The Effect of a Program to Improve Adherence to the Mediterranean Diet on Cardiometabolic Parameters in 7034 Spanish Workers.

BACKGROUND: Cardiovascular and metabolic diseases include a large group of pathologies and constitute one of the most serious chronic health problems facing the 21st century, with high rates of morbidity and mortality worldwide. Unhealthy diets influence the development of these pathologies. The Mediterranean diet can be an important part in the treatment of these diseases. The objective of this study was to assess the effect of a program that aims to increase adherence to the Mediterranean diet on the improvement of different cardiometabolic risk parameters. METHODS: A prospective intervention study was carried out on 7034 Spanish workers. Prior to the intervention, 22 cardiometabolic risk scales were evaluated. Participants in this study were informed both orally and in writing of the characteristics and benefits of the Mediterranean diet and were given the website of the Ministry of Health, Consumption and Social Welfare of Spain, which provides advice on nutrition. Adherence to the Mediterranean diet was reinforced by sending a monthly SMS to their mobile phones. After six months of follow-up, the 22 risk scales were re-evaluated to assess changes. Means and standard deviations were calculated using Student's t test to analyse quantitative variables. Prevalence was calculated using the Chi-square test when the variables were qualitative. RESULTS: All the cardiometabolic risk scales studied decreased after implementing a program to improve and enhance adherence to the Mediterranean diet. The number of losses in the sample was very low, standing at 4.31%. CONCLUSIONS: The Mediterranean diet is effective in reducing all cardiovascular risk scales evaluated. The mean values and prevalence of high values of the different cardiometabolic risk scales analysed led to lower values after the implementation of the program to increase adherence to the Mediterranean diet. We observed a significant positive difference in metabolic age in both sexes. We have obtained a significant improvement in the insulin resistance index, especially in the SPISE-IR index, data that we have not found in previous publications. Easy access to the Internet and new information and communication technologies facilitate adherence to a diet and can reduce the number of losses.

Development of a three-dimensional printed model from a digital impression of a real patient for aesthetic dentistry undergraduate teaching.

INTRODUCTION: The acquisition of skills and manual dexterity in aesthetic dentistry in undergraduate teaching requires preclinical practices with simulation that should approximate real clinical situations. OBJECTIVE: We will present a digital procedure for the creation of three-dimensional (3D) resin models adapted to the practices of the Aesthetic Dentistry course. MATERIAL AND METHOD: Stereolithography or Standard Tesellation Language (STL) files of a real patient were previously obtained with a 3-shape intraoral scanner. Using the Exocad computer programme for dental prosthesis design, various modifications were made, such as incisor rotation, surface alterations imitating dysplasias or erosions, the creation of diastemas, or even changes in tooth size. The virtual model was printed in resin for use by students. Once the practices were finished, the students and the teachers evaluated the use of the 3D printed models. RESULTS: The result is the typodont model, in which seven laboratory sessions took place: 1-Restoration of conoid tooth morphology, 2-Cervical abrasion/ erosion restoration, 3-Direct Composite Veneer, 4-Aesthetic correction in a tooth with rotation, 5-Diastem closure, 6-Occlusal abrasions/ erosion, and 7-Maryland bridge. 90.48% of the students evaluated the designed 3D model as the best method for laboratory practice compared to other methods, obtaining a general assessment of 8.3 out of 10. CONCLUSION: The method used has provided a reproducible standard analog model for direct aesthetic dental restoration practice, with a good assessment by students and teachers.

Relación predictiva de los índices de adiposidad visceral y adiposidad disfuncional con el riesgo cardiovascular en población laboral / Predictive relationship of visceral adiposity index (VAI) and dysfunctiuonal adiposity index (DAI) with cardiovascular risk in the spanish working population

Objetivo: estimar la capacidad predictiva de los índices de adiposidad visceral (VAI) y disfuncional (DAI) en riesgo cardiovascular (RCV) de población laboral española. Métodos: análisis descriptivo en 418.343 trabajadores españoles de diferentes sectores durante la vigilancia de la salud en sus empresas. Se calculó el VAI y el DAI ajustándose a sus ecuaciones y el RCV mediante Registre Gironí del Cor (REGICOR), Systematic Coronary Risk Evaluation (SCORE) y estudio DORICA. Se estimó fortaleza asociativa mediante curvas de características operativas del receptor (ROC). El programa estadístico fue SPSS 27.0, considerando significación estadística p < 0,05. Resultados: los valores de RCV con los tres métodos son más elevados en hombres (p < 0,0001). El RCV más alto en mujeres se obtiene con REGICOR (1,58%) y en hombres con Score (11,28%). Con los métodos de valoración de RCV utilizados en ambos sexos, los valores medios de VAI y DAI van aumentando según lo hace el RCV. VAI y DAI son estimadores útiles de RCV en mujeres con DORICA AUC (área bajo la curva)-VAI 0,865 (intervalo de confianza [IC] 95%: 0,836-0,894) y AUC-DAI 0,859 (IC 95%: 0,829-0,888). En hombres, solo muestran moderada capacidad predictiva (valores AUC-VAI 0,774 (IC 95%: 0,768-0,780), AUC-DAI 0,762 (IC 95%: 0,756-0,768). La fortaleza asociativa es baja en ambos sexos con Score y REGICOR (AUC < 0,7). Conclusión: VAI y DAI aumentan sus valores medios según aumenta el RCV estimado con REGICOR, SCORE y DORICA. VAI y DAI tienen elevada capacidad predictiva con el RCV estimado con DORICA en mujeres y moderada fortaleza en hombres. (AU)

