Revistas
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2023
Vol.:
129
Págs.:
704 - 714
The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the 'Seguimiento Universidad de Navarra' (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0 center dot 67, 95 % CI (0 center dot 40, 1 center dot 10), P-for trend = 0 center dot 10. Participants at the highest CQI category and with daily carbohydrate amounts >= 50 % of total energy intake had the lowest incidence of GDM (OR = 0 center dot 29 (95 % CI (0 center dot 09, 0 center dot 89)) compared with those with the lowest quality (lowest CQI) and quantity (<= 40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.
Revista:
BUILDING AND ENVIRONMENT
ISSN:
0360-1323
Año:
2023
Vol.:
228
Págs.:
109899
Overheating in dwellings is a global concern that is increasing due to global warming and more frequent and extreme heatwaves. This study assesses the relationship between different building parameters (built period, floor level, orientation, window area and solar shading) and compares indoor overheating hours during summer in twelve apartments monitored in Pamplona (North of Spain). They were selected as samples from different Spanish built periods related to different energy regulations, without mechanical cooling and with some kind of exterior solar shading. Overheating hours were calculated using the UNE-EN 16798 standard, which establishes a maximum acceptable operative temperature. This limit is adaptive and it is defined as the exponentially weighted running mean of the daily outdoor temperature. Multilevel mixed-effects linear and logistic regressions were used to analyse and compare overheating hours. Floor level, window area and solar shading were the parameters that showed a significant relationship with indoor overheating hours (p < 0.01). Orientation and built period did not reach a statistically significant value (p > 0.01). It is particularly noteworthy that the apartments built under the current Spanish Energy Regulations (after 2006) do not show a significant reduction in indoor overheating hours compared to those built without any energy regulations. This assessment reveals that current building energy regulations may not be enough to avoid overheating or ensure adaptation to warmer conditions. Therefore, this study contributes to establishing the main building parameters to improve in order to adapt Spanish apartment buildings to warming conditions in temperate climates.
Autores:
García, S.; Bouzas, C.; Mateos, D.; et al.
Revista:
ENVIRONMENTAL HEALTH
ISSN:
1476-069X
Año:
2023
Vol.:
22
N°:
1
Págs.:
1
Background Research related to sustainable diets is is highly relevant to provide better understanding of the impact of dietary intake on the health and the environment. Aim To assess the association between the adherence to an energy-restricted Mediterranean diet and the amount of CO2 emitted in an older adult population. Design and population Using a cross-sectional design, the association between the adherence to an energy-reduced Mediterranean Diet (erMedDiet) score and dietary CO2 emissions in 6646 participants was assessed. Methods Food intake and adherence to the erMedDiet was assessed using validated food frequency questionnaire and 17-item Mediterranean questionnaire. Sociodemographic characteristics were documented. Environmental impact was calculated through greenhouse gas emissions estimations, specifically CO2 emissions of each participant diet per day, using a European database. Participants were distributed in quartiles according to their estimated CO2 emissions expressed in kg/day: Q1 (<= 2.01 kg CO2), Q2 (2.02-2.34 kg CO2), Q3 (2.35-2.79 kg CO2) and Q4 (>= 2.80 kg CO2). Results More men than women induced higher dietary levels of CO2 emissions. Participants reporting higher consumption of vegetables, fruits, legumes, nuts, whole cereals, preferring white meat, and having less consumption of red meat were mostly emitting less kg of CO2 through diet. Participants with higher adherence to the Mediterranean Diet showed lower odds for dietary CO2 emissions: Q2 (OR 0.87; 95%CI: 0.76-1.00), Q3 (OR 0.69; 95%CI: 0.69-0.79) and Q4 (OR 0.48; 95%CI: 0.42-0.55) vs Q1 (reference). Conclusions The Mediterranean diet can be environmentally protective since the higher the adherence to the Mediterranean diet, the lower total dietary CO2 emissions. Mediterranean Diet index may be used as a pollution level index.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2023
Vol.:
15
N°:
5
Págs.:
1072
Background: Binge-drinking is one of the alcohol drinking patterns with the worst health consequences. Nonetheless, binge-drinking is highly prevalent. The perceived benefits that motivate it are ultimately related to subjective well-being. In this context, we analyzed the relationship between binge-drinking and quality of life.
Methods: We evaluated 8992 participants of the SUN cohort. We classified as binge-drinkers those who reported consuming six or more drinks on at least one occasion the year before recruitment (n = 3075). We fitted multivariable logistic regression models to calculate the odds ratios (ORs) of a worse physical and mental quality of life, measured with the validated SF-36 questionnaire at 8 years of follow-up (cut-off point = P75 or highest score).
Results: Binge-drinking was associated with greater odds of having a worse mental quality of life, even adjusting for quality of life at 4 years of follow-up, used as an approximation to a baseline measure (OR = 1.22 (1.07-1.38)). This value was mainly due to the effects on vitality (OR = 1.17 (1.01-1.34)) and mental health (OR = 1.22 (1.07-1.39)).
Conclusions: Binge-drinking may lead to poorer mental quality of life; therefore, binge-drinking for enhancement purposes does not seem to be justified by this effect.
Revista:
ANTIOXIDANTS
ISSN:
2076-3921
Año:
2023
Vol.:
12
N°:
2
Págs.:
507
The global incidence of type 2 diabetes (T2D) has been steadily increasing in recent decades. The Mediterranean dietary pattern has shown a preventive effect on the risk of T2D. Evaluating the association between bioactive compounds such as phenolic compounds (PC) in a Mediterranean cohort could help to better understand the mechanisms implicated in this protection. We evaluated the association between dietary intake of PC and the risk of T2D in a relatively young cohort of 17,821 Spanish participants initially free of T2D, through the University of Navarra Follow-up Project (Seguimiento Universidad de Navarra or SUN cohort) after 10 years of median follow-up using time-dependent Cox models. Intake of PC was estimated at baseline and repeatedly at 10-year follow-up using a 136-item validated food frequency and the Phenol-Explorer database. The incidence of T2D was identified by a biennial follow-up, and only medically confirmed cases were included. During 224,751 person-years of follow-up, 186 cases of T2D were confirmed. A suboptimal intake of stilbenes was independently associated with a higher risk of T2D in subjects over 50 years (HR: 1.75, 95% CI: 1.06-2.90, p value < 0.05) after adjusting for potential confounders. Our results suggest that a moderate-high intake of stilbenes can decrease the risk of developing T2D in subjects over 50 years in our cohort.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2023
Vol.:
26
N°:
3
Págs.:
563 - 574
Objective: To investigate the association between different versions of a provegetarian food pattern (FP) and micronutrient inadequacy. Design: Cross-sectional analysis. Dietary intake was assessed at baseline through a validated 136-item FFQ. Participants were classified according to groups of different versions of a provegetarian FP: overall, healthful and unhealthful. The prevalence of inadequate intake of vitamins B-1, B-2, B-3, B-6, B-12, C, A, D, E, folic acid, Zn, I, Se, Fe, Ca, K, P, Mg and Cr was evaluated using the estimated average requirement (EAR) cut-point method and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either >= 3 or >= 6 micronutrients. Setting: Seguimiento Universidad de Navarra (SUN) cohort. Participants: 17 825 Spanish adults. Results: Overall, subjects in the highest group of the unhealthful provegetarian FP had the highest prevalence of inadequate dietary intake for every vitamin and mineral, compared to those in the lowest group. The adjusted OR of failing to meet >= 3 EAR (highest v. lowest group) was 0 center dot 65 (0 center dot 54, 0 center dot 69) for the overall, 0 center dot 27 (0 center dot 24, 0 center dot 31) for the healthful and 9 center dot 04 (7 center dot 57, 10 center dot 4) for the unhealthful provegetarian FP. Conclusion: A higher adherence to an overall and healthful provegetarian FP was inversely associated with the risk of failing to meet EAR values, whereas the unhealthful version was directly associated with micronutrient inadequacy. Provegetarian FP should be well planned, prioritising nutrient-dense plant foods and minimising ultra-processed and unhealthy ones.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2023
Vol.:
15
N°:
2
Págs.:
1-13
Alcohol drinking patterns may determine the risk of hypertension and may also modify the detrimental effect of high alcohol intake. We prospectively evaluated the effect of the Mediterranean alcohol-drinking pattern and its interaction with the amount of alcohol consumed on the incidence of arterial hypertension. In the ¿Seguimiento Universidad de Navarra¿ (SUN) cohort, we followed-up 13,805 participants, all of them initially free of hypertension, during a maximum period of 16 years. Information about diet, chronic diseases, lifestyle and newly diagnosed hypertension was collected using validated questionnaires. We used a 7-item score (0 to 9 points) that jointly considered moderate alcohol consumption, distributed over the week, with meals, and a preference for red wine and avoidance of binge-drinking. During 142,404 person-years of follow-up, 1443 incident cases of hypertension were identified. Low adherence (score < 2) to the Mediterranean alcohol-drinking pattern was significantly associated with a higher incidence of hypertension (multivariable-adjusted hazard ratio 1.81, 95% confidence interval 1.09¿2.99) as compared to the high-adherence (score > 7) category. Among alcohol consumers, a high adherence to the MADP is associated with a lower incidence of hypertension. Compared with abstinence, a high adherence did not seem to differ regarding its effect on hypertension risk.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2023
Vol.:
15
N°:
2
Págs.:
307
Alcohol drinking patterns may determine the risk of hypertension and may also modify the detrimental effect of high alcohol intake. We prospectively evaluated the effect of the Mediterranean alcohol-drinking pattern and its interaction with the amount of alcohol consumed on the incidence of arterial hypertension. In the Seguimiento Universidad de Navarra (SUN) cohort, we followed-up 13,805 participants, all of them initially free of hypertension, during a maximum period of 16 years. Information about diet, chronic diseases, lifestyle and newly diagnosed hypertension was collected using validated questionnaires. We used a 7-item score (0 to 9 points) that jointly considered moderate alcohol consumption, distributed over the week, with meals, and a preference for red wine and avoidance of binge-drinking. During 142,404 person-years of follow-up, 1443 incident cases of hypertension were identified. Low adherence (score < 2) to the Mediterranean alcohol-drinking pattern was significantly associated with a higher incidence of hypertension (multivariable-adjusted hazard ratio 1.81, 95% confidence interval 1.09-2.99) as compared to the high-adherence (score > 7) category. Among alcohol consumers, a high adherence to the MADP is associated with a lower incidence of hypertension. Compared with abstinence, a high adherence did not seem to differ regarding its effect on hypertension risk.
Revista:
EXPERIMENTAL GERONTOLOGY
ISSN:
0531-5565
Año:
2023
Vol.:
172
Págs.:
112048
Several studies have tried to analyse the association between all-cause mortality and different risk factors, (especially those which are modifiable, such as smoking, diet or exercise), to develop public health preventive strategies. However, a specific analysis of predictors of premature and late mortality is needed to give more precise recommendations. Considering that there are risk factors which exert an influence on some diseases and not on others, we expect that, similarly, they may have a different impact depending on the timing of mortality, separating premature (<65 years) from late mortality (>65 years). Thus, we prospectively followed-up during a median of 12 years a cohort of 20,272 university graduates comprising an ample range of ages at inception. Time-dependent, covariate-adjusted Cox models were used to estimate adjusted hazard ratios (HR) and their 95 % confidence intervals (CI) for each predictor. The strongest independent predictor of mortality at any age was physical activity which was associated with reduced risk of total, premature and late mortality (range of HRs when comparing the highest vs. the lowest level: 0.24 to 0.48). Specific strong predictors for premature mortality were smoking, HR: 4.22 (95 % CI: 2.42-7.38), and the concurrence of >2 metabolic conditions at baseline, HR: 1.97 (1.10-3.51). The habit of sleeping a long nap (>30 min/d), with HR: 2.53 (1.30-4.91), and poor adherence to the Mediterranean Diet (<3 points in a 0 to 8 score vs. >6 points), with HR: 2.27 (1.08-4.76), were the strongest specific predictors for late mortality. Smoking, diet quality or lifestyles, probably should be differen-tially assessed as specific predictors for early and late mortality. In the era of precision medicine, this approach will allow tailored recommendations appropriate to each person's age and baseline condition.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2022
Vol.:
61
N°:
2
Págs.:
957 - 971
Purpose: To assess the association between a score appraising adherence to the PaleoDiet and the risk of cardiovascular disease (CVD) in a Mediterranean cohort.
Methods: We included 18,210 participants from the Seguimiento Universidad de Navarra (SUN) cohort study. The PaleoDiet score comprised six food groups promoted within this diet (fruit, nuts, vegetables, eggs, meat and fish) and five food groups whose consumption is discouraged (cereals and grains, dairy products, legumes, culinary ingredients, and processed/ultra-processed foods). CVD was defined as acute myocardial infarction with or without ST elevation, non-fatal stroke and cardiovascular death. Cox proportional hazards models adjusted for potential confounders were fitted to assess the association between the PaleoDiet score and CVD risk, and the PaleoDiet and MedDiet indices to explore differences between both diets.
Results: During 12.2 years of follow-up, 165 incident CVD cases were confirmed. A significant inverse association was found between the PaleoDiet score and CVD (HR Q5 vs. Q1: 0.45, 95% CI 0.27-0.76, P for trend = 0.007). A weaker association that became non-significant was observed when the item for low consumption of ultra-processed foods was removed from the score. Joint analysis of PaleoDiet and MedDiet Trichopoulou scores suggested that the inverse association between PaleoDiet and CVD was mainly present when adherence to the MedDiet was also high (HR for high adherence vs low adherence to both diet scores: 0.22, 95% CI 0.08-0.64).
Conclusions: Our findings suggest that the PaleoDiet may have cardiovascular benefits in participants from a Mediterranean country. Avoidance of ultra-processed foods seems to play a key role in this inverse association.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
23
Págs.:
5129
Background: Previous studies regarding antioxidant consumption and glaucoma have shown contradictory results. The aim of this study was to analyze the combined effect of the consumption of three vitamins (A, C and E) on the incidence of glaucoma in the SUN Project. Methods: For this study, 18,669 participants were included. The mean follow-up was 11.5 years. An index including vitamins A, C and E (ACE-Vitamin Index) was calculated. Vitamin intake was extracted from participants' dietary data and vitamin supplements, if taken. Information on glaucoma incidence was collected by previously validated self-reported questionnaires. The association between glaucoma and vitamin intake was assessed by repeated-measures Cox regression using multi-adjusted hazard ratios. Results: A total of 251 (1.3%) cases of glaucoma were detected. Participants with a higher ACE-Vitamin Index presented a reduced risk of glaucoma compared to participants with lower consumption (adjusted HR = 0.73; 95% CI, (0.55-0.98)). When each vitamin was analyzed individually, none of them had a significant protective effect. The protective effect of the ACE-Vitamin Index was higher in men and older participants (>= 55 year). Conclusions: The consumption of vitamins A, C and E considered separately do not seem to exert a protective effect against glaucoma, but when these vitamins are considered together, they are associated with a lower risk of glaucoma.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2022
Vol.:
75
N°:
4
Págs.:
308 - 315
Introduction and objectives: Telomeres are noncoding regions located at the end of chromosomes and their shortening has been associated with risk factors and cardiovascular disease. The aim of this study was to evaluate the association between ideal cardiovascular health (Life's simple 7) and the odds of having short telomeres in a subsample of participants older than 55 years from the Seguimiento Universidad de Navarra (SUN) study.
Methods: We included 886 participants older than 55 years (645 men and 241 women). Telomere length was measured using a real-time quantitative polymerase chain reaction. Cardiovascular health score was defined by the American Heart Association as a composite score of 7 key risk factors (smoking status, physical activity, diet, body mass index, blood pressure, total cholesterol, and fasting blood glucose) with 0 to 2 points for each factor. We categorized this score in tertiles as poor (0-9 points), intermediate (10-11 points) and ideal (12-14 points). The odds of having short telomeres was defined as telomere length below the 20th percentile.
Results: Individuals with higher ideal cardiovascular health had a lower prevalence of having short telomeres (adjusted OR, 0.60; 95%CI, 0.34-1.05; P trend = .052). This association was statistically significant in men (adjusted OR, 0.37; 95%CI, 0.17-0.83; P trend = .025) but not in women.
Conclusions: An inverse association between cardiovascular health score and short telomeres was found especially for men older than 55 years in the SUN population.
Autores:
Jannasch, F. (Autor de correspondencia); Dietrich, S.; Bishop, T. R. P.; et al.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2022
Vol.:
61
N°:
7
Págs.:
3649 - 3667
Purpose In several studies, exploratory dietary patterns (DP), derived by principal component analysis, were inversely or positively associated with incident type 2 diabetes (T2D). However, findings remained study-specific, inconsistent and rarely replicated. This study aimed to investigate the associations between DPs and T2D in multiple cohorts across the world. Methods This federated meta-analysis of individual participant data was based on 25 prospective cohort studies from 5 continents including a total of 390,664 participants with a follow-up for T2D (3.8-25.0 years). After data harmonization across cohorts we evaluated 15 previously identified T2D-related DPs for association with incident T2D estimating pooled incidence rate ratios (IRR) and confidence intervals (CI) by Piecewise Poisson regression and random-effects meta-analysis. Results 29,386 participants developed T2D during follow-up. Five DPs, characterized by higher intake of red meat, processed meat, French fries and refined grains, were associated with higher incidence of T2D. The strongest association was observed for a DP comprising these food groups besides others (IRRpooled per 1 SD = 1.104, 95% CI 1.059-1.151). Although heterogeneity was present (I-2 = 85%), IRR exceeded 1 in 18 of the 20 meta-analyzed studies. Original DPs associated with lower T2D risk were not confirmed. Instead, a healthy DP (HDP1) was associated with higher T2D risk (IRRpooled per 1 SD = 1.057, 95% CI 1.027-1.088). Conclusion Our findings from various cohorts revealed positive associations for several DPs, characterized by higher intake of red meat, processed meat, French fries and refined grains, adding to the evidence-base that links DPs to higher T2D risk. However, no inverse DP-T2D associations were confirmed.
Autores:
Khoury, N.; Gómez-Donoso, C.; Martínez, M. A.; et al.
Revista:
FRONTIERS IN NUTRITION
ISSN:
2296-861X
Año:
2022
Vol.:
9
Págs.:
897089
Background: Helping consumers to improve the nutritional quality of their diet is a key public health action to prevent cardiovascular diseases (CVDs). The modified version of the Food Standard Agency Nutrient Profiling System Dietary Index (FSAm-NPS DI) underpinning the Nutri-Score front-of-pack label has been used in public health strategies to address the deleterious consequences of poor diets. This study aimed to assess the association between the FSAm-NPS DI and some CVD risk factors including body mass index (BMI), waist circumference, plasma glucose levels, triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and diastolic and systolic blood pressure. Materials and Methods: Dietary intake was assessed at baseline and after 1 year of follow-up using a 143-item validated semi-quantitative food-frequency questionnaire. Dietary indices based on FSAm-NPS applied at an individual level were computed to characterize the diet quality of 5,921 participants aged 55-75 years with overweight/obesity and metabolic syndrome from the PREDIMED-plus cohort. Associations between the FSAm-NPS DI and CVD risk factors were assessed using linear regression models. Results: Compared to participants with a higher nutritional quality of diet (measured by a lower FSAm-NPS DI at baseline or a decrease in FSAm-NPS DI after 1 year), those participants with a lower nutritional quality of diet (higher FSAm-NPS DI or an increase in score) showed a significant increase in the levels of plasma glucose, triglycerides, diastolic blood pressure, BMI, and waist circumference (beta coefficient [95% confidence interval]; P for trend) (1.67 [0.43, 2.90]; <0.001; 6.27 [2.46, 10.09]; <0.001; 0.56 [0.08, 1.05]; 0.001; 0.51 [0.41, 0.60]; <0.001; 1.19 [0.89, 1.50]; <0.001, respectively). No significant associations in relation to changes in HDL and LDL-cholesterol nor with systolic blood pressure were shown. Conclusion: This prospective cohort study suggests that the consumption of food items with a higher FSAm-NPS DI is associated with increased levels of several major risk factors for CVD including adiposity, fasting plasma glucose, triglycerides, and diastolic blood pressure. However, results must be cautiously interpreted because no significant prospective associations were identified for critical CVD risk factors, such as HDL and LDL-cholesterol, and systolic blood pressure.
Revista:
HEALTHCARE
ISSN:
2227-9032
Año:
2022
Vol.:
10
N°:
6
Págs.:
1088
Healthy and unhealthy lifestyles are tightly linked to general health and well-being. However, measurements of well-being have failed to include elements of health and easy to interpret information for patients seeking to improve lifestyles. Therefore, this study aimed to create an index for the assessment of general health and well-being along with two cut-off points: the lifestyle and well-being index (LWB-I). This was a cross-sectional analysis of 15,168 individuals. Internally valid multivariate linear models were constructed using key lifestyle features predicting a modified Short Form 36 questionnaire (SF-36) and used to score the LWB-I. Categorization of the LWB-I was based on self-perceived health (SPH) and analyzed using receiver operating characteristic curve analysis. Optimal cut-points identified individuals with poor and excellent SPH. Lifestyle and well-being were adequately accounted for using 12 lifestyle items. SPH groups had increasingly healthier lifestyle features and LWB-I scores; optimal cut-point for poor SPH were scores below 80 points (AUC: 0.80 (0.79, 0.82); sensitivity 75.7%, specificity 72.3%)) and above 86 points for excellent SPH (AUC: 0.67 (0.66, 0.69); sensitivity 61.4%, specificity 63.3%). Lifestyle and well-being were quantitatively scored based on their associations with a general health measure in order to create the LWB-I along with two cut points.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
2
Págs.:
353
Exposure to persistent organic pollutants (POPs) may influence telomere length (TL), which is considered as a marker of biological age associated with the risk of chronic disease. We hypothesized that dietary exposure to polychlorinated biphenyls (PCBs) and dioxins could affect TL. Our aim was to evaluate the association of dietary exposure to PCBs and dioxins with TL. In this cross-sectional study of 886 subjects older than 55 y (mean age: 67.7; standard deviation (SD): 6.1; 27% women) from the "Seguimiento Universidad de Navarra" (SUN) project. TL was determined by real-time quantitative polymerase chain reaction and dietary PCBs and dioxins exposure was collected using a validated 136-item Food Frequency Questionnaire. Multivariable linear regression models were used to control for potential confounding factors. Shorter TL was associated with dietary total PCBs (SD of T/S ratio/(ng/day) = -0.30 x 10(-7); 95% CI, -0.55 x 10(-7) to -0.06 x 10(-7)), dioxin-like PCBs (DL-PCBs) (SD of T/S ratio/(pg WHO TEQ (Toxic Equivalents)/day) = -6.17 x 10(-7); 95% CI, -11.30 x 10(-7) to -1.03 x 10(-7)), and total TEQ exposure (SD of T/S ratio/(pg WHO TEQ/day) = -5.02 x 10(-7); 95% CI, -9.44 x 10(-7) to -0.61 x 10(-7)), but not with dioxins (SD of T/S ratio/(pg WHO TEQ/day) = -13.90 x 10(-7); 95% CI, -37.70 x 10(-7) to 9.79 x 10(-7)). In this sample of middle-aged and older Spanish adults, dietary exposure to total PCBs and DL-PCBs alone and together with dioxins was associated with shorter TL. Further longitudinal studies, preferably with POPs measured in biological samples, are needed to confirm this finding.
