Polyphenols are secondary metabolites present in small quantities in plant-based food and beverages, with antioxidant and anti-inflammatory properties. Main groups of polyphenols include flavonoids, phenolic acids, stilbenes, and lignans, but their association with mortality has barely been examined. We aimed to assess the association between the intake of 23 polyphenol subgroups and all-cause, cardiovascular, and cancer mortality in a representative sample of the Spanish adult population. Population-based cohort study conducted with 12,161 individuals aged 18+ recruited in 2008-2010 and followed-up during a mean of 12.5 years. At baseline, food consumption was obtained with a validated dietary history, and the Phenol-Explorer database was used to estimate polyphenol intake. Associations were examined using Cox regression adjusted for main confounders. During follow-up, 967 all-cause deaths occurred, 219 were cardiovascular, and 277 cancer. Comparing extreme categories of consumption, hazard ratios (95% CI) of total mortality for subgroups were: dihydroflavonols 0.85 (0.72-1.00; p-trend:0.046); flavonols 0.79 (0.63-0.97; p-trend:0.04); methoxyphenols 0.75 (0.59-0.94; p-trend:0.021); tyrosols 0.80 (0.65-0.98; p-trend:0.044); alkylmethoxyphenols 0.74 (0.59-0.93; p-trend:0.007); hydroxycinnamic acids 0.79 (0.64-0.98; p-trend:0.014); and hydroxyphenilacetic acids 0.82 (0.67-0.99; p-trend:0.064). For cardiovascular mortality, hazard ratios were: methoxyphenols 0.58 (0.38-0.89; p-trend:0.010); alkylmethoxyphenols 0.59 (0.39-0.90; p-trend:0.011); hydroxycinnamic acids 0.63 (0.42-0.94; p-trend:0.020); and hydroxyphenilacetic acids 0.69 (0.48-0.99; p-trend:0.044), when comparing extreme tertiles of consumption. No statistically significant associations were observed for cancer. The main food sources for these polyphenol subgroups were red wine, leafy green vegetables, olive oil, green olives, and coffee (the latter being the major contributor of methoxyphenols, alkylmethoxyphenols, and hydroxycinnamic acids). In the Spanish adult population, intake of specific polyphenol subgroups was prospectively associated with a 20% lower all-cause mortality risk. This decrease was mainly due to a 40% lower cardiovascular mortality risk over time.

A higher energy intake (EI) at night has been associated with a higher risk of obesity, while a higher EI at lunch may protect against weight gain. This study examined the association between EI throughout the day and incident metabolic syndrome (MetS) among older adults. A cohort of 607 individuals aged ≥ 60 free from MetS at baseline was followed from 2008–2010 until 2015. At baseline, habitual EI was assessed on six eating occasions: breakfast, mid-morning snack, lunch, afternoon snack, dinner, and snacking. MetS was defined according to the harmonized definition. Statistical analyses were performed with logistic regression and adjusted for the main confounders, including total EI, diet quality, and physical activity/sedentary behavior. During follow-up, 101 new MetS cases occurred. Compared to the lowest sex-specific quartile of EI at dinner, the OR (95% confidence interval) for incident MetS were: 1.71 (0.85–3.46) in the second, 1.70 (0.81–3.54) in the third, and 2.57 (1.14–5.79) in the fourth quartile (p-trend: 0.034). Elevated waist circumference and triglycerides were the MetS components that most contributed to this association. A higher EI at dinner was associated with a higher risk of MetS in older adults. Reducing EI at dinner might be a simple strategy to prevent MetS.

