Carga por mortalidad del cáncer de labio, cavidad bucal y faringe

Fundamento: un análisis de la tendencia al cambio en la mortalidad del cáncer de labio, cavidad bucal y faringe y la cuantificación del impacto sobre la esperanza de vida en la población cubana puede ayudar a los investigadores y a los responsables de la formulación de políticas de Salud Pública a tener una visión integral de este problema. Objetivo: estimar la carga por mortalidad de cáncer de labio, cavidad bucal y faringe, por sexo, en Cuba en el período comprendido de 2005- 2020. Método: se realizó un estudio descriptivo, de corte transversal en el que se utilizaron series de datos quinquenales. El universo estuvo conformado por todas las muertes por cáncer de labio, cavidad bucal y faringe para los años estudiados. Se utilizó, para cada año y causas, el número de defunciones, se calcularon tasas por 100 000 habitantes y los años de vida potencialmente perdidos por mortalidad. Se calculó, el promedio y se estimó del cambio porcentual anual. Resultados: las tasas de mortalidad fueron entre 7,62 y 12,23 en hombres y 2,60 y 3,74 en mujeres, por 100 000 habitantes. En cuanto a los años de vida dejados de vivir temparanamente, por cáncer de labio, cavidad bucal y faringe se observó que en hombres las tasas asciendieron de 131 en el 2005 a 169 en el 2020 y de 40 a 52 en las mujeres. Concluciones: la carga por cáncer de labio, cavidad bucal y faringe en Cuba ha aumentado, fue superior en hombres, la tendencia es creciente en ambos sexos, por cáncer nasofaríngeo tanto hombres como mujeres fallecieron a edades más tempranas que, por otras localizaciones estudiadas, el cambio porcentual fue superior por cáncer faríngeo.

Background: an analysis of the trend of change in the mortality of cancer of the lip, oral cavity and pharynx and the quantification of the impact on life expectancy in the Cuban population can help researchers and those responsible for formulating health policies. Public to have a comprehensive view of this problem. Objective: to estimate the mortality burden of cancer of the lip, oral cavity and pharynx, by sex, in Cuba in the period 2005-2020. Method: a descriptive, cross-sectional study was carried out in which five-year data series were used. The universe was made up of all deaths from cancer of the lip, oral cavity and pharynx for the years studied. For each year and causes, the number of deaths was used; rates per 100,000 inhabitants and the years of life potentially lost due to mortality were calculated. The average was calculated and the annual percentage change was estimated. Results: mortality rates were between 7.62 and 12.23 in men and 2.60 and 3.74 in women, per 100,000 inhabitants. Regarding the years of life lost early, due to cancer of the lip, oral cavity and pharynx, it was observed that in men the rates rose from 131 in 2005 to 169 in 2020 and from 40 to 52 in women. Conclusions: the burden of cancer of the lip, oral cavity and pharynx in Cuba has increased, it was higher in men, the trend is growing in both sexes, both men and women died at younger ages due to nasopharyngeal cancer than, due to other locations studied, the percentage change was higher for pharyngeal cancer.

Diabetes prevalence and risk factors, underestimated without oral glucose tolerance test, in rural Gombe-Matadi Adults, Democratic Republic of Congo, 2019.

An increase in the diabetes prevalence is reported worldwide. We aimed to determine the diabetes prevalence and its risk factors among adults in a rural area of the Democratic Republic of Congo. A cross-sectional study was conducted in 1531 inhabitants, selected by five stages, in the Health Zone of Gombe-Matadi. Diabetes was defined according to the American Diabetes Association and the International Diabetes Federation. Fasting glycemia and/or an oral glucose tolerance test were collected. We measured body mass index, waist circumference and blood pressure. Mann Whitney's and chi-square tests compared respondents with non-respondents. Multivariable logistic regression measured associations between diabetes and its risk factors. Crude and standardized prevalence of diabetes were 6.7% and 5.3%, respectively. Undiagnosed diabetes accounted for 58.8%. The oral glucose tolerance test alone diagnosed 2.6% of cases. Diabetes was more frequent in males, unemployed, obese and hypertensive (p < 0.05). Risk factors for diabetes were being male, aged ≥ 40 years, general and abdominal obesity associated with elderly, family history of diabetes, and hypertension. Diabetes in rural areas of the Democratic Republic of Congo appears to be underdiagnosed. The oral glucose tolerance test provides an opportunity to screen individuals for diabetes in this setting.

Estudio de la carga de mortalidad materna por causas directas. Cuba, 2005-2018 / Maternal mortality burden study from direct causes. Cuba, 2005-2018

RESUMEN Fundamento las complicaciones durante el embarazo, parto y puerperio constituyen las principales causas de muertes de mujeres en edad fértil. El estudio de la carga de mortalidad derivada de estas complicaciones es útil para cuantificar el impacto de muertes prematuras sobre la esperanza de vida de la población. Objetivo describir el comportamiento de la carga por muertes maternas debidas a causas directas en Cuba, entre el periodo 2005-2018. Métodos estudio descriptivo de series anuales, de corte transversal. El universo lo conformó el total de las muertes maternas directas (N=463). Se calcularon la razón de mortalidad, años de vida potencialmente perdidos por mortalidad, la tendencia, el porcentaje y el promedio. Resultados durante los años 2005-2018 fallecieron en Cuba 463 mujeres por causas obstétricas directas. Las muertes prematuras cuantificaron 22897 años de vida perdidos debido a esta causa, con una tendencia a decrecer en el tiempo y con un promedio anual de 1636 años de vida potencialmente perdidos; como promedio se dejaron de vivir por cada fallecida, 49 años. La causa directa que más años de vida perdidos generó fue el grupo de las complicaciones relacionadas con el puerperio (6 790). Conclusión las causas con mayor impacto sobre la esperanza de vida fueron las complicaciones relacionadas con el puerperio, otras hemorragias y embarazo ectópico; pero las mujeres que murieron en edades más jóvenes fueron a causa de aborto e infección puerperal. Las infecciones puerperales, trastornos placentarios y otras complicaciones mostraron tendencia a aumentar en el tiempo.