Autores:
Konieczna, J. (Autor de correspondencia); Fiol, M.; Colom, A.; et al.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
19
Págs.:
4142
Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver alterations that can result in severe disease and even death. Consumption of ultra-processed foods (UPF) has been associated with obesity and related comorbidities. However, the link between UPF and NAFLD has not been sufficiently assessed. We aimed to investigate the prospective association between UPF consumption and liver health biomarkers. Methods: We followed for 1 year 5867 older participants with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus trial. A validated 143-item semi-quantitative food frequency questionnaire was used to evaluate consumption of UPF at baseline, 6, and 12 months. The degree of processing for foods and beverages (g/day) was established according to the NOVA classification system. The non-invasive fatty liver index (FLI) and hepatic steatosis index (HSI) were used to evaluate liver health at three points in time. The associations between changes in UPF consumption (percentage of total daily dietary intake (g)) and liver biomarkers were assessed using mixed-effects linear models with repeated measurements. Results: In this cohort, UPF consumption at baseline was 8.19% (SD 6.95%) of total daily dietary intake in grams. In multivariable models, each 10% daily increment in UPF consumption in 1 year was associated with significantly greater FLI (beta 1.60 points, 95% CI 1.24;1.96 points) and HSI (0.43, 0.29; 0.57) scores (all p-values < 0.001). These associations persisted statistically significant after adjusting for potential dietary confounders and NAFLD risk factors. Conclusions: A higher UPF consumption was associated with higher levels of NAFLD-related biomarkers in older adults with overweight/obesity and MetS.
Revista:
ANTIOXIDANTS
ISSN:
2076-3921
Año:
2022
Vol.:
11
N°:
4
Págs.:
783
The health benefits of plant-based diets have been reported. Plant-based diets found in Spain and other Mediterranean countries differ from typical diets in other countries. In the Mediterranean diet, a high intake of phenolic compounds through olives, olive oil, and red wine may play an important role in cardiovascular prevention. Prospective studies carried out in Mediterranean countries may provide interesting insights. A relatively young Mediterranean cohort of 16,147 Spanish participants free of cardiovascular disease (CVD) was followed (61% women, mean (SD) age 37(12) years at baseline) for a median of 12.2 years. Dietary intake was repeatedly assessed using a 136-item validated food frequency questionnaire, and (poly)phenol intake was obtained using the Phenol-Explorer database. Participants were classified as incident cases of CVD if a medical diagnosis of myocardial infarction, stroke, or cardiovascular death was medically confirmed. Time-dependent Cox regression models were used to assess the relationship between (poly)phenol intake and the incidence of major CVD. A suboptimal intake of phenolic compounds was independently associated with a higher risk of CVD, multivariable-adjusted hazard ratio for the lowest versus top 4 quintiles: 1.85 (95% CI: 1.09-3.16). A moderate-to-high dietary intake of phenolic compounds, especially flavonoids, is likely to reduce CVD incidence in the context of a Mediterranean dietary pattern.
Revista:
ENERGY AND BUILDINGS
ISSN:
0378-7788
Año:
2022
Vol.:
254
Págs.:
111567
The COVID pandemic has strongly affected daily life both in Spanish schools and worldwide. Providing the best environmental conditions for children allowing face-to-face learning with healthy and safe indoor spaces is a challenge. In the present study, empirical research about how these environmental conditions change with COVID is presented comparing the situation from March 2020 to January 2021. The methodology combines surveys conducted in nine schools with a case study in a selected school where a detailed monitoring of the building was developed during both heating seasons. This data analyzes the impact of the new COVID prevention protocols on indoor environmental conditions (especially those related to natural ventilation). Results show a mean CO2 reduction of 1,400 ppm, having in the second term values around 1,000 ppm, although temperatures diminished nearly 2 degrees C to mean values of 18 degrees C. Evolution of temperature and CO2 concentration throughout the day was also analyzed, being these indoor conditions especially important for the children with poorer health. Mechanical ventilation with heating recovery should complement natural ventilation, at least during the coldest months or hours of the day, although systems have to be carefully designed and installed to work effectively. (C) 2021 The Authors. Published by Elsevier B.V.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
4
Págs.:
779
Background: The relationship between modifiable risk factors, such as diet and lifestyle, and glaucoma remains controversial. We analyse the effect of the Mediterranean lifestyle (ML) on glaucoma incidence in the Seguimiento Universidad de Navarra (SUN) Project. Methods: The SUN Healthy Lifestyle Score (SHLS) includes 10 healthy habits: never having smoked, moderate to high physical activity, Mediterranean diet adherence, moderate alcohol consumption, low television exposure, no binge drinking, short afternoon napping, meeting up with friends, working at least 40 h/wk, and low body mass index. The information was collected biennially through self-reported questionnaires. The relationship between new glaucoma cases and the SHLS was assessed by Cox regression using hazard ratios. Crude, multi-adjusted, and sensitivity analyses were performed. Results: During a median of 12 years of follow-up, 261 (1.42%) new cases of glaucoma were identified among 18,420 participants. After adjusting for potential confounders, participants in the healthiest SHLS category showed a significantly reduced risk of glaucoma compared to those in the lowest SHLS category (adjusted HR = 0.51, 95% CI = 0.28-0.93). For each point added to the SHLS, the risk of glaucoma relatively dropped 5%. Conclusions: Higher adherence to a ML, measured by the SHLS, was significantly associated with a lower risk of developing glaucoma. Based on our study, the ML is a protective factor for glaucoma incidence.
Autores:
Martínez-Pérez, C.; Daimiel, L. (Autor de correspondencia); Climent-Mainar, C.; et al.
Revista:
INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY
ISSN:
1479-5868
Año:
2022
Vol.:
19
N°:
1
Págs.:
6
Background: Recent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems. Methods: Data from 4400 participants (48.1% female and 51.9% male, 64.9 +/- 4.9 years) of the Spanish PREDIMED-Plus ("PREvention with MEDiterranean DIet") trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach's analysis, and agreement with the four classifications was assessed with weighted kappa coefficients. Results: Regression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the "HPF dietary pattern" (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems. Conclusions: We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs.
Autores:
De Deus Mendonca, R.; Aparecida Mingoti, S.; Gazzinelli Bethony, M. F.; et al.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2022
Vol.:
25
N°:
3
Págs.:
781 - 793
Objective: To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake. Design: A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire's pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire. Setting: Health promotion services of Brazilian Primary Health Care. Participants: 3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)). Results: At baseline, the average daily FV intake was 370 center dot 4 g/d (95 % CI 364 center dot 2, 376 center dot 6). The increase in FV intake (23 center dot 4 g/d; 95 % CI 6 center dot 7, 40 center dot 0) and fruit intake (+17 center dot 3 g/d; 95 % CI 5 center dot 1, 29 center dot 4; P = 0 center dot 01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0 center dot 001), increased self-efficacy (P < 0 center dot 001) and improved knowledge of FV crops (P < 0 center dot 001). Conclusions: The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d).
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
24
Págs.:
5310
Background: Most of the available epidemiological evidence on alcohol and chronic disease agrees on recommending alcohol abstention to young people, but some controversy exists about the most appropriate recommendation for alcohol abstention for people of older ages. A growing body of evidence suggests that the pattern of alcohol consumption is likely to be a strong effect modifier. The Mediterranean Alcohol Drinking Pattern (MADP) represents a score integrating several dimensions of drinking patterns (moderation, preference for red wine, drinking with meals, and avoiding binge drinking). Our aim was to clarify this issue and provide more precise recommendations on alcohol consumption. Methods: We prospectively followed-up 2226 participants (men older than 50 years and women older than 55 years at baseline) in the Seguimiento Universidad de Navarra (SUN) cohort. We classified participants into three categories of adherence to the MADP score (low, moderate, and high), and we added a fourth category for abstainers. Cox regression models estimated multivariable-adjusted hazard ratios (HR) of all-cause death and 95% confidence intervals (CI) using low MADP adherence as the reference category. Results: The strongest reduction in risk of mortality was observed for those with high adherence to the MADP, with an HR of 0.54 (95% CI: 0.37-0.80). The moderate adherence group (HR = 0.65, 95% CI: 0.44-0.96) and the abstention group (HR = 0.60, 95% CI: 0.36-0.98) also exhibited lower risks of mortality than the low MADP adherence group. Conclusions: based on the available evidence, a public health message can be provided to people older than 50 years as follows: among those who drink alcohol, high adherence to the MADP score could substantially reduce their risk of all-cause mortality.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2022
Vol.:
41
N°:
12
Págs.:
3061 - 3068
Background & aims: A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.
Methods: We assessed 9,677 participants from the SUN Project, a prospective cohort of middle-aged university graduates in Spain. We inquired about a positive result in a COVID-19 diagnostic test during the months of February to December 2020. After excluding health professionals (HP), 5,194 participants were included in the statistical analyses (mean age: 52.6, SD: 12.4; 55.2% women). Food habits were assessed at baseline using a previously validated semiquantitative 136-item food frequency questionnaire. Adherence to the Mediterranean diet (cumulative average of 2 repeated measurements 10 years apart) was assessed using the 0-to-9 Mediterranean Diet Score (MDS). We used multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for incident COVID-19 according to the MDS.
Results: Among 5,194 non-HP participants, 122 reported to have received a positive COVID-19 diagnostic test. Participants with intermediate adherence to the Mediterranean diet (3 < MDS ¿ 6) had a significantly lower odds of developing COVID-19 (multivariable-adjusted OR = 0.50, 95% CI: 0.34-0.73), and those with the highest adherence (MDS > 6) exhibited the lowest risk (multivariable-adjusted OR = 0.36, 95% CI: 0.16-0.84, p for trend < 0.001) as compared with participants with MDS ¿ 3. This inverse association remained robust within subgroups and in sensitivity analyses. Notwithstanding, no significant associations were observed for health professionals (p for interaction = 0.06).
Conclusion: In conclusion, better adherence to the Mediterranean diet may be associated with a lower risk of COVID-19. Our results are applicable only to persons who are not health professionals.
Revista:
FRONTIERS IN NUTRITION
ISSN:
2296-861X
Año:
2022
Vol.:
9
Págs.:
951738
Background and aimsFront-of-Pack (FoP) nutrition labelling has been established as a policy, empowering consumers to choose healthy food options for preventing diet-related non-communicable diseases. This study aimed to evaluate the association between the nutrient profile underlying the Chilean warning label score and all-cause mortality and to conduct a calibration with the Nutri-Score in a large cohort of Spanish university graduates. Materials and methodsThis prospective cohort study analysed 20,666 participants (8,068 men and 12,598 women) with a mean (standard deviation) age of 38 years (+/- 12.4) from the SUN cohort. Dietary food intake was assessed by a validated semi-quantitative food-frequency questionnaire at baseline and after 10 years of follow-up. The warning label score was calculated by considering the threshold of nutrients (sugar, saturated fat, and sodium) and energy density per 100 g/ml of product, as established by Chilean Legislation. Participants were classified according to quartiles of consumption of daily label score: Q1 (<= 5.0), Q2 (>5.0-7.1), Q3 (>7.1-9.8), and Q4 (>9.8). Time-dependent, multivariable-adjusted Cox models were applied. To compare the performance of the warning label score and Nutri-Score to predict mortality, we used the Akaike information criterion (AIC) and Bayesian information criterion (BIC) methods. ResultsDuring a median of 12.2 years of follow-up, 467 deaths were identified. A higher score in the warning label values (lower nutritional quality) was associated with an increased risk of all-cause mortality [HR (95% CI) Q4 vs. Q1: 1.51 (1.07-2.13); p-trend = 0.010] and cancer mortality [HR (95% CI) Q4 vs. Q1: 1.91 (1.18-3.10); p-trend = 0.006]. However, no statistically significant association was found for cardiovascular mortality. Furthermore, the warning label score and Nutri-Score exhibited comparable AIC and BIC values, showing similar power of prediction for mortality. ConclusionA diet with a higher warning label score (>9.8 per day) was a good predictor of all cases and cancer mortality in a large Spanish cohort of university graduates. Also, the warning label score was capable to predict mortality as well as the Nutri-Score. Our findings support the validity of the warning label score as a FoP nutrition labelling policy since it can highlight less healthy food products.
Autores:
Donat-Vargas, C. (Autor de correspondencia); Sandoval-Insausti, H.; Peñalvo, J. L.; et al.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2022
Vol.:
41
N°:
1
Págs.:
122 - 130
Background & aims: The specific association of olive oil consumption with coronary heart disease (CHD) or stroke has not been totally established. Objective: to examine whether olive oil consumption is associated with subclinical atherosclerosis, the risk of total cardiovascular disease (CVD), CHD, and stroke. Methods: Three cohorts were included: AWHS (2318 men), SUN Project (18,266 men and women), and EPIC-Spain (39,393 men and women). Olive oil consumption was measured at baseline using validated questionnaires. Results: In the AWHS, 747 participants had a positive coronary artery calcium score (CACS>0), and the OR (95% CI) was 0.89 (0.72, 1.10) in those with virgin olive oil consumption >30 g/day (v. <10 g/day). In the SUN Project (follow-up 10.8 years) 261 total CVD cases occurred, and the HR was 0.57 (0.34, 0.96) for consumptions >30 g/day (v. <10 g/day). In the EPIC-Spain (follow-up 22.8 years) 1300 CHD cases and 938 stroke cases occurred; the HRs for stroke according, 0 to <10 (ref), 10 to <20, 20 to <30, and >30 g/day of olive oil consumption, were 0.84 (0.70, 1.02), 0.80 (0.66, 0.96), 0.89 (0.74, 1.07). A weaker association was observed for CHD. The association was stronger among those consuming virgin olive oil, instead of common (refined). Conclusions: Olive oil is associated with lower risk of CVD and stroke. The maximum benefit could be obtained with a consumption between 20 and 30 g/day. The association could be stronger for virgin olive oil and might operate from the early stages of the disease.
Autores:
Donat-Vargas, C. (Autor de correspondencia); Sandoval-Insausti, H.; Penalvo, J. L.; et al.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2022
Vol.:
41
N°:
3
Págs.:
784 - 785
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
13
Págs.:
2561
Obesity is associated with a higher risk of several types of cancer, grouped as obesity-related cancers (ORC). Vitamin D deficiency is more prevalent in obese subjects, and it has been suggested to play a role in the association between obesity and cancer risk. The aim of the study was to analyze the association between vitamin D intake and the subsequent risk of ORC in a prospective Spanish cohort of university graduates. The SUN Project, initiated in 1999, is a prospective dynamic multipurpose cohort. Participants answered a 556-item lifestyle baseline questionnaire that included a validated food-frequency questionnaire. We performed Cox regression models to estimate the hazard ratios (HRs) of ORC according to quartiles of energy-adjusted vitamin D intake (diet and supplements). We included 18,017 participants (mean age = 38 years, SD = 12 years), with a median follow-up of 12 years. Among 206,783 person-years of follow-up, we identified 225 cases of ORC. We found no significant associations between vitamin D intake and ORC risk after adjusting for potential confounders: HRQ2vsQ1 = 1.19 (95% CI 0.81-1.75), HRQ3vsQ1 = 1.20 (95% CI 0.81-1.78), and HRQ4vsQ1 = 1.02 (95% CI 0.69-1.51). Dietary and supplemented vitamin D do not seem to be associated with ORC prevention in the middle-aged Spanish population.
Revista:
JOURNAL OF ALZHEIMERS DISEASE
ISSN:
1387-2877
Año:
2021
Vol.:
79
N°:
3
Págs.:
1257 - 1268
Background: Available evidence on the association of physical activity (PA) or sedentary behavior with cognitive decline is inconclusive. Objective: To assess the association between an active lifestyle score and leisure-time physical activity (LTPA) and changes in cognitive function in the Seguimiento Universidad de Navarra (SUN) prospective cohort. Methods: Cognitive function was evaluated in a subsample of 806 participants of the SUN cohort study using the validated Telephone Interview for Cognitive Status-modified (STICS-m) questionnaire at baseline and after 6 years. LTPA was evaluated with a previously validated 17-item self-administered questionnaire and with information on sedentary lifestyles. We also calculated a multidimensional 8-item PA score. Multivariable linear regression analysis evaluated the association between PA and changes in cognitive function and its interaction by APOE genotype. Results: Mean age of participants was 66 (SD 5.3) years and 69.7% were male. When stratifying by APOE variants, no significant associations between the active lifestyle score or LTPA and changes in cognitive performance over time were found among APOE epsilon 4 carriers. However, we observed that a higher adherence to an active lifestyle (high versus low PA score beta = 0.76 95%CI 0.15,1.36; p trend = 0.011) and a high LTPA (Q4 versus Q1 beta = 0.63; 95%CI -0.01,1.26; p trend = 0.030) were associated with more favorable changes in cognitive function over time among APOE epsilon 4 non-carriers with statistically significant interactions in both cases (p for interaction = 0.042 for PA score, and p = 0.039 for LTPA). Conclusion: The results of the present study suggest that an active lifestyle is associated with a better status of cognitive function over time only among APOE epsilon 4 non-carriers.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2021
Vol.:
40
N°:
3
Págs.:
1085 - 1094
Background & aims: Front-of-pack nutrition labelling is a key public health policy that can be adopted as part of a comprehensive set of measures to promote healthy diets. The Nutri-Score, a five-colour summary label based on a modified version of the British Food Standards Agency Nutrient Profiling System (FSAm-NPS), is being considered for implementation in several European countries including Spain. This study aimed to prospectively assess the association between the FSAm-NPS and mortality rate in a Spanish cohort of university graduates.
Methods: Analyses included 20 503 participants (mean [SD] age: 38 [12] years) from the SUN cohort. Dietary intake was assessed at baseline and after 10-years of follow-up with a validated semi-quantitative food-frequency questionnaire. The FSAm-NPS was calculated for each food/beverage based on their amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes, nuts, rapeseed, walnut and olive oils per 100 g of product. The FSAm-NPS Dietary Index (DI) was computed as an energy-weighted mean of the FSAm-NPS scores of all foods and beverages consumed by each participant. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to baseline and updated FSAm-NPS DI scores.
Results: Over a median follow-up of 10.9 years, 407 participants died. A higher baseline FSAm-NPS DI score, reflecting consumption of foods with lower nutritional quality and hence less favourable Nutri-Score rating, was directly associated with all-cause mortality (HR Q4 versus Q1 = 1.82; 95% CI: 1.34 to 2.47; p-trend<0.001) and cancer mortality (HR: 2.44; 95% CI: 1.54 to 3.85; p-trend<0.001). No association was found for cardiovascular mortality.
Conclusions: The consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher rate of all-cause and cancer mortality in a large prospective cohort of Spanish, middle-aged university graduates. These findings further support the implementation of Nutri-Score in Euro-Mediterranean countries.
Autores:
Pearce, M. (Autor de correspondencia); Fanidi, A.; Bishop, T. R. P.; et al.
Revista:
JOURNAL OF NUTRITION
ISSN:
0022-3166
Año:
2021
Vol.:
151
N°:
5
Págs.:
1231 - 1240
Background: The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. Objective: To examine the prospective associations of total and types of legume intake with the risk of incident T2D. Methods: Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted using a federated approach without physical data-pooling. Prospective cohorts were included if legume exposure and T2D outcome data were available and the cohort investigators agreed to participate. We estimated incidence rate ratios (IRRs) and C Is of associations using individual participant data including <42,473 incident cases among 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterranean, Europe, and Western Pacific. Random-effects meta-analysis was used to combine effect estimates and estimate heterogeneity. Results: Median total legume intake ranged from 0-140 g/d across cohorts. We observed a weak positive association between total legume consumption and T2D (IRR = 1.02, 95% CI: 1.01 to 1.04) per 20 g/d higher intake, with moderately high heterogeneity (I-2 = 74%). Analysis by region showed no evidence of associations in the Americas, Eastern Mediterranean, and Western Pacific. The positive association in Europe (IRR = 1.05, 95% CI: 1.01 to 1.10, I-2 = 82%) was mainly driven by studies from Germany, UK, and Sweden. No evidence of associations was observed for the consumption of pulses or soy. Conclusions: These findings suggest no evidence of an association of legume intakes with T2D in several world regions. The positive association observed in some European studies warrants further investigation relating to overall dietary contexts in which legumes are consumed, including accompanying foods which may be positively associated with T2D.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2021
Vol.:
40
N°:
6
Págs.:
4290 - 4300
Background & aims: Ultra-processed food and drink products (UPF) consumption has been associated with obesity and its-related comorbidities. Excess of visceral fat, which appears with increasing age, has been considered as the culprit contributing to adiposity-associated adverse health outcomes. However, none of previous studies elucidated the link between UPF and directly quantified adiposity and its distribution. We aimed to prospectively investigate the association between concurrent changes in UPF consumption and objectively assessed adiposity distribution. Methods: A subsample of 1485 PREDIMED-Plus participants (Spanish men and women aged 55-75 years with overweight/obesity and metabolic syndrome) underwent body composition measurements. Consumption of UPF at baseline, 6 and 12 months was evaluated using a validated 143-item semiquantitative Food Frequency Questionnaire. Food items (g/day) were categorized according to their degree of processing using NOVA system. Regional adiposity (visceral fat (in g) and android-to-gynoid fat & nbsp; ratio) and total fat mass (in g) at three time points were measured with dual-energy X-ray absorpti-ometry (DXA) and were normalized using sex-specific z-scores. The association of changes in UPF consumption, expressed as the percentage of total daily intake (daily g of UPF/total daily g of food and beverage intake*10 0), with adiposity changes was evaluated using linear mixed-effects models. Results: On average, the consumption of UPF accounted for 8.11% (SD 7.41%) of total daily intake (in grams) at baseline. In multivariable-adjusted model, 10% daily increment in consumption of UPF was associated with significantly (all p-values <0.05) greater accumulation of visceral fat (b 0.09 z-scores, 95% CI 0.05; 0.13), android-to-gynoid fat ratio (0.05, 0.00; 0.09) and total fat (0.09, 0.06; 0.13). Conclusion: A higher consumption of UPF was associated with greater age-related visceral and overall adiposity accumulation. Further studies are warranted to confirm these results in other populations and settings. Trial registration: The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered . (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. ratio) and total fat mass (in g) at three time points were measured with dual-energy X-ray absorptiometry (DXA) and were normalized using sex-specific z-scores. The association of changes in UPF consumption, expressed as the percentage of total daily intake (daily g of UPF/total daily g of food and beverage intake*10 0), with adiposity changes was evaluated using linear mixed-effects models. Results: On average, the consumption of UPF accounted for 8.11% (SD 7.41%) of total daily intake (in grams) at baseline. In multivariable-adjusted model, 10% daily increment in consumption of UPF was associated with significantly (all p-values <0.05) greater accumulation of visceral fat (b 0.09 z-scores, 95% CI 0.05; 0.13), android-to-gynoid fat ratio (0.05, 0.00; 0.09) and total fat (0.09, 0.06; 0.13). Conclusion: A higher consumption of UPF was associated with greater age-related visceral and overall adiposity accumulation. Further studies are warranted to confirm these results in other populations and settings. Trial registration: The trial was registered at the International Standard Randomized Controlled Trial
Revista:
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
ISSN:
2212-2672
Año:
2021
Vol.:
121
N°:
10
Págs.:
1948 - 1960.e7
Background: Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood. Objective: To evaluate within-participant longitudinal changes in scores for nine a priori¿defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the ¿Seguimiento Universidad de Navarra¿ (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up. Design: In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ). Participants/setting: Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7). ...
Revista:
METODE (ENGLISH EDITION)
ISSN:
2174-3487
Año:
2021
N°:
11
Págs.:
123 - 129
Over the last centuries, in the context of industrialization, globalization, and urbanization, profound dietary changes have occurred. Ubiquitous access to cheap, readily available and highly palatable unhealthy products, together with aggressive marketing that significantly influences social norms, have led to overconsumption of energy-dense, nutrient-poor foods. This has not only been associated with a higher prevalence of obesity and diet-related non-communicable diseases, but also with detrimental effects on the world's natural resources. Broader and braver public health measures favoring the availability and affordability of healthy, minimally processed foods should be implemented in conjunction with educational strategies to re-encourage a healthy and sustainable food consumption.
Autores:
Pastorino, S. (Autor de correspondencia); Bishop, T.; Sharp, S. J.; et al.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2021
Vol.:
13
N°:
4
Págs.:
1223
The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I-2 = 61%) for total fish, 1.04 (1.01-1.07, I-2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I-2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I-2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2021
Vol.:
13
N°:
3
Págs.:
972
No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3-14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59-1.06; P-trend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45-0.90; P-trend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2021
Vol.:
60
N°:
3
Págs.:
1489 - 1498
Purpose The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality. Methods We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality. Results During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33-3.07]. Similar results were found for cancer mortality and cardiovascular mortality. Conclusions Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2021
Vol.:
44
N°:
1
Págs.:
5 - 8
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2021
Vol.:
31
N°:
2
Págs.:
411 - 419
Background and aim: Both physical activity (PA) and sedentary behaviors have demonstrated independent associations with the development of type 2 diabetes mellitus (T2DM). However, the combination of both, has been less explored. We aimed to compare the associations of PA-only versus the simultaneous effect of PA and sedentary behaviors on T2DM in a Mediterranean cohort.
Methods and results: Participants (n = 19,524) initially free of T2DM from the SUN Project were followed-up for a median of 10.4 years. Analyses were conducted in 2018. PA and sedentary parameters (TV viewing time and sitting time) were assessed through a validated questionnaire. The amount of each PA was expressed in METs-h/wk. After that, a previously developed 8-item active + sedentary lifestyle score was computed. T2DM was defined according to ADA criteria. To adjust for potential confounders, Cox regression models were adjusted. Among 19,524 participants, 175 cases of new-onset T2DM were observed during follow-up. After multivariable adjustment, higher PA was strongly inversely associated with T2DM, showing highly significant differences between extreme quartiles (HR = 0.51; 95% CI 0.32-0.79 p for trend<0.001). When considering not only PA, but also the more comprehensive active + sedentary lifestyle combined score, even stronger differences were found between the lowest and the highest categories (HR = 0.40; 95%CI 0.20-0.80; p for trend<0.001).
Conclusion: Sedentary lifestyles, in addition to PA patterns, should be included in the assessment of T2DM risk. Promoting PA should be coupled with the avoidance of a sedentary lifestyle to lower the risk of T2DM.
Revista:
INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY
ISSN:
1479-5868
Año:
2021
Vol.:
18
N°:
1
Págs.:
78
Background Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. Methods A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: 'checkouts with only healthy products', 'fewer end-of-aisle displays containing unhealthy foods or soft drinks' or availability: 'more shelf space for fresh and healthier foods') as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. Results The initiative that received the highest support was 'more shelf space for fresh and healthier foods': 72.0% [95% CI 71.3-72.7], whereas 'checkouts with only healthy products' received the lowest support: 48.6% [95% CI 47.8-49.4]. The level of support differed between countries (p < 0.001 for all initiatives), with the US generally showing the lowest support and Mexico the highest. Noteworthy, in the overall sample, there was not much opposition to any of the initiatives (2.5-14.2%), whereas there was a large proportion of neutral responses (25.5-37.2%). Respondents who were older, female, highly educated, and those who reported having more nutrition knowledge tended to be more supportive, with several differences between countries and initiatives. Conclusions Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
Revista:
ATENCION PRIMARIA
ISSN:
0212-6567
Año:
2021
Vol.:
53
N°:
2
Págs.:
101950
Objective: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published. Participants and main measurements: We defined exposure as consumption of >= 3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80 years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR= 0.88; IC 95%: 0.84-0.93 for all-cause mortality and RR =0.92; IC 95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths. Results: If 60% of the population was exposed, with a 95% CI, the number of cardiovascular deaths that could be averted each year if population consumed < 3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577. Conclusions: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption < 3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2021
Vol.:
13
N°:
11
Págs.:
4182
Background: Siesta has been associated with increased incidence of cardiovascular disease but the mechanism remains unclear. New studies into the relationship between siesta and metabolic syndrome have identified siesta length as a crucial differential, suggesting that siesta less than 40 min is associated with decreased risk of metabolic syndrome, while longer siesta is associated with increased risk. We aimed to investigate the effect of siesta duration on development of metabolic syndrome in a Mediterranean population using a prospective cohort study design. Methods: Our sample consisted of 9161 participants of the SUN cohort without components of metabolic syndrome at baseline. Siesta exposure was assessed at baseline and the development of metabolic syndrome components was assessed after an average 6.8 years of follow-up. We estimated odds ratios and fitted logistic regression models to adjust for potential cofounders including night-time sleep duration and quality, as well as other diet, health, and lifestyle factors. Results: We observed a positive association between average daily siesta > 30 min and development of metabolic syndrome (aOR = 1.39 CI: 1.03-1.88). We found no significant difference in risk of developing metabolic syndrome between the group averaging & LE;30 min of daily siesta and the group not taking siesta (aOR = 1.07 CI: 0.83-1.37). Further analysis suggested that average daily siesta < 15 min may reduce risk of metabolic syndrome. Conclusions: Our study supports the J-curve model of the association between siesta and risk of metabolic syndrome, but suggests the protective effect is limited to a shorter range of siesta length than previously proposed.
Revista:
DRUG AND ALCOHOL DEPENDENCE
ISSN:
0376-8716
Background: Myopia is a highly prevalent disorder, and one of the first causes of blindness. In turn, alcohol consumption has been shown to be a risk factor for many diseases and a main contributor to the global burden of disease. However, no studies have investigated the relationship between alcohol intake and myopia. Our aim was to prospectively assess the association between alcohol intake and the development or progression of myopia. Methods: In a Spanish dynamic prospective cohort (the SUN Project) we assessed 15,642 university graduates, recruited between 1999 and 2018 and followed up biennially through mailed questionnaires. Alcohol intake was assessed with a validated 136-item food frequency questionnaire. Development or progression of myopia was collected in subsequent questionnaires during follow-up every two years. Results: Alcohol intake was linearly and significantly associated with a higher risk of myopia development or progression: the OR for 10-year incidence/progression of myopia was 1.05, 95% CI 1.01-1.09 per each 10-grams increase in alcohol intake. Conclusions: Alcohol consumption might lead to the development or progression of myopia, although confirmation is needed for the mechanisms through which this association may occur, thus further research is needed to verify these findings.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2021
Vol.:
40
N°:
5
Págs.:
2817 - 2824
Background & aim: The association between ultra-processed foods (UPF) consumption and the risk of type 2 diabetes (T2D) has not been much explored. We aimed to evaluate the association between consumption of UPF and the incidence of T2D. Methods: We assessed 20,060 participants (61.5% women) from the SUN project (Seguimiento Universidad de Navarra) followed-up every two years (median follow-up 12 years). Food and drink consumption were evaluated through a validated 136-item food frequency questionnaire and grouped according to their degree of processing by the NOVA classification. Participants were categorized into tertiles of UPF consumption adjusted for total energy intake. We fitted Cox proportional hazard models with repeated dietary measurements at baseline and updating information on food consumption after 10 years of follow-up to minimise the potential effect of diet variation. Results: During 215,149 person-years of follow-up, 175 new-onset T2D cases were confirmed. Participants in the highest baseline tertile (high consumption) of UPF consumption had a higher risk of T2D as compared to those in the lowest tertile (multivariable adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.06 to 2.22) with a significant dose-response relationship (p for linear trend 1/4 0.024). The multivariable adjusted HR using repeated measurements of UPF intake was 1.65 (95% CI 1.14-2.38) when comparing extreme tertiles. Conclusions: In a highly-educated Mediterranean cohort with a low absolute risk, a higher intake of UPF was independently associated with a higher risk for T2D. These results provide more evidence to encourage the limitation of UPF consumption to reduce the population burden of T2D. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Revista:
PREVENTIVE MEDICINE
ISSN:
0091-7435
Año:
2020
Vol.:
137
Págs.:
106124
Several healthy diet indices have been associated with mortality risk. However, the ideal diet should not only be healthy but also environmentally friendly and affordable. The study aimed to determine if a new Sustainable Diet Index (SDI), which takes into account the nutritional quality, environmental impacts and market price of diets, was associated with all-cause and cause-specific mortality. Using data from the "Seguimiento Universidad de Navarra" Project, a prospective cohort study of Spanish university graduates, the study included 15,492 participants who were recruited between December 1999 and March 2014 and followed-up for a median of 10 years. Cox regression was used to determine the relationship of SDI and its components with all-cause and cause-specific mortality risk. Hazard ratios with adjustment for several confounders were calculated. The weights for the foods contributing to the SDI were assessed with multiple regression analyses and variability with nested regression analyses. The highest quartile of the SDI scores was associated with a 59% relative reduction in all-cause mortality (HR 0.41, 95% CI 0.23-0.75; P-trend < 0.001) and 79% reduction in cardiovascular mortality (HR 0.21, 95% CI 0.05-0.85; P-trend < 0.001). SDI was positively correlated with beans and potato consumption but negatively correlated with red meat intake. Red and processed meats, fatty dairy products and fish consumption accounted for most of the variability in the SDI. Altogether, dietary patterns accounting not only for nutritional quality of the food but also the impact on the environment and affordability could still provide health benefits.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2020
Vol.:
12
N°:
3
Págs.:
731
Alcohol intake is associated with the risk of breast cancer. Different patterns of alcohol-drinking may have different effects on breast cancer even when keeping constant the total amount of alcohol consumed. We aimed to assess the association between binge drinking and breast cancer risk. The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. In the 556-item lifestyle baseline questionnaire a validated food-frequency questionnaire was embedded. Participants completed biennial follow-up questionnaires. Cox regression models were used to estimate the hazard ratio (HR) for breast cancer associated with the exposure to binge drinking. A stratified analysis was performed according to menopausal status. We included 9577 women (mean age = 34 years, SD = 10 years), with a median follow-up of 11.8 years. Among 104,932 women-years of follow-up, we confirmed 88 incident cases of breast cancer. Women in the binge drinking group showed a higher risk of breast cancer (HR = 1.76; 95% CI: 1.03-2.99) compared to women in the non-binge drinking category. In the stratified analysis, a 2-fold higher risk for premenopausal breast cancer was associated with binge drinking habit (HR = 2.06; 95% CI: 1.11-3.82). This study adds new evidence on the association of binge drinking with breast cancer risk.
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2020
Vol.:
30
N°:
10
Págs.:
1742 - 1750
Background and aim: The aim of this study was to assess the association between body shape trajectories and all-cause mortality in a Mediterranean cohort. Methods and results: Using a group-based modeling approach to fit body shape trajectories from the age of 5-40 years, among 11,423 participants from the Spanish SUN cohort, we assessed the subsequent risk of all-cause mortality. To create the trajectories, we used a censored normal model as a polynomial function of age. Cox regression models adjusted for sex, age, years of university education, marital status, smoking status, package-years of smoking, and recruitment period were used to estimate the hazard ratios (HR) for mortality according to each assigned trajectory. Overall, five distinct trajectories were identified: "lean-moderate increase," "medium-moderate increase," "medium-stable," "heavy-medium," and "heavy-moderate increase." During 106,657 person-years of follow-up, we observed 240 deaths. Compared with those who maintained a medium body shape in early and middle life ("medium-stable" trajectory), those who were heavy and had a moderate increase (" heavy-moderate increase" trajectory) showed higher mortality risk [HR = 1.91 (95% confidence interval: 1.14-3.21)]. In contrast, participants who were heavy in early life, and then decreased their body shape during early adulthood, and maintained a medium body shape throughout middle adulthood ("heavy-medium"), tend to exhibit lower mortality risk [HR = 0.60 (0.34-1.05)], similarly to those who were lean at childhood and had a moderate increase during adulthood ("lean-moderate increase") [HR = 0.82 (0.58-1.15)]. Conclusion: A moderate increase in body shape among subjects who were already heavy at early life was associated with higher risk of mortality in a Mediterranean cohort of university graduates. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2020
Vol.:
155
N°:
1
Págs.:
9 - 17
Background and objectives: Cured ham is one of the most characteristic foods in the Spanish diet. Because it is a red processed meat and due to its nutritional composition, including high sodium content, a potential association between cured ham consumption and a higher risk of hypertension could be expected. However, epidemiological studies evaluating this association are scarce. We prospectively assessed the association between cured ham consumption and the incidence of hypertension.
Methods: The "Seguimiento Universidad de Navarra" (SUN) study is a cohort of Spanish middle-aged adult university graduates (average age: 38 (SD: 12) years, 60% women). We included 13,900 participants of the SUN cohort free of hypertension at baseline. One serving of cured ham is 50g. They were classified into 4 categories of cured ham consumption: <1; 1; 2-4 and ¿5servs/week. Multivariable-adjusted Cox regression models were fitted to assess the association between cured ham consumption and subsequent hypertension risk using the category of lowest consumption as the reference.
Results: After a median follow-up of 10.9 years, 1465 incident self-reported cases of hypertension were identified. After adjusting for potential confounders, including dietary confounders, a high consumption of cured ham (¿5servs/week vs. <1serv/week) was not significantly associated with hypertension risk in this prospective cohort (HR=0.88, 95% CI: 0.70-1.10, p linear trend=0.40).
Conclusions: Our results showed that cured ham consumption was not associated with a significantly higher or lower risk of hypertension in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal and experimental studies are needed to disentangle the association between cured ham consumption and the risk of hypertension.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2020
Vol.:
17
N°:
5
Págs.:
1468
Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults.
Revista:
INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION
ISSN:
0963-7486
Año:
2020
Vol.:
71
N°:
4
Págs.:
395 - 396
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2020
Vol.:
30
N°:
8
Págs.:
1355 - 1364
Background and aims: We prospectively assessed the association between a healthy lifestyle score (HLS) and the risk of type 2 diabetes mellitus (T2DM) in a Mediterranean cohort. Methods and results: We followed up 11,005 participants initially free of diabetes diagnosis in the "Seguimiento Universidad de Navarra" (SUN) cohort. We evaluated the influence of lifestyle related factors based on a score previously related to a lower risk of cardiovascular disease. Only one incident case of T2DM was found among those with a baseline BMI 22 kg/m(2). Therefore, we excluded the BMI item and restricted the analysis to participants with a baseline BMI 22 kg/m(2). We measured the baseline adherence of a HLS that included: never smoking, physical activity, Mediterranean diet adherence, moderate alcohol consumption, avoidance of binge drinking, low television exposure, taking a short nap, spending time with friends and working hours. Incident cases of T2DM were self-reported by participants and confirmed by a physician. Cox proportional-hazards regression models were fitted to assess the association between HLS and the incidence of T2DM. After a median follow-up of 12 years, 145 incident cases of T2DM were observed. Among participants with a BMI >22 kg/m(2), the highest category of HLS adherence (7-9 points) showed a significant 46% relatively decreased hazard of T2DM compared with the lowest category (0-4 points) (multivariable adjusted HR: 0.54; 95% CI: 0.30-0.99). Conclusions: Higher adherence to a HLS, including some factors not typically studied, may reduce T2DM risk. Preventive efforts should preferentially focus on weight control. However, this score may promote a comprehensive approach to diabetes prevention beyond weight reduction. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Revista:
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
ISSN:
0749-3797
Año:
2020
Vol.:
59
N°:
2
Págs.:
e59 - e67
Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors.
Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ¿40 hours per week.
Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7-10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0-3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).
Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority.
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2020
Vol.:
112
N°:
2
Págs.:
364 - 372
Background: The association of dietary pattern with the risk of basal cell carcinoma (BCC) is little understood and has scarcely been investigated. Objectives: We assessed the association of several complete dietary patterns [Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Pro-vegetarian dietary pattern] with the risk of BCC, conducting a nested case-control study (4 controls for each case). Methods: Cases and controls were selected from the SUN (Seguimiento Universidad de Navarra) cohort using risk set sampling. Cases were identified among subjects free of skin cancer at baseline but who later reported a physician-made BCC diagnosis during the follow-up period. In the cohort we identified 101 incident cases of BCC. Results: In multivariable-adjusted conditional logistic regression analyses, better adherence to the Mediterranean diet (highest compared with lowest quintile) was associated with a 72% relative reduction in the odds of BCC (OR: 0.28; 95% CI: 0.10, 0.77; P-trend = 0.014); the DASH diet was associated with a 68% RR reduction (OR: 0.32; 95% CI: 0.14, 0.76; P-trend = 0.013) for the comparison between extreme quintiles. No association was found between a Pro-vegetarian dietary pattern and BCC. Higher fruit consumption (highest compared with lowest quintile, OR: 0.27; 95% CI: 0.11, 0.64; P-trend < 0.001) and low-fat dairy products (OR: 0.39; 95% CI: 0.16, 0.92; P-trend = 0.014) were associated with a lower BCC risk. Conclusions: Our results suggest that Mediterranean and DASH dietary patterns may be associated with a lower risk of BCC, but confirmatory studies are required.
Revista:
NUTRIENTS
ISSN:
2072-6643
Current dietary patterns are negatively affecting both the environment and people's health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2020
Vol.:
17
N°:
11
Págs.:
3897
Health related quality of life (HRQoL) is a subjective appreciation of how personal characteristics and health influence well-being. This cross-sectional analysis aimed to quantitatively measure the influence of dietary, lifestyle, and demographic factors on HRQoL. A sub-sample of the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort, was analyzed (n = 15,674). Through self-administered questionnaires the relationship between HRQoL and dietary patterns (Mediterranean-diet (MedDiet) and provegetarian food pattern (FP) assessment), lifestyles (sleeping hours, physical activity) and demographic characteristics were measured. Multivariate linear regression and flexible regression models were used to estimate the pondered effect of personal factors on Short Form-36 (SF-36) scores. Coefficients for MedDiet and provegetarian scores (beta-coefficient for global SF-36 score: 0.32 (0.22, 0.42); 0.09 (0.06, 0.12) respectively for every unit increase), physical activity (beta: 0.03 (0.02, 0.03) for every metabolic equivalent of task indexes (MET)-h/week) had a positive association to HRQoL. The female sex (beta: -3.28 (-3.68, -2.89)), and pre-existing diseases (diabetes, beta: -2.27 (-3.48, -1.06), hypertension beta: -1.79 (-2.36, -1.22), hypercholesterolemia beta: -1.04 (-1.48, -0.59)) account for lower SF-36 scores. Adherence to MedDiet or provegetarian FP, physical activity and sleep are associated with higher HRQoL, whereas the female sex, "other" (versus married status) and the presence of chronic diseases were associated with lower SF-36 scores in this sample.
Revista:
INTERNATIONAL JOURNAL OF OBESITY
ISSN:
0307-0565
Año:
2020
Vol.:
44
N°:
2
Págs.:
320 - 329
BACKGROUND:
The use of oral contraceptives (OC) has been suggested to represent a potential risk factor for the development of obesity. However, the available literature assessing the relationship between OC use and the development of obesity is still scarce and characterised by controversial heterogeneity. We prospectively evaluated the association between the use of OC and the development of obesity in female participants of a middle-aged and free-living cohort.
METHODS:
The study population included 4920 female Spanish university graduates, initially nonobese women, with mean age (standard deviation) 28.2 (5.4) years. The study population was followed up for a mean of 8.6 (3.7) years. Self-reported use of OC and body mass index were assessed at baseline and biennially during follow-up. We used generalized estimating equation models to evaluate the association between exposure to OC and the development of obesity.
RESULTS:
After adjusting for potential confounders, baseline OC use was associated with higher odds of new-onset obesity during the full follow-up period (multivariable-adjusted odds ratio [OR]¿=¿1.78; 95% Confidence Interval [CI]: 1.01-3.15). The continued use of OC for periods of time longer than 2 years was significantly associated with a higher risk of developing obesity (OR¿=¿2.82, 95% CI: 1.17-6.82).
CONCLUSIONS:
According to our prospective cohort study, OC use is significantly associated with higher odds of obesity development, especially when the use of OC is steady and extends over periods of more than 2 years.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2020
Vol.:
59
N°:
3
Págs.:
1093 - 1103
Purpose A growing body of evidence shows that consumption of ultra-processed foods (UPF) is associated with a higher risk of cardiometabolic diseases, which, in turn, have been linked to depression. This suggests that UPF might also be associated with depression, which is among the global leading causes of disability and disease. We prospectively evaluated the relationship between UPF consumption and the risk of depression in a Mediterranean cohort. Methods We included 14,907 Spanish university graduates [mean (SD) age: 36.7 year (11.7)] initially free of depression who were followed up for a median of 10.3 years. Consumption of UPF (industrial formulations made mostly or entirely from substances derived from foods and additives, with little, if any, intact food), as defined by the NOVA food classification system, was assessed at baseline through a validated semi-quantitative 136-item food-frequency questionnaire. Participants were classified as incident cases of depression if they reported a medical diagnosis of depression or the habitual use of antidepressant medication in at least one of the follow-up assessments conducted after the first 2 years of follow-up. Cox regression models were used to assess the relationship between UPF consumption and depression incidence. Results A total of 774 incident cases of depression were identified during follow-up. Participants in the highest quartile of UPF consumption had a higher risk of developing depression [HR (95% CI) 1.33 (1.07-1.64); p trend = 0.004] than those in the lowest quartile after adjusting for potential confounders. Conclusions In a prospective cohort of Spanish university graduates, we found a positive association between UPF consumption and the risk of depression that was strongest among participants with low levels of physical activity.
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2020
Vol.:
111
N°:
6
Págs.:
1259 - 1266
Background: Telomere length (TL) is a marker of biological age that may be affected by dietary factors through oxidation and inflammation mechanisms. In addition, ultra-processed food (UPF) consumption has increasedworldwide and it has been associated with the risk of developing several diseases. Objectives: We aimed to evaluate the association between UPF consumption and the risk of having short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. Methods: This is a cross-sectional study of 886 participants (645 men and 241 women) aged 57-91 y recruited from the SUN Project (Spain, 1999-2018). TL was measured from saliva samples by real-time qPCR at baseline and UPF consumption was collected using a validated 136-item FFQ and classified according to the NOVA system. We evaluated the association between consumption of energy-adjusted UPF categorized into quartiles (low, medium-low, medium-high, and high consumption) and the risk of having short telomeres (<20th percentile) using logistic regression models. Results: Those participants with the highest UPF consumption had almost twice the odds of having short telomeres compared with those with the lowest consumption (adjusted OR: 1.82; 95% CI: 1.05, 3.22; P-trend = 0.03). Conclusions: A higher consumption of UPF (>3 servings/d) was associated with higher risk of having shorter telomeres in an elderly Spanish population of the SUN Project.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2019
Vol.:
38
N°:
6
Págs.:
2607 - 2615
Background & aims: Given the enormous health, economic and societal consequences of the obesity pandemic, identifying effective primary prevention strategies represents a global priority. The aim of this study was to provide evidence on the association between adherence to a food-based score reflecting a set of targeted, well-informed, simple dietary recommendations and the incidence of overweight/obesity.
Methods: A total of 11,349 initially free of overweight/obesity young adults (mean [SD] age: 34.7 y [10.7]), were followed up biennially during a median of 9.3 years. The Dietary Obesity-Prevention Score (DOS) was created based on a priori evidence of foods associated with weight changes. The DOS positively weighted the consumption of vegetables, fruits, legumes, yogurt, nuts, fish, and a ratio of vegetable to animal protein; whereas the consumption of red meat, processed meat, saturated animal fat, refined grains, ultra-processed food, sugary beverages, beer and spirits were inversely weighted. Energy-adjusted tertiles of each item were used to build the DOS, ranging from 14 (lowest adherence) to 42 points (highest adherence). Adherence to the DOS was calculated at baseline and after 10 years of follow-up. We assessed both incident overweight/obesity (BMI >= 25 kg/m(2)) and average yearly weight changes in grams per year (g/y).
