Association of blood manganese concentrations with 24-h based brachial and central blood pressure, and pulse-wave velocity.

Potential environmental determinants of BP and hypertension in older adults are far less known than their lifestyle risk factors. Manganese (Mn) is an essential element for life that may induce changes in blood pressure (BP), but the direction of the association is unclear. We aimed to examine the association of blood manganese (bMn) with 24-h-based brachial, central BP (cBP), and pulse-wave velocity (PWV). With this purpose, we analyzed data from 1009 community-living adults aged >65 years without BP medication. bMn was measured using inductively-coupled plasma-mass spectrometry and 24-h BP with validated devices. The association of bMn (median: 6.77 µg/L; IQR: 5.59-8.27) with daytime brachial and central systolic (SBP) and with diastolic BP (DBP) was non-linear, with BP increases up to around the median of Mn and then stabilization or slight rightward decrease. Mean BP differences (95% confidence interval) comparing Mn Q2 to Q5 (vs Q1 quintile) for brachial daytime SBP were 2.56 (0.22; 4.90), 3.59 (1.22; 5.96), 3.14 (0.77; 5.51) and 1.72 (-0.68; 4.11) mmHg, respectively; and 2.22 (0.70, 3.73), 2.55 (1.01, 4.08), 2.45 (0.91; 3.98), and 1.68 (0.13; 3.24), respectively, for DBP. Daytime central-pressures showed a similar dose-response relationship with bMn as daytime brachial-pressures. The association with nighttime BP was linearly positive for brachial BPs, and only increasing for Q5 for cBP. Regarding PWV, a tendency to significant linear increase along bMn levels was observed (p-trend = 0.042). The present findings extend the scarce evidence on the association between Mn and brachial BP to 2 other vascular parameters, suggesting Mn levels as a candidate risk factor for increasing levels of both brachial and cBPs in older adults, yet further research is needed with larger cohort studies in adults at all age ranges.

Prevention of Alzheimer's Disease and Cognitive Decline with Diet and Lifestyle: Proceedings of the A. G. Leventis Foundation Conference.

The A. G. Leventis Foundation International Conference, "Prevention of Alzheimer's Disease and Cognitive Decline with Diet and Lifestyle", was held on May 11-12th, 2022 in Nicosia, Cyprus. This conference examined the role of diet and lifestyle for the prevention and treatment of Alzheimer's Disease and other forms of cognitive decline. Speakers from leading academic institutions presented evidence on healthy dietary patterns, with a particular focus on the traditional Mediterranean diet (MedDiet), in association with cognitive outcomes, mainly cognitive decline, dementia, and Alzheimer's disease, from both observational and interventional studies. Moreover, future directions for the potential use of olive oil, rich in polyphenols, for its therapeutic use as a nutraceutical, as well as nutritional interventions with high-quality dietary patterns (i.e. MedDiet) that support existing primarily observational evidence for the prevention of cognitive decline, as well as challenges in designing rigorous clinical trials are summarized and discussed within the conference proceedings.

Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'.

BACKGROUND: Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS: We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS: The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS: The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.

Plant-Based Diets and All-cause and Cardiovascular Mortality in a Nationwide Cohort in Spain: The ENRICA Study.

OBJECTIVE: To investigate the associations of a healthful plant-based diet index (hPDI) and an unhealthful plant-based diet index (uPDI) with all-cause and cardiovascular disease (CVD) mortality in Spanish adults. PATIENTS AND METHODS: We analyzed data from 11,825 individuals 18 years of age or older, representative of the Spanish population, recruited between 2008 and 2010 and followed-up to 2020. Food consumption was collected at baseline using a validated dietary history, which served to calculate two plant-based diet indices based on 18 major food groups (range, 18-90 points). For (1) hPDI only the consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee) received positive scores; whereas for (2) uPDI, only the consumption of less healthy plant foods (fruit juices, sugar-sweetened beverages, refined grains, potatoes, and sweets/desserts) received positive scores. Multivariable-adjusted Cox models were used to estimate HRs and their 95% CIs. RESULTS: After a median follow-up of 10.9 and 9.8 years, 699 all-cause and 157 CVD deaths were ascertained, respectively. Each 10-point increase in hPDI was associated with 14% lower risk of all-cause death (HR, 0.86; 95% CI, 0.74 to 0.99), and 37% lower risk of CVD death (HR, 0.63; 95% CI, 0.46 to 0.85). No significant associations were found for uPDI. CONCLUSION: Higher adherence to an hPDI diet, but not to a uPDI, was associated with lower all-cause and CVD mortality. This suggests that the quality of the plant food consumed is paramount to achieve diet-related benefits in mortality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02804672.

Selenium and impaired physical function in US and Spanish older adults.