ABSTRACT Background complications during pregnancy, childbirth and the puerperium are the main causes of death in women of childbearing age. The study of the mortality burden derived from these complications is useful to quantify the impact of premature deaths on the population life expectancy. Objective to describe the behavior of the maternal deaths burden due to direct causes in Cuba, between 2005 and 2018. Methods descriptive study of annual series, cross-sectional. The universe was the total of direct maternal deaths (N = 463). The mortality ratio, years of life potentially lost due to mortality, the trend, the percentage and the average were calculated. Results during the years 2005-2018, 463 women died in Cuba from direct obstetric causes. Premature deaths quantified 22897 years of life lost due to this cause, with a tendency to decrease over time and with an annual average of 1636 years of life potentially lost; on average, they stopped living for each deceased, 49 years. The group of complications related to the puerperium (6790) was the direct cause that generated more years of life lost. Conclusion the causes with the greatest impact on life expectancy were complications related to the puerperium, other hemorrhages and ectopic pregnancy; but the women who died at younger ages were from abortion and puerperal infection. Puerperal infections, placental disorders, and other complications tended to increase over time.

Rationale and design of the SI! Program for health promotion in elementary students aged 6 to 11 years: A cluster randomized trial.

Unhealthy habits in children are increasing at an alarming rate. The school provides a promising setting for effective preventive strategies to improve children's lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based educational intervention aimed at all stages of compulsory education in Spain. Here, we present the design of the SI! Program for Elementary School cluster-randomized controlled trial, targeting children aged 6 to 11 years. This trial aims to study the impact of different timings and intensities of exposure to SI! Program activities on elementary school children and their immediate environment (parents/caregivers, teachers, and school). The trial includes 1770 children from 48 public elementary schools in Madrid (Spain), together with their parents and teachers. Schools and their children were randomly assigned to the intervention group (the SI! curriculum-based educational program over 3 or 6 academic years) or to the control group (standard curriculum). The primary outcomes are the change from baseline at 3-year and 6-year follow-up in children's scores for knowledge, attitudes, and habits (KAH) and health factors (blood pressure, height, weight, waist circumference, and skinfold thickness). Secondary outcomes include 3-year and 6-year changes from baseline in lifestyle questionnaire scores for parents/caregivers and teachers, and in the school environment questionnaire. The overarching goal of the SI! Program is to provide an effective and sustainable health promotion program for the adoption of healthy behaviors in children. The present trial will address the impact and the optimal timing and duration of this educational intervention in the elementary school setting.

Mediterranean diet and cardio-metabolic health: what is the role of meat?

Traditional Mediterranean diet is known for its health benefits in prevention of cardio-metabolic diseases and risk factors associated with it. The role of red meat in Mediterranean diet is to some extent overlooked with the main focus on foods of plant origin. The majority of existing guidelines encourage general population to limit intakes of red meat. However, in reality, it is a significant part of the Mediterranean cuisine. Red meat is an excellent source of macro and micronutrients: high-quality protein, B vitamins, essential amino acids, omega-3 polyunsaturated fatty acids, phosphorus, zinc, iron, and selenium. Currently, there is not enough scientific evidence to suggest the strict limitation of the red meat consumption among the general population, however, there is a substantial evidence to support the advice to eliminate the consumption of processed meat from the diet.

Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study.

BACKGROUND: Detection of subclinical atherosclerosis improves risk prediction beyond cardiovascular risk factors (CVRFs) and risk scores, but quantification of plaque burden may improve it further. Novel 3-dimensional vascular ultrasound (3DVUS) provides accurate volumetric quantification of plaque burden. OBJECTIVES: The authors evaluated associations between 3DVUS-based plaque burden and CVRFs and explored potential added value over simple plaque detection. METHODS: The authors included 3,860 (92.2%) PESA (Progression of Early Subclinical Atherosclerosis) study participants (age 45.8 ± 4.3 years; 63% men). Bilateral carotid and femoral territories were explored by 3DVUS to determine the number of plaques and territories affected, and to quantify global plaque burden defined as the sum of all plaque volumes. Linear regression and proportional odds models were used to evaluate associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk. RESULTS: Plaque burden was higher in men (63.4 mm3 [interquartile range (IQR): 23.8 to 144.8 mm3] vs. 25.7 mm3 [IQR: 11.5 to 61.6 mm3] in women; p < 0.001), in the femoral territory (64 mm3 [IQR: 27.6 to 140.5 mm3] vs. 23.1 mm3 [IQR: 9.9 to 48.7 mm3] in the carotid territory; p < 0.001), and with increasing age (p < 0.001). Age, sex, smoking, and dyslipidemia were more strongly associated with femoral than with carotid disease burden, whereas hypertension and diabetes showed no territorial differences. Plaque burden was directly associated with estimated cardiovascular risk independently of the number of plaques or territories affected (p < 0.01). CONCLUSIONS: 3DVUS quantifies higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Plaque burden correlates strongly with CVRFs, especially at the femoral level, and reflects estimated cardiovascular risk more closely than plaque detection alone. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).