Results: During 104,887 person-years, 2153 incident cases of overweight/obesity were identified. A higher adherence to the DOS at baseline was significantly associated with lower risk of future development of overweight/obesity [multivariable-adjusted HR (95% CI) for the highest vs. lowest quintile = 0.63 (0.54-0.74)], with a significant linear dose-response relationship (p for trend < 0.001). When the analyses were updated with repeated measures, the results were similar and remained statistically significant. Consistently, increases in average yearly weight gain were significantly lower with better adherence to the DOS.
Conclusions: In this Mediterranean cohort of university graduates, a higher adherence to a food-based score was significantly associated with lower risk of overweight/obesity and lower average annual weight gain. These findings may help counsel patients regarding dietary risks and raise awareness of weight gain before the onset of overweight/obesity.
Revista:
NUTRIENTS
ISSN:
2072-6643
Provegetarian diets (i.e., preference for plant-derived foods but not exclusion of animal foods) have been associated with a reduced risk of long-term weight gain and could be more easily embraced than strict vegetarian diets. However, not all plant-derived foods are equally healthy. In the "Seguimiento Universidad de Navarra" (SUN) cohort, we prospectively evaluated the association between different provegetarian food patterns and the incidence of overweight/obesity in 11,554 participants with initial body mass index <25 kg/m(2). A provegetarian food pattern (FP) was built by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful provegetarian FP, which distinguished between healthy (fruits/vegetables/whole grains/nuts/legumes/olive oil/coffee) and less-healthy plant foods (fruit juices/potatoes/refined grains/pastries/sugary beverages), were also built. A total of 2320 new cases of overweight or obesity were identified after a median follow-up of 10.3 years. Higher baseline conformity with the overall provegetarian FP was inversely associated with overweight/obesity (HR comparing extreme quintiles: 0.85; 95% CI: 0.75 to 0.96; p-trend: 0.014). This association was stronger for the healthful FP (HR: 0.78; 95% CI: 0.67 to 0.90; p-trend: <0.001) and was not apparent for the unhealthful FP (HR: 1.07; 95% CI: 0.92 to 1.23; p-trend: 0.551). In a large prospective cohort of relatively young adults, better conformity with a healthy provegetarian diet was associated with a reduced long-term risk of overweight/obesity, whereas no consistent trend was found for a FP that emphasized less-healthy plant foods.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2019
Vol.:
14
N°:
12
Págs.:
e0226565
Dietary guidelines play a key role in setting standards for nutrition policies and promoting healthy eating. Like other public health guidelines, they are often influenced by political and economic factors that could place other concerns ahead of the population's health. In order to determine their effectiveness on obesity prevention, we prospectively examined the association between adherence to the latest available national dietary guidelines and the incidence of overweight/obesity in a Spanish cohort study. A sample of 11,554 participants of the "Seguimiento Universidad de Navarra" (SUN) cohort, initially free of overweight or obesity, was included in the study. The Spanish Society of Community Nutrition (SENC) food pyramid (FP) score was computed based on the ratio of consumed to recommended daily servings of grains, fruits, vegetables, dairy, protein-rich foods, olive oil, red and processed meat, sweets, salty snacks and spreadable fats, fermented alcoholic beverages and water. The same approach was followed to calculate the SENC hydration pyramid (HP) score, considering the intake of water and different kind of beverages. Adherence was calculated at baseline and after 10 years of follow-up. Cox proportional hazards models were used to assess the incidence of overweight/obesity (BMI >= 25 kg/m(2)). During a median follow-up of 10.3 years, 2320 incident cases were identified. The highest level of adherence to the SENC FP score was modestly associated with a reduced risk of overweight/obesity (multi variable-adjusted HR for the fifth quintile vs. the first quintile = 0.78; 95% CI: 0.67-0.91; p-trend: 0.007). No consistent trends were found for the SENC HP. In a large prospective cohort of Spanish university graduates, we found an inverse linear association between adherence to the SENC FP and overweight/obesity risk, whereas this was not the case for the HP.
Revista:
PREVENTIVE MEDICINE
ISSN:
0091-7435
Año:
2019
Vol.:
118
Págs.:
317 - 324
The 2015-2020 Dietary Guidelines for Americans (DGA) was issued in early 2016. It remains untested if adherence to these guidelines could reduce mortality risk. Using a modified version of the 2015 Dietary Guidelines for American Index (2015 DGAI), we investigated if adherence to the new DGA is associated with mortality in a Spanish (the Seguimiento Universidad de Navarra, SUN) cohort. We assessed the habitual diet of 16,866 participants of this cohort recruited between 1999 and 2014 and calculated their adherence scores to the new DGA using the modified 2015 DGAI (0-21 points). Mortality data was determined from the yearly National Death Index reports. After adjusting for demographic and lifestyle confounders, high adherence scores (fourth quartile) were found to be associated with reduced all-cause, cardiovascular and cancer mortality risk, hazard ratios (HR) (95% confidence intervals [CI]) 0.42 (0.25-0.70), 0.30 (0.10-0.90) and 0.46 (0.22-0.96), respectively, compared to low adherence scores (first quartile). A 2-point increase in the 2015 DGAI score was linearly inversely associated with all-cause mortality (HR [95% CI] 0.78 [0.67-0.92]). Main sources of variability in the adherence scores were whole-fat dairy products, red/orange vegetables, fresh fruits, red meat, and dark green vegetables. In conclusion, higher adherence to 2015-2020 Dietary Guidelines for Americans was inversely associated with total, cardiovascular and cancer mortality risk in a Spanish cohort.
Revista:
BMJ (ONLINE)
ISSN:
1756-1833
Año:
2019
Vol.:
365
Págs.:
l1949
OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%.
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2019
Vol.:
122
N°:
7
Págs.:
800 - 807
It is crucial to identify people at risk for type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) to implement preventive interventions in order to address these pandemics. A simple score exclusively based on dietary components, the Dietary-Based Diabetes-Risk Score (DDS) showed a strong inverse association with incident T2DM. The objective was to assess the association between DDS and the risk of GDM in a cohort of Spanish university graduates. The 'Seguimiento Universidad de Navarra' project is a prospective and dynamic cohort which included data of 3455 women who notified pregnancies between 1999 and 2012. The diagnosis of GDM is self-reported and further confirmed by physicians. A validated 136-item semi-quantitative FFQ was used to assess pre-gestational dietary habits. The development of the DDS was aimed to quantify the association between the adherence to this a priori dietary score and T2DM incidence. The score exclusively included dietary components (nine food groups with reported inverse associations with T2DM incidence and three food groups which reported direct associations with T2DM). Three categories of adherence to the DDS were assessed: low (11-24), intermediate (25-39) and high (40-60). The upper category showed an independent inverse association with the risk of incident GDM compared with the lowest category (multivariate-adjusted OR 0 center dot 48; 95 % CI 0 center dot 24, 0 center dot 99; P for linear trend: 0 center dot 01). Several sensitivity analyses supported the robustness of these results. These results reinforce the importance of pre-gestational dietary habits for reducing GDM and provide a brief tool to practically assess the relevant dietary habits in clinical practice.
Revista:
JOURNAL OF AFFECTIVE DISORDERS
ISSN:
0165-0327
Año:
2019
Vol.:
251
Págs.:
170 - 179
Backgrounds and aim: The association between trajectories of body-shape from early childhood to early adulthood (first 40 years of life) and subsequent depression risk has not been explored before. We assessed this association in a prospective cohort of university graduates. Methods: We used a group-based modeling approach to assess the body shape trajectories from age 5 to 40 years, among 3888 women and 4124 men of the "Seguimiento Universidad de Navarra" (SUN) cohort study. All participants were free of depression at the beginning of the follow-up, and the occurrence of a new medical diagnosis of depression was evaluated every two years. Results: Four distinct trajectories for women and men were found ("lean-moderate increase", "medium-stable", "heavy-medium" and "heavy-marked increase" for women and "lean-marked increase", "medium-marked increase", "medium-stable" and "heavy-stable" for men). Among 78,475 person-years of follow-up a total of 351 incident cases of depression were identified. Among women, compared to those who maintained a medium body shape during life span ("medium-stable" trajectory), women who were heavy at childhood and had a marked increase in their body shape during early adult life ("heavy-marked increase" trajectory) showed significantly higher risk of a new-onset depression [HR= 1.92 (1.18-3.13)]. No association was observed in men between body-shape trajectories and subsequent risk of depression. Conclusions: Our results suggest that in a Mediterranean cohort, women who were heavy at early childhood and showed marked increases in body shape during early adulthood were at higher risk of developing depression later in life.
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2019
Vol.:
29
N°:
3
Págs.:
244 - 253
AIMS:
Our aim was to assess the association between trajectories of body-shape across the first 40 years of life and subsequent development of hypertension in a Mediterranean cohort.
METHODS AND RESULTS:
We used a group-based modeling approach to assess body shape trajectories from age 5 to 40 years, among 7514 participants included in the SUN study (1999-2016), and assessed the subsequent incidence of hypertension. To create the trajectories, we used a censored normal model as a polynomial function of age. Cox models were used to estimates hazard ratios (HR) for hypertension according to body shape trajectories. Identified trajectories were "childhood lean -mid-life increase", "childhood medium-mid-life stable", " childhood heavy -mid-life decrease", and "childhood heavy -mid-life increase" for women; and "childhood lean-mid-life increase", "childhood medium-mid-life stable", "childhood medium -mid-life increase" and "childhood heavy-mid-life stable" for men. After a follow-up of 63,068 person-years, 865 incident cases of hypertension were found. Among women, compared to those in the "childhood medium-mid-life stable" trajectory, those, in the "childhood heavy -mid-life increase" trajectory showed higher risk to develop hypertension [HR = 1.72 (1.17-2.53)]. In men, compared with those in the "childhood medium-mid-life stable" trajectory, those in the "childhood lean and childhood medium -mid-life increase" and the "childhood heavy- mid-life stable" trajectories showed higher subsequent incidence of hypertension [HR = 1.43 (1.11-1.85), HR = 1.52 (1.17-1.97) and HR = 1.56 (1.14-2.14), respectively] after adjusting for potential confounders (including age, lifestyles, dietary intake, personality traits, physical activity and sedentary behaviors).
CONCLUSIONS:
Our results suggest that mid-life increases in body shape or maintaining a heavy body shape during early and middle life in men and childhood heavy-mid-life increase in women is associated with a higher subsequent risk of developing hypertension in this Mediterranean population.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2019
Vol.:
58
N°:
8
Págs.:
3009 - 3022
PurposeTo prospectively assess the association of dietary fiber intake (from different dietary sources) with all-cause mortality in a Mediterranean cohort.MethodsWe assessed 19,703 participants of the SUN (Seguimiento Universidad de Navarra) cohort (mean follow-up: 10.1 years). A validated 136-item FFQ was administered at baseline. We used Cox proportional hazards models adjusted for multiple socio-demographic, anthropometric, lifestyle factors, and prevalent conditions at baseline.ResultsWe observed 323 deaths during 198,341 person-years of follow-up. A significantly inverse linear trend in Cox models was observed for the association of total dietary fiber intake and all-cause mortality after adjustment for confounders (p for trend 0.017). Each additional intake of 5 g/1000 kcal of dietary fiber was associated with a 9% relative reduction in all-cause mortality risk (HR 0.91, 95% CI 0.84-0.99). Considering separate dietary sources in separate models, a significant inverse trend was apparent for fiber derived from vegetables (p for trend 0.001), but it was non-significant for fiber derived from fruit, legumes, cereals, or other sources. Soluble fiber was significantly inversely associated with all-cause mortality in the fully adjusted model (p for trend 0.007), and insoluble fiber was marginally significant (p for trend 0.08).ConclusionsA higher intake of total dietary fiber, and particularly fiber from vegetables, was related to a reduced all-cause mortality in our Mediterranean cohort. Dietary messages to increase the consumption of dietary patterns rich in fiber-rich foods should be broadly disseminated to decrease the alarming rate of chronic diseases and its derived mortality.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2019
Vol.:
58
N°:
3
Págs.:
1271 - 1282
PURPOSE:
To prospectively evaluate the association of the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet and the Mediterranean diet (and their components), and depression risk.
METHODS:
We followed-up (median 10.4 years) 15,980 adults initially free of depression at baseline or in the first 2 years of follow-up. Food consumption was measured at baseline through a validated food-frequency questionnaire, and was used to compute adherence to the MIND and the Mediterranean diets. Relationships between these two diets and incident depression were assessed through Cox regression models.
RESULTS:
We identified 666 cases of incident depression. Comparing the highest versus the lowest quartiles of adherence, we found no association of the MIND diet and incident depression. This relation was statistically significant for the Mediterranean diet {hazard ratio (HR) 0.75, [95% confidence interval (95% CI) 0.61, 0.94]; p¿<¿0.01}, although with departure from linearity. A reduced depression risk was associated with higher consumption of both fruits and nuts [HR 0.82 (95% CI 0.69, 0.96); p¿=¿0.02], moderate nuts consumption [HR 0.77 (95% CI 0.64, 0.93); p¿=¿0.01], and avoidance of fast/fried food [HR 0.63 (95% CI 0.41, 0.96); p¿=¿0.03].
CONCLUSIONS:
The Mediterranean diet was associated with reduced depression risk, but we found no evidence of such an association for the MIND diet.
Revista:
BMJ OPEN
ISSN:
2044-6055
Año:
2019
Vol.:
9
N°:
2
Págs.:
e021541
Objective To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability. Design Prospective, ongoing cohort study of university graduates. Settings The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999. Participants A total of 18 429 participants. Methods Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern. Results After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern ((sic)5.87/day [95% CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern ((sic)7.52/day [95% CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern. Conclusion Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2019
Vol.:
11
N°:
1
Págs.:
E65
We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The "Seguimiento Universidad de Navarra" (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 years, 67% women) initially free of metabolic syndrome were followed prospectively for a minimum of 6 years. To evaluate healthy lifestyle, nine habits were used to derive a Healthy Lifestyle Score (HLS): Never smoking, moderate to high physical activity (>20 MET-h/week), Mediterranean diet (>= 4/8 adherence points), moderate alcohol consumption (women, 0.1-5.0 g/day; men, 0.1-10.0 g/day), low television exposure (<2 h/day), no binge drinking (<= 5 alcoholic drinks at any time), taking a short afternoon nap (<30 min/day), meeting up with friends >1 h/day, and working at least 40 h/week. Metabolic syndrome was defined according to the harmonizing definition. The association between the baseline HLS and metabolic syndrome at follow-up was assessed with multivariable-adjusted logistic regressions. During follow-up, we observed 458 (4.24%) new cases of metabolic syndrome. Participants in the highest category of HLS adherence (7-9 points) enjoyed a significantly reduced risk of developing metabolic syndrome compared to those in the lowest category (0-3 points) (adjusted odds ratio (OR) = 0.66, 95% confidence interval (CI) = 0.47-0.93). Higher adherence to the Healthy Lifestyle Score was associated with a lower risk of developing metabolic syndrome. The HLS may be a simple metabolic health promotion tool.
Revista:
EUROPEAN PSYCHIATRY
ISSN:
0924-9338
Año:
2019
Vol.:
61
Págs.:
33 - 40
Background: Lifestyles are involved in the pathogenesis of depression and many of these factors can be modified for the potential prevention of depression. Our aim was to assess the association between a healthy-lifestyle score, that includes some less-studied lifestyle indicators, and the risk of depression. Methods: We followed 14,908 participants initially free of any history of depression in the "Seguimiento Universidad de Navarra" (SUN) cohort. Information was collected biennially from 1999 to December 2016. We calculated a healthy-lifestyle score (0-10 points), previously associated with cardioprotection, by giving one point to each of the following components: never smoking, physical activity (> 20 METs-h/ week), Mediterranean diet adherence (>= 4 points), healthy body mass index (<= 22 kg/m(2)), moderate alcohol consumption (women 0.1-5 g/d; men 0.1-10 g/d of ethanol), avoidance of binge drinking (never more than 5 alcoholic drinks in a row), low television exposure (<= 2 h/d), short afternoon nap (<= 30 min/ day), time spent with friends (> 1 h/d) and working at least 40 h/week. Results: During a median follow-up of 10.4 years, we observed 774 new cases of major depression among participants initially free of depression. The highest category (8-10 factors) showed a significant inverse association with a 32% relative risk reduction for depression compared to the lowest category (0-3 factors) (multivariable-adjusted hazard ratio: 0.68; 95% CI: 0.49-0.95) (p for trend = 0.010). Conclusions: Adopting a healthy-lifestyle was associated with a lower risk of incident depression in the SUN cohort. This index, including ten simple healthy lifestyle habits, may be useful for a more integrative approach to depression prevention. (C) 2019 Elsevier Masson SAS. All rights reserved.
Autores:
Al Wattar, B. H.; Dodds, J.; Placzek, A.; et al.
Revista:
PLOS MEDICINE
ISSN:
1549-1277
Background Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. Methods and findings We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p <= 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p <= 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I-2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers. Conclusions A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2019
Vol.:
36
Págs.:
39 - 46
Introduction: Navarra is a Community that presents a great geographical and climatic variety, which results in a wide food supply. Objectives: to review the typical gastronomy of Navarra, as well as the available evidence on dietary patterns, nutritional profile and health indicators of Navarra population. Results: Navarra has 7 Protected Designations of Origin and 6 Protected Geographical Indications. Its gastronomic identity is mainly associated with vegetables, lamb, veal and local sausages, which is reflected in dietary patterns. Comparatively, Navarra population consumes more vegetables and fresh fruits, but also has a frequent and excessive intake of meat (especially red) and sausages. The studies available on nutritional profile show high intakes of proteins and fats in the adult population, and inadequacy in some micronutrients in children. In the national context, Navarra has lower rates of overweight, obesity and sedentariness in the adult population, and there is a downward trend in the prevalence of childhood obesity. Conclusions: the food and gastronomic offer of Navarra is varied and with a great prominence of vegetables, although dietary patterns can be improved. To achieve a healthy and sustainable diet, it is essential to promote culinary knowledge and skills from an early age.
Revista:
JMIR PUBLIC HEALTH AND SURVEILLANCE
ISSN:
2369-2960
Año:
2019
Vol.:
5
N°:
4
Págs.:
e11997
Web-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake.
Revista:
JAMA INTERNAL MEDICINE
ISSN:
2168-6106
Año:
2019
Vol.:
179
N°:
11
Págs.:
1604
Autores:
Royo-Bordonada, M. A. (Autor de correspondencia); Rodriguez-Artalejo, F.; Bes-Rastrollo, Maira; et al.
Revista:
GACETA SANITARIA
ISSN:
0213-9111
Año:
2019
Vol.:
33
N°:
6
Págs.:
584 - 592
Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments.
The power (PODER in Spanish) of food policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugar-sweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulacion): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance.
A final thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy foods.
Revista:
PREVENTIVE MEDICINE
ISSN:
0091-7435
Año:
2019
Vol.:
123
Págs.:
171 - 178
Lifestyles may influence the risk of hypertension. Our objective was to assess the association between a healthy-lifestyle score and the incidence of hypertension. The SUN Project is a dynamic, prospective cohort of Spanish university graduates (1999-2014). Among 14,057 participants initially free of hypertension, we assessed the influence of lifestyle-related factors based on a 10-item score that we previously reported to be associated with lower risk of major cardiovascular events. However, we focused on factors related to hypertension risk according to previous scientific evidence and international clinical guidelines and constructed a 6-item score including: no smoking, moderate-to-high physical activity, Mediterranean diet adherence, healthy body mass index, moderate alcohol intake and no binge drinking. We fitted Cox regression models to adjust for potential confounders. During a median follow-up of 10.2 years, we identified 1406 incident cases of medically diagnosed hypertension. The risk of developing hypertension was linearly reduced as participants better adhered to a healthy lifestyle pattern built by summing up these 6 factors (p for trend < 0.001). The highest category (5-6 factors) exhibited a significant 46% relative reduction in the risk of developing hypertension compared to the lowest category (0-1 factors) (multivariable-adjusted hazard ratio = 0.54; 95% CI: 0.42-0.68). Among the components of the score, BMI was apparently the main factor driving the association between the HLS and lower risk of hypertension. A healthy-lifestyle score including six simple healthy habits was longitudinally and linearly associated with a substantially reduced risk of hypertension. This index may be a useful tool for hypertension prevention.
Autores:
Mendonca, R. D.; Carvalho, N. C. ; Martin-Moreno, J. M.; et al.
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2019
Vol.:
29
N°:
1
Págs.:
69 - 78
Background and aims: Polyphenol-rich diets have been associated with reduced risk of cardiovascular disease (CVD). However, few prospective epidemiological studies have examined the relationship between classes of ingested polyphenols and risk of CVD. Our aim was to evaluate the association between polyphenol intake and risk of major cardiovascular events in a prospective Spanish cohort. Methods and results: We included 17,065 university graduates (60.7% women, mean age: 37.2 years, age range: 20-89) followed-up for a mean of 10.1 years. Polyphenol intake was assessed at baseline using a validated semi-quantitative 136-item food frequency questionnaire and matching food consumption data with the Phenol-Explorer database. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for incident cardiovascular events (myocardial infarction, stroke or cardiovascular death). Cherries, chocolate, coffee, apples, and olives were the major sources of variability in polyphenol intake. Participants with higher flavonoids intake (fifth quintile) had a 47% lower incidence of cardiovascular events compared to those in the lowest quintile (HR: 0.53, 95% CI: 0.29-0.98; P for trend = 0.09) after adjusting for potential confounders. The results were non-significant for other polyphenol types. Conclusion: The intake of flavonoids showed an inverse association with risk of cardiovascular events in a prospective cohort of Spanish middle-aged adult university graduates. (C) 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2019
Vol.:
152
N°:
5
Págs.:
181 - 184
Introduction and objective: Our aim was to examine the secular trends in obesity prevalence among Spanish adults with diabetes. Material and methods: Data were collected from 8 waves (from 1987 to 2012) of the National Health Surveys (NHS). NHS are cross-sectional studies conducted in representative samples of the Spanish adult population. Data of 7378 adults (>= 16 years) who reported having been diagnosed of diabetes were analyzed. Previously validated self-reported weight and height were used to estimate body mass index (BMI). Obesity was defined as a BMI of 30 kg/m(2) or greater. Age-adjusted obesity prevalence for each wave was calculated by the direct standardization method. Results: From 1987 to 2012 age-adjusted prevalence of obesity among persons with diabetes increased from 18.2% (95% confidence interval [CI]: 14.2-22.2%) to 39.8% (95% CI: 36.8-42.8%). Age-adjusted prevalence of obesity in males with diabetes increased from 13.2% (95% CI: 7.3-19.1%) to 38.0% (95% CI: 33.8-42.1%) and in females from 23.0% (95% CI: 17.6-28.4%) to 42.3% (95% CI: 38.0-46.6%). Conclusions: Between 1987 and 2012 the prevalence of obesity markedly increased in Spain among adults with diabetes. (C) 2018 Elsevier Espana, S.L.U. All rights reserved.
Revista:
JOURNAL OF AFFECTIVE DISORDERS
ISSN:
0165-0327
Año:
2019
Vol.:
247
Págs.:
161 - 167
Background: The potential effect of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to prevent depression remains largely unknown, in spite of the implication of inflammation in depression. This study aimed to investigate whether the habitual intake of aspirin and other NSAIDs was prospectively associated with a reduction in the observed incidence of depression. Methods: A dynamic cohort including 22,564 Spanish university graduates (mean age: 37 years) initially free of depression was followed during an average of 8.7 years. Exposure to NSAIDs was assessed with specific repeated questionnaires throughout follow-up, starting in the 2-year follow-up questionnaire. Incident cases of depression were defined as either a new validated medical diagnosis of depression or reporting the initiation of habitual use of antidepressants. Results: We identified 772 incident cases of depression. Regular intake of aspirin and other NSAIDs was not associated with depression risk. Only in secondary sensitivity analyses using a definition of the outcome with higher specificity (a validated medical diagnosis of depression), an inverse association of aspirin with depression was found [HR (95%CI): 0.20 (0.04-0.87)]. However, these results were non-significant after adjustment for multiple testing. Limitations: A possible underestimation of incident depression and a limited ability to detect all possible residual confounding. Conclusions: Regular use of NSAIDs was not associated with the incidence of depression. Further longitudinal controlled studies are necessary to clarify a potential role of aspirin use in depression risk.