Diet has been clearly associated with cardiovascular disease, but few studies focus on the influence of cooking and food preservation methods on health. The aim of this study was to describe cooking and food preservation patterns, as well as to examine their association with inflammatory and cardio-metabolic biomarkers in the Spanish adult population. A cross-sectional study of 10,010 individuals, representative of the Spanish population, aged 18 years or over was performed using data from the ENRICA study. Food consumption data were collected through a face-to-face dietary history. Cooking and food preservation patterns were identified by factor analysis with varimax rotation. Linear regression models adjusted for main confounders were built. Four cooking and food preservation patterns were identified. The Spanish traditional pattern (positively correlated with boiling and sautéing, brining, and light frying) tends to be cardio-metabolically beneficial (with a reduction in C-reactive protein (−7.69%)), except for high density lipoprotein cholesterol (HDL-c), insulin levels, and anthropometrics. The health-conscious pattern (negatively correlated with battering, frying, and stewing) tends to improve renal function (with a reduction in urine albumin (−9.60%) and the urine albumin/creatinine ratio (−4.82%)). The youth-style pattern (positively correlated with soft drinks and distilled alcoholic drinks and negatively with raw food consumption) tends to be associated with good cardio-metabolic health except, for lower HDL-c (−6.12%), higher insulin (+6.35%), and higher urine albumin (+27.8%) levels. The social business pattern (positively correlated with the consumption of fermented alcoholic drinks, food cured with salt or smoke, and cured cheese) tends to be detrimental for the lipid profile (except HDL-c), renal function (urine albumin +8.04%), diastolic blood pressure (+2.48%), and anthropometrics. Cooking and food preservation patterns showed a relationship with inflammatory and cardio-metabolic health biomarkers. The Spanish traditional pattern and the health-conscious pattern were associated with beneficial effects on health and should be promoted. The youth-style pattern calls attention to some concerns, and the social business pattern was the most detrimental one. These findings support the influence of cooking and preservation patterns on health.

Food consumption has a prominent role in the occurrence of cardiometabolic diseases, however, little is known about the specific influence of cooking methods. This study examined the association between cooking methods and anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers in older adults. Data were taken from 2476 individuals aged ≥65 from the Seniors-ENRICA 2 cohort in Spain and recruited between 2015 and 2017. Eight cooking methods (raw, boiling, roasting, pan-frying, frying, toasting, sautéing, and stewing) were assessed using a face-to-face validated dietary history. Study associations were summarized as adjusted percentage differences (PDs) in anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers between extreme sex-specific quintiles ((5th − 1st/1st) × 100) of food consumed with each cooking method, estimated using marginal effects from generalized linear models. After adjusting for potential confounders, including diet quality, PDs corresponding to raw food consumption were −13.4% (p-trend: <0.001) for weight, −12.9% (p-trend: <0.001) for body mass index (BMI), −14.8% (p-trend: <0.001) for triglycerides, and −13.6% (p-trend: <0.115) for insulin. PDs for boiled food consumption were −13.3% (p-trend: <0.001) for weight, −10.0% (p-trend: <0.001) for BMI, and −20.5% (p-trend: <0.001) for insulin. PDs for roasted food consumption were −11.1 (p-trend: <0.001) for weight and −23.3% (p-trend: <0.001) for insulin. PDs for pan-fried food consumption were −18.7% (p-trend: <0.019) for insulin, −15.3% (p-trend: <0.094) for pro-B-type natriuretic peptide amino-terminal, and −10.9% (p-trend: <0.295) for troponin T. No relevant differences were observed for blood pressure nor for other cooking methods. Raw food consumption along with boiling, roasting, and pan-frying were associated with healthier cardiovascular profiles, mainly due to lower weight and insulin levels. Future experimental research should test the effectiveness of these cooking methods for cardiovascular prevention in older adults.

Nutri-Score is a front-of-package (FOP) labeling designed to assist consumers in selecting healthier options at the point of purchase and ultimately enhance their health. This study aims to evaluate the association between the Nutri-Score system and incident abdominal obesity (AO) in community-dwelling older adults. A prospective cohort of 628 individuals aged ≥ 60 were recruited in Spain between 2008–2010 and were reexamined between 2015–2017. Dietary intake was evaluated utilizing a validated computerized dietary history. Food was categorized based on the Nutri-Score system into five levels from A (green, representing the best quality) to E (red, representing the poorest quality). A five-color Nutri-Score dietary index (5-CNS DI) in g/day/kg was calculated for each participant. AO was determined by a waist circumference (WC) of ≥102 cm for men and ≥88 cm for women. Logistic regression models were adjusted for the main potential confounders. During a mean six-year follow-up, 184 incident cases of AO occurred. The odds ratio (OR) and 95% confidence interval (CI) for AO, when comparing the highest and lowest quartiles of the 5-CNS DI, were 2.45 (1.17–5.14), with a p-value for trend of 0.035. In sensitivity analyses, the OR was 2.59 (1.22–5.52, p-trend: 0.032) after adjustment for WC at baseline, and 1.75 (0.74–4.18, p-trend: 0.316) after adjustment for ultra-processed food consumption. In conclusion, less favorable food-consumption ratings in the Nutri-Score are associated with incident AO in the elderly. These findings support the use of this FOP system to potentially improve metabolic health.

Background: Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population. Methods and findings: We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up. Conclusions: In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.