A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.

BACKGROUND: Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES: This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS: A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS: Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS: The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).

ASSOCIATION BETWEEN DAILY SITTING TIME AND PREVALENT METABOLIC SYNDROME IN AN ADULT WORKING POPULATION: THE AWHS COHORT.

OBJECTIVE: the aim of this analysis was to measure the association between daily sitting time and prevalent metabolic syndrome, independently of the physical activity performed. SUBJECTS AND METHODS: the Aragon Workers' Health Study cohort consists of 5 865 participants from which a sample of 1 415 male participants (40-55 years old) with completed data at baseline was selected. Sitting time and physical activity were assessed by validated questionnaires, and the socio-demographic, clinical and biochemical covariates needed to diagnose metabolic syndrome were collected as part of the study protocols. Metabolic syndrome was defined according to the modified National Cholesterol Education Program - Adult Treatment Panel III. Multiple linear and logistic regression models were carried out to quantify this association using sitting time categorized into tertiles. RESULTS: mean sitting time was 5.78 ± 1.72 h/day, and the prevalence of metabolic syndrome was 19.2%. Comparing participants in the highest (> 6.57 h/day) versus lowest (1.85-4.57 h/day) tertile of sitting time, a positive association was observed for metabolic syndrome (OR 1.77, 95%CI: 1.25-2.49) and triglyceride (OR 1.70, 95%CI: 1.30-2.24), HDL-cholesterol (OR 1.65, 95%CI: 1.06-2.58), waist circumference (OR 1.57, 95%CI: 1.17-2.11) and fasting blood glucose (OR 1.35, 95%CI: 1.03-1.77) criteria, adjusting the level of physical activity. CONCLUSIONS: higher sitting time is associated with an increased prevalence of metabolic syndrome independently of physical activity performed. These results could be useful to carry out effective strategies for cardiovascular health promotion especially in workplaces.

Objetivo: el objetivo del presente análisis fue medir la asociación entre el tiempo sentado y la prevalencia de síndrome metabólico, de forma independiente a la actividad física realizada. Sujetos y métodos: la cohorte del Aragon Workers' Health Study está formada por 5.865 participantes de los cuales se seleccionó una muestra de 1.415 voluntarios varones (40-55 años) con datos completos al inicio del estudio. El tiempo sentado y la actividad física se valoraron mediante cuestionarios validados, y las variables sociodemográficas, clínicas y bioquímicas necesarias para el diagnóstico del síndrome metabólico fueron recogidas como parte de los protocolos del estudio. Para la definición de síndrome metabólico se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Se llevaron a cabo modelos de regresión lineal y logística para cuantificar esta asociación usando el tiempo sentado categorizado en tertiles. Resultados: la media de tiempo sentado fue de 5,78 ± 1,72 h/día, y la prevalencia de síndrome metabólico del 19,2%. Comparando los participantes en el tertil superior de tiempo sentado frente a los del tertil inferior observamos una asociación positiva para síndrome metabólico (OR 1,77, 95%CI: 1,25-2,49) y los criterios de triglicéridos (OR 1,70, 95%CI: 1,30-2,24), HDL-colesterol (OR 1,65, 95%CI: 1,06-2,58), circunferencia de cintura (OR 1,57, 95%CI: 1,17-2,11) y glucosa en ayunas (OR 1,35, 95%CI: 1,03-1,77), ajustando por el nivel de actividad física. Conclusiones: un mayor tiempo sentado se asocia con un aumento de la prevalencia de síndrome metabólico independientemente de la actividad física realizada. Estos resultados podrían ser útiles para llevar a cabo estrategias efectivas de promoción de la salud cardiovascular, especialmente en los lugares de trabajo.

Association between daily sitting time and prevalent metabolic syndrome in an adult working population: the AWHS cohorte / Asociación entre tiempo sentado y prevalencia de síndrome metabólico en una población adulta trabajadora: la cohorte AWHS

Objective: the aim of this analysis was to measure the association between daily sitting time and prevalent metabolic syndrome, independently of the physical activity performed. Subjects and methods: the Aragon Workers’ Health Study cohort consists of 5 865 participants from which a sample of 1 415 male participants (40-55 years old) with completed data at baseline was selected. Sitting time and physical activity were assessed by validated questionnaires, and the socio-demographic, clinical and biochemical covariates needed to diagnose metabolic syndrome were collected as part of the study protocols. Metabolic syndrome was defined according to the modified National Cholesterol Education Program - Adult Treatment Panel III. Multiple linear and logistic regression models were carried out to quantify this association using sitting time categorized into tertiles. Results: mean sitting time was 5.78 ± 1.72 h/day, and the prevalence of metabolic syndrome was 19.2%. Comparing participants in the highest (>6.57 h/day) versus lowest (1.85-4.57 h/day) tertile of sitting time, a positive association was observed for metabolic syndrome (OR 1.77, 95%CI: 1.25-2.49) and triglyceride (OR 1.70, 95%CI: 1.30-2.24), HDL-cholesterol (OR 1.65, 95%CI: 1.06-2.58), waist circumference (OR 1.57, 95%CI: 1.17-2.11) and fasting blood glucose (OR 1.35, 95%CI: 1.03-1.77) criteria, adjusting the level of physical activity. Conclusions: higher sitting time is associated with an increased prevalence of metabolic syndrome independently of physical activity performed. These results could be useful to carry out effective strategies for cardiovascular health promotion especially in workplaces (AU)

Objetivo: el objetivo del presente análisis fue medir la asociación entre el tiempo sentado y la prevalencia de síndrome metabólico, de forma independiente a la actividad física realizada. Sujetos y métodos: la cohorte del Aragon Workers’ Health Study está formada por 5.865 participantes de los cuales se seleccionó una muestra de 1.415 voluntarios varones (40-55 años) con datos completos al inicio del estudio. El tiempo sentado y la actividad física se valoraron mediante cuestionarios validados, y las variables sociodemográficas, clínicas y bioquímicas necesarias para el diagnóstico del síndrome metabólico fueron recogidas como parte de los protocolos del estudio. Para la definición de síndrome metabólico se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Se llevaron a cabo modelos de regresión lineal y logística para cuantificar esta asociación usando el tiempo sentado categorizado en tertiles. Resultados: la media de tiempo sentado fue de 5,78 ± 1,72 h/día, y la prevalencia de síndrome metabólico del 19,2%. Comparando los participantes en el tertil superior de tiempo sentado frente a los del tertil inferior observamos una asociación positiva para síndrome metabólico (OR 1,77, 95%CI: 1,25-2,49) y los criterios de triglicéridos (OR 1,70, 95%CI: 1,30-2,24), HDL-colesterol (OR 1,65, 95%CI: 1,06-2,58), circunferencia de cintura (OR 1,57, 95%CI: 1,17-2,11) y glucosa en ayunas (OR 1,35, 95%CI: 1,03-1,77), ajustando por el nivel de actividad física. Conclusiones: un mayor tiempo sentado se asocia con un aumento de la prevalencia de síndrome metabólico independientemente de la actividad física realizada. Estos resultados podrían ser útiles para llevar a cabo estrategias efectivas de promoción de la salud cardiovascular, especialmente en los lugares de trabajo (AU)

Validation of a questionnaire to measure overall Mediterranean lifestyle habits for research application: the MEDiterranean LIFEstyle index (MEDLIFE) / Validación de un cuestionario para medir los hábitos de estilo de vida mediterráneos para su aplicación en investigación: índice de estilo de vida mediterráneo (MEDLIFE)

Background: the Mediterranean Lifestyle index (MEDLIFE) was developed as a questionnaire to capture adherence to an overall Mediterranean healthy lifestyle. The reliability of the MEDLIFE as an independent questionnaire must be evaluated prior its use in research studies. Objective: to assess the inter-method reliability of the MEDLIFE as a short and independent research tool. Design: the 28-item MEDLIFE questionnaire and a 142-item validated questionnaire (full-Q) from which we derived the 28-items MEDLIFE (MEDLIFE-derived) were administered simultaneously to 196 adults (mean age 41.4 ± 9.2 y) living in Madrid, Spain. The reliability was assessed by Kappa (k) statistics, intra-class correlation coefficients (ICC) and limits of agreement (LOA). Results: overall correlation between the two instruments was 0.626. MEDLIFE had an acceptable ability to rank participants by MEDLIFE-derived from full-Q (ICC=0.544). Absolute agreement showed very good concordance for 10.7% of the items evaluated; good to moderate concordance for most items, and fair concordance for 32.1% of the items. Intake of sweets, processed meats, low-fat dairy products and cereals were overestimated by MEDLIFE. About 38%, 15%, 12% and 10% of participants who scored 1-point for those items in MEDLIFE also scored 1-point in the MEDLIFE-derived respectively. Bland Altman’s analysis showed that LOA ranged from -4.66 to 7.45 (mean=1.40). Conclusion: the MEDLIFE is a valid instrument to measure overall adherence to the Mediterranean lifestyle in middle age adults from a Spanish population, and could be used as an independent questionnaire in clinical and epidemiological studies for such population. Its generalizability and predictive validity for clinical outcomes remains to be investigated (AU)

Antecedentes: el índice de estilo de vida mediterráneo (MEDLIFE) fue desarrollado como un cuestionario para recoger la adherencia a un estilo de vida saludable mediterráneo. La fiabilidad del MEDLIFE como cuestionario independiente debe ser evaluada antes de su uso en estudios de investigación. Objetivo: evaluar la fiabilidad inter-método del MEDLIFE como herramienta de investigación corta e independiente. Diseño: cuestionario corto del MEDLIFE de 28 ítems y un cuestionario largo validado de 142 ítems, del cual se derivó posteriormente el cuestionario del MEDLIFE de 28 ítems (MEDLIFE-derivado), se administraron simultáneamente a 196 adultos (edad media 41,4 ± 9,2 años) con residencia en Madrid, España. La fiabilidad se evaluó mediante el coeficiente kappa de Cohen, el coeficiente de correlación intraclase (CCI) y el límite de acuerdo (LOA). Resultados: el grado de correlación entre los dos instrumentos fue 0,626. El MEDLIFE tuvo una capacidad aceptable para clasificar a los participantes mediante el MEDLIFE-derivado (ICC=0,544). El grado de acuerdo absoluto (coeficiente kappa) mostró muy buena concordancia para el 10,7% de los ítems evaluados; de buena a moderada para la mayoría de los ítems, y razonable para el 32,1% de los ítems. La ingesta de dulces, carnes procesadas, productos lácteos bajos en grasa y cereales se sobreestimó por el MEDLIFE. El 38%, 15%, 12% y 10% de los participantes que obtuvieron 1 punto para esos ítems en el MEDLIFE también obtuvieron 1 punto en el MEDLIFE-derivado, respectivamente. El análisis de Bland Altman mostró un rango de LOA de -4,66 a 7,45 (media = 1,40). Conclusión: el MEDLIFE es un instrumento válido para medir la adherencia global al estilo de vida mediterráneo en adultos de mediana edad de una población española, y podría ser utilizado como cuestionario independiente en estudios clínicos y epidemiológicos para tal población. Su generalización y validez predictiva para los parámetros clínicos debe ser investigada (AU)

VALIDATION OF A QUESTIONNAIRE TO MEASURE OVERALL MEDITERRANEAN LIFESTYLE HABITS FOR RESEARCH APPLICATION: THE MEDITERRANEAN LIFESTYLE INDEX (MEDLIFE).

BACKGROUND: the Mediterranean Lifestyle index (MEDLIFE) was developed as a questionnaire to capture adherence to an overall Mediterranean healthy lifestyle. The reliability of the MEDLIFE as an independent questionnaire must be evaluated prior its use in research studies. OBJECTIVE: to assess the inter-method reliability of the MEDLIFE as a short and independent research tool. DESIGN: the 28-item MEDLIFE questionnaire and a 142-item validated questionnaire (full-Q) from which we derived the 28-items MEDLIFE (MEDLIFE-derived) were administered simultaneously to 196 adults (mean age 41.4 ± 9.2 y) living in Madrid, Spain. The reliability was assessed by Kappa (k) statistics, intra-class correlation coefficients (ICC) and limits of agreement (LOA). RESULTS: overall correlation between the two instruments was 0.626. MEDLIFE had an acceptable ability to rank participants by MEDLIFE-derived from full-Q (ICC = 0.544). Absolute agreement showed very good concordance for 10.7% of the items evaluated; good to moderate concordance for most items, and fair concordance for 32.1% of the items. Intake of sweets, processed meats, low-fat dairy products and cereals were overestimated by MEDLIFE. About 38%, 15%, 12% and 10% of participants who scored 1-point for those items in MEDLIFE also scored 1-point in the MEDLIFE-derived respectively. Bland Altman's analysis showed that LOA ranged from -4.66 to 7.45 (mean = 1.40). CONCLUSION: the MEDLIFE is a valid instrument to measure overall adherence to the Mediterranean lifestyle in middle age adults from a Spanish population, and could be used as an independent questionnaire in clinical and epidemiological studies for such population. Its generalizability and predictive validity for clinical outcomes remains to be investigated.

Antecedentes: el índice de estilo de vida mediterráneo (MEDLIFE) fue desarrollado como un cuestionario para recoger la adherencia a un estilo de vida saludable mediterráneo. La fiabilidad del MEDLIFE como cuestionario independiente debe ser evaluada antes de su uso en estudios de investigación. Objetivo: evaluar la fiabilidad inter-método del MEDLIFE como herramienta de investigación corta e independiente. Diseño: cuestionario corto del MEDLIFE de 28 ítems y un cuestionario largo validado de 142 ítems, del cual se derivó posteriormente el cuestionario del MEDLIFE de 28 ítems (MEDLIFE-derivado), se administraron simultáneamente a 196 adultos (edad media 41,4 ± 9,2 años) con residencia en Madrid, España. La fiabilidad se evaluó mediante el coeficiente kappa de Cohen, el coeficiente de correlación intraclase (CCI) y el límite de acuerdo (LOA). Resultados: el grado de correlación entre los dos instrumentos fue 0,626. El MEDLIFE tuvo una capacidad aceptable para clasificar a los participantes mediante el MEDLIFE-derivado (ICC = 0,544). El grado de acuerdo absoluto (coeficiente kappa) mostró muy buena concordancia para el 10,7% de los ítems evaluados; de buena a moderada para la mayoría de los ítems, y razonable para el 32,1% de los ítems. La ingesta de dulces, carnes procesadas, productos lácteos bajos en grasa y cereales se sobreestimó por el MEDLIFE. El 38%, 15%, 12% y 10% de los participantes que obtuvieron 1 punto para esos ítems en el MEDLIFE también obtuvieron 1 punto en el MEDLIFE-derivado, respectivamente. El análisis de Bland Altman mostró un rango de LOA de -4,66 a 7,45 (media = 1,40). Conclusión: el MEDLIFE es un instrumento válido para medir la adherencia global al estilo de vida mediterráneo en adultos de mediana edad de una población española, y podría ser utilizado como cuestionario independiente en estudios clínicos y epidemiológicos para tal población. Su generalización y validez predictiva para los parámetros clínicos debe ser investigada.

Soluble and insoluble dietary fibre intake and risk factors for metabolic syndrome and cardiovascular disease in middle-aged adults: the AWHS cohort / Ingesta de fibra soluble e insoluble y factores de riesgo de síndrome metabólico y enfermedad cardiovascular en adultos de mediana edad: la cohorte AWHS

Introduction: The Westernization of the Mediterranean lifestyle has led to a modification of certain dietary habits such as a decrease in the consumption of dietary fibre-rich foods. The impact of these changes on cardiovascular diseases (CVD) has been studied over the last few years and the effect of the different sources of fibre on cardiovascular risk parameters and coronary heart disease (CHD) continues to create controversy. Objective: To evaluate the association between the source of dietary fibre and the prevalence of metabolic syndrome (MetS) and other cardiovascular risk factors in a Spanish working population. Subjects and methods: The study was carried out in a sample of 1592 Spanish workers free of CVD (40-55 years old) within the Aragon Workers' Health Study (AWHS) cohort. Sociodemographic, anthropometric, clinical and biochemical data were collected. Fibre intake was assessed by means of a validated 136-items semiquantitative food-frequency questionnaire. MetS was defined by using the modified National Cholesterol Education Programme - Adult Treatment Panel III (NCEP- ATP III) definition. Results: After adjusting for possible confounding factors, we found an inverse association between insoluble fibre intake and systolic and diastolic blood pressure, total cholesterol, triglycerides, apolipoprotein B100 and ratio TG/HDL. Soluble fibre was inversely associated with triglycerides and apolipoprotein B100. Furthermore, prevalence of MetS was found to be lower (OR 0.62, 95% CI: 0.40-0.96) in those participants in the highest quartile of insoluble fibre intake. Conclusion: A higher intake of insoluble fibre could play an important role in the control and management of hypertension, lipid profile and MetS (AU)

