Design and development of an instrument to measure overall lifestyle habits for epidemiological research: the Mediterranean Lifestyle (MEDLIFE) index.

OBJECTIVE: To design and develop a questionnaire that can account for an individual's adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction. DESIGN: The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eight-item derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency. SETTING: A subset of participants in the Aragon Workers' Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE. SUBJECTS: Participants (n 988) of the Aragon Workers' Health Study cohort in Spain. RESULTS: Mean MEDLIFE score was 11·3 (sd 2·6; range: 0-28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44-0·53; P<0·001) for the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and Mediterranean Diet Adherence Screener. CONCLUSIONS: MEDLIFE is the first index to include an overall assessment of lifestyle habits. It is expected to be a more holistic tool to measure adherence to the Mediterranean lifestyle in epidemiological studies.

Effects of long-term azithromycin therapy on airway oxidative stress markers in non-cystic fibrosis bronchiectasis.

BACKGROUND AND OBJECTIVE: To explore the effect of long-term therapy with azithromycin in regards to airway oxidative stress markers in exhaled breath condensate (EBC) of adult patients with stable non-cystic fibrosis (CF) bronchiectasis. METHODS: Open-label prospective study of 30 patients randomized to azithromycin 250 mg three times per week during 3 months (16 patients) or control (14 patients). Primary outcome were changes in nitric oxide, 8-isoprostane, pH, nitrites and nitrates in EBC. Secondary outcomes were changes in exacerbation rates, dyspnoea (Borg scale), sputum volume (cc), sputum colour (15-point scale), bacterial infection, health-related quality of life (St George's Respiratory Questionnaire), lung function and radiological extension. RESULTS: Azithromycin produced a significant decrease in sputum volume (8.9 (1.8) mL vs 2.1 (3.4) mL) and number of exacerbations (0.1 (0.6) vs 1.2 (0.9)). Dyspnoea (0.4 (0.1) vs 0.1 (0.2)) and health-related quality of life also improved after therapy. However, oxidative stress markers in EBC, systemic inflammatory markers as well as functional respiratory tests did not differ from the control group after therapy. A post-hoc analysis comparing patients infected or not with Pseudomonas aeruginosa revealed that these effects were more pronounced in infected patients. In this subgroup, treatment was followed by a significant reduction in sputum volume, number of exacerbations, dyspnoea and St George's Respiratory Questionnaire total score. Of all airway oxidative stress markers, only nitrates in EBC were reduced after therapy. CONCLUSIONS: Long-term azythromicin treatment has some clinical benefits in patients with non-CF stable bronchiectasis, but it does not affect airway oxidative stress markers.

Gender differences in obesity related cardiovascular risk factors in Spain.

BACKGROUND: Obesity and overweight are increasing progressively leading to an increase in cardiovascular risk factors and cardiovascular events. METHODS: The MESYAS Registry (Metabolic Syndrome in Active Subjects) recruited active workers from their annual health examinations in Spain through 2003. Body mass index was used to diagnose overweight and obesity. Metabolic syndrome (MS) and risk factors were assessed according to the ATP-III definitions. RESULTS: 19,041 subjects were included (80% males), mean age 42.2 (10.7). The prevalence of overweight was 44.6% (44.0-45.2), obesity 17.3% (17.0-17.5) and MS 12.0% (11.8-12.2). Women had lower prevalence of all cardiovascular risk factors. Multivariate analysis showed independent associations between overweight (OR: 2.4; 95% CI 2.2-2.6) or obesity (OR: 5.3; 95% CI 4.7-5.9) and any other two MS criteria. Overweight and obesity were independently associated with all cardiovascular risk factors, except low high-density lipoproteins in women. Significantly higher association was found in women between obesity and diabetes (OR: 13.6; 95% CI 3.8-48.6), MS (OR: 10.6; 7.6-14.8), hypertriglyceridemia (OR: 8.6; 95% CI 5.6-13.1), and impaired fasting glucose (OR: 3.7; 95% CI 2.7-5.3). CONCLUSIONS: Overweight and obesity are strongly related to classical cardiovascular risk factors, atherogenic dyslipidaemia and MS. Obesity has higher association to insulin-resistance related risk factors in women.

[Cardiovascular risk factors and metabolic syndrome associated with subclinical renal failure]. / Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS.

BACKGROUND AND OBJECTIVE: The objectives of this study were to describe the prevalence of subclinical renal dysfunction, assessed by glomerular filtration rate (GFR), and identify the associated cardiovascular risk factors in active working subjects of Spain. SUBJECTS AND METHOD: Data were collected in 11,582 active healthy workers (78.5% males), mean age (standard deviation) 40.2 (10.7) years, in their annual health examinations. Renal function was assessed by the GFR estimated by 3 methods: the abbreviated equation of Modification of Diet in Renal Disease (MDRD) study, the Cockroft-Gault (CG) equation and the weight/creatinine ratio. The assessment of the metabolic syndrome was done according to the modified Adult Treatment Panel III criteria. RESULTS: The 3 equations used for the estimation of GFR showed different values. GFR mean values were highest with the CG method (99.0 [25.0]) ml/min/1.73 m2, followed by the results of the MDRD and weigh/creatinine ratio (90.2 [18.5] ml/min/1.73 m2 and 81.2 [18.3] ml/min/1.73 m2, respectively). The prevalence of mild renal dysfunction (GFR: 60-89 ml/min/1.73 m2) ranged between 35.7% and 50.8% depending on the method applied, and the presence of moderate-severe (GFR < 60 ml/min/1.73 m2) ranged between 1.2% and 2.6%. All cardiovascular risk factors were more prevalent in the categories of worst renal function. Multivariant regression analysis showed that hypertriglyceridemia (odds ratio [OR] = 1.2), metabolic syndrome (OR = 1.2), overweight (OR = 1.2) and hypercholesterolemia (OR = 1.5) were associated independently with mild renal dysfunction. Hypercholesterolemia (OR = 1.6), hypertension (OR = 1.6), low HDL (OR = 2.4), and diabetes mellitus (OR = 3.2) were associated with moderate-severe renal dysfunction. CONCLUSIONS: Renal subclinical dysfunction is highly prevalent and is independently associated with classical cardiovascular risk factors and metabolic syndrome.