Aim: to estimate the predictive relationship of visceral adiposity (VAI) and dysfunctional adiposity (DAI) indices with cardiovascular risk (CVR) in the Spanish working population. Methods: descriptive analysis in 418,343 Spanish workers from different sectors during health monitoring in their companies. VAI and DAI were calculated according to their equations and cardiovascular risk was calculated using Regicor, Score and Dorica. Associative strength was estimated using ROC curves. The statistical programme used was SPSS 27.0, considering statistical significance P<0.05. Results: CVR values with the three methods are higher in men (P<0.0001). The highest CVR in women and men is obtained with Regicor (1.58%) and Score (11.28%), respectively. With the CVR evaluation methods used and in both sexes, the mean values of VAI and DAI increase as CVR increases. VAI and DAI are useful estimators of CVR in women with Dorica AUC -VAI 0.865 (95%CI 0.836-0.894) and AUC-DAI 0.859 (95%CI 0.829-0.888). In men they show only a moderate predictive relationship (AUC values for VAI 0.774 [95%CI 0.768-0.780] AUC DAI 0.762 [95%CI 0.756-0.768]). Strength of association is low in both sexes with Score and Regicor (AUC<0.7). Conclusion: VAI and DAI increase their mean values as estimated CVR increases with Regicor, Score and Dorica. VAI and DAI have a high predictive relationship with estimated CVR-Dorica in women and moderate strength in men. (AU)

Estimación del envejecimiento en población laboral y relación con salud psicofísica y condiciones de trabajo / Estimation of aging in the working population and relationship with psychophysical health and working conditions

Introducción:El envejecimiento de la población conlleva una mayor prevalencia de trabajadores con patología psicofísica y cognitiva con riesgo de fragilidad.Objetivo:Estimar la relación entre envejecimiento asociado a la edad en hombres y mujeres, y la salud psicofísica, emocional y deterioro cognitivo en población laboral y su repercusión según tipo de trabajo y turnicidad.Material y Método:Estudio transversal en 389 trabajadores. Se valora <50 y ≥50 años con prensión manual, circunferencia del gemelo, Fragilidad-Frail, depresión-Beck, Ansiedad-Estado-Rasgo y deterioro cognitivo-Pfeiffer y la influencia del tipo de trabajo y turnicidad.Resultados:Existe mayor fragilidad-Frail en hombres ≥ 50 años (p<0,05). El resto de variables relacionadas con estado físico, emocional y cognitivo no muestra diferencias por edad, ni con el tipo de trabajo y turnicidad (p>0,05).Conclusiones:La fragilidad estimada con el cuestionario de Frail muestra los resultados más precoces de fragilidad en hombres ≥ 50 años. (AU)

Introduction:The aging of the population leads to a higher prevalence of workers with psychophysical and cognitive pathologies at risk of frailty.Objective:To estimate the relationship between age-associated aging in men and women and psychophysical, emotional health, and cognitive impairment in the working population and its impact according to the type of work and shift work.Material and Method:Cross-sectional study with 389 workers. We assessed individuals aged <50 and ≥50 years using handgrip strength, calf circumference, Frailty-Frail assessment, Beck Depression Inventory for depression, State-Trait Anxiety Inventory for anxiety, and Pfeiffer test for cognitive impairment, while also considering the influence of the type of work and shift work.Results:There is a higher prevalence of frailty in men aged ≥50 years (p<0.05). The rest of the variables related to physical, emotional, and cognitive status do not show significant differences based on age, type of work, or shift work (p>0.05).Conclusions:Frailty, as assessed by the Frail questionnaire, reveals the earliest signs of frailty in men aged ≥50 years. (AU)

Influence of Sociodemographic Variables and Healthy Habits on the Values of Insulin Resistance Indicators in 386,924 Spanish Workers.

BACKGROUND: Insulin resistance (IR) is an alