods is associated with lower risk of chronic diseases. However, the mechanism of action and the components involved in this effect have not been identified clearly. In recent years, the scientific community has agreed to focus its attention on a class of secondary metabolites extensively present in a wide range of plant foods: the flavonoids, suggested as having different biological roles. The anti-inflammatory actions of flavonoids in vitro or in cellular models involve the inhibition of the synthesis and activities of different pro-inflammatory mediators such as eicosanoids, cytokines, adhesion molecules and C-reactive protein. Molecular activities of flavonoids include inhibition of transcription factors such as NF-kappaB and activating protein-1 (AP-1), as well as activation of nuclear factor-erythroid 2-related factor 2 (Nrf2). However, the in vitro evidence might be somehow of limited impact due to the non-physiological concentrations utilized and to the fact that in vivo flavonoids are extensively metabolized to molecules with different chemical structures and activities compared with the ones originally present in the food. Human studies investigating the effect of flavonoids on markers of inflammation are insufficient, and are mainly focused on flavonoid-rich foods but not on pure molecules. Most of the studies lack assessment of flavonoid absorption or fail to associate an effect on inflammation with a change in circulating levels of flavonoids. Human trials with appropriate placebo and pure flavonoid molecules are needed to clarify if flavonoids represent ancillary ingredients or key molecules involved in the anti-inflammatory properties of plant foods.
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              Cardiovascular complications in chronic kidney disease.

              The risk for cardiovascular disease (CVD) morbidity and mortality remains alarmingly high in all stages of chronic kidney disease (CKD). CVD often begins before end-stage renal disease (ESRD), and patients with reduced kidney function are more likely to die of CVD than to develop ESRD. Three pathological forms of CVD should be considered in patients with CKD: alterations in cardiac geometry, including left ventricular hypertrophy, atherosclerosis, and arteriosclerosis. All are highly prevalent in patients with CKD. Although patients with CKD share many of the same risk factors for CVD as the general population, there are a number of uremia-related risk factors, such as anemia and alterations in calcium/phosphorus metabolism, that also play a role in promoting CVD. Treatment of both traditional and uremia-related risk factors should be initiated in the earlier stages of CKD. Additional clinical trials with a goal to reduce CVD are urgently needed in CKD.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                24 March 2017
                : 7
                : 3
                : e011720
                Affiliations
                [1 ]Sir Charles Gairdner Hospital Unit, University of Western Australia School of Medicine and Pharmacology , Perth, Western Australia, Australia
                [2 ]Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth, Western Australia, Australia
                [3 ]Centre for Kidney Research, Children's Hospital at Westmead , Sydney, New South Wales, Australia
                [4 ]School of Public Health, Sydney Medical School, The University of Sydney , Sydney, New South Wales, Australia
                [5 ]Department of Medicine, University of Toronto; Division of Nephrology, Toronto General Hospital , Toronto, Ontario, Canada
                [6 ]Department of Nephrology, Monash Medical Centre , Clayton, Melbourne, Australia
                [7 ]Department of Medicine, Monash University , Clayton, Melbourne, Australia
                [8 ]Department of Epidemiology and Preventive Medicine, Monash University , Prahan, Melbourne, Australia
                [9 ]School of Medical and Health Sciences, Edith Cowan University , Perth, Western Australia, Australia
                [10 ]PathWest, Sir Charles Gairdner Hospital , Perth, Western Australia, Australia
                [11 ]Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Perth, Western Australia, Australia
                Author notes
                [Correspondence to ] Dr Wai H Lim; wai.lim@ 123456health.wa.gov.au

                WHL, GW and JRL contributed equally.

                Article
                bmjopen-2016-011720
                10.1136/bmjopen-2016-011720
                5372039
                28341683
                5d842907-819d-48ba-90d5-195b0a40629b
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 29 February 2016
                : 17 January 2017
                : 19 January 2017
                Categories
                Epidemiology
                Research
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                Medicine
                fluid intake,epidemiology,elderly,mortality,tea
                Medicine
                fluid intake, epidemiology, elderly, mortality, tea

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