Introducción: La occidentalización del estilo de vida mediterráneo ha dado lugar a una modificación de ciertos hábitos dietéticos, tales como una disminución en el consumo de alimentos ricos en fibra dietética. El impacto de estos cambios sobre las enfermedades cardiovasculares (ECV) se ha estudiado en los últimos años y el efecto de las diferentes fuentes de fibra en los parámetros de riesgo cardiovascular y en la enfermedad coronaria sigue creando controversia. Objetivo: Evaluar la asociación entre la fuente de fibra dietética y la prevalencia de síndrome metabólico (SM) y otros factores de riesgo cardiovascular en una población laboral española. Sujetos y métodos: El estudio se llevó a cabo en una muestra de 1592 trabajadores españoles libres de ECV (40-55 años) pertenecientes a la cohorte del Estudio de la Salud de los Trabajadores de Aragón (AWHS). Se recogieron datos sociodemográficos, antropométricos, clínicos y bioquímicos. La ingesta de fibra se evaluó por medio de un cuestionario semicuantitativo de frecuencia de consumo de alimentos de 136-items previamente validado. Para la definición de SM se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Resultados: Se encontró una asociación inversa entre el consumo de fibra insoluble y la presión arterial sistólica y diastólica, colesterol total, triglicéridos, apolipoproteína B100 y la relación TG/HDL, tras ajustar por posibles factores de confusión. Así mismo, la fibra soluble se asoció inversamente con triglicéridos y apolipoproteína B100. Además, se encontró una menor prevalencia de SM (OR 0.62, IC del 95%: 0.40 a 0.96) en aquellos participantes en el cuartil más alto de consumo de fibra insoluble. Conclusión: Una mayor ingesta de fibra insoluble puede desempeñar un papel importante en el control y manejo de la hipertensión, el perfil lipídico y el SM (AU)

Soluble and insoluble dietary fibre intake and risk factors for metabolic syndrome and cardiovascular disease in middle-aged adults: the AWHS cohort.

INTRODUCTION: The Westernization of the Mediterranean lifestyle has led to a modification of certain dietary habits such as a decrease in the consumption of dietary fibre-rich foods. The impact of these changes on cardiovascular diseases (CVD) has been studied over the last few years and the effect of the different sources of fibre on cardiovascular risk parameters and coronary heart disease (CHD) continues to create controversy. OBJECTIVE: To evaluate the association between the source of dietary fibre and the prevalence of metabolic syndrome (MetS) and other cardiovascular risk factors in a Spanish working population. SUBJECTS AND METHODS: The study was carried out in a sample of 1592 Spanish workers free of CVD (40-55 years old) within the Aragon Workers' Health Study (AWHS) cohort. Sociodemographic, anthropometric, clinical and biochemical data were collected. Fibre intake was assessed by means of a validated 136-items semiquantitative food-frequency questionnaire. MetS was defined by using the modified National Cholesterol Education Programme - Adult Treatment Panel III (NCEP- ATP III) definition. RESULTS: After adjusting for possible confounding factors, we found an inverse association between insoluble fibre intake and systolic and diastolic blood pressure, total cholesterol, triglycerides, apolipoprotein B100 and ratio TG/HDL. Soluble fibre was inversely associated with triglycerides and apolipoprotein B100. Furthermore, prevalence of MetS was found to be lower (OR 0.62, 95% CI: 0.40-0.96) in those participants in the highest quartile of insoluble fibre intake. CONCLUSION: A higher intake of insoluble fibre could play an important role in the control and management of hypertension, lipid profile and MetS.

Introducción: La occidentalización del estilo de vida mediterráneo ha dado lugar a una modificación de ciertos hábitos dietéticos, tales como una disminución en el consumo de alimentos ricos en fibra dietética. El impacto de estos cambios sobre las enfermedades cardiovasculares (ECV) se ha estudiado en los últimos años y el efecto de las diferentes fuentes de fibra en los parámetros de riesgo cardiovascular y en la enfermedad coronaria sigue creando controversia. Objetivo: Evaluar la asociación entre la fuente de fibra dietética y la prevalencia de síndrome metabólico (SM) y otros factores de riesgo cardiovascular en una población laboral española. Sujetos y métodos: El estudio se llevó a cabo en una muestra de 1592 trabajadores españoles libres de ECV (40-55 años) pertenecientes a la cohorte del Estudio de la Salud de los Trabajadores de Aragón (AWHS). Se recogieron datos sociodemográficos, antropométricos, clínicos y bioquímicos. La ingesta de fibra se evaluó por medio de un cuestionario semicuantitativo de frecuencia de consumo de alimentos de 136-items previamente validado. Para la definición de SM se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Resultados: Se encontró una asociación inversa entre el consumo de fibra insoluble y la presión arterial sistólica y diastólica, colesterol total, triglicéridos, apolipoproteína B100 y la relación TG/HDL, tras ajustar por posibles factores de confusión. Así mismo, la fibra soluble se asoció inversamente con triglicéridos y apolipoproteína B100. Además, se encontró una menor prevalencia de SM (OR 0.62, IC del 95%: 0.40 a 0.96) en aquellos participantes en el cuartil más alto de consumo de fibra insoluble. Conclusión: Una mayor ingesta de fibra insoluble puede desempeñar un papel importante en el control y manejo de la hipertensión, el perfil lipídico y el SM.