BACKGROUND: Selenium (Se) is a trace element with a narrow safety margin. OBJECTIVES: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DESIGN: NHANES 2011-2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017-2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. RESULTS: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 µg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 µg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DISCUSSION: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.

Association between a Healthy Lifestyle Score and inflammatory markers among Puerto Rican adults.

BACKGROUND AND AIMS: The relationship between multiple lifestyle components analyzed in combination and inflammation remains understudied. We aimed to assess the association between a Healthy Lifestyle Score (HLS) that includes adherence to five behavioral components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep) and inflammatory markers, as well as the role of the HLS in inflammation among individuals with cardiometabolic conditions, in Puerto Rican adults. METHODS AND RESULTS: In a cross-sectional study of 842 Puerto Ricans adults (aged 45-75 y) living in Boston, MA, the HLS (range = 0-190; maximum indicative of healthiest adherence) was analyzed for association with three inflammatory markers: interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP). In multivariable-adjusted models, the HLS was inversely associated with IL-6 (ß ± SE = -0.55 ± 0.13; P < 0.001) and TNF-α (-0.39 ± 0.13; P = 0.004). The dietary and smoking components were associated with both inflammatory markers independently of the other HLS components. Significant inverse associations were observed for each 20-unit increase in HLS and IL-6 and TNF-α for participants with hypertension (n = 600; ß ± SE = -0.58 ± 0.16; -0.46 ± 0.16, respectively) and with overweight/obesity (n = 743; ß ± SE = -0.59 ± 0.13; -0.50 ± 0.14, respectively), but not for those with diabetes (n = 187) or heart disease (n = 192). The HLS was not associated with CRP, after adjustment for potential confounders. CONCLUSION: Higher adherence to multiple lifestyle behaviors was associated with lower concentrations of inflammatory markers. Because low-grade inflammation may precede chronic diseases, following an overall healthy lifestyle may help lower risk of these diseases.

Development and validation of a questionnaire to evaluate lifestyle-related behaviors in elementary school children.

BACKGROUND: The SI! Program promotes cardiovascular health through a multilevel school-based intervention on four lifestyle-related components: diet, physical activity, understanding the body and heart, and management of emotions. We report here the development and validation of the KAH (knowledge, attitudes and habits)-questionnaire adapted for elementary school children (6-7 years old) as a tool for the forthcoming evaluation of the SI! Program, where the KAH scoring will be the primary outcome. The efficacy of such an intervention will be based on the improvements in children's KAH towards a healthy lifestyle. METHODS: The questionnaire validation process started with a pool of items proposed by the pedagogical team who developed the SI! Program for elementary school. The questionnaire was finalized by decreasing the number of items from 155 to 48 using expert panels and statistical tests on the responses from 384 children (ages 6-7). A team of specialized psychologists administered the questionnaire at schools providing standard directions for the final administration. The internal consistency was assessed using Cronbach's α coefficients. Reliability was measured through the split-half method, and problematic items were detected applying the item response theory. Analysis of variance and Tukey's test of additivity were used for multiple comparisons. RESULTS: The final KAH-questionnaire for elementary school children should be administered to children individually by trained staff. The 48 items-questionnaire is divided evenly between the 4 components of the intervention, with an overall Cronbach's α = 0.791 (α = 0.526 for diet, α = 0.537 for physical activity, α = 0.523 for human body and heart, and α = 0.537 for management of emotions). CONCLUSIONS: The KAH-questionnaire is a reliable instrument to assess the efficacy of the SI! Program on instilling healthy lifestyle-related behaviors in elementary school children.

[Meat and fish consumption in a high cardiovascular risk Spanish Mediterranean population]. / Consumo de carne y pescado en población mediterránea española de edad avanzada y alto riesgo cardiovascular.

BACKGROUND: High saturated fat consumption, mostly from red meat and sausage meat has been associated with an increase in cardiovascular risk (CVR) in contrast to the effect of high fish consumption. OBJECTIVE: To get to know the frequency of meat and fish consumption in an elderly high Mediterranean population, their correlations with adherence to the Mediterranean diet (MD) and their association with intermediate CVR phenotypes. METHODS: A cross-sectional study was carried out on 945 people (67.4±6.2 years old) with high CVR recruited in primary care centres of Valencia, and participating in the PREDIMED study. The frequency of meat and fish consumption was determined through a validated questionnaire. We analyzed clinical, biochemical and anthropometric variables using standard methods. RESULTS: Mean red meat consumption was high (7.4±4.7 times/week), being higher in men than in women (P=0.031) and was associated with greater weight (P=0.001) and prevalence of obesity (P=0.025). Fish consumption was also high (4.5±2.6 time/week) and was associated with lower concentrations of fasting plasma glucose (P=0.016) as well as with lower prevalence of diabetes (P=0.017). CONCLUSION: Red meat consumption in this high CVR population is very high and far from the recommendations of MD, needing, therefore, to be reduced. Fish consumption is closer to the recommendations and should be maintained.

