Decelerated Biological Aging as a Potential Mechanism for the Cardioprotective Effects of the Mediterranean Diet and the Dietary Approaches to Stop Hypertension Diet: A Twin Study Open Access

Abstract

Emerging evidence points to accelerated biological aging as a potential mechanism in the pathogenesis of cardiovascular disease (CVD). Traditionally, biological aging has been viewed as immutable and synonymous with chronological aging. However, recent studies suggest that markers of biological aging can be altered and accelerated in the presence of certain CVD risk factors, implying a possible link between biological aging and vascular deterioration. Although age is a dominant risk factor for cardiovascular disease, there are shortcomings in our present-day understanding of why age is a powerful determinant for chronic disease.

The Mediterranean diet has been shown to reduce inflammation and oxidative stress, suggesting its potential to decelerate the biological aging process that is thought to underlie the development of atherosclerosis. Similarly, the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure and decrease the risk of heart disease. However, no previous study to our knowledge has systematically examined markers of biological aging with the intent to explore the cardioprotective mechanisms of either the Mediterranean or DASH-style diet. To better understand this association, we leveraged data from the Emory Twin Studies. Participants in our study were middle-aged male twin pairs who were naturally matched for shared early-life environmental and genetic factors, as well as for chronological age.

Through our research efforts, we found that both greater adherence to the Mediterranean diet and greater adherence to the DASH-style diet were inversely associated with markers of accelerated biological aging, independent of traditional CVD risk factors and shared familial and genetic factors. We also found that greater habitual dietary sodium intake and greater habitual consumption of sugar-sweetened beverages were both inversely linked with a marker of subclinical CVD, coronary flow reserve, and directly associated with markers of accelerated biological aging, independent of conventional risk factors and shared early-life environmental and genetic factors. The findings of this dissertation suggest the potential importance of a healthy diet in decreasing the speed of biological aging and preventing the onset of CVD. However, further examination of these findings in the context of a randomized controlled trial is warranted.

Table of Contents

CHAPTER 1: INTRODUCTION ...................................................................................... 1

References ............................................................................................................ 10

CHAPTER 2: ADHERENCE TO THE MEDITERRANEAN DIET AND ITS ASSOCIATION WITH

DECELERATED BIOLOGICAL AGING IN MIDDLE-AGED MALE TWINS ..................................... 23

Abstract ............................................................................................................... 25 Introduction .......................................................................................................... 27 Methods ............................................................................................................... 28 Results ................................................................................................................. 34 Discussion ............................................................................................................. 38 References ............................................................................................................ 45

CHAPTER 3: ADHERENCE TO THE DIETARY APPROACHES TO STOP HYPERTENSION DIET

AND ITS ASSOCIATION WITH DECELERATED BIOLOGICAL AGING IN MIDDLE-AGED

MALE TWINS .......................................................................................................... 62

Abstract ................................................................................................................ 64 Introduction ........................................................................................................... 66 Methods ................................................................................................................ 67 Results .................................................................................................................. 74 Discussion .............................................................................................................. 76 References ............................................................................................................. 84

CHAPTER 4: HABITUAL DIETARY SODIUM INTAKE IS INVERSELY ASSOCIATED WITH

CORONARY FLOW RESERVE IN MIDDLE-AGED MALE TWINS ............................................... 100

Abstract ................................................................................................................ 102 Introduction ........................................................................................................... 104

Subjects and Methods .............................................................................................. 105

Results .................................................................................................................. 112 Discussion .............................................................................................................. 115 References ............................................................................................................. 122

CHAPTER 5: SUGAR-SWEETENED BEVERAGE CONSUMPTION IS INVERSELY ASSOCIATED

WITH CORONARY FLOW RESERVE IN MIDDLE-AGED MALE TWINS ....................................... 135

Abstract ................................................................................................................ 137 Introduction ........................................................................................................... 139 Methods ................................................................................................................ 140 Results .................................................................................................................. 144 Discussion .............................................................................................................. 146 References ............................................................................................................. 153

CHAPTER 6: THE ASSOCIATION BETWEEN ACCELERATED BIOLOGICAL AGING AND BOTH

HABITUAL DIETARY SODIUM INTAKE AND HABITUAL SUGAR-SWEETENED BEVERAGE

CONSUMPTION IN MIDDLE-AGED MALE TWINS ............................................................... 166

Abstract ................................................................................................................ 168 Introduction ........................................................................................................... 170 Methods ................................................................................................................ 171 Results .................................................................................................................. 177 Discussion .............................................................................................................. 182 References ............................................................................................................. 191

CHAPTER 7: DISCUSSION .......................................................................................... 213

Main Findings .......................................................................................................... 213

Strengths and Limitations .......................................................................................... 219

Public Health Implications .......................................................................................... 224

Summary ................................................................................................................ 227 References ............................................................................................................. 229

About this Dissertation

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School	Laney Graduate School
Department	Biological and Biomedical Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Dietary intake DASH diet Nutrition Biological aging Mediterranean diet Epidemiology
Committee Chair / Thesis Advisor	Vaccarino, Viola, Emory University
Committee Members	Ziegler, Thomas R, Emory University McClellan, William, Emory University Le, Ngoc-Anh, Emory University Manatunga, Amita, Emory University

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