Revista:
NUTRITION
ISSN:
0899-9007
Año:
2018
Vol.:
54
Págs.:
19 - 25
Objective: To our knowledge, no study has yet assessed the association between dietary patterns and incidence of eating disorders. This study aimed to assess the association between adherence to the Mediterranean dietary pattern (MDP) and incident risk of anorexia (AN) and bulimia nervosa (BN). Methods: We conducted a prospective cohort study of 11 800 women from the Seguimiento Universidad de Navarra follow-up project. Participants were classified as having incident AN or BN if they were free of AN or BN at baseline and reported a physician-made diagnosis of AN or BN during the follow-up period. Nutritional status, lifestyle, and behavioral variables were investigated and used as covariates. A validated 136-item food frequency questionnaire and the Trichopoulou score were used to assess adherence to the MDP. Results: After a median follow-up time of 9.4 y, 100 new cases of AN and BN were identified. The multivariate hazard ratio of AN and BN for the two upper categories of adherence to the MDP were 0.39 (95% Cl: 0.20-0.75) and 0.32 (95% Cl: 0.14-0.70; P-trend = 0.021). Inverse dose-response relationships were found for the consumption of cereals and olive oil and marginally for polyunsaturated fatty acid intake. To address reverse causation, multivariable linear regressions were run using a cross-sectional approach between adherence to the MDP and risk of AN and BN at baseline. No difference in adherence was found between participants with and without eating disorders. Conclusions: Our results suggest a potential inverse association between the MDP and the risk of AN and BN. Additional longitudinal studies and trials are needed. (C) 2018 Elsevier Inc. All rights reserved.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2018
Vol.:
13
N°:
3
Págs.:
e0193568
A few studies have assessed the association between omega-3 polyunsaturated fatty acids (n-3 PUFA) and cognitive impairment (CI) in very old adults. The aim of this study was to evaluate the effect of a multinutrient supplementation rich in n-3 PUFA on the cognitive function in an institutionalized >= 75-year-old population without CI or with mild cognitive impairment (MCI). A multicenter placebo-controlled double-blind randomized trial was conducted between 2012 and 2013. Cognitive function was assessed at baseline and after one year using 4 neuropsychological tests. Nutritional status was assessed using Mini Nutritional Assessment (MNA). Interaction between Mini-Mental State Examination (MMSE) score and nutritional status were analyzed using linear regression models. A total of 99 participants were randomized to receive placebo or pills rich in n-3 PUFA. After 1-year follow-up, both groups decreased their MMSE score (-1.18, SD:0.53 and-0.82, SD:0.63, p = 0.67 for the control and the intervention group respectively). The memory subscale of the MMSE showed an improvement (+0.26, SD:0.18) in the intervention group against a worsening in the control group (-0.11, SD: 0.14; p = 0.09 for differences between groups). Patients at intervention group with normal nutritional status (MNA >= 24) showed an improvement in the MMSE (+1.03, p = 0.025 for differences between 1-y and baseline measurements) against a worsening in the group with malnutrition (MNA<24) (-0.4, p = 0.886 for differences between 1-y and baseline; p of interaction p = 0.05). Supplementation with n-3 PUFA did not show an improvement in the global cognitive function in institutionalized elderly people without CI or with MCI. They only suggest an apparent improvement in memory loss if previously they were well nourished.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2018
Vol.:
57
N°:
3
Págs.:
939 - 949
Purpose We assessed the association of total meat, processed, and unprocessed red meat and iron intake with the risk of developing gestational diabetes mellitus (GDM) in pregnant women. Methods We conducted a prospective study among 3298 disease-free Spanish women participants of the SUN cohort who reported at least one pregnancy between December 1999 and March 2012. Meat consumption and iron intake were assessed at baseline through a validated, 136-item semi-quantitative, food frequency questionnaire. We categorized total, red, and processed meat consumption and iron intake into quartiles. Logistic regression models were used to adjust for potential confounders. Results We identified 172 incident cases of GDM. In the fully adjusted analysis, total meat consumption was significantly associated with a higher risk of GDM [OR = 1.67 (95% CI 1.06-2.63, p-trend 0.010)] for the highest versus the lowest quartile of consumption. The observed associations were particularly strong for red meat consumption [OR = 2.37 (95% CI 1.49-3.78, p-trend < 0.001)] and processed meat consumption [OR = 2.01 (95% CI 1.26-3.21, p-trend 0.003)]. Heme iron intake was also directly associated with GDM [OR = 2.21 (95% CI 1.37-3.58, p-trend 0.003)], although the association was attenuated and lost its statistical significance when we adjusted for red meat consumption [OR = 1.57 (95% CI 0.91-2.70, p-trend 0.213)]. No association was observed for non-heme and total iron intake, including supplements. Conclusions Our overall findings suggest that higher pre-pregnancy consumption of total meat, especially red and processed meat, and heme iron intake, are significantly associated with an increased GDM risk in a Mediterranean cohort of university graduates.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2018
Vol.:
15
N°:
10
Págs.:
E2104
The aim of this study was to investigate determinants of self-rated health (SRH) perception in Spanish adults. This cross-sectional study including data from 11,342 participants from the Spanish PLENUFAR VI study. SRH status was grouped in two categories ('good'/'poor') and the associations of socio-demographic characteristics, lifestyles, diet adequacy and chronic disease with SRH were assessed. After adjusting for relevant confounders, the risk ratios (RR) and (95% confidence intervals) for poor SRH were 1.05 (1.03-1.07) for each hour of increment of sitting, 1.56 (1.30-1.88) for short (>= 5 h vs. 7-8 h) sleep duration, 0.63 (0.55-0.72) for vigorous (vs. light) physical activity, 0.61 (0.50-0.74) for adequate (vs. non-adequate) diet. Activities like jogging [RR for each unit of increment in the METs-h/day = 0.87 (0.82-0.92)], gymnastics [0.87 (0.81-0.93)], biking [0.91 (0.85-0.98)], and track and field [0.94 (0.89-0.98)], were associated with better health perception. Normally weight participants with any chronic disease had lower probability to report poor SRH than overweight/obese participants with any chronic disease. Frequent consumption of bread (>2 servings/day) was associated with a lower adjusted mean of health perception scale, while higher consumption of vegetables and fruit or fish were associated with higher values, concerning good SRH. We can conclude that normal-weight participants even suffering a chronic disease had lower probability to report poor health perception than participants with overweight/obesity and a chronic disease especially for hypertension and diabetes. Activities like jogging, gymnastics, biking, and track and field, and a higher consumption of fruits, vegetables and fish, were associated with better health rated perception.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2018
Vol.:
35
N°:
1
Págs.:
153 - 161
Introduction and objectives: Our aim was to prospectively evaluate the association between egg consumption and dyslipidemia in a Mediterranean cohort. Methods: We followed-up 13,104 Spanish university graduates for a mean period of 8 years. Dietary habits at baseline were assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Self-reported blood concentrations of total cholesterol, high-density lipoproteins cholesterol (HDL-c) and triglycerides were evaluated according to categories of egg consumption after 6 and 8 years of follow-up. We also assessed the association between baseline egg consumption and the incidence of hypercholesterolemia, low HDL-c concentrations and hypertriglyceridemia during follow-up. Results: We observed a significant inverse association for intermediate levels of egg consumption (2 to 4 eggs/week vs. less than 1 egg/week) and hypertriglyceridemia with OR = 0.71 (95% confidence interval [CI]: 0.54 to 0.93, p < 0.05) in the multivariable-adjusted model. Using HDL-c values after 8-year follow-up, we found an association between higher egg consumption and lower HDL-c levels (p for trend = 0.02) with an adjusted difference of -4.01 mg/dl (-7.42 to -0.61) for > 4 vs. < 1 egg/week. Lower means of triglycerides were found in each of the three upper categories of egg consumption compared to the lowest category (< 1 egg/week) with significant results for some of these categories both after 6 and 8 year follow-up. Conclusions: Our data do not support that higher egg consumption was associated with abnormal blood levels of total cholesterol or triglycerides; an inverse association with HDL-c as a quantitative variable was found only in one of our analyses.
Revista:
JOURNAL OF NUTRITION HEALTH AND AGING
ISSN:
1279-7707
Año:
2018
Vol.:
22
N°:
4
Págs.:
526 - 533
To examine the association between a dietary fat quality index (FQI), and the risk of incident cardiovascular events or deaths in the Seguimiento Universidad de Navarra (SUN) cohort.
Longitudinal analysis during 10.1 years of median follow-up. Cox models were used to estimate adjusted hazard ratios (HR) of incident cardiovascular diseases (CVD) according to tertiles of FQI and of different fat subtypes.
University of Navarra, Spain.
19,341 middle-aged adults.
Fat intake was measured with a validated food-frequency questionnaire. The FQI was calculated according to the ratio: (monounsaturated+polyunsaturated) / (saturated+trans fatty acids).
We observed 140 incident cases of CVD. No association was found for FQI (HR=0.94, 95 %CI 0.61-1.47 for the highest vs the lowest tertile, p for trend=0.884). No significant associations were found for different dietary fat subtypes on CVD risk. The results suggest no clear association between a higher FQI and a higher amount of energy from fat and incidence of CVD (p for interaction: 0.259 and p for trend only among participants with a percentage of energy from fat ae<yen>35% of total energy: 0.272).
In this Mediterranean cohort, the FQI was not associated with cardiovascular events. A "heart-healthy diet" should focus its attention on dietary fat sources and should use an overall dietary pattern approach, rather than limiting the focus on fat subtypes. More research is needed to validate dietary advice on specific fatty acids intake or saturated fatty acids replacements for reducing CVD risk.
Autores:
Barcones-Molero, M. F. (Autor de correspondencia); Sanchez-Villegas, A.; Martínez, Miguel Ángel; et al.
Revista:
REVISTA CLINICA ESPAÑOLA
ISSN:
0014-2565
Año:
2018
Vol.:
218
N°:
8
Págs.:
408 - 416
Antecedentes La calidad de vida relacionada con la salud es un elemento importante en la valoración integral del sobrepeso y la obesidad.
Objetivo Evaluar el impacto de la obesidad y la ganancia de peso sobre la calidad de vida relacionada con la salud en la cohorte dinámica Seguimiento Universidad de Navarra.
Materiales y métodos Los análisis incluyeron a 10.033 participantes de la cohorte dinámica prospectiva del Proyecto Seguimiento Universidad de Navarra, con una tasa de respuesta de aproximadamente el 90%. La calidad de vida fue medida con la versión abreviada de la Encuesta de Salud (SF-36) (0: peor calidad de vida, 100: mejor calidad de vida). El análisis estadístico se realizó con modelos lineales generalizados (media de cada dominio del SF-36 e IC al 95%). Una diferencia de 3 puntos fue considerada como clínicamente relevante.
Resultados El análisis del SF-36 mostró que la función física, la salud general y la variable física sumario fueron inferiores en las personas con sobrepeso y obesidad al inicio del estudio que en los individuos con normopeso.
La población a estudio con sobrepeso u obesidad sin cambios tras 2años de seguimiento presentó peores puntuaciones en los dominios del SF-36 correspondientes a la función física, dolor corporal, variable física sumario y salud general que los individuos que mantuvieron la categoría del normopeso según el IMC (kg/m2).
Conclusiones La obesidad parece asociarse a un impacto negativo sobre la calidad de vida relacionada con la salud, que afecta más significativamente al área física que a la psicosocial.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2018
Vol.:
10
N°:
4
Págs.:
439
The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018. Data on diet, lifestyle and clinical diagnosis are collected at baseline and every two years. After reviewing 21 publications from the SUN cohort on the effects of the MedDiet, we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality, fatal and non-fatal major cardiovascular disease (CVD), type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis. An inverse dose-response relationship was found for many of these associations. The MedDiet was also associated with lower average heart rate, a mitigation of the harmful effects of overweight/obesity on the risk of CVD, and an attenuation of the effects of obesity on type 2 diabetes. A suggestion that the MedDiet may enhance fertility was also found.
Revista:
PREVENTIVE MEDICINE
ISSN:
0091-7435
Año:
2018
Vol.:
106
Págs.:
45 - 52
The health benefits of the Mediterranean diet (MedDiet) and of physical activity (PA) have been widely documented. However, no longitudinal studies have investigated their combined effect on mortality. We assessed the individual and combined effects of adherence to the MedDiet and PA on all-cause mortality.
We used data from 19,467 participants from a prospective cohort of Spanish university graduates, the SUN cohort, followed-up between December 1999 and February 2016. Adherence to the MedDiet was assessed using four different dietary scores, categorizing the quantitative scores into tertiles of adherence. To assess multiple dimensions of PA, an 8-item score was built. Multivariable Cox regression models were used to study the individual and combined relationship of adherence to the MedDiet and PA with all-cause mortality.
During a median follow-up of 10.3 years, we registered 305 deaths. Compared with the lowest adherence to the MedDiet (< 20 in the modified Mediterranean diet score), better adherence (23¿30 points) was associated with lower mortality (multivariable-adjusted hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.46¿0.96). Engaging in moderate or high levels of PA (versus lower levels) was associated with 44% and 52% relative reductions in mortality, respectively. High adherence to the MedDiet combined with engaging in higher amounts of PA showed a HR = 0.36 (95% CI: 0.19¿0.67).
We documented that the combined effect of better adherence to the MedDiet and increased PA had multiplicative effects on mortality risk reduction.
Revista:
AMERICAN JOURNAL OF CARDIOLOGY
ISSN:
0002-9149
Año:
2018
Vol.:
122
N°:
11
Págs.:
1871 - 1878
The association between the intensity of physical activity and the incidence of cardiovascular diseases (CVD), irrespective of energy expenditure (EE), requires further study. Our objective is to examine this relationship using data from a large Spanish cohort. The Seguimiento Universidad de Navarra cohort is formed of university graduates recruited from March 1999 to October 2015. We included 18,737 adults free of CVD (mean age 38 years, 61 % women), with a median follow-up of 10.3 years. We estimated the average intensity of leisure time physical activity (LTPA) using a validated questionnaire. We classified respondents into 3 groups: Inactive, < 6 average metabolic equivalents (METs) and >= 6 average METs. We used Cox proportional hazards models adjusted by the EE in LTPA (MET-h/week) and other confounding factors, to examine this association. During 1,72,299 person-years of follow-up, we registered 127 cases of CVD (myocardial infarction, stroke, and death due to cardiovascular causes). The adjusted hazard ratio for CVD was 0.76 (95% CI 0.48 to 1.21) in the lower intensity group, and 0.31 (95% CI 0.12 to 0.79) in the higher intensity group, compared with the inactive, with a linear trend (p = 0.03). In conclusion, given the same level of EE, those respondents engaged in higher intensity LTPA, had a lower risk of CVD.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2018
Vol.:
37
N°:
4
Págs.:
1389 - 1398
Background & aims: While most studies have shown increased mortality associated with excessive red/processed meat consumption, the association of saturated fatty acids (SFA) intake with mortality is less homogeneous. We aimed to prospectively assess the association of both, meat consumption (red, processed, red + processed, and total) and SFA intake, with the risk of all-cause death. Methods: We assessed 18,540 participants of the SUN (Seguimiento Universidad de Navarra) cohort, followed-up for a mean of 9.5 years. A validated 136-item FFQ was administered at baseline. We used Cox models adjusted for potential confounders. Results: We observed 255 deaths during 176,916 person-years of follow-up. Age modified the association between meat consumption and all-cause mortality (p for interaction = 0.027, 0.075, and 0.013, for red, total, and processed meat, respectively). Among participants aged >45 years the fully-adjusted HRs (95% CIs) for one additional serving/d of red, total, and red + processed meat consumption were 1.47 (1.06, 2.04), 1.23 (1.05, 1.45), and 1.32 (1.05, 1.65), respectively, with significant linear trends (P for trend 0.022, 0.012, and 0.018, respectively). In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. Likewise, replacing 100 g of vegetables, fruits & nuts or cereals by 100 g of red meat resulted in higher mortality risk. No association of meat consumption or SFA with all-cause mortality was observed in participants younger than 46 years. Conclusions: Among highly educated persons, aged >45 years, a high consumption of red, total, and red + processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake. (C) 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2018
Vol.:
37
N°:
2
Págs.:
638 - 645
Background & aims: Gestational diabetes mellitus (GDM) prevalence is increasing worldwide. To the best of our knowledge the specific evaluation of soft drink consumption as a risk factor for developing GDM has only been conducted in the Nurses' Health Study II. Objective: To investigate the incidence of GDM according to soft drink consumption in the SUN project. Design: The "Seguimiento Universidad de Navarra" (SUN) project is a prospective and dynamic cohort which included data of 3396 women who notified at least one pregnancy between December 1999 and March 2012. A validated 136-item semi-quantitative food frequency questionnaire was used to assess soft drink consumption. Four categories of sugar-sweetened soft drink (SSSD) and diet soft drink (DSD) consumption (servings) were established: rarely or never (< 1/month), low (1-3/month), intermediate (> 3/month and <= 1/week) and high (>= 2/week). Potential confounders were adjusted through non-conditional logistic regression models. Results: During the follow-up, we identified 172 incident cases of GDM. After adjusting for age, baseline body mass index, family history of diabetes, smoking, total energy intake, physical activity, parity, fast-food consumption, adherence to Mediterranean dietary pattern, alcohol intake, multiple pregnancy, cardiovascular disease/hypertension at baseline, fiber intake, following special diet and snacking, SSSD consumption was significantly associated with an increased risk of incident GDM, with multivariable adjusted odds ratios (OR) of 2.03 (95% confidence interval [Cl]: 1.25-3.31) and 1.67 (95% Cl: 1.01-2.77) for the highest and intermediate categories, respectively, versus the lowest category (p for linear trend: 0.006). Conversely, DSD consumption was not associated with GDM incidence (adjusted OR: 0.82; 95% Cl: 0.52-1.31) for the highest versus the lowest category (p for linear trend: 0.258). Additional sensitivity analyses did not change the results. Conclusion: Higher consumption of SSSDs before pregnancy was an independent risk factor for GDM, however, no association was observed between DSD consumption and GDM risk. (c) 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Revista:
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
ISSN:
2047-4873
Año:
2018
Vol.:
25
N°:
11
Págs.:
1186 - 1197
Background Inverse associations of the Mediterranean diet (MedDiet) and physical activity with cardiovascular disease have been previously reported. We investigated the individual and combined contributions of both to this inverse association in a Mediterranean cohort. Design We used data from 19,536 participants from a prospective cohort of Spanish university graduates, the 'Seguimiento Universidad de Navarra' (SUN) cohort, followed up between December 1999 and December 2016. Methods Adherence to the MedDiet was obtained from a 136-item validated food-frequency questionnaire and categorized in tertiles using four previously reported dietary scores. A validated questionnaire assessed the physical activity levels according to volume, intensity and frequency. Results Participants were followed up during a median time of 10.4 years. Compared with the lowest category of adherence to the MedDiet (¿3 in the Mediterranean Diet Score), higher adherence (6-9 points) was strongly inversely associated with cardiovascular disease (multivariable adjusted hazard ratio¿=¿0.33; 95% confidence interval (CI) 0.20-0.55). Also, engaging in an active lifestyle (6-8 points in an eight-item score) compared with low activity (<2 points) was associated with a reduced risk of incident cardiovascular disease (hazard ratio¿=¿0.43; 95% CI 0.20-0.90). Greater adherence to the MedDiet and engaging in high levels of active lifestyle showed a 75% relatively reduced risk of cardiovascular disease (hazard ratio¿=¿0.25; 95% CI 0.13-0.48). Conclusions The combined effect of adherence to the MedDiet and adopting an active lifestyle showed a synergistic inverse association with cardiovascular disease risk.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2018
Vol.:
21
N°:
8
Págs.:
1573 - 1582
Objective: How food is produced and consumed has consequences for ecosystems, such as resource use and greenhouse gas (GHG) emission among others. The Mediterranean diet (MedDiet) was proposed as a sustainable dietary model, due to its nutritional, environmental, economic and sociocultural dimensions. However, further evidence is needed. Thus, our objective was to evaluate the impact on resource (land, water and energy) use and GHG emission of better adherence to the MedDiet in a Mediterranean Spanish cohort. Design: We analysed the dietary pattern of participants through a validated FFQ. The outcomes were land use, water and energy consumption and GHG emission according to MedDiet adherence. The specific environmental footprints of food item production and processing were obtained from different available life-cycle assessments. Setting: Spanish university graduates. Subjects: Participants (n 20 363) in the Seguimiento Universidad de Navarra (SUN) cohort. Results: Better adherence to the MedDiet was associated with lower land use (-0.71 (95% CI -0.76, -0.66) m(2)/d), water consumption (-58.88 (95% CI -90.12, -27.64) litres/d), energy consumption (-0.86 (95% CI -1.01, -0.70) MJ/d) and GHG emission (-0.73 (95% CI -0.78, -0.69) kg CO(2)e/d). A statistically significant linear trend (P<0.05) was observed in all these analyses. Conclusions: In this Mediterranean cohort, better adherence to the MedDiet was an eco-friendly option according to resource consumption and GHG emission.
Revista:
AMERICAN JOURNAL OF KIDNEY DISEASES
ISSN:
0272-6386
Año:
2017
Vol.:
70
N°:
6
Págs.:
778 - 786
Background: Diet plays an important role in the pathogenesis of nephrolithiasis. Limited data are available to investigate the association between a Mediterranean dietary pattern and risk for nephrolithiasis. Study Design: Prospective cohort study. Setting & Participants: 16,094 men and women without a history of nephrolithiasis who participated in the Seguimiento Universidad de Navarra Follow-up (SUN) Project. Predictors: A validated 136-item food frequency questionnaire was used to assess baseline adherence to a Mediterranean dietary pattern that is high in fruits, vegetables, nuts, fish, and legumes, but moderate in alcohol and low in meats, saturated fats, and sugars. A Mediterranean dietary pattern score was calculated and categorized into 3 groups (0-3, 4-6, and 7-9 points). Additional factors included in statistical models were sex, age, body mass index, smoking, physical activity, time spent watching television, following a medical nutritional therapy, water and energy intake, calcium and vitamin D supplementation, and history of hypertension or diabetes. Outcomes: Incidence of nephrolithiasis. Participants were classified as having incident nephrolithiasis if they reported a physician-made diagnosis of nephrolithiasis during follow-up. Results: After a mean follow-up of 9.6 years, 735 new cases of nephrolithiasis were identified. The multivariable HRs of nephrolithiasis for the 2 highest categories of adherence to the Mediterranean dietary pattern, using the lowest category as the reference, were 0.93 (95% CI, 0.79-1.09) and 0.64 (95% CI, 0.48-0.87); P for trend = 0.01. The risk for nephrolithiasis was lower with greater consumption of dairy products and vegetables and greater with higher monounsaturated fatty acid to saturated fatty acid ratio. Limitations: No information for kidney stone composition. Conclusions: Greater adherence to a Mediterranean dietary pattern was associated with reduced risk for incident nephrolithiasis. Additional longitudinal studies are needed. (C) 2017 by the National Kidney Foundation, Inc.