Consumo de carne y pescado en población mediterránea española de edad avanzada y alto riesgo cardiovascular / Meat and fish consumption in a high cardiovascular risk Spanish Mediterranean population

Introducción: El consumo elevado de grasas saturadas procedentes, en gran parte, de la ingesta de carne roja y embutidos se ha asociado con mayor riesgo cardiovascular (RCV) a diferencia de lo que ocurre con el consumo de pescado. Objetivo: Conocer el patrón de consumo de carne y pescado en pacientes de edad avanzada y alto RCV, sus correlaciones con la adherencia a la Dieta Mediterránea (DM) y su asociación con factores de RCV. Material y métodos: Estudio transversal en 945 personas (media de edad 67,4 ± 6,2 años), de alto RCV participantes en el estudio PREDIMED-Valencia. La frecuencia del consumo de carne y pescado se determinó a través de un cuestionario validado. Se han analizado variables clínicas, bioquímicas por métodos estándar. Resultados: El consumo de carne roja en la muestra estudiada fue elevado (7,4 ± 4,7 veces/semana) y superior en hombres que en mujeres (P = 0,031) y se asoció con mayor peso (P = 0,001) y prevalencia de obesidad (P = 0,025). El consumo de pescado también fue alto (4,5 ± 2,6 veces/semana) y se correlacionó con menor glucemia en ayunas (P = 0,016) así como con menor prevalencia de diabetes (P = 0,017). Conclusiones: El consumo de carne roja en población de alto RCV es muy elevado y se aleja de las recomendaciones de la DM, por lo que habría que disminuirlo. El consumo de pescado se ajusta más a las recomendaciones y habría que mantenerlo (AU)

Background: High saturated fat consumption, mostly from red meat and sausage meat has been associated with an increase in cardiovascular risk (CVR) in contrast to the effect of high fish consumption. Objective: To get to know the frequency of meat and fish consumption in an elderly high Mediterranean population, their correlations with adherence to the Mediterranean diet (MD) and their association with intermediate CVR phenotypes. Methods: A cross-sectional study was carried out on 945 people (67.4 ± 6.2 years old) with high CVR recruited in primary care centres of Valencia, and participating in the PREDIMED study. The frequency of meat and fish consumption was determined through a validated questionnaire. We analyzed clinical, biochemical and anthropometric variables using standard methods. Results: Mean red meat consumption was high (7.4 ± 4.7 times/week), being higher in men than in women (P = 0.031) and was associated with greater weight (P = 0.001) and prevalence of obesity (P = 0.025). Fish consumption was also high (4.5 ± 2.6 time/week) and was associated with lower concentrations of fasting plasma glucose (P = 0.016) as well as with lower prevalence of diabetes (P = 0.017). Conclusion: Red meat consumption in this high CVR population is very high and far from the recommendations of MD, needing, therefore, to be reduced. Fish consumption is closer to the recommendations and should be maintained (AU)

Association between the APOA2 promoter polymorphism and body weight in Mediterranean and Asian populations: replication of a gene-saturated fat interaction.

OBJECTIVE: The APOA2 gene has been associated with obesity and insulin resistance (IR) in animal and human studies with controversial results. We have reported an APOA2-saturated fat interaction determining body mass index (BMI) and obesity in American populations. This work aims to extend our findings to European and Asian populations. METHODS: Cross-sectional study in 4602 subjects from two independent populations: a high-cardiovascular risk Mediterranean population (n = 907 men and women; aged 67 ± 6 years) and a multiethnic Asian population (n = 2506 Chinese, n = 605 Malays and n = 494 Asian Indians; aged 39 ± 12 years) participating in a Singapore National Health Survey. Anthropometric, clinical, biochemical, lifestyle and dietary variables were determined. Homeostasis model assessment of insulin resistance was used in Asians. We analyzed gene-diet interactions between the APOA2 -265T>C polymorphism and saturated fat intake (C polymorphism on body-weight-related measures was modulated by saturated fat in Mediterranean and Asian populations.

[Coffee and tea consumption in a high cardiovascular risk Mediterranean population]. / Consumo de café y té en población mediterránea de alto riesgo cardiovascular.

