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Articles
June 15, 2011
Letter to the Editor

Olive oil consumption, plasma oleic acid, and stroke incidence
The Three-City Study

August 2, 2011 issue
77 (5) 418-425

Abstract

Objective:

To determine whether high olive oil consumption, and high plasma oleic acid as an indirect biological marker of olive oil intake, are associated with lower incidence of stroke in older subjects.

Methods:

Among participants from the Three-City Study with no history of stroke at baseline, we examined the association between olive oil consumption (main sample, n = 7,625) or plasma oleic acid (secondary sample, n = 1,245) and incidence of stroke (median follow-up 5.25 years), ascertained according to a diagnosis validated by an expert committee.

Results:

In the main sample, 148 incident strokes occurred. After adjustment for sociodemographic and dietary variables, physical activity, body mass index, and risk factors for stroke, a lower incidence for stroke with higher olive oil use was observed (p for trend = 0.02). Compared to those who never used olive oil, those with intensive use had a 41%(95% confidence interval 6%–63%, p = 0.03) lower risk of stroke. In the secondary sample, 27 incident strokes occurred. After full adjustment, higher plasma oleic acid was associated with lower stroke incidence (p for trend = 0.03). Compared to those in the first tertile, participants in the third tertile of plasma oleic acid had a 73% (95% confidence interval 10%–92%, p = 0.03) reduction of stroke risk.

Conclusions:

These results suggest a protective role for high olive oil consumption on the risk of stroke in older subjects.

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Supplementary Material

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File (e-results.doc)
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File (samieri.pdf)
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File (table_e-5.doc)
File (table_e-6.doc)

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Letters to the Editor
23 August 2011
Olive oil and stroke: caution
Francesco Visioli, Senior Scientist

I read with great interest the paper by Samieri et al. [1] on the effects of olive oil consumption on stroke incidence. However, I believe that the true contribution of olive oil to stroke prevention should be very small, given that in France yearly consumption is only ~1.4 Kg/capita, i.e. ~4 ml/day. [2,3] Of this, the majority is non-extra virgin and, globally, people consume much more olive oil than extra virgin olive oil. Therefore, even though the authors carefully corrected for confounders, this interesting paper should be considered as a valuable staring point of future experimental investigations with controlled amounts of well-characterized extra virgin olive oils.

References

1. Samieri C et al. Olive oil consumption, plasma oleic acid, and stroke incidence: The Three-City Study. Neurology. 2011 77:418-425.

2. French Association Française Interprofessionnelle de l'Olive (Afidol). http://www.afidol.org [accessed August 23, 2011]

3. MarketOlea 2008 Number 8. http://www.afidol.org/fichiers/Marketolea_no8.pdf [accessed August 23, 2011]

23 August 2011
Olive oil-derived polyphenols, iron, and stroke occurrence
Luca Mascitelli, Medical Officer
Mark R Goldstein

Samieri et al.(1) reported that higher olive oil consumption was associated with lower incidence of stroke in elderly subjects, and suggested that components other than oleic acid might be involved in this beneficial association. In fact, increasing evidences have accumulated on the beneficial properties of minor though highly bioactive components of olive oil, such as phenolic compounds. We suggest that lower body iron stores induced by olive oil derived polyphenols may be involved in the reduced risk of stroke related to this dietary pattern. Indeed, with prolonged use, olive oil-derived polyphenols are associated with progressive loss of body iron stores(2). Interestingly, serum ferritin concentration, a useful marker of body iron stores, has been found to be 2-fold lower in men from Crete, in the Mediterranean south of Europe, than in men from Zutphen in the north of Europe(3). On the other hand, it has recently been shown a strong association between body iron stores and asymptomatic carotid atherosclerosis(4). Furthermore, serum ferritin has also been found to be associated with an increased risk of ischemic stroke(5). Therefore, lower body iron stores induced by polyphenols might be involved in the beneficial health effects of olive oil in stroke prevention.

Luca Mascitelli, MD Comando Brigata alpina Julia Udine, Italy

Mark R Goldstein, MD, FACP NCH Healthcare Group Naples, FL

REFERENCES

1. Samieri C, Feart C, Proust-Lima C, et al. Olive oil consumption, plasma oleic acid, and stroke incidence: The Three-City Study. Neurology 2011;77:418-425.

2. Mascitelli L, Pezzetta F, Goldstein MR. Is the beneficial antioxidant effect of olive oil mediated by interaction of its phenolic constituents and iron? Arch Med Res 2010;41:295-296.

3. Buijsse B, Feskens EJ, Moschandreas J, et al. Oxidative stress, and iron and antioxidant status in elderly men: differences between the Mediterranean south (Crete) and northern Europe (Zutphen). Eur J Cardiovasc Prev Rehabil 2007;14:495-500.

4. Syrovatka P, Kraml P, Hulikova K, et al. Iron stores are associated with asymptomatic atherosclerosis in healthy men of primary prevention. Eur J Clin Invest 2011;41:846-853.