Factores de riesgo cardiovascular y síndrome metabólico asociados a la disfunción renal subclínica: subanálisis del Registro MESYAS / Cardiovascular risk factors and metabolic syndrome associated with subclinical renal failure

Fundamento y objetivo: Describir la prevalencia de la disfunción renal subclínica, valorada mediante el filtrado glomerular (FG), e identificar a qué factores de riesgo cardiovascular se asocia en una población laboral activa española. Sujetos y método: Se recogieron los datos de 11.582 trabajadores activos (un 78,5% varones), con una edad media (desviación estándar) de 40,2 (10,7) años, mediante las revisiones anuales de las mutuas laborales. La función renal se clasificó según el FG, valorado mediante la fórmula abreviada del estudio Modification of Diet in Renal Disease (MDRD), la fórmula Cockroft-Gault (CG) y el cociente peso/creatinina. El diagnóstico del síndrome metabólico se realizó mediante los criterios del Adult Treatment Panel III modificados. Resultados: Las 3 fórmulas de estimación del FG aportan valores diferentes. Los valores medios de FG fueron mayores con la fórmula CG (99,0 [25,0]) ml/min/1,73 m2, seguidos de los obtenidos por la fórmula MDRD (90,2 [18,5]) ml/min/1,73 m2 y la fórmula peso/creatinina (81,2 [18,3]) ml/min/1,73 m2. La prevalencia de disfunción renal leve (FG: 60-89 ml/min/1,73 m2) varió entre el 35,7 y el 50,8% en función de la ecuación empleada, y moderada-grave (FG < 60 ml/min/1,73 m2) entre un 1,2 y un 2,6%. Todos los factores de riesgo cardiovascular fueron más prevalentes en las categorías de mayor disfunción renal. El análisis de regresión multivariante muestra que la hipertrigliceridemia (odds ratio [OR] = 1,2), el síndrome metabólico (OR = 1,2), el sobrepeso OR = 1,2) y la hipercolesterolemia (OR = 1,5) se asocian independientemente a la disfunción renal leve. La hipercolesterolemia (OR = 1,6), la hipertensión (OR = 1,6), una concentración baja de colesterol unido a lipoproteínas de alta densidad (OR = 2,4) y la diabetes mellitus (OR = 3,2) se asocian con la disfunción renal moderada-grave. Conclusiones: La disfunción renal subclínica es muy prevalente y se asocia independientemente a los factores de riesgo cardiovascular clásicos y el síndrome metabólico

Background and objective: The objectives of this study were to describe the prevalence of subclinical renal dysfunction, assessed by glomerular filtration rate (GFR), and identify the associated cardiovascular risk factors in active working subjects of Spain. Subjects and method: Data were collected in 11,582 active healthy workers (78.5% males), mean age (standard deviation) 40.2 (10.7) years, in their annual health examinations. Renal function was assessed by the GFR estimated by 3 methods: the abbreviated equation of Modification of Diet in Renal Disease (MDRD) study, the Cockroft-Gault (CG) equation and the weight/creatinine ratio. The assessment of the metabolic syndrome was done according to the modified Adult Treatment Panel III criteria. Results: The 3 equations used for the estimation of GFR showed different values. GFR mean values were highest with the CG method (99.0 [25.0]) ml/min/1.73 m2, followed by the results of the MDRD and weigh/creatinine ratio (90.2 [18.5] ml/min/1.73 m2 and 81.2 [18.3] ml/min/1.73 m2, respectively). The prevalence of mild renal dysfunction (GFR: 60-89 ml/min/1.73 m2) ranged between 35.7% and 50.8% depending on the method applied, and the presence of moderate-severe (GFR < 60 ml/min/1.73 m2) ranged between 1.2% and 2.6%. All cardiovascular risk factors were more prevalent in the categories of worst renal function. Multivariant regression analysis showed that hypertriglyceridemia (odds ratio [OR] = 1.2), metabolic syndrome (OR = 1.2), overweight (OR = 1.2) and hypercholesterolemia (OR = 1.5) were associated independently with mild renal dysfunction. Hypercholesterolemia (OR = 1.6), hypertension (OR = 1.6), low HDL (OR = 2.4), and diabetes mellitus (OR = 3.2) were associated with moderate-severe renal dysfunction. Conclusions: Renal subclinical dysfunction is highly prevalent and is independently associated with classical cardiovascular risk factors and metabolic syndrome