INTRODUCTION: Coffee and tea consumption recommendations for a healthy diet have been changing in recent years as it has increased the level of evidence on their benefits has increased. OBJECTIVE: To know the frequency of coffee and tea consumption of in a high cardiovascular risk Mediterranean population (CVR) and to analyze whether there are differences between the consumption of these drinks by cardiovascular risk factors. METHODS: A cross-sectional study was carried out on 945 people (340 males, 605 females) (67.4+/-6.2 years old) with high CVR recruited in primary care centres of Valencia, included in the PREDIMED study. Coffee and tea consumption has been determined through a validated questionnaire. We analyzed biochemical, clinical and anthropometric variables by standard methods. RESULTS: Tea consumption is very low in this Mediterranean population (0.4+/-1.6 cups/weeks). By contrast, coffee consumption averaged nearly one cup per day (6.5+/-5.2 cups/weeks). Hypertensive patients showed a lower overall consumption of coffee than in non-hypertensive patients (6.6+/-5.1 vs 7.3+/-5.9; P=0.023 respectively). These differences were greatest when caffeinated coffee consumption is analyzed (2.9+/-4.5 vs 4.3+/-5.3, P<0001). Moreover, diabetics consumed significantly less coffee and tea than non-diabetics (P=0.015 and P=0.022 respectively), these differences being greater for caffeinated coffee (P<0.025). CONCLUSIONS: In conclusion, in this high cardiovascular risk Mediterranean population a coffee consumption pattern, based on traditional recommendations, is observed, that as a result of new scientific evidence should be update.

Consumo de café y té en población mediterránea de alto riesgo cardiovascular / Coffee and tea consumption in a high cardiovascular risk mediterranean population

Introducción: Las recomendaciones de consumo de café y té en una alimentación saludable han ido variando en los últimos años a medida que ha aumentado el nivel de evidencia acerca de los beneficios de los mismos. Objetivo: Conocer la frecuencia de consumo actual de café y té en población mediterránea de alto riesgo cardiovascular (RCV) y analizar, si hay diferencias entre el consumo de estas bebidas por factores de RCV. Material y métodos: Se ha realizado un estudio transversal en 945 personas (340 hombres, 605 mujeres) (67,4 ± 6,2 años) de alto RCV reclutados en centros de atención primaria de la Comunidad Valenciana incluidos en el estudio PREDIMED. Se ha determinado el consumo de café y de té mediante un cuestionario validado. Se han analizado variables bioquímicas, clínicas y antropométricas por métodos estándar. Resultados: El consumo de té es muy bajo en esta población mediterránea (0,4 ± 1,6 tazas/sem). Por el contrario, el consumo de café casi alcanza en promedio una taza al día (6,5 ± 5,2 tazas/sem). En los hipertensos se observa un menor consumo global de café que en los no hipertensos (6,6 ± 5,1 vs 7,3 ± 5,9; P = 0,023 respectivamente), siendo estas diferencias de consumo limitadas al café con cafeína (2,9 ± 4,5 vs 4,3 ± 5,3; P < 0,001). También los diabéticos consumen significativamente menos café y té que los no diabéticos (P = 0,015 y P = 0,022 respectivamente), siendo mayores estas diferencias para el café con cafeína (P < 0,025).Conclusión: En conclusión en esta población mediterránea de alto riesgo cardiovascular se observa un patrón de consumo de café basado en las recomendaciones clínicas tradicionales, que debería revisarse en base a las nuevas evidencias científicas (AU)

Introduction: Coffee and tea consumption recommendations for a healthy diet have been changing in recent years as it has increased the level of evidence on their benefits has increased. Objective: To know the frequency of coffee and tea consumption of in a high cardiovascular risk Mediterranean population (CVR) and to analyze whether there are differences between the consumption of these drinks by cardiovascular risk factors. Methods: A cross-sectional study was carried out on 945 people (340 males, 605 females) (67.4 ± 6.2 years old) with high CVR recruited in primary care centres of Valencia, included in the PREDIMED study. Coffee and tea consumption has been determined through a validated questionnaire. We analyzed biochemical, clinical and anthropometric variables by standard methods. Results: Tea consumption is very low in this Mediterranean population (0,4 ± 1,6 cups/weeks). By contrast, coffee consumption averaged nearly one cup per day (6,5 ± 5,2 cups/weeks). Hypertensive patients showed a lower overall consumption of coffee than in non-hypertensive patients (6,6 ± 5,1 vs 7,3 ± 5,9; P = 0,023 respectively). These differences were greatest when caffeinated coffee consumption is analyzed (2.9 ± 4.5 vs 4 3 ± 5.3, P < 0001). Moreover, diabetics consumed significantly less coffee and tea than non-diabetics (P = 0,015 and P = 0,022 respectively), these differences being greater for caffeinated coffee (P < 0,025). Conclusions: In conclusion, in this high cardiovascular risk Mediterranean population a coffee consumption pattern, based on traditional recommendations, is observed, that as a result of new scientific evidence should be update (AU