Revista:
ADVANCES IN NUTRITION
ISSN:
2161-8313
Año:
2017
Vol.:
8
N°:
1
Págs.:
146S - 154S
The role of yogurt consumption in the risk of developing overweight, obesity, or metabolic syndrome has been the subject of epidemiologic studies over the last 10 y. A comprehensive literature search on MEDLINE and ISI Web of Knowledge from 1966 through June 2016 was conducted to examine the relation between yogurt consumption and weight gain, as well as the risk of overweight, obesity, or metabolic syndrome, in prospective cohort studies. Ten articles met all the inclusion criteria and were included in our systematic review. Of the 10 cohort studies, 3 analyzed the relation between yogurt consumption and the risk of overweight or obesity, 8 analyzed changes in waist circumference or weight changes, 3 studied the association with the risk of developing metabolic syndrome, and 1 studied the probability of abdominal obesity reversion. Although an inverse association between yogurt consumption and the risk of developing overweight or obesity was not fully consistent or always statistically significant, all studies but one showed in their point estimates inverse associations between yogurt consumption and changes in waist circumference, changes in weight, risk of overweight or obesity, and risk of metabolic syndrome during follow-up, although not all estimates were statistically significant ( 2 studies). Prospective cohort studies consistently suggested that yogurt consumption may contribute to a reduction in adiposity indexes and the risk of metabolic syndrome. Therefore, there is a need for more prospective studies and high-quality randomized clinical trials to confirm this apparent inverse association.
Revista:
OBESITY FACTS
ISSN:
1662-4025
Año:
2017
Vol.:
10
N°:
1
Págs.:
61 - 63
National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust
Autores:
Mendonca, R. D. ; Pimenta, A. M.; Gea, Alfredo; et al.
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2017
Vol.:
105
N°:
4
Págs.:
1012 - 1013
Revista:
INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION
ISSN:
0963-7486
Año:
2017
Vol.:
68
N°:
7
Págs.:
865 - 872
The association of dietary energy density (ED) and overweight is not clear in the literature. Our aim was to study in 4259 of the PREDIMED trial whether an increase in dietary ED based on a higher adherence to a Mediterranean dietary pattern was associated with 3-year weight gain.A validated 137-item food-frequency questionnaire was administered. Multivariable-adjusted models were used to analyze the association between 3-year ED change and the subsequent 3-year body weight change.The most important weight reduction after 3-year follow-up was observed in the two lowest quintiles and the highest quintile of ED change. The highest ED increase was characterized by an increased intake of extra virgin olive oil (EVOO) and nuts and a decreased intake of other oils, vegetable and fruit consumption (p<.001).In conclusion, increased 3-year ED in the PREDIMED study, associated with a higher EVOO and nuts consumption, was not associated with weight gain.
Revista:
EYE
ISSN:
0950-222X
Año:
2017
Vol.:
31
N°:
7
Págs.:
1085 - 1092
Purpose Previous studies have suggested that pregnancy may induce myopia progression. However, no longitudinal study with a large sample size and long-term follow-up has assessed this association. Our objective was to investigate whether pregnancy was related to mid-or long-term myopic refraction changes. Patients and methods A prospective study was conducted in a Mediterranean cohort. The study included 10 401 women (20-50 years old) from the SUN Project. SUN project is a multipurpose, prospective, and dynamic cohort of university graduates conducted in Spain. The recruitment of participants started in 1999 and it is permanently open. All participants in this cohort had university studies. Participants were followed up for a period of up to 14 years, and pregnancy and refractive changes were assessed through baseline and biennial questionnaires. Pregnancies and myopia were repeatedly assessed in each biennial follow-up questionnaire during a total of 14 years of follow-up. Results Pregnancy was inversely associated with the risk of myopia development or progression during each of the 2 years periods, with fully adjusted hazard ratio = 0.61; (95% confidence interval = 0.49-0.75) after adjusting for known potential confounders. Conclusion To our knowledge this is the first large-longitudinal assessment in young adult women, showing that pregnancy is inversely associated with myopia development or progression. Further studies are needed to confirm these epidemiological findings.
Revista:
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
ISSN:
0749-3797
Año:
2017
Vol.:
52
N°:
4
Págs.:
e95 - e101
INTRODUCTION:
Emerging evidence suggests that vigorous physical activity may be associated with higher cardioprotective benefits than moderate physical activity. This study aimed to assess the long-term relationship between the intensity of leisure time physical activity (LTPA) and the risk of developing metabolic syndrome (MS) in a prospective cohort study.
METHODS:
The Seguimiento Universidad de Navarra (SUN) Project comprises Spanish university graduates. Participants (n=10,145) initially free of MS were followed for a minimum of 6 years (2008-2014). Analysis was conducted in 2015. Physical activity was assessed though a validated questionnaire. The intensity of each physical activity was measured in METs. The intensity of LTPA was estimated by the ratio between total METs/week and total hours of LTPA/week, obtaining the mean METs/hour of LTPA. MS was defined according to the harmonizing definition. The association between the intensity of LTPA (METs/hour) and MS was assessed with logistic regression models adjusting for potential confounders.
RESULTS:
Among 10,145 participants initially free of any MS criteria, 412 new MS cases were observed. Vigorous LTPA was associated with a 37% relatively lower risk (AOR=0.63, 95% CI=0.44, 0.89) compared with light LTPA. For a given total energy expenditure, independent of the time spent on it, participants who performed vigorous LTPA exhibited a higher reduction in the risk of MS than those who performed light to moderate LTPA.
CONCLUSIONS:
Vigorous LTPA was significantly associated with lower risk of developing MS after a 6-year follow-up period.
Revista:
FRONTIERS IN PHYSIOLOGY
ISSN:
1664-042X
Año:
2017
Vol.:
7
Págs.:
658
Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (<122 m) of altitude of residence [Model 2: Hazard ratio = 0.75 (95% Confidence interval: 0.580.97); p for trend = 0.029]. Living at geographically higher altitude was associated with a lower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases.
Autores:
Grosso, G.; Micek, A.; Godos, J.; et al.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2017
Vol.:
9
N°:
8
Págs.:
890
Objective: To performa dose-response meta-analysis of prospective cohort studies investigating the association between long-term coffee intake and risk of hypertension. Methods: An online systematic search of studies published up to November 2016 was performed. Linear and non-linear dose-response meta-analyses were conducted; potential evidence of heterogeneity, publication bias, and confounding effect of selected variables were investigated through sensitivity and meta-regression analyses. Results: Seven cohorts including 205,349 individuals and 44,120 cases of hypertension were included. In the non-linear analysis, there was a 9% significant decreased risk of hypertension per seven cups of coffee a day, while, in the linear dose-response association, there was a 1% decreased risk of hypertension for each additional cup of coffee per day. Among subgroups, there were significant inverse associations for females, caffeinated coffee, and studies conducted in the US with longer follow-up. Analysis of potential confounders revealed that smoking-related variables weakened the strength of association between coffee consumption and risk of hypertension. Conclusions: Increased coffee consumption is associated with a modest decrease in risk of hypertension in prospective cohort studies. Smoking status is a potential effect modifier on the association between coffee consumption and risk of hypertension.
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2017
Vol.:
117
N°:
10
Págs.:
1478 - 1485
It is likely that the Mediterranean diet (MedDiet) may mitigate the adverse effects of obesity on the incidence of type 2 diabetes mellitus (T2DM). We assessed this hypothesis in a cohort of 18 225 participants initially free of diabetes (mean age: 38 years, 61 % women). A validated semi-quantitative 136-item FFQ was used to assess dietary intake and to build a 0-9 score of adherence to MedDiet. After a median of 9.5-year follow-up, 136 incident cases of T2DM were confirmed during 173 591 person-years follow-up. When MedDiet adherence was low (4 points), the multivariable-adjusted hazard ratios (HR) were 4.07 (95 % CI 1.58, 10.50) for participants with BMI 25-29.99 kg/m(2) and 17.70 (95 % CI 6.29, 49.78) kg/m(2) for participants with BMI >= 30 kg/m(2), (v.<25 kg/m(2)). In the group with better adherence to the MedDiet (>4 points), these multivariable-adjusted HR were 3.13 (95 % CI 1.63, 6.01) and 10.70 (95 % CI 4.98, 22.99) for BMI 25-30 and >= 30 kg/m(2), respectively. The P value for the interaction was statistically significant (P=0.002). When we assessed both variables (BMI and MedDiet) as continuous, the P value for their interaction product-term was marginally significant (P=0.051) in fully adjusted models. This effect modification was not explained by weight changes during follow-up. Our results suggest that the MedDiet may attenuate the adverse effects of obesity on the risk of T2DM.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2017
Vol.:
149
N°:
7
Págs.:
319
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2017
Vol.:
118
N°:
9
Págs.:
715 - 721
The aim of this study was to investigate the association between the adherence to empirically derived dietary patterns and gestational diabetes mellitus (GDM) risk and of healthy lifestyles with the prevention of GDM defining an overall healthy score. The Seguimiento Universidad de Navarra project is a Mediterranean cohort of university graduates started in 1999. We included 3455 pregnant women. During a mean follow-up of 10·3 (sd 3·3) years, we identified 173 incident GDM cases. Two major dietary patterns were identified using principal component analysis: the Western dietary pattern (WDP) (characterised by a high consumption of meat-based products and processed foods) and the Mediterranean dietary pattern (MDP) (characterised by a high consumption of vegetables, fruits, fish and non-processed foods). A low-risk score for GDM was defined taking into account important risk factors (age, BMI and unhealthy dietary pattern) for GDM. Positive association was found in the multivariable model between the highest quartile of adherence to WDP and GDM incidence compared with the lowest quartile (OR 1·56; 95 % CI 1·00, 2·43). No association was found between adherence to the MDP and GDM incidence (OR 1·08; 95 % CI 0·68, 1·70 for the highest quartile compared with the lowest). Women who adhered to all three low-risk factors had a 76 % lower risk of GDM (OR 0·24; 95 % CI 0·10, 0·55) compared with women who did not adhere to any factor before pregnancy. In conclusion, our results reinforce the importance of dietary recommendations and other two factors (low BMI and young age at pregnancy) in pre-gravid women.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2017
Vol.:
148
N°:
6
Págs.:
250 - 256
Background and objective: The prevalence of obesity and diabetes mellitus (DM) has increased worldwide. Our objective was to examine trends in the prevalence of overweight, obesity, morbid obesity and DM in Spain from 1987 to 2012. Participants and methods: Data were obtained from 8 waves of the national health surveys which are cross-sectional studies conducted in representative samples of the Spanish adult population. Self-reported data of 156,440 adults (>= 16 years) from 1987 to 2012 were used. Body mass index (BMI) was calculated from self-reported weight and height. Overweight was defined as a BMI of 25.0 to 29.9 kg/m(2), obesity as a BMI >= 30 kg/m(2) and morbid obesity as a BMI >= 40 kg/m(2). DM was considered present if the participant reported having been diagnosed. Age-adjusted prevalence was adjusted by the direct standardisation method to the 2003 survey population. Results: From 1987 to 2012 age-adjusted prevalence of overweight increased from 34.0% (95% confidence interval [95% CI] 33.2-34.8) to 35.8% (95% CI 35.0-36.6), prevalence of obesity from 8.0% (95% CI 7.5-8.5) to 16.5% (95% CI 15.7-17.1%) and DM prevalence from 4.2% (95% CI 3.9-4.5) to 7.1% (95% CI 6.7-7.4%). Morbid obesity increased from 0.20% (95% Cl 0.13-0.27) in 1993 to 0.88% (95% CI 0.70-1.05) in 2012. The growth rate was greater among males. Conclusions: An increasing trend of the prevalence of overweight, obesity, morbid obesity and DM was found in Spain from 1987 to 2012, particularly in males. (C) 2016 Elsevier Espana, S.L.U. All rights reserved.
Autores:
Mendonca, R. D.; Pimenta, A. M.; Gea, Alfredo; et al.
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2017
Vol.:
105
N°:
4
Págs.:
1011 - 1012
Autores:
Mendonca, R. D. ; Pimenta, A. M. ; Gea, Alfredo; et al.
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2017
Vol.:
105
N°:
4
Págs.:
1013 - 1014
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2017
Vol.:
27
N°:
10
Págs.:
874 - 880
Background and aims The relationship between juice consumption and type 2 diabetes (T2D) has not been widely evidenced. Our aims were to prospectively evaluate the associations with T2D incidence of: 1) isovolumetric substitution of a water serving/day for one of fruit juice (different types), and of fresh fruit juice for its bottled version; 2) consumption of total, fresh or bottled juice; 3) energy intake from juices. Methods and results We followed 17,518 adults without T2D at baseline. Beverage consumption was assessed at baseline through a validated food-frequency questionnaire. The outcome was T2D incidence, according to American Diabetes Association's criteria. During a median follow-up of 10.2 years, 142 incident cases of T2D were identified. In substitution models, the substitution of water for bottled juice was associated with a lower T2D incidence, and also if the replacement was done by fresh juice, or especially fresh orange juice [HR 0.75 (95% CI 0.57¿0.99), 0.65 (95% CI 0.43¿0.98) and 0.56 (95% CI 0.34¿0.92); respectively]. Each additional serving/day of bottled juice was directly associated with T2D incidence [HR 1.33 (95% CI 1.01¿1.75)]. No significant association was observed for energy coming for bottled juice [HR 1.74 (95% CI 0.94¿3.20)]. Conclusion Our results suggest that isovolumetric substitution of water or fresh juice for bottled juice was inversely associated with T2D incidence in a long-term prospective study. Thus, these substitutions could be useful to tackle the diabetes epidemic.
Revista:
OBESITY FACTS
ISSN:
1662-4025
Año:
2017
Vol.:
10
N°:
6
Págs.:
674 - 693
Objective: Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults. Methods: Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted. Results: 30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry. Conclusion: Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water. (c) 2017 The Author(s) Published by S. Karger GmbH, Freiburg
Revista:
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
ISSN:
0731-5724
Año:
2017
Vol.:
36
N°:
5
Págs.:
319 - 329
OBJECTIVE:
The objective of this study was to assess the within-subject longitudinal changes in self-perceived healthy eating attitudes after 10 years of follow-up and to identify predictors of long-term changes in a middle-aged adult cohort.
METHODS:
Four thousand five hundred seventy-two participants completed a validated food frequency questionnaire (FFQ) at baseline and after 10 years of follow-up. The FFQ was expanded with a brief 10-item questionnaire about eating attitudes with 2 possible answers: yes or no. A baseline score and a 10-year score were calculated with these 10 items (range from 0 to 10). Participants were categorized into 3 groups according to this score. Linear and logistic regressions were used to examine changes at follow-up and associations between baseline characteristics and improvement in the score.
RESULTS:
After 10 years of follow-up, a statistically significant favorable change (p < 0.001) was achieved in all questions about eating attitudes, particularly in these items: "Do you try to eat less sweets and pastries?" (12%), "Do you try to eat less meat?" (11.1%), and "Do you try to reduce your fat intake?" (10%). Being female (odds ratio [OR] = 1.19, 95% confidence interval [CI], 1.02-1.39), being 35-50 or ¿ 50 years old (OR = 1.24, 95% CI, 1.07-1.44 and OR = 1.74, 95% CI, 1.38-2.18, respectively), a high level of physical activity (OR for third vs first tertile = 1.20, 95% CI, 1.02-1.41), and a higher Mediterranean diet score (OR for second and third tertiles = 1.18, 95% CI, 1.01-1.37 and OR = 1.26, 95% CI, 1.04-1.52, respectively) were associated with a higher probability of improving the eating attitudes score, while a low body mass index (BMI; OR = 0.71, 95% CI, 0.51-1.00) and snacking between meals (OR = 0.84, 95% CI, 0.73-0.97) were associated with a lower probability of improving their score.
CONCLUSIONS:
The eating attitudes of the participants in the Seguimiento Universidad de Navarra (SUN) cohort became more favorable after 10 years of follow-up. Certain sociodemographic or clinical variables may predict a positive change.
Autores:
Mendonca, R. D. ; Lopes, A. C. S.; Pimenta, A. M. ; et al.
Revista:
AMERICAN JOURNAL OF HYPERTENSION
ISSN:
0895-7061
Año:
2017
Vol.:
30
N°:
4
Págs.:
358 - 366
BACKGROUND Some available evidence suggests that high consumption of ultra-processed foods (UPFs) is associated with a higher risk of obesity. Collectively, this association and the nutritional characteristics of UPFs suggest that UPFs might also be associated with hypertension. METHODS We prospectively evaluated the relationship between UPF consumption and the risk of hypertension in a prospective Spanish cohort, the Seguimiento Universidad de Navarra project. We included 14,790 Spanish adult university graduates who were initially free of hypertension at baseline who were followed for a mean of 9.1 years (SD, 3.9 years; total person-years: 134,784). UPF (industrial formulations of chemical compounds which, beyond substances of common culinary use such as salt, sugar, oils, and fats, include substances also derived from foods but not used in culinary preparations) consumption was assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hypertension incidence. RESULTS During follow-up, 1,702 incident cases of hypertension were identified. Participants in the highest tertile of UPF consumption had a higher risk of developing hypertension (adjusted HR, 1.21; 95% CI, 1.06, 1.37; P for trend = 0.004) than those in the lowest tertile after adjusting for potential confounders. CONCLUSIONS In this large prospective cohort of Spanish middle-aged adult university graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confirm our results.
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2016
Vol.:
26
N°:
11
Págs.:
1048 - 1058
BACKGROUND AND AIMS:
Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD.
METHODS AND RESULTS:
We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD.
CONCLUSION:
In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.
Revista:
BMC PUBLIC HEALTH
ISSN:
1471-2458
Año:
2016
Vol.:
16
N°:
209
Págs.:
203
Nutritional adequacy implies sufficient intake of essential nutrients needed to [...]
Background The assessment of changes in dietary habits provides interesting information on whether or not the observed trends are in line with accepted nutritional guidelines. The objective was to evaluate within-subject longitudinal changes in food consumption and nutrient intake and in a 10-year follow-up study. Methods The SUN ( ) project is a prospective Spanish cohort study. Diet was assessed using a 136-item food-frequency questionnaire (FFQ), previously validated in Spain. The participants were 3036 university graduates (55.8 % women) of Spain and the main outcome measures the changes in dietary quality and in food consumption and nutrient intake. Paired t-tests and conditional logistic regression models were used to evaluate within-subject longitudinal dietary changes and the risk of inadequacy respectively, after 10 years of follow-up. Results During follow-up, participants showed a relevant and significant increase (p 0.001) in the consumption of fruits (7.4 %), vegetables (8.6 %), low-fat dairy products (35.2 %), lean meat (12.4 %), fish (2.9 %), whole grains (53.2 %), nuts (52.4 %) and a significant decrease in legumes (-7.4 %), whole-fat dairy products (-44.2 %), red meat (-17.6 %), sugar-sweetened beverages (-58.7 %) and wine (-11.9 %). With respect to nutrients, we found a higher proportion of carbohydrates (3.6 %) and fiber (7.4 %) and a decrease in total energy intake (2.7 %), total fat (-4.5 %), SFA (-9.4 %), MUFA (-4.9 %), PUFA (-12.7 %), w-3 and w-6 fatty acids (-9.1 and -20.5 % respectively) and cholesterol (-9.6 %). Conclusions In this Mediterranean cohort study, mainly beneficial changes in the consumption of most foods and macronutrients were observed after 10 years of follow-up.
Revista:
JOURNAL OF FOOD SCIENCE
ISSN:
0022-1147
Año:
2016
Vol.:
81
N°:
4
Págs.:
M921 - M927
Prerequisite programs are considered the most efficient tool for a successful implementation of self-control systems to ensure food safety. The main objective of this study was to evaluate the implementation of these programs in 15 catering services located in Navarra and the Basque Country (regions in northern Spain), through on-site audits and microbiological analyses. The implementation of the prerequisite program was incomplete in 60% of the sample. The unobserved temperature control during both the storage and preparation of meals in 20% of the kitchens reveals misunderstanding in the importance of checking these critical control points. A high level of food safety and hygiene (absence of pathogens) was observed in the analyzed meals, while 27.8% of the tested surfaces exceeded the established limit for total mesophilic aerobic microorganisms (¿100 CFU/25 cm²). The group of hand-contact surfaces (oven door handles and aprons) showed the highest level of total mesophilic aerobic microorganisms and Enterobacteriaceae, and the differences observed with respect to the food-contact surfaces (work and distribution utensils) were statistically significant (P < 0.001). With regard to the food workers' hands, lower levels of microorganisms were observed in the handlers wearing gloves (that is, for Staphylococcus spp we identified 43 CFU/cm2 on average compared with 4 CFU/cm2 (P < 0.001) for those not wearing and wearing gloves, respectively). For a proper implementation of the prerequisites, it is necessary to focus on attaining a higher level of supervision of activities and better hygiene training for the food handlers, through specific activities such as informal meetings and theoretical-practical sessions adapted to the characteristics of each establishment.
Revista:
JOURNAL OF NUTRITION
ISSN:
0022-3166
Año:
2016
Vol.:
146
N°:
9
Págs.:
1731 - 1739
Background: Yogurt and prebiotic consumption has been linked to better health. However, to our knowledge, no longitudinal study has assessed the association of yogurt and prebiotic consumption with depression risk.
Objective: We longitudinally evaluated the association of yogurt and prebiotic consumption with depression risk in a Mediterranean cohort.
Methods: The SUN (Seguimiento Universidad de Navarra) Project is a dynamic, prospective cohort of Spanish university graduates. A total of 14,539 men and women (mean age: 37 y) initially free of depression were assessed during a median follow-up period of 9.3 y. Validated food-frequency questionnaires at baseline and after a 10-y follow-up were used to assess prebiotic (fructans and galacto-oligosaccharide) intake and yogurt consumption (<0.5, ¿0.5 to <3, ¿3 to <7, and ¿7 servings/wk). Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression by a physician (previously validated). Multivariable Cox proportional hazards models were used to calculate HRs and 95% CIs.
Results: We identified 727 incident cases of depression during follow-up. Whole-fat yogurt intake was associated with reduced depression risk: HR for the highest [¿7 servings/wk (1 serving = 125 g)] compared with the lowest (<0.5 servings/wk) consumption: 0.78 (95% CI: 0.63, 0.98; P-trend = 0.020). When stratified by sex, this association was significant only in women (HR: 0.66; 95% CI: 0.50, 0.87; P-trend = 0.004). Low-fat yogurt consumption was associated with a higher incidence of depression (HR: 1.32; 95% CI: 1.06, 1.65; P-trend = 0.001), although this association lost significance after the exclusion of early incident cases, suggesting possible reverse causation bias. Prebiotic consumption was not significantly associated with depression risk.
Conclusions: Our study suggests that high consumption of whole-fat yogurt was related to a lower risk of depression in women of the SUN cohort. No association was observed for prebiotics. Further studies are needed to clarify why the yogurt-depression association may differ by fat content of the yogurt.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2016
Vol.:
11
N°:
11
Págs.:
e0164483
BACKGROUND:
Residence at high altitude has been associated with lower obesity rates probably due to hypoxia conditions. However, there is no evidence of this association in a free-living population.
OBJECTIVES:
We assessed the association between the altitude where each participant of a Spanish cohort (the SUN Project) was living and the incidence of overweight/obesity.
METHODS:
The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with a retention rate of 89%. We included in the analysis 9 365 participants free of overweight/obesity at baseline. At the baseline questionnaire, participants reported their postal code and the time they had been living in their city/village. We imputed the altitude of each postal code according to the data of the Spanish National Cartographic Institute and categorized participants in tertiles. We used Cox regression models to adjust for potential confounding variables.
RESULTS:
During a median follow-up of 10 years, we identified 2 156 incident cases of overweight/obesity. After adjusting for sex, age, time of residence at current city, baseline body mass index, physical activity, sedentarism and years of education (¿ 3 years, ¿ 4 years, Master/PhD), those participants in the third tertile (>456 m) exhibited a statistically significant 14% reduction in the risk of developing overweight/obesity in comparison to those in the first tertile (<124 m) (adjusted HR = 0.86; 95% CI: 0.77, 0.96).
CONCLUSIONS:
Living in cities of higher altitude was inversely associated with the risk of developing overweight/obesity in a cohort of Spanish university graduates.
Revista:
BRITISH JOURNAL OF ANAESTHESIA
ISSN:
0007-0912
Año:
2016
Vol.:
117
N°:
4
Págs.:
458 - 463
Background: Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients.
Methods: In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals.
Results: We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension. The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses.
Conclusions: The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.
Revista:
EUROPEAN JOURNAL OF NUTRITION
ISSN:
1436-6207
Año:
2016
Vol.:
55
N°:
1
Págs.:
93 - 106
Purpose
To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain.
Methods
We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ¿6 DRI or ¿8 DRI were estimated to assess nutritional adequacy according to quintiles of each index.
Results
The lowest prevalence of inadequate micronutrient intake (¿8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values.
Conclusions
A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2016
Vol.:
20
N°:
13
Págs.:
2383 - 2392
Objective: Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression. Design: In a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed. Results: After a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped). Conclusions: Moderate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.
Revista:
BMC PUBLIC HEALTH
ISSN:
1471-2458
Año:
2015
Vol.:
15
Págs.:
170
Background: The role of yogurt consumption in the development of metabolic syndrome (MetS) is not fully understood and the available epidemiologic evidence is scarce. The aim of our study was to assess the association between total, whole-fat, or low-fat yogurt consumption and the risk of developing MetS.Methods: Yogurt consumption was assessed at baseline through a 136-item validated FFQ. MetS was defined following the harmonized definition for MetS according to the AHA and the IDF criteria. Logistic regression models were used.Results: During the first 6-y of follow-up of the SUN cohort, 306 incident cases of MetS were identified. Frequent consumption [>= 875 g/week (>= 7 servings/week) versus <= 250 g/week (2 servings/week)] of total, whole-fat and low-fat yogurt consumption showed non-significant inverse associations with MetS [OR = 0.84 (95% CI: 0.60-1.18); 0.98 (95% CI: 0.68-1.41); and 0.63 (95% CI: 0.39-1.02) respectively]. Only one component of the MetS, central adiposity, was inversely associated with total and whole-fat yogurt consumption [OR = 0.85 (95% CI: 0.74-0.98) and 0.85 (95% CI: 0.73-0.99) respectively]. In the joint assessment of exposure to total yogurt consumption and fruit consumption, those in the highest category of total yogurt consumption, and having a high fruit consumption (above the median = 264.5 g/day) exhibited a significantly lower risk of developing MetS [OR = 0.61 (95% CI: 0.38-0.99)] compared with those in the lowest category of total ...
Revista:
EUROPEAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0954-3007
Año:
2015
Vol.:
69
N°:
3
Págs.:
297 - 302
Background/ Objectives: To evaluate the association between the carbohydrate quality (CQI) and weight change or incident overweight/obesity (BMI¿25 kg/m2) in the ¿Seguimiento Universidad de Navarra (SUN)¿ cohort. Subjects/ Methods: 8 741 participants initially free of overweight/obesity were followed¿up for a median of 7.9 years. We evaluated at baseline the CQI following 4 criteria: dietary fibre intake, glycemic index (GI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Subjects were classified into quintiles according to CQI. Weight was recorded at baseline and updated every 2 years during follow¿up. Results: Increasing CQI of diet was not significantly associated with lower weight gain, although participants in the highest quintile had the lowest average crude weight gain (+211 g/year). We observed 1 862 incident cases of overweight/obesity during followup. CQI was significantly associated (p for trend 0.006) with lower risk of overweight/obesity: adjusted OR for the 4rd and 5th quintiles: 0.81 (95% CI 0.66 to 0.99), and 0.74 (95% CI 0.60 to 0.92), respectively. Conclusions: In this Mediterranean cohort, CQI showed a significant inverse association with the incidence of overweight/obesity, which highlights that carbohydrate intake guidelines related to obesity prevention should be focused in improving the CQI of the diet.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2015
Vol.:
31
N°:
1
Págs.:
466 - 474
Objetivo: Investigar la asociación entre la frecuencia de comidas fuera de casa (CFC) con a) la calidad de hidratos de carbono y b) la calidad de grasas. Materiales y métodos: Se evaluaron 19.371 participantes de la cohorte SUN que completaron un cuestionario basal de frecuencia de consumo de alimentos previamente validado. Se utilizaron los índices de calidad de hidratos de carbono (ICHC) en una escala de 4 a 20 y de grasas (ICG) en una escala de 0,62 a 5,92. En ambos casos, a mayor puntuación mayor calidad. Se utilizó la regresión lineal múltiple para determinar la asociación entre la frecuencia de CFC (4 categorías) y la puntuación de ambos índices, y la regresión logística para medir la asociación entre la frecuencia de CFC y un bajo ICHC o ICG (<percentil 25). Resultados: Los participantes mostraron una media de ICHC e ICG de 11,3 (DE 3,2) y 1,7 (DE 0,5), respectivamente. Una mayor frecuencia de CFC (¿ 2 veces / semana) se asoció con un menor ICHC (ß: -0,29, IC 95%: -0,41 a -0,17, p <0,001), y con un menor ICG (ß: -0,02, IC 95%: -0,03 a -0,001, p <0,03). Los participantes con CFC ¿ 2 veces/semana tuvieron mayor riesgo de peor ICHC (OR: 1,31, IC 95%: 1,17-1,46, p <0,001), pero no de peor ICG (OR: 0,93 IC 95%: 0,83-1,03, p 0,194). Conclusiones: Hacer con mayor frecuencia CFC se asoció con una peor calidad de grasas en la dieta y especialmente con peor calidad de hidratos de carbono. Estos resultados destacan la importancia de la educación nutricional dirigida a los consumidores de CFC.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2015
Vol.:
7
N°:
11
Págs.:
9116-26
Revista:
AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0002-9165
Año:
2015
Vol.:
102
N°:
6
Págs.:
1554 - 1562
DESIGN:
The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with an overall retention rate of 90%. The study population encompassed 8569 Spanish university graduates (mean age: 37 y) who were initially free of overweight or obesity. Self-reported weight (previously validated) was collected at baseline and updated every 2 y during the follow-up period. Fructan consumption and GOS consumption were assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire and were updated after 10 y. Time-dependent Cox proportional hazards models were used to estimate HRs and 95% CIs for incident overweight and to adjust for potential confounding factors.
RESULTS:
During follow-up (median: 9 y), 1964 incident cases of overweight were identified. After potential confounders were adjusted for, risk of overweight was 15% lower in participants in the highest quartile of fructan consumption (¿2.3 g/d) (95% CI: 0.74, 0.97; P-trend = 0.019). Subjects in the highest quartile of GOS consumption (¿0.45 g/d) had 17% lower risk of overweight (95% CI: 0.74, 0.94; P-trend = 0.001).
CONCLUSIONS:
Higher prebiotic consumption was associated with lower risk of overweight in a cohort of initially normal-weight, middle-aged adults. This potential protection has been previously scarcely assessed; therefore, additional longitudinal studies are needed to confirm our results.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2015
Vol.:
19
N°:
4
Págs.:
658 - 666
OBJECTIVE:
To evaluate the association of snacking between main meals with the risk of developing metabolic syndrome.
DESIGN:
A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Snack consumption was evaluated using the question: 'Do you have the habit of snacking between main meals?' Metabolic syndrome was defined according to the updated harmonizing criteria. We estimated multivariable-adjusted relative risks (RR) of metabolic syndrome and their 95 % confidence intervals using Poisson regression models. An exploratory factor analysis was also used to identify patterns of snacking.
SETTING:
University of Navarra, Spain.
SUBJECTS:
The study included 6851 university graduates, initially free of metabolic syndrome, and followed-up them for a median of 8·3 years.
RESULTS:
Among our participants, 34·6 % reported usual snacking between main meals. The cumulative incidence of metabolic syndrome was 5·1 % (9·5 % among men and 2·8 % among women). Snacking between main meals was significantly associated with higher risk for developing metabolic syndrome after multivariable adjustment (RR=1·44; 95 %CI 1·18, 1·77). Higher adherence to an 'unhealthy snacking pattern' was also independently associated with increased incidence of metabolic syndrome (fourth quartile of adherence compared with non-snacking: RR=1·68; 95 % CI 1·23, 2·29; P for trend <0·001).
CONCLUSIONS:
Our findings suggest that avoidance of snacking between main meals can be included among the preventive approaches to reduce the risk of metabolic syndrome development, especially when snacks contain foods of poor nutritional quality.
Revista:
PREVENTIVE MEDICINE
ISSN:
0091-7435
Año:
2015
Vol.:
71
Págs.:
67 - 71
Objective
Many subjects, especially highly educated subjects, are increasingly exposed to computer use. This exposure might represent an explanation for the growing rates of myopia.
Methods
We assessed 17,217 Spanish university graduates from the SUN project, an open-recruitment cohort. Their mean age was 38.5 years (SD 12.1), and their mean time of exposure to computers was 14.3 h/week (SD 14.6). We estimated multivariable-adjusted odds ratios (OR) for the risk of myopia development and/or progression (¿ 0.5 diopters) according to baseline exposure to computer and to changes in exposure.
Results
The age and sex-adjusted OR comparing > 40 h/week of exposure versus < 10 h/week was 1.34 (95% confidence interval (CI): 1.12¿1.60). This association remained essentially unchanged after additional adjustments. Comparing participants who increased their exposure to computers, versus those with no change, the age and sex-adjusted OR was 1.49 (1.34¿1.66). This result was unchanged after additional adjustments.
Conclusions
To our knowledge this is the first large longitudinal assessment in young adults, showing that exposure to computer use is associated with myopia development or progression in a cohort of Spanish university graduates. Further studies are needed to confirm these epidemiological findings.
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2014
Vol.:
111
N°:
11
Págs.:
2000 - 2009
Epidemiological research confirms that the prevalence of suboptimal micronutrient intakes across Europe is an emerging concern in terms of public health. The aim of the present study was to investigate the association between a new index of carbohydrate (CHO) quality and micronutrient intake adequacy in the `Seguimiento Universidad de Navarra (SUN)¿ cohort. The baseline assessment extended from 1999 to March 2012. We assessed 16 841 participants who completed a validated 136-item semi-quantitative FFQ at baseline. We created a new index to evaluate CHO quality for the following four criteria: dietary fibre intake; glycaemic index; whole grains:total grains ratio; solid CHO:total CHO ratio. The subjects were classified into quintiles according to this index. We evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E and folic acid. The probability of intake adequacy was evaluated using the estimated average requirement cut-point approach and the probabilistic approach. Logistic regression analysis was used to assess the nutritional adequacy according to the CHO quality index (CQI). Participants in the highest quintile of CQI were found to have the lowest prevalence of inadequacy. A higher quality of CHO intake was found to be associated with a lower risk of nutritional inadequacy in comparison with the lowest quintile of CQI (adjusted OR 0·06, 95 % CI 0·02, 0·16; P for trend < 0·001). A higher CQI was found to be strongly associated with better micronutrient intake adequacy in the young Mediterranean cohort, stressing the importance of focusing nutritional education not only on CHO quantity, but also on quality.
Revista:
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH
ISSN:
0143-005X
Año:
2014
Vol.:
68
N°:
9
Págs.:
834 - 841
Background Polychlorinated biphenyls (PCB) are persistent organic pollutants (POP) that are consumed because of their bioaccumulation through the food chain. Recent studies have suggested the implication of POPs in the development of metabolic diseases such as type 2 diabetes and obesity. However, this relationship is not entirely consistent, and has not been investigated in longitudinal studies. The purpose of this study was to prospectively examine the association between dietary intake of PCBs and the incidence of obesity in the Seguimiento Universidad de Navarra (SUN) Project.
Methods Our study included 12¿313 participants without obesity at baseline, who were followed-up for a median of 8.1¿years. Dietary intakes of PCBs, expressed as WHO toxic equivalents, were assessed at baseline through a 136-item semiquantitative food-frequency questionnaire. The published concentration levels of PCBs measured in samples of food consumed in Spain were used to estimate intakes. Multivariable Cox regression models were fitted to estimate HRs and 95% CI for incident obesity.
Results During follow-up, we observed 621 incident cases of obesity. After adjustment for total energy intake and additional adjustment for potential confounders, participants in the fifth quintile of PCBs intake were at higher risk of becoming obese (adjusted HR: 1.58; (95% CI 1.21 to 2.06)) compared to those in the first quintile. The linear trend test was statistically significant (p<0.001).
Conclusions Dietary intake of PCBs as estimated using a food frequency questionnaire was associated with a higher incidence of obesity. Nevertheless, further longitudinal studies are needed to confirm our results.
Revista:
FOOD CONTROL
ISSN:
0956-7135
Año:
2014
Vol.:
43
Págs.:
193 - 198
Proper application of HACCP in catering services involves monitoring decisive critical points. The purpose of this study was to assess food temperatures and surface hygiene control in two catering services in Navarra (Spain) at two different time periods: the first one after implementation of the HACCP system and the second period, after the initial supervision through audits and a specific training session regarding temperatures of products and hygienic conditions of surfaces and equipment because the majority of detected nonconformities were related to these parameters. The recorded temperatures of 650 cooked food products within the first period showed that only 65.1% of the hot dishes had a temperature higher than 65 °C, in accordance with Spanish legislation, and 12.9% of them showed a risky holding temperature (<55 °C). However, the percentage of noncomplying dishes was reduced by a half after the training session (p < 0.001). Since the significant differences observed in recorded temperatures were related to the type of meal (with or without sauces) and the type of cooking procedure, a lower safe criterion for the retention of hot dishes was suggested if the temperature is continuously maintained over 55 °C until serving. With regard to cleaning and disinfection, 18.3% of the 600 analyzed surfaces did not meet the established cleaning criterion (¿100 CFU/25 cm2) in the first period, while in the second period this percentage was reduced to 13.6% in both catering businesses (p = 0.021). The dirtiest surfaces were equipment such as cutting boards and meat slicing machines (>26%) compared to utensils for distribution (12.0%). As the impact of dirty surfaces on the hygienic quality of a finished product will depend on which step was being taken during dish elaboration when equipment or utensil was used, it is suggested that more restrictive limits be established regarding utensils and equipment that are in direct contact with the finished product (¿1 CFU/cm2). Results of the study demonstrate that a specific training session on these items has improved the temperature control of prepared meals and the effectiveness of cleaning and disinfection, essentials for guaranteeing the hygienic quality of prepared foods.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2014
Vol.:
30
N°:
1
Págs.:
132 - 139
Introducción: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida. Objetivos: Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. Métodos: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado. Resultados: El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011).
Revista:
BMC PUBLIC HEALTH
ISSN:
1471-2458
Año:
2014
Vol.:
14
N°:
1091
Background
To evaluate prospectively the relationship between white, or whole grain bread, and glycemic index, or glycemic load from diet and weight change in a Mediterranean cohort.
Methods
We followed-up 9 267 Spanish university graduates for a mean period of 5 years. Dietary habits at baseline were assessed using a semi-quantitative 136-item food-frequency questionnaire. Average yearly weight change was evaluated according to quintiles of baseline glycemic index, glycemic load, and categories of bread consumption. We also assessed the association between bread consumption, glycemic index, or glycemic load, and the incidence of overweight/obesity.
Results
White bread and whole-grain bread were not associated with higher weight gain. No association between glycemic index, glycemic load and weight change was found. White bread consumption was directly associated with a higher risk of becoming overweight/obese (adjusted OR (¿2 portions/day) versus (¿1 portion/week): 1.40; 95% CI: 1.08-1.81; p for trend: 0.008). However, no statistically significant association was observed between whole-grain bread, glycemic index or glycemic load and overweight/obesity.
Conclusions
Consumption of white bread (¿2 portions/day) showed a significant direct association with the risk of becoming overweight/obese.
Revista:
NUTRITION
ISSN:
0899-9007
Año:
2014
Vol.:
30
N°:
9
Págs.:
1022 - 1027
Objective: The aim of this study was to assess the association between nut consumption and all-cause mortality after 5-y follow-up in a Spanish cohort. Methods: The SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) project is a prospective cohort study, formed by Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. In all, 17 184 participants were followed for up to 5 y. Baseline nut consumption was collected by self-reported data, using a validated 136-item semi-quantitative food frequency questionnaire. Information on mortality was collected by permanent contact with the SUN participants and their families, postal authorities, and the National Death Index. The association between baseline nut consumption and all-cause mortality was assessed using Cox proportional hazards models to adjust for potential confounding. Baseline nut consumption was categorized in two ways. In a first analysis energy-adjusted quintiles of nut consumption (measured in g/d) were used. To adjust for total energy intake the residuals method was used. In a second analysis, participants were categorized into four groups according to pre-established categories of nut consumption (servings/d or servings/wk). Both analyses were adjusted for potential confounding factors. Results: Participants who consumed nuts ¿2/wk had a 56% lower risk for all-cause mortality than those who never or almost never consumed nuts (adjusted hazard ratio, 0.44; 95% confidence intervals, 0.23-0.86). Conclusion: Nut consumption was significantly associated with a reduced risk for all-cause mortality after the first 5 y of follow-up in the SUN project.
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2014
Vol.:
112
N°:
6
Págs.:
984 - 991
Reported associations between the consumption of fried foods and the incidence of obesity or weight gain make it likely that fried food consumption might also be associated with the development of hypertension. However, evidence from long-term prospective studies is scarce. Therefore, the aim of the present study was to longitudinally evaluate this association in a prospective cohort. The SUN (Seguimiento Universidad de Navarra) project is a Mediterranean cohort study of university graduates conducted in Spain, which started in December 1999 and is still ongoing. In the present study, we included 13,679 participants (5059 men and 8620 women), free of hypertension at baseline with a mean age of 36·5 (SD 10·8) years. Total fried food consumption was estimated at baseline. The outcome was the incidence of a medical diagnosis of self-reported hypertension during the follow-up period. To assess the association between the consumption of fried foods and the subsequent risk of developing incident hypertension during the follow-up period, Cox regression models were used. During a median follow-up period of 6·3 years, 1232 incident cases of hypertension were identified. After adjusting for potential confounders, the adjusted hazard ratios for developing hypertension were 1·18 (95% CI 1·03, 1·36) and 1·21 (95% CI 1·04, 1·41) for those consuming fried foods 2-4 and >4 times/week, respectively, compared with those consuming fried foods < 2 times/week (P for trend = 0·009). In conclusion, frequent consumption of fried foods at baseline was found to be associated with a higher risk of hypertension during the follow-up period in a Mediterranean cohort of university graduates.
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2014
Vol.:
17
N°:
10
Págs.:
2185 - 2193
Objective: To assess the association between the consumption of sugar-sweetened carbonated beverages (SSCB) and obesity in children and adolescents from Navarra (Spain).
Design: We used a matched case-control study design. The exposure, SSCB consumption (1 serving: 200 ml), was measured with a previously validated FFQ. Anthropometrical measures were taken using standardized protocols. The outcome, obesity, was defined as BMI above the age- and sex-specific 97th percentile according to the Spanish reference charts. In the analysis we used conditional logistic regression. Potential confounders were controlled using a multivariable model.
Setting: Subjects were recruited in the paediatric departments of the Universidad de Navarra Clinic and the Navarra Hospital Complex, and in three primary health centres of Navarra. Controls were recruited when attending for a routine medical examination or vaccination.
Subjects: One hundred and seventy-four obese children and 174 individually sex- and age-matched controls, 52·87 % boys, with a mean age of 11·6 years. Exclusion criteria were dietary interventions, exposure to hormone treatment, development of secondary obesity due to endocrinopathy and serious intercurrent illness.
Results: Independently of other factors, high consumption of SSCB (>4 servings/week) was significantly associated with obesity (OR = 3·46; 95 % CI 1·24, 9·62; P = 0·01). Besides, each additional daily serving of SSCB was associated with a 69 % relative increase in the risk of obesity (OR = 1·69; 95 % CI 1·04, 2·73; P = 0·03).
Conclusions: We found a strong and significant association between SSCB consumption and obesity risk. Our results suggest a monotonic dose-response linear shape for this association in children and adolescents (P for trend = 0·02).
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2014
Vol.:
17
N°:
10
Págs.:
2185 - 2193
Objective: To assess the association between the consumption of sugar-sweetened carbonated beverages (SSCB) and obesity in children and adolescents from Navarra (Spain).
Design: We used a matched case-control study design. The exposure, SSCB consumption (1 serving: 200 ml), was measured with a previously validated FFQ. Anthropometrical measures were taken using standardized protocols. The outcome, obesity, was defined as BMI above the age- and sex-specific 97th percentile according to the Spanish reference charts. In the analysis we used conditional logistic regression. Potential confounders were controlled using a multivariable model.
Setting: Subjects were recruited in the paediatric departments of the Universidad de Navarra Clinic and the Navarra Hospital Complex, and in three primary health centres of Navarra. Controls were recruited when attending for a routine medical examination or vaccination.
Subjects: One hundred and seventy-four obese children and 174 individually sex- and age-matched controls, 52·87% boys, with a mean age of 11·6 years. Exclusion criteria were dietary interventions, exposure to hormone treatment, development of secondary obesity due to endocrinopathy and serious intercurrent illness.
Results: Independently of other factors, high consumption of SSCB (>4 servings/week) was significantly associated with obesity (OR = 3·46; 95% CI 1·24, 9·62; P = 0·01). Besides, each additional daily serving of SSCB was associated with a 69% relative increase in the risk of obesity (OR = 1·69; 95% CI 1·04, 2·73; P = 0·03).
Conclusions: We found a strong and significant association between SSCB consumption and obesity risk. Our results suggest a monotonic dose-response linear shape for this association in children and adolescents (P for trend = 0·02).
Revista:
OBESITY FACTS
ISSN:
1662-4025
Año:
2013
Vol.:
6
N°:
4
Págs.:
337 - 347
METHODS:
After a median of 6.5 years of follow-up, we included 10,532 or 9,470 participants without chronic disease or obesity at baseline for analyzing the association between the incidence of obesity and nocturnal sleep duration or having siesta. Sleeping hours and siesta were assessed at baseline. Weight was recorded at baseline and every 2 years during the follow-up. The outcome was the incidence of obesity during follow-up among participants with initial BMI <30 kg/m(2).
RESULTS:
During follow-up we observed 446 new cases of obesity in the analysis of nocturnal sleep duration. Sleeping less than 5 h at night was associated with a higher risk of becoming obese compared to sleeping between 7 and <8 h (HR 1.94; 95% CI 1.19-3.18; p for quadratic trend = 0.06) after adjusting for potential confounders. During follow-up, we observed 396 incident cases of obesity in the analysis of siesta. Those who took a siesta for 30 min/day had a 33% lower risk of becoming obese (HR 0.67; 95% CI 0.46-0.96; p for quadratic trend = 0.13) compared to those who did not take siesta.
CONCLUSION:
Our results suggest that short nocturnal sleep duration could be a modifiable risk factor for obesity. It is possible that this association may be stronger among men and subjects who experienced previous weight gain. Additionally, siesta might be a novel and independent protective factor for obesity; however, confirmatory studies are needed.
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2013
Vol.:
23
N°:
2
Págs.:
144 - 150
Background and aims: The consumption of fried foods is believed to be linked with obesity and higher weight gain, however, the evidence from long-term randomized trials or prospective epidemiological studies is scarce. Therefore, the aim of our study was to prospectively evaluate the association between the consumption of fried foods and weight change and the incidence of overweight/obesity in a Mediterranean cohort.
Methods and results: Prospective cohort study of 9850 men and women with a mean age of 38.1 years (SD 11.4) were followed-up for a median of 6.1 years to assess average yearly change in body weight, and incidence of overweight/obesity. The consumption of fried foods was associated with higher weight gain, but the differences were of small magnitude and statistically non-significant. The incidence of overweight/obesity during follow-up was also assessed in the subset of 6821 participants with initial body mass index <25 kg/m(2) (initially free of overweight/obesity), after adjusting for potential confounders, the odds ratio for developing overweight/obesity among participants who consumed fried foods >4 times/week was 1.37 (95% confidence interval: 1.08 to 1.73) in comparison with those who consumed fried foods <2 times/week (p for trend = 0.02).
Conclusion: In this Mediterranean prospective cohort, a more frequent consumption of fried foods at baseline was associated with a higher risk of subsequently developing overweight/obesity during follow-up.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2013
Vol.:
32
N°:
5
Págs.:
797-804
We observed 341 incident cases of MS. Consumers of ¿7 drinks/wk presented a significantly higher risk of developing MS (aOR: 1.80; 95% CI: 1.22-2.66; p < 0.001) compared with non-drinkers. In addition, alcohol drinkers (¿7 drinks/wk) had higher risk of hypertriglyceridemia (aOR: 2.07; 95% CI: 1.46-2.93) and impaired fasting glucose (aOR: 1.54; 95% CI: 1.16-2.04). Beer consumption was associated with higher risk for MS (p for trend = 0.027) and higher risk of hypertriglyceridemia (aOR: 1.81; 95% CI: 1.02-3.20), but with lower risk of low HDL-cholesterol criterion (aOR: 0.21; 95% CI: 0.05-0.89) for ¿7 drinks/wk versus no consumption. Non-significant association was observed between wine or liquor consumption and MS.
CONCLUSIONS:
Consumption of at least seven alcoholic drinks per week was associated with a higher risk of developing MS among subjects initially free of any MS criteria.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2013
Vol.:
28
N°:
1
Págs.:
105-111
Introduction & Aim: The prevalence of diabetes is increasing at an alarming rate in nearly all countries. Some studies from non-Mediterranean populations suggest that higher egg consumption is associated with an increased risk of diabetes. The aim of our study was to prospectively assess the association between egg consumption and the incidence of type 2 diabetes in a large cohort of Spanish university graduates. Methods: In this prospective cohort including 15,956 participants (mean age: 38.5 years) during 6.6 years (median), free of diabetes mellitus at baseline. Egg consumption was assessed at baseline through a semi-quantitative food-frequency questionnaire repeatedly validated in Spain. Incident diabetes mellitus diagnosed by a doctor was assessed through biennial follow-up questionnaires and confirmed subsequently by medical reports or records, according to the American Diabetes Association criteria. Analyses were performed through multivariable non-conditional logistic regression. Results: After adjustment for confounders, egg consumption was not associated with the development of diabetes mellitus, comparing the highest versus the lowest quartile of egg consumption (>4 eggs/week vs <1 egg/week): odds ratio = 0.7; 95% CI 0.3-1.7. Conclusion: Egg consumption was not associated with the development of diabetes mellitus in this Mediterranean cohort. (Nutr Hosp. 2013;28:105-111) DOI: 10.3305/nh.2013.28.1.6124
Revista:
PUBLIC HEALTH NUTRITION
ISSN:
1368-9800
Año:
2013
Vol.:
16
N°:
11
Págs.:
2064 - 2072
Objective To assess the long-term relationship between tree nut consumption and the risk of developing metabolic syndrome (MetS).
Design Nut consumption was collected using a validated 136-item FFQ. The MetS was defined according to the International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute harmonizing definition. The association between nut consumption and MetS was assessed with logistic regression models adjusting for potential confounders. We compared the incidence of MetS between extreme categories of nut intake (¿2 servings/week v. never/almost never) after 6 years of follow-up.
Setting The SUN Project (Seguimiento Universidad de Navarra, University of Navarra Follow-up) is a prospective cohort study, formed of Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. Nut consumption and MetS information was collected by self-reported data.
Subjects Participants (n 9887) initially free of MetS or diabetes and followed up for a minimum of 6 years were included.
Results We observed 567 new cases of MetS during follow-up. Participants who consumed nuts ¿2 servings/week presented a 32 % lower risk of developing MetS than those who never/almost never consumed (adjusted OR = 0·68, 95 % CI 0·50, 0·92). The inverse association was stronger among participants who were health professionals.
Conclusions Nut consumption was significantly associated with lower risk of developing MetS after a 6-year follow-up period in a cohort of Spanish graduates.
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2013
Vol.:
110
N°:
9
Págs.:
1722 - 1731
The incidence of the metabolic syndrome (MetS) is increasing and lifestyle behaviours may play a role. The aim of the present study was to prospectively assess the association between changes in the consumption of sugar-sweetened beverages (SSB) and the incidence of the MetS and its components in a Spanish cohort of university graduates. We included 8157 participants initially free of the MetS and followed up during at least 6 years. SSB consumption was collected by a FFQ previously validated in Spain. The change in SSB consumption was calculated as the difference between SSB consumption at a 6-year follow-up and baseline consumption. The MetS was defined according to the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute's new definition of the MetS that had harmonised previous definitions. The associations between changes in SSB intake and the MetS were examined using multiple logistic regression. We observed 361 incident cases of the MetS. Participants who increased their consumption of SSB (upper v. lower quintile) had a significantly higher risk of developing the MetS (adjusted OR 2·2, 95 % CI 1·4, 3·5; P for trend = 0·003). Similarly, they presented a significantly higher risk of developing high blood pressure (adjusted OR 1·6, 95 % CI 1·3, 2·1), central obesity (adjusted OR 2·3, 95 % CI 1·9, 2·7), hypertriacylglycerolaemia (adjusted OR 1·7, 95 % CI 1·1, 2·6) or impaired fasting glucose (adjusted OR 1·6, 95 % CI 1·1, 2·2). In conclusion, an increase in SSB consumption was associated with a higher risk of developing the MetS and other metabolic disorders after 6 years of follow-up in a Mediterranean cohort of university graduates.
Revista:
REVISTA ESPAÑOLA DE ANESTESIOLOGIA Y REANIMACION
ISSN:
0034-9356
Año:
2013
Vol.:
60
N°:
2
Págs.:
79-86.
To assess the correlation between intraoperative packed red blood cells transfusion and adverse outcome in a Spanish cohort of cardiac surgery patients. METHODS: Retrospective observational multicentre study. An analysis was performed on the data from 927 cardiac surgery patients treated in 24 Spanish hospitals in 2007. Patients who received intraoperative transfusions were compared with non-transfused patients. Multivariate analyses were performed (including, among others, several items from the Euroscore, surgery type, basal renal status and haemoglobin levels, and Thakar score).
RESULTS: Every transfusion of packed red cells was associated with increased postoperative risk of acute kidney damage at 72 hours after surgery, prolonged mechanical ventilation, and need for haemodynamic support. Moreover, transfused patients showed an increased in-hospital mortality rates (Adjusted OR: 1.30; 95% CI: 1.19-1.42), as well as longer hospital stays (almost 4 days).
CONCLUSIONS: In this cohort of patients, intraoperative transfusion might independently predict higher risk of early acute kidney damage, prolonged postoperative mechanical ventilation, and a need for haemodynamic support, and reduced short term survival (adjusted OR for mortality: 1.30; 95% CI: 1.19-1.42), and longer hospital stays (4 days longer).
Revista:
BMC PUBLIC HEALTH
ISSN:
1471-2458
Año:
2012
Vol.:
12
Págs.:
954
Background: Longitudinal studies assessing the long-term association between alcohol intake and depression are scarce. The type of beverage may also be important. Therefore we aimed to prospectively evaluate the influence of alcohol intake on incident depression in a Mediterranean cohort. Methods: We assessed 13,619 university graduates (mean age: 38 years, 42% men) participating in a Spanish prospective epidemiological cohort (the SUN Project), initially free of depression. They were recruited between 1999-2008 and biennially followed-up during 2001-2010. At baseline, a 136-item validated food-frequency questionnaire was used to assess alcohol intake. Wine was the preferred beverage. Participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression and restricted cubic splines analyses were performed over 82,926 person-years. Results: Only among women, an U-shaped relationship between total alcohol intake and depression risk was found (P=0.01). Moderate alcohol intake (5-15 g/day) was associated with lower risk (Hazard Ratio: 0.62; 95% Confidence Interval: 0.43-0.89). No association was apparent for higher intakes of alcohol or for any specific type of alcoholic beverage. Conclusions: Moderate alcohol intake might protect against depression among women. Further confirmatory studies are needed.
Revista:
JOURNAL OF NUTRITION
ISSN:
0022-3166
Año:
2012
Vol.:
142
N°:
6
Págs.:
1053 - 1059
Magnesium is the second most predominant intracellular cation and it is an important cofactor in over 300 enzymatic reactions. It is a calcium antagonist and a voltage-dependant blocker of the N-methyl-D-aspartate channel, which plays a role in the entrance of calcium into the neuron. Other mechanisms also add biological plausibility to neuro-protective properties for magnesium, including an inverse association with major depression. A higher magnesium intake has been related to lower depressive symptoms. However, epidemiological evidence on this issue is scarce. Our aim was to prospectively evaluate the association between dietary magnesium intake and depression incidence in a cohort of 12,939 Spanish university graduates initially free of depression (Seguimiento Universidad de Navarra Cohort Study). Total magnesium intake was assessed with a validated, semiquantitative FFQ and incident depression was ascertained through self-reports of a new clinical diagnosis of depression done by a medical doctor and/or the habitual use of antidepressive drugs. The self-report was validated against the Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria in a subsample of the cohort. Cox regression models were used to obtain HR of incident depression during follow-up according to baseline quintiles of magnesium intake using the lowest quintile as the reference category. After a median follow-up of 6.3 y, 737 new cases of depression were identified. No association between magnesium intake and depression was found, with multivariate-adjusted HR = 1 (reference), 1.00 (95% CI: 0.78-1.27), 1.00 (0.76-1.31), 0.95 (0.70-1.30), and 1.11 (0.77-1.59) for increasing categories (quintiles 1-5) of total magnesium intake. No dose-response relationship was found (P-trend = 0.59). Results were robust through different sensitivity analyses, including nutrient density or residual models. In conclusion, our findings do not suggest an inverse association between magnesium intake and depressive disorder. J. Nutr. 142: 1053-1059, 2012.
Revista:
JOURNAL OF NUTRITION
ISSN:
0022-3166
Año:
2012
Vol.:
142
N°:
9
Págs.:
1672-8
The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P = 0.05) and 0.38 (95% CI: 0.21, 0.70; P = 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death
Revista:
BRITISH JOURNAL OF NUTRITION
ISSN:
0007-1145
Año:
2011
Vol.:
105
N°:
5
Págs.:
765 - 775
Assessment of eating habits (EH) through closed questions could be an alternative tool to assess diet as a predictor of weight change in epidemiological studies. The aim was to assess the association between baseline EH and the risk of weight gain or becoming overweight/obese in a Spanish dynamic prospective cohort (the Seguimiento Universidad de Navarra Project) of 10 509 participants. The baseline questionnaire included ten short questions with two possible answers: yes or no. We calculated a baseline EH score, categorised in quartiles, positively weighting answers on more fruit, vegetables, fish and fibre and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. Reducing the consumption of meat or fat and removing fat from meat were significantly associated with lower weight gain. The partial correlation coefficient between EH score and weight change was ¿ 0·033 (P = 0·001). We observed 1063 cases of incident overweight/obesity among 7217 participants without overweight/obesity at baseline. Trying to eat more fruit, fish or fibre and less meat was inversely significantly associated with incident overweight/obesity. Those participants in the upper quartile of the score were at a 38 % (adjusted OR 0·62; 95 % CI 0·48, 0·81) lower risk of developing overweight/obesity during the follow-up compared with those in the lower quartile. However, the receiver-operating characteristic curves for the model with and without the EH score were materially identical. Despite the apparent significant inverse association, this score had a low predictive value for future weight gain and for incident overweight/obesity in a Mediterranean population, although some EH were independently and positively associated with weight gain.
Revista:
Public Health Nutrition
ISSN:
1368-9800
Año:
2011
Vol.:
14
N°:
7
Págs.:
1237 - 1244
Objective: To assess associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome (MetS).
Design: A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Participants were asked to select which of nine body images most closely represented their body shape at ages 5 and 20 years, and it was used as a proxy of BMI. An incident case of MetS was diagnosed according to criteria of the International Diabetes Federation. Associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult MetS were estimated by multiple-adjusted odds ratios and their 95 % confidence intervals.
Setting: University of Navarra, Spain.
Subjects: The study included 5317 university graduates, followed-up for a median of 6·1 years.
Results: The incidence of MetS was 2·9 % (1·7 % in women and 5·1 % in men). Among men, body shape at age 5 years was inversely related to adult MetS (OR = 0·83, 95 % CI 0·72, 0·97), whereas weight gain during childhood to adolescence/young adulthood was directly associated with adult MetS (OR = 1·49, 95 % CI 1·01, 2·18); both childhood underweight (OR = 5·20, 95 % CI 1·87, 14·50) and childhood obesity (OR = 4·66, 95 % CI 1·40, 15·51) increased the likelihood of adult MetS. No association was apparent among women.
Conclusions: These results support treating childhood underweight and weight gain during childhood to adolescence/young adulthood as part of comprehensive adult MetS prevention efforts in men.
Revista:
Nutrition Journal
ISSN:
1475-2891
Año:
2011
Vol.:
10
N°:
121
Págs.:
121 - 121
Few studies have related nutritional factors with quality of life in healthy populations. The purpose of the study was to assess whether dietary fat intake is associated to mental and physical quality of life
Revista:
European Journal of Clinical Nutrition
ISSN:
0954-3007
Año:
2011
Vol.:
65
N°:
6
Págs.:
676 - 682
BACKGROUND/OBJECTIVES:
Egg consumption has been associated with the risk of cardiovascular diseases (CVDs), but evidence is scarce and inconsistent. Our aim was to examine the association between egg consumption and incidence of CVD in a prospective dynamic Mediterranean cohort of 14,185 university graduates.
SUBJECTS/METHODS:
Egg intake was assessed using a 136-item-validated food-frequency questionnaire. Baseline consumption was categorized into no consumption or <1 egg/week, 1 egg/week, 2-4 eggs/week and >4 eggs/week. The presence of cardiovascular risk factors was assessed by questionnaire at baseline, and the incidence of CVD was assessed using biennial assessments. The median follow-up was 6.1 years. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios (HRs) for CVD (myocardial infarction, revascularization procedures or stroke). Outcomes were confirmed by review of medical records.
RESULTS:
During a median follow-up of 6.1 years, 91 new confirmed cases of CVD were observed. No association was found between egg consumption and the incidence of CVD (HR: 1.10, 95% confidence interval: 0.46-2.63) for the highest versus the lowest category of egg consumption after adjusting for age, sex, total energy intake, adherence to the Mediterranean food pattern and other cardiovascular risk factors. Results were robust to different analytical scenarios.
CONCLUSIONS:
No association between egg consumption and the incidence of CVD was found in this Mediterranean cohort.
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN:
0391-3988
Año:
2011
Vol.:
34
N°:
4
Págs.:
329 - 338
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2011
Vol.:
21
N°:
4
Págs.:
237 - 244
Background and aim: The Mediterranean diet is considered a model for healthy eating. However, prospective evidence in Mediterranean countries evaluating the relationship between this dietary pattern and non-fatal cardiovascular events is scarce. The aim of the present study was to evaluate the association between the adherence to the Mediterranean diet and the incidence of fatal and non-fatal cardiovascular events among initially healthy middle-aged adults from the Mediterranean area.
Methods and results: We followed-up 13,609 participants (60 percent women, mean age: 38 years) initially free of cardiovascular disease (CVD) during 4.9 years. Participants were part of a prospective cohort study of university graduates from all regions of Spain. Baseline diet was assessed using a validated 136-item food-frequency questionnaire. A 9-point score was used to appraise adherence to the Mediterranean diet. Incident clinical events were confirmed by a review of medical records. We observed 100 incident cases of CVD. In multivariate analyses, participants with the highest adherence to the Mediterranean diet (score > 6) exhibited a lower cardiovascular risk (hazard ratio = 0.41, 95% confidence interval [CI]: 0.18-0.95) compared to those with the lowest score (<3). For each 2-point increment in the score, the adjusted hazard ratios were 0.80 (95% CI: 0.62-1.02) for total CVD and 0.74 (0.55-0.99) for coronary heart disease.
Conclusions: There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non-fatal CVD in initially healthy middle-aged adults.
Revista:
BLOOD PURIFICATION
ISSN:
0253-5068
Año:
2011
Vol.:
32
N°:
2
Págs.:
104 - 111
Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay
Revista:
Nutrition
ISSN:
0899-9007
Año:
2011
Vol.:
27
N°:
7-8
Págs.:
802 - 808
Objective: The effects of alcohol on body weight might be modulated by the total amount of alcohol intake and type of alcoholic beverage. However, available results are contradictory. There is a scarcity of studies on this topic in Mediterranean areas where wine consumption is high. We prospectively evaluated the association between the type of alcoholic beverage intake and weight change in a Mediterranean cohort.
Methods: We followed for an average of 6.1 y 9318 adults without previous chronic disease at baseline. Validated data on diet including alcohol consumption were collected at baseline. Weight was recorded at baseline and updated every 2 y during follow-up. The outcomes were average weight gained every year and incidence of overweight/obesity after a 6-y follow-up.
Results: During follow-up, 1006 incident cases of overweight/obesity were identified in participants with normal weight at baseline. Beer and spirits consumption (>= 7 drinks/wk) was associated with a +119 g/y (95% confidence interval +27 to +212) higher average yearly weight gain after adjusting for relevant confounders. It was also associated with a higher risk of developing overweight/obesity compared with non-drinkers. No association between wine consumption and yearly weight change or the risk of developing overweight/obesity was apparent.
Conclusion: The type of alcoholic beverage can modulate the effect of alcohol intake on the risk of developing overweight/obesity.
Revista:
GACETA SANITARIA
ISSN:
0213-9111
Año:
2011
Vol.:
25
N°:
4
Págs.:
303 - 307
Objetivos
Valorar la validez de los datos autodeclarados sobre los criterios de síndrome metabólico, en la cohorte SUN (Seguimiento Universidad de Navarra).
Métodos
El proyecto SUN es una cohorte abierta multidisciplinaria formada por más de 20.000 graduados universitarios seguidos mediante cuestionarios enviados por correo cada 2 años. En una muestra de 287 participantes de la cohorte se valoró el acuerdo entre sus datos autodeclarados para el perímetro de la cintura, la presión arterial, los triglicéridos, el colesterol HDL y la glucemia, con los datos obtenidos por análisis de muestras biológicas o medidos por personal médico especializado. Para cada variable se calcularon coeficientes de correlación intraclase (CCI) con intervalos de confianza del 95% (IC95%), el error relativo medio y el porcentaje de valores dentro de los límites de acuerdo al 95% según el método de Altman y Bland.
Resultados
Se encontraron correlaciones intraclase altas para los valores del perímetro de la cintura (CCI = 0,86, IC95%: 0,80-0,90) y la trigliceridemia (CCI = 0,71, IC95%: 0,61-0,79). Se halló una consistencia moderada (CCI entre 0,46 y 0,63) para el resto de los factores que se usan como criterios para definir el síndrome metabólico. Los errores relativos medios nunca superaron el 2,5%, y el porcentaje de valores dentro de los límites de acuerdo superó en todos los casos el 91%.
Conclusiones
Los resultados obtenidos sugieren que los valores autodeclarados sobre los criterios del síndrome metabólico obtenidos en la cohorte SUN poseen una validez moderada y pueden tenerse en cuenta, aunque con ciertas precauciones, en estudios epidemiológicos.
Revista:
BMC PUBLIC HEALTH
ISSN:
1471-2458
Año:
2011
Vol.:
11
Págs.:
867
The objective of this study was to evaluate the validity of self reported criteria of Metabolic Syndrome (MS) in the SUN (Seguimiento Universidad de Navarra) cohort using their medical records as the gold standard. METHODS: We selected 336 participants and we obtained MS related data according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF). Then we compared information on the self reported diagnosis of MS and MS diagnosed in their medical records. We calculated the proportion of confirmed MS, the proportion of confirmed non-MS and the intraclass correlation coefficients for each component of the MS. RESULTS: From those 336 selected participants, we obtained sufficient data in 172 participants to confirm or reject MS using ATP III criteria. The proportion of confirmed MS was 91.2% (95% CI: 80.7- 97.1) and the proportion of confirmed non-MS was 92.2% (95% CI: 85.7-96.4) using ATP III criteria. The proportion of confirmed MS using IDF criteria was 100% (95% CI: 87.2-100) and the proportion of confirmed non-MS was 97.1% (95% CI: 85.1-99.9). Kappa Index was 0.82 in the group diagnosed by ATP III criteria and 0.97 in the group diagnosed by IDF criteria. Intraclass correlation coefficients for the different component of MS were: 0.93 (IC 95%:0.91- 0.95) for BMI; 0.96 (IC 95%: 0.93-0.98) for waist circumference; 0.75 (IC 95%: 0.66-0.82) for fasting glucose; 0.50 (IC 95%:0.35-0.639) for HDL cholesterol; 0.78 (IC 95%: 0.70-0.84) for triglycerides; 0.49 (IC 95%:0.34-0.61) for systolic blood pressure and 0.55 (IC 95%: 0.41-0.65) for diastolic blood pressure. CONCLUSIONS: Self-reported MS based on self reported components of the SM in a Spanish cohort of university graduates was sufficiently valid as to be used in epidemiological studies.
Revista:
INTERNATIONAL JOURNAL OF OBESITY
ISSN:
0307-0565
Año:
2010
Vol.:
34
N°:
2
Págs.:
266 - 272
Revista:
Public Health Nutrition
ISSN:
1368-9800
Año:
2010
Vol.:
13
N°:
9
Págs.:
1356 - 1363
Revista:
American Journal of Clinical Nutrition
ISSN:
0002-9165
Año:
2010
Vol.:
92
N°:
6
Págs.:
1484 - 1493
Revista:
Revista española de cardiología. (Ed. impresa)
ISSN:
0300-8932
Año:
2010
Vol.:
63
N°:
1
Págs.:
20 - 27
Revista:
Annals of Nutrition and Metabolism
ISSN:
0250-6807
Año:
2010
Vol.:
56
N°:
2
Págs.:
152 - 159
Revista:
NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN:
0939-4753
Año:
2010
Vol.:
20
N°:
5
Págs.:
359 - 365
Background and aims The consumption of tree nuts could reduce the risk of hypertension, but scarce research has been done to evaluate this potential association. We assessed the association between nut consumption and the incidence of hypertension among 9919 Spanish university graduates followed-up biennially for a median of 4.3 years.
Methods and results Food habits were assessed with a validated 136-item food-frequency questionnaire. Nut consumption was classified into four categories: rarely/never, 1¿3/month, 1/week, and 2+/week. A participant was classified as an incident case of hypertension when, being free of hypertension at baseline, he/she subsequently reported a physician-made diagnosis of hypertension in at least one of the follow-up questionnaires. The incidence of hypertension was 12.4 per 1000 person-years. We found no association between nut consumption and incidence of hypertension after adjusting for sex, age and other dietary and non-dietary potential confounders (hazard ratio [HR] for those in the highest vs. lowest nut consumption category=0.77 [IC 95%: 0.46¿1.30] p=0.795). Results were not modified when we stratified them analyses according to sex or to body mass index.
Conclusion Our data do not provide evidence for an inverse association between nut consumption and incident hypertension in our cohort. Further results from cohorts and trials with a higher baseline risk of hypertension should be obtained to test this relationship.