5. van der A DL, Grobbee DE, Roest M, Marx JJ, Voorbij HA, van der Schouw YT. Serum ferritin is a risk factor for stroke in postmenopausal women. Stroke 2005;36:1637-1641.

Information & Authors

Information

Published In

Neurology®
Volume 77Number 5August 2, 2011
Pages: 418-425
PubMed: 21676914

Publication History

Received: September 27, 2010
Accepted: January 19, 2011
Published online: June 15, 2011
Published in print: August 2, 2011

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Disclosure

Dr. Samieri received research support from Institut Carnot LISA (Lipides pour l'Industrie et la Santé [Lipids for Industry, Safety and Health]). Dr. Féart reports no disclosures. Dr. Proust-Lima serves as a consultant for Danone and receives research support from INCA (Institut National du Cancer [National Institute for Cancer]). Dr. Peuchant reports no disclosures. Dr. Stapf serves as an Associate Editor for Cerebrovascular Disease and receives research support from the NIH/NINDS, Columbia University, and University Paris. Dr. Tzourio serves on scientific advisory boards for Merck Sharp & Dohme and Fondation Plan Alzheimer; serves on the editorial boards of Neuroepidemiology and the Journal of Hypertension; and receives research support from Agence Nationale de la Recherche and Fondation Plan Alzheimer. Dr. Berr has served on a scientific advisory board for Janssen; serves on the editorial advisory board for Revue Epidémiologie et Santé Publique; and receives research support from Agence Nationale de la Recherche and Fond de Coopération Scientifique Alzheimer. Dr. Barberger-Gateau serves on a scientific advisory board for Caisse Nationale pour la Solidarité et l'Autonomie (CNSA); has received funding for travel and speaker honoraria from Lesieur, Bausch & Lomb, Aprifel, Canadian Association of Gerontology, and the Jean Mayer Human Nutrition Research Center on Aging, Tufts University; serves on the editorial boards of Disability and Rehabilitation and the European Journal of Ageing; and receives research support from Lesieur, Danone, Agence Nationale de la Recherche, and Institut Carnot LISA.

Authors

Affiliations & Disclosures

C. Samieri, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
C. Féart, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
C. Proust-Lima, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
E. Peuchant, MD, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
C. Tzourio, MD, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
C. Stapf, MD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
C. Berr, MD, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.
P. Barberger-Gateau, MD, PhD
From the Research Center INSERM, U897, Department of Nutritional Epidemiology (C. Samieri, C.F., P.B.-G.), Bordeaux; Research Center INSERM, U897, Department of Biostatistics (C.P.-L.), Bordeaux; University Victor Segalen Bordeaux 2 (C. Samieri, C.F., C.P.-L., P.B.-G.), ISPED, Bordeaux; INSERM (E.P.), U876, Bordeaux; CHU de Bordeaux (E.P.), Hôpital Saint-André, Department of Biochemistry, Bordeaux; INSERM (C.T.), U708, Neuroepidemiology Unit, University Pierre et Marie Curie Paris VI, Paris; Department of Neurology (C.T., C. Stapf), Hôpital Lariboisière, APHP, Paris; University Diderot Paris VII (C. Stapf), Paris; INSERM (C.B.), U1061, University Montpellier 1, Montpellier; and CHU Montpellier (C.B.), CMRR Languedoc Roussillon, Montpellier, France.

Notes

Study funding: The Three-City Study is conducted under a partnership agreement among the Institut National de la Santé et de la Recherche Médicale (INSERM), the Institut de Santé Publique et Développement of the Victor Segalen Bordeaux 2 University, and sanofi-aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Mutuelle Générale de l'Education Nationale, Institut de la Longévité, Regional Governments of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research—INSERM Programme “Cohortes et Collections de Données Biologiques.” This work was carried out with the financial support of the “ANR: Agence Nationale de la Recherche [The French National Research Agency]” under the “Programme National de Recherche en Alimentation et Nutrition Humaine,” project COGINUT ANR-06-PNRA-005.
Address correspondence and reprint requests to Dr. Cécilia Samieri, Equipe Epidémiologie de la Nutrition et des Comportements Alimentaires, INSERM, U897, Université Bordeaux 2, ISPED case 11, 146 rue Léo-Saignat, F-33076 Bordeaux cedex, France [email protected]

Author Contributions

Design and conduct of the study: Dr. Barberger-Gateau, Dr. Berr, Dr. Tzourio. Collection: Dr. Barberger-Gateau, Dr. Berr, Dr. Tzourio. Management: Dr. Barberger-Gateau, Dr. Berr, Dr. Tzourio. Analysis and interpretation of data: Dr. Samieri, Dr. Proust-Lima, Dr. Féart. Preparation of the manuscript: Dr. Samieri, Dr. Barberger-Gateau. Review and approval of the manuscript: Dr. Samieri, Dr. Féart, Dr. Proust-Lima, Dr. Tzourio, Dr. Stapf, Dr. Berr, Dr. Barberger-Gateau. Statistical analysis was conducted by Dr. Samieri.

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