Our findings suggest that serum levels of individual carotenoids, particularly the oxygenated species are inversely associated with all-cause mortality and should be considered as candidates for further investigations.

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The association between serum total cholesterol and cancer mortality was investigated in a 28-year follow-up study of 3,091 Dutch civil servants aged 40-65 years and their spouses. After adjustment for age, body mass index, and smoking, an inverse association between serum total cholesterol and all-cancer mortality was observed in men during the first 15 years of follow-up, excluding the first 2 years: The multivariate rate ratio of those in the lowest cholesterol quintile compared with those in the highest quintile was 2.1 (95% confidence interval (Cl) 1.1-4.0); this association was accounted for mainly by gastrointestinal cancers (RR = 4.2, 95% Cl 1.4-12.9). For follow-up years 16-28, the multivariate rate ratio for all-cancer mortality was 0.8 (95% Cl 0.5-1.40. In women, no consistent association between serum total cholesterol and cancer was observed. After the first 5 years of follow-up were excluded, the significant inverse association in men still persisted. These results suggest that in this study population, low serum cholesterol seems not to be attributable to undetected cancer, but might be a risk factor for cancer mortality in men.

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Objective: Several studies suggest that a fatty meal impairs flow-mediated vasodilation (FMD), a measure of endothelial function. We tested whether the impairment was greater for trans fats than for saturated fats. We did this because we previously showed that replacement of saturated fats by trans fats in a controlled diet decreased FMD after 4 weeks. Design: We fed 21 healthy men two different test meals with 0.9 -1.0 g fat=kg body weight in random order: one rich in saturated fatty acids (Sat), mainly from palm kernel fat, and one rich in trans fatty acids (Trans) from partially hydrogenated soy bean oil. The study was performed in our metabolic ward. We had complete data for both diets of 21 men. Results: FMD increased from a fasting value of 2.3 AE 2.0% of the baseline diameter to 3.0 AE 1.7% after the Sat test meal (95% CI for change 7 0.33, 1.70) and from 2.7 AE 2.3 to 3.1 AE 2.0% after the Trans test meal (95% CI for change 7 0.57, 1.29). The increase after the Sat meal was 0.22 ( 7 1.18 -1.61) FMD% higher than after the Trans meal. Serum triacylglycerols increased by 0.46 AE 0.36 mmol=l after the Sat test meal and by 0.68 AE 0.59 mmol=l after the Trans test meal; a difference of 0.23 (0.07, 0.39) mmol=l. Serum HDL-cholesterol was hardly affected by the test meals. The activity of serum paraoxonase, an esterase bound to HDL, increased slightly after the two test meals but the difference between meals was not significant. Conclusion: FMD was not impaired and not different after test meals with saturated or trans fatty acids. Thus, differences in long-term effects of these fats are not caused by differences in acute effects on the vascular wall.

Combinations of dietary factors were studied in relation to breast-cancer occurrence among 133 breast cancer cases and 289 population controls in The Netherlands. Dietary factors were classified according to their possible mechanism of action, i.e., relating either to the intestinal microflora (total fat, fiber, fermented milk products) or to the anti-oxidant hypothesis (beta-carotene, selenium and polyunsaturated fatty acids). From 6 interactions evaluated, the combination of high fiber intake and high intake of fermented milk products was the only one suggesting synergistic protection (age-and-fat-adjusted OR for interaction = 0.48, 95% confidence interval (CI) = 0.21 - 1.13). In order to estimate the extent to which the above dietary factors together might be related to breast cancer, subjects with a supposedly favorable dietary pattern (low fat intake, high fiber intake, high intake of fermented milk products; high intake of beta-carotene and selenium, low intake of polyunsaturated fatty acids) were compared with subjects with an unfavorable dietary pattern. This resulted in an age-adjusted odds ratio of 0.40 (95% CI = 0.14 - 1.15), which was largely attributable to the combination of low intake of fat and high intake of fermented milk products and fiber (age-adjusted OR = 0.33, 95% CI = 0.15 - 0.73). The other factors did not appreciably affect the odds ratio. These analyses show in a quantitative way that a dietary pattern which combines low intake of fat and high intake of fiber and fermented milk products might provide substantial protection against breast cancer.

To provide further insight into the possible role of selenium in cardiovascular disease, we examined the relationship between cardiovascular risk factors, some nutritional parameters, and short- and long-term selenium status. A total of 82 healthy Dutch volunteers, 59 men and 23 women, aged 40-75 years, were studied. Means and standard deviations of selenium parameters were: plasma selenium 106.4 +/- 23.7 micrograms/L, erythrocyte selenium 0.59 +/- 0.19 microgram/g Hb, toenail selenium 0.78 +/- 0.17 ppm, and erythrocyte glutathione peroxidase activity 28.0 +/- 8.1 U/g Hb. No association was found between selenium status and gender, age, serum total-, LDL-, and HDL-cholesterol, systolic and diastolic blood pressure, alcohol intake, and body mass index. A significantly lower plasma selenium level was observed among smokers compared to nonsmokers (101.0 micrograms/L, SE = 3.9 vs 112.0 micrograms/L, SE = 3.6, p = 0.04). A significant negative association was found between erythrocyte selenium and serum levels of vitamin A and ferritin. No relevant relationship was observed between selenium status and serum fatty acid composition, vitamin E, vitamin B6, and iron. Apart from an association between smoking and short-term selenium status, we found no indications that a possible effect of selenium on cardiovascular disease may operate through the known risk factors.