Professional Documents
Culture Documents
Am J Clin Nutr 2004;79:289 94. Printed in USA. 2004 American Society for Clinical Nutrition 289
290 CESARI ET AL
performance. The purpose of this study was to assess the semitandem position, and a full-tandem position. Good to
correlation of plasma antioxidant concentrations and daily di- excellent reliability of these tests has been shown, which sup-
etary intakes of antioxidants with skeletal muscle strength and ports the utilization of these measures in aging research (16).
physical performance in elderly persons. An arithmetic summary performance score was calculated to
obtain a continuous measure (17). The timed scores of the
performance tests were rescaled to values ranging from 0 to 1,
SUBJECTS AND METHODS where 1 indicates the best performance and 0 the worst per-
formance. The worst performers were participants who were
The present study is part of the Invecchiare in Chianti
unable to complete the task or those who had a performance
(InCHIANTI) study, a prospective population-based study of
above the 99th percentile (walking time: 15.5 s; chair-stand
elderly people in Italy designed by the Laboratory of Clinical
time: 27.3 s; standing-balance test: 30 s). The following for-
Epidemiology of the Italian National Research Council of
mulas were applied to rescale measures: 1) walking speed, 1
Aging (Florence, Italy). The aims of the study are to identify
(15.5/speed in centimeters per second); 2) chair-stand test, 1
risk factors for the onset of disability in elderly persons, to
(time in seconds/27.3); and 3) standing-balance test, time in
study physiologic subsystems critical for walking, and to de-
seconds/30. A summary physical performance score ranging
fine critical ranges for tests that evaluate the integrity of the
from 0 to 3 was calculated by adding these 3 rescaled scores.
physiologic subsystems that are important for walking. The
Such a summary score has been shown to have excellent
study population included 1156 participants aged 65102 y,
predictive validity for mortality, institutionalization, hospital-
who were randomly selected from residents in 2 towns of the
ization, and incident disability (1, 3, 18, 19). The internal
Chianti geographic area (Greve In Chianti and Bagno a Ripoli,
consistency (Cronbachs ) of the summary scale in our study
Tuscany, Italy) with the use of a multistage stratified sampling
TABLE 3
Adjusted regression coefficients for knee extension strength and summary physical performance scores per SD increase (log) in plasma antioxidants
and in dietary intakes of antioxidants1
Plasma
-Tocopherol (mol/L) 0.566 (0.193) 0.003 0.044 (0.017) 0.008
-Tocopherol (mol/L) 0.327 (0.165) 0.04 0.004 (0.015) 0.80
Daily intake
Vitamin C (mg) 0.383 (0.162) 0.02 0.029 (0.014) 0.04
Vitamin E (mg) 0.277 (0.204) 0.17 0.013 (0.018) 0.47
-Carotene (g) 0.311 (0.159) 0.05 0.015 (0.014) 0.29
Retinol (g) 0.012 (0.147) 0.94 0.010 (0.013) 0.31
1
The coefficients were adjusted for age, sex, site, Mini-Mental State Examination score, smoking, education, BMI, physical activity, total cholesterol,
triacylglycerol (log value), hypertension, coronary heart disease, stroke, congestive heart failure, number of medications taken, and daily dietary energy
intake. The -tocopherol SD 0.278, -tocopherol SD 0.441, daily vitamin C intake (log) SD 0.449, daily vitamin E intake (log) SD 0.323, daily
-carotene intake (log) SD 0.508, and daily retinol intake (log) SD 0.910.
ANTIOXIDANTS AND PHYSICAL PERFORMANCE 293
found for the daily dietary intakes of several antioxidants, nonsignificant association between the dietary intake of vita-
including vitamin C and -carotene. min E and physical performance and strength measures.
Free radical oxidative stress has been implicated in the Even though antioxidant supplementation has been sug-
pathogenesis of a variety of diseases, and natural antioxidant gested as a mean to perform better and recover more quickly
defenses have been found to be defective in many diseases and fully from vigorous exercise, the theoretical basis for why
(10). A free radical is a molecule that contains an unpaired antioxidants may enhance performance is not clear. An im-
electron in its outer orbit and that can exist independently (5, proved antioxidant status is one adaptation to regular exercise
12). Stability is achieved by the removal of electrons from training (32), and an acute increase in plasma antioxidant
surrounding molecules to produce an electron pair. The re- activity has been observed after exercise (33). This finding
mainder of the attached molecule then possesses an unpaired suggests that antioxidant status may be important in healthy
electron and therefore becomes a free radical. In this way, the muscle function, especially during the recovery phase after
presence of a single radical may initiate a chain sequence of exercise. To our knowledge, no evidence is available that
electron transfer (redox) reactions. Several studies suggest an documents the suppression of oxidative damage in muscle by
important role of oxidation in physiologic decline with normal antioxidant supplements, but it seems reasonable that an ade-
aging (8, 9, 13). Oxidative stress can come from a variety of quate antioxidant intake is needed to maintain healthy muscular
sources, from abnormal metabolic pathways to inflammatory activity (10, 34).
cells (eg, macrophages and neutrophils producing hydrogen Several limitations of our study should be mentioned. The
peroxide and hypochlorus acid as means of bacterial killing) cross-sectional design of the study did not permit us to evaluate
(28), smoking, and radiation (10). the effect of daily nutrient intakes on changes in physical
Our results confirmed previous findings that suggest a strong performance. Further longitudinal studies are needed to eval-
Vegetarian diets and exposure to organochlorine biphenyls and phthalate esters) have been found in human serum in the
pollutants, lead, and mercury following relative concentrations: urban fish eaters rural fish eaters
urban vegetarians rural vegetarians (7). Vegetarian vegans from
Hong Kong who consumed no fish or shellfish were shown to have very
Dear Sir: low concentrations of hair mercury compared with nonvegetarians (8).
Passos et al (9) suggest that an increased consumption of fruit can lower
The practice of feeding animal meat and bone meal to cattle has the body burden of mercury in Brazilian Amazon fish-eating popula-
been linked to the recent epidemic of bovine spongiform encepha- tions. After 12 mo of changing from an omnivorous diet to a lactoveg-
lopathy. Bovine spongiform encephalopathy, in turn, has been etarian diet, healthy adults had decreased hair concentrations of mercury
linked to the human prion disease variant Creutzfeldt-Jakob disease and lead (10). Therefore, a predominance of plant food in human diets
(1). In that recent issue of the Journal, Trevitt and Singh introduced is an important step in lowering the body burden of harmful substances
an interesting issue that has escaped previous discussions regarding in populations exposed to pollutants.
vegetarian diets and human health. Not only are harmful prions Strict vegetarianism, or veganism, is defined as the practice of
found in the meats of animals that have consumed animal products,
consuming plant food only (no animal products). However, variants
but also found in these meats are persistent lipophilic organic pol-
of vegetarianismsuch as lactoovovegetarianisminvolve the
lutants (PLOP), such as pesticides, polychlorinated dibenzo-p-
practice of consuming eggs and dairy products. Although a vegetar-
dioxins, dibenzofurans, polychlorinated biphenyls, and polybromi-
nated compounds. Animal products can also contain other ian lifestyle can lower the body burden of PLOP, MMHg, and lead,
neurotoxic substances, such as monomethyl mercury (MMHg) and such benefits can be undermined by the consumption of contami-
lead. nated milk and egg products. Farm animals that have been fed con-
Substances that are resistant to degradation and that are released taminated animal products produce contaminated milk and egg
in the environment accumulate in the food web and often end up products.
being consumed by humans. The chemical characteristics of these In summary, the inclusion of animal products in some forms of
persistent pollutants determine the location of accumulation, the vegetarianism can increase the exposure of humans to persistent
metabolism, and the half-time within animal tissues. Lipophilic sub- pollutants. Vegetarians with a desire to reduce their exposure to
stances such as PLOP accumulate in fat tissues, whereas lead accu- neurotoxic substances (eg, PLOP, MMHg, and lead) should be
mulates in bones as a function of age and diet. Although organo- aware of farming practices that introduce these pollutants into the
chlorine pesticides are a significant contaminant of crops, animal human diet.
byproducts are the major carriers of these harmful substances (2).
MMHg is also a fat-soluble substance, but it is complexed with
hydrophilic sulfhydril-containing molecules of protein matrices in Jos G Dorea
animal tissues. A series of chemical reactions involving mercury and
sulfate-reducing bacteria produce MMHg, which is then introduced Department of Nutrition
in the aquatic food chain and is thereby acquired by humans through CP 04322
the consumption of fish and shellfish. Animals and humans share Universidade de Brasilia
some of the bioaccumulation features of these persistent substances, 70919.970 Brasilia DF
but, because of different dietary habits, humans may or may not be Brazil
exposed to them. E-mail: dorea@rudah.com.br
The trend among affluent countries is to feed animal byproducts
to poultry and ruminants (herbivores such as cows, sheep, and goats).
These animals are used in milk production or are consumed as meat.
Fishmeal is mainly used as feed for dairy cows (3). Fishmeal con- REFERENCES
sumption results in an increase in milk production and stimulates an 1. Trevitt CR, Singh PN. Variant Creutzfeldt-Jakob disease: pathology,
increase in docosahexaenoic and eicosapentaenoic acids (4). Cow epidemiology, and public health implications. Am J Clin Nutr 2003;
feed may also contain significant proportions of bone meal (5). 78(suppl):651S 6S.
The health benefits of vegetarian diets have been a topic of health 2. Singh PP, Chawla RP. Insecticide residues in total diet samples in Pun-
and nutrition research since long before the emergence of modern jab, India. Sci Total Environ 1988;76:139 46.
3. Yeo JM, Knight CH, Chamberlain DG. Effects of changes in dietary
environmental concerns. However, because of increases in environ-
amino acid balance on milk yield and mammary function in dairy cows.
mental pollution, dietary habits have become an increasingly important J Dairy Sci 2003;86:1436 44.
public health issue. Studies have shown that a primarily vegetarian diet 4. Gulati SK, McGrath S, Wynn PC, Scott TW. Preliminary results on the
results in decreased exposures to bioconcentrated environmental pol- relative incorporation of docosahexaenoic and eicosapentaenoic acids
lutants. Vegetarian mothers have been shown to secrete substantially into cows milk from two types of rumen protected fish oil. Int Dairy J
fewer organochlorine substances in breast milk than do nonvegetarian 2003;13:339 43.
mothers (6). Environmental estrogenic substances (polychlorinated 5. Akayezu JM, Hansen WP, Otterby DE, Crooker BA, Marx GD. Yield
Am J Clin Nutr 2004;80:237 8. Printed in USA. 2004 American Society for Clinical Nutrition 237
238 ERRATUM
response of lactating Holstein dairy cows to dietary fish meal and bone 8. Dickman MD, Leung CK, Leong MK. Hong Kong male subfertility links
meal. J Dairy Sci 1997;80:2950 63. to mercury in human hair and fish. Sci Total Environ 1998;214:16574.
6. Noren K. Levels of organochlorine contaminants in human milk in 9. Passos CJ, Mergler D, Gaspar E, et al. Eating tropical fruit reduces
relation to the dietary habits of the mothers. Acta Paediatr Scand 1983; mercury exposure from fish consumption in the Brazilian Amazon.
72:811 6. Environ Res 2003;93:12331.
7. Rozati R, Reddy PP, Reddanna P, Mujtaba R. Role of environmental 10. Srikumar TS, Johansson GK, Ockerman PA, Gustafsson JA, Akesson B.
estrogens in the deterioration of male factor fertility. Fertil Steril 2002; Trace element status in healthy subjects switching from a mixed to a
78:118794. lactovegetarian diet for 12 mo. Am J Clin Nutr 1992;55:88590.
Erratum
Cesari M, Pahor M, Bartali B, et al. Antioxidants and physical performance in elderly persons: the Invecchiare
in Chianti (InCHIANTI) study. Am J Clin Nutr 2004;79:289 94.
On page 290, column 2, paragraph 3, the unit mL is used incorrectly in 4 instances; the correct unit is L.
The text should have been presented as follows: Briefly, 100 L plasma was mixed with 100 L ethanol; after
being mixed by vortex, tocopherol was extracted into 500 L hexane containing 0.002% butylated hydroxy-
toluene (Sigma, St Louis). Tocol, a gift from Hoffmann-La Roche (Nutley, NJ), was added to the mixture as an
internal standard. Samples were centrifuged at 180 g for 5 min at 4 C. The supernatant fluid was collected
and dried under a stream of nitrogen gas and was reconstituted in 100 L methanol.