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Title: Increases in plasma tryptophan are inversely associated with incident cardiovascular disease in the prevencion con dieta mediterránea (PREDIMED) study
Authors: Yu, Edward
Ruiz-Canela, Miguel
Guasch-Ferré, Marta
Toledo, Estefanía
Clish, Clary B.
Salas-Salvadó, Jordi
Liang, Liming
Wang, Dong D.
Corella, Dolores
Fitó, Montse
Gómez-Gracia, Enrique
Lapetra, José
Estruch, Ramón
Ros, Emilio
Cofán, M.
Arós, Fernando
Romaguera, Dora
Serra-Majem, Lluis 
Sorlí, José V.
Hu, Frank B.
Martínez-González, Miguel Ángel
UNESCO Clasification: 3206 Ciencias de la nutrición
Keywords: Metabolomics
Cardiovascular disease
Mediterranean diet
Epidemiology, et al
Issue Date: 2017
Journal: Journal of Nutrition 
Abstract: Background: During development of cardiovascular disease (CVD), interferon-gamma-mediated inflammation accelerates degradation of tryptophan into downstream metabolites. A Mediterranean diet (MedDiet) consisting of a high intake of extravirgin olive oil (EVOO), nuts, fruits, vegetables, and cereals has been demonstrated to lower the risk of CVD. The longitudinal relation between tryptophan and its downstream metabolites and CVD in the context of a MedDiet is unstudied. Objective: We sought to investigate the relation between metabolites in the tryptophan-kynurenine pathway and CVD in the context of a MedDiet pattern. Methods: We used a case-cohort design nested in the Prevencion con DietaMediterranea randomized controlled trial. There were 231 CVD cases (stroke, myocardial infarction, cardiovascular death) among 985 participants over a median of 4.7 y of follow-up [mean +/- SD age: 67.6 +/- 6.1 y; 53.7% women; mean6 SD bodymass index (in kg/m(2)): 29.7 +/- 3.7]. We assessed plasma tryptophan, kynurenine, kynurenic acid, 3-hydroxyanthranilic acid, and quinolinic acid concentrations at baseline and after 1 y of intervention with aMedDiet. We combined thesemetabolites in a kynurenine risk score (KRS) by weighting each metabolite by the adjusted coefficient of its associations with CVD. Cox models were used in the primary analysis. Results: Increases in tryptophan after 1 ywere associatedwith a lower risk of compositeCVD(HR per SD: 0.79; 95% CI: 0.63, 0.98). The baseline kynurenic acid concentration was associated with a higher risk of myocardial infarction and coronary artery disease death but not stroke. A higher KRSwas more strongly associatedwith CVD in the control group than in the 2 intervention groups (P-interaction = 0.003). Adjustment for changes in plasma tryptophan attenuated the inverse association between MedDiet+ EVOO and CVD. Conclusions: An increase in the plasma tryptophan concentrationwas significantly associated with a decreased risk of CVD. A MedDiet may counteract the deleterious effects of a high tryptophan risk score.
ISSN: 0022-3166
DOI: 10.3945/jn.116.241711
Source: Journal of Nutrition [ISSN 0022-3166], v. 147 (3), p. 314-322
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