Genetic variation of apolipoproteins, diet and other environmental interactions; an updated review / Variaciones genéticas de las apolipoproteínas y su interacción con componentes de la dieta y otros factores ambientales; una revisión actualizada

This paper summarizes the recent findings from studies investigating the potential environmental modulation of the genetic variation of apolipoprotein genes on metabolic traits. We reviewed nutrigenetic studies evaluating variations on apolipoproteins-related genes and its associated response to nutrients (mostly dietary fatty acids) or any other dietary or environmental component. Most revised research studied single nucleotide polymorphism (SNP) and specific nutrients through small intervention studies, and only few interactions have been replicated in large and independent populations (as in the case of -265T > C SNP in APOA2 gene). Although current knowledge shows that variations on apolipoprotein genes may contribute to the different response on metabolic traits due to dietary interventions, evidence is still scarce and results are inconsistent. Success in this area will require going beyond the limitations of current experimental designs and explore the hypotheses within large populations. Some of these limitations are being covered by the rapidly advance in high-throughput technologies and large scale-genome wide association studies (AU)

Este artículo resume los hallazgos recientes de estudios que investigan la potencial modulación, por parte de factores ambientales, del riesgo metabólico asociado a determinadas variantes genéticas de apolipoproteínas. Se han revisado estudios nutrigenéticos que evalúan variaciones en genes relacionados con apolipoproteínas y su asociación en respuesta a la ingesta de nutrientes (frecuentemente ácidos grasos) o cualquier otro componente de la dieta o del medio ambiente. La mayoría de la bibliografía revisada se centra en polimorfismos de un solo nucléotido (SNP) y nutrientes específicos a través de estudios de intervención de pequeña escala y pocas interacciones han sido replicadas en poblaciones independientes y de gran tamaño (como en el caso del SNP-265T > C en el gen APOA2). Aunque el conocimiento actual indica que ciertas variaciones genéticas de las apolipoproteínas pueden contribuir a la diferente respuesta sobre determinados factores metabólicos debido a las intervenciones dietéticas, la evidencia es todavía escasa y los resultados son inconsistentes. El éxito en esta área requiere superar las limitaciones de los diseños experimentales actuales y explorar estas hipótesis en poblaciones más amplias aprovechando el rápido avance de las tecnologías de alto rendimiento y la disponibilidad de datos del genoma completo (AU)

Genetic variation of apolipoproteins, diet and other environmental interactions; an updated review.

This paper summarizes the recent findings from studies investigating the potential environmental modulation of the genetic variation of apolipoprotein genes on metabolic traits. We reviewed nutrigenetic studies evaluating variations on apolipoproteins-related genes and its associated response to nutrients (mostly dietary fatty acids) or any other dietary or environmental component. Most revised research studied single nucleotide polymorphism (SNP) and specific nutrients through small intervention studies, and only few interactions have been replicated in large and independent populations (as in the case of -265T > C SNP in APOA2 gene). Although current knowledge shows that variations on apolipoprotein genes may contribute to the different response on metabolic traits due to dietary interventions, evidence is still scarce and results are inconsistent. Success in this area will require going beyond the limitations of current experimental designs and explore the hypotheses within large populations. Some of these limitations are being covered by the rapidly advance in high-throughput technologies and large scale-genome wide association studies.

Este artículo resume los hallazgos recientes de estudios que investigan la potencial modulación, por parte de factores ambientales, del riesgo metabólico asociado a determinadas variantes genéticas de apolipoproteínas. Se han revisado estudios nutrigenéticos que evalúan variaciones en genes relacionados con apolipoproteínas y su asociación en respuesta a la ingesta de nutrientes (frecuentemente ácidos grasos) o cualquier otro componente de la dieta o del medio ambiente. La mayoría de la bibliografía revisada se centra en polimorfismos de un solo nucléotido (SNP) y nutrientes específicos a través de estudios de intervención de pequeña escala y pocas interacciones han sido replicadas en poblaciones independientes y de gran tamaño (como en el caso del SNP-265T > C en el gen APOA2). Aunque el conocimiento actual indica que ciertas variaciones genéticas de las apolipoproteínas pueden contribuir a la diferente respuesta sobre determinados factores metabólicos debido a las intervenciones dietéticas, la evidencia es todavía escasa y los resultados son inconsistentes. El éxito en esta área requiere superar las limitaciones de los diseños experimentales actuales y explorar estas hipótesis en poblaciones más amplias aprovechando el rápido avance de las tecnologías de alto rendimiento y la disponibilidad de datos del genoma completo.

Validation of FFQ-based assessment of dietary lignans compared with serum enterolactone in Swedish women.

The validity of using FFQ to assess dietary lignans is uncertain. We aimed to validate the use of FFQ for the assessment of dietary intake of lignans compared to the serum biomarker enterolactone, the main product of dietary lignans' metabolism in human subjects. A random sample of women, aged 55-75 years, from the Swedish Mammography Cohort was selected. Information from two FFQ, the FFQ-87 (sixty-seven food items) and the FFQ-97 (ninety-three food items), and blood samples were collected. Dietary intake of lignans (secoisolariciresinol, matairesinol, lariciresinol, pinoresinol, medioresinol and syringaresinol) was assessed by the FFQ. Serum concentrations of enterolactone were analysed by time-resolved fluoroimmunoassay. The correlation coefficient between energy-adjusted lignan intake and serum enterolactone was estimated in crude and multivariable-adjusted models, taking into account the factors potentially influencing the serum enterolactone. Among the 135 participants aged 55-75 years, with a mean BMI of 26·7 kg/m², the average energy-adjusted intake of total lignans was 1616 (sd 424) and 1516 (sd 409) µg/d according to the FFQ-87 (forty-five food items containing lignans) and the FFQ-97 (sixty-five food items containing lignans), respectively. The mean concentration of serum enterolactone was 23·2 (sd 15·4) nmol/l. The adjusted Pearson's correlation between dietary intake of lignans assessed by the FFQ-97 and serum enterolactone was statistically significant (r 0·22, P= 0·01). No significant correlation was observed for the FFQ-87 (r 0·09, P= 0·30). The present study indicates that the FFQ-97 might be better than the FFQ-87 for assessing dietary intake of lignans, although the correlation was low.

Transient increase in homocysteine but not hyperhomocysteinemia during acute exercise at different intensities in sedentary individuals.

Considering that hyperhomocysteinemia is an independent risk factor for cardiovascular disease, the purpose of this study was to determine the kinetics of serum homocysteine (tHcy) and the vitamins involved in its metabolism (folates, B(12), and B(6)) in response to acute exercise at different intensities. Eight sedentary males (18-27 yr) took part in the study. Subjects were required to complete two isocaloric (400 kcal) acute exercise trials on separate occasions at 40% (low intensity, LI) and 80% VO(2peak) (high intensity, HI). Blood samples were drawn at different points before (pre4 and pre0 h), during (exer10, exer20, exer30, exer45, and exer60 min), and after exercise (post0, post3, and post19 h). Dietary, genetic, and lifestyle factors were controlled. Maximum tHcy occurred during exercise, both at LI (8.6 (8.0-10.1) µmol/L, 9.3% increase from pre0) and HI (9.4 (8.2-10.6) µmol/L, 25.7% increase from pre0), coinciding with an accumulated energy expenditure independent of the exercise intensity. From this point onwards tHcy declined until the cessation of exercise and continued descending. At post19, tHcy was not different from pre-exercise values. No values of hyperhomocysteinemia were observed at any sampling point and intensity. In conclusion, acute exercise in sedentary individuals, even at HI, shows no negative effect on tHcy when at least 400 kcal are spent during exercise and the nutritional status for folate, B(12), and B(6) is adequate, since no hyperhomocysteinemia has been observed and basal concentrations were recovered in less than 24 h. This could be relevant for further informing healthy exercise recommendations.

Aragon workers' health study--design and cohort description.

BACKGROUND: Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers' Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS. METHODS/DESIGN: Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain). Study participants were recruited during a standardized clinical exam in 2009-2010 (participation rate 95.6%). Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index). Participants will be followed-up for 10 years. RESULTS: The average (SD) age, body mass index, and waist circumference were 49.3 (8.7) years, 27.7 (3.6) kg/m² and 97.2 (9.9) cm, respectively, among males (N = 5,048), and 40.8 (11.6) years, 24.4 (3.8) kg/m², and 81.9 (9.9) cm, among females (N = 351). The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male), the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least one plaque in the carotid or femoral arteries. DISCUSSION: Baseline data from the AWHS show a high prevalence of cardiovascular risk factors and of sublinical atherosclerosis. Follow-up of this cohort will allow the assessment of subclinical atherosclerosis progression and the link of disease progression to traditional and emergent risk factors.

Comparative activities of daidzein metabolites, equol and O-desmethylangolensin, on bone mineral density and lipid metabolism in ovariectomized mice and in osteoclast cell cultures.

Daidzein, a major isoflavone predominantly found in soybean, is mainly metabolized to equol and O-desmethylangolensin (O-DMA) by the human gut microflora. Equol exhibits a stronger estrogenic activity than daidzein, however, only approximately 30% of the population has been identified as equol-producers and there are too few direct evidences of the effects of the other major metabolite, O-DMA on estrogen-deficient status. The purpose of this study is therefore, to compare the effect of both O-DMA and equol on bone and lipid metabolism in vivo and in vitro. For the in vivo study, 8-week-old female mice were assigned to five groups as follows: sham-operated (sham), ovariectomized (OVX), OVX + 0.5 mg/day O-DMA (OVX + O-DMA), OVX + 0.5 mg/day equol (OVX + Eq), and OVX + 0.03 microg/day 17beta-estradiol (OVX + E2) administration. Three weeks after the intervention, O-DMA and equol did not affect uterine atrophy in OVX mice. The bone mineral density (BMD) of the femur was lower in the OVX group than in the sham group. The administration of equol but not O-DMA, maintained BMD through the intervention. Values of whole body fat mass and plasma lipids were lower in the equol and O-DMA treated OVX mice than those in OVX mice. In the in vitro study, equol significantly inhibited the osteoclast formation induced by 1alpha,25(OH)(2)D(3) in a dose-dependent manner in a co-culture system of mouse bone-marrow cells with primary osteoblastic cells. However, O-DMA slightly inhibited osteoclast formation, and the effect was not dose dependent. These results suggest that the effects of O-DMA on bone and lipid metabolism in OVX mice and osteoclast cell cultures are weaker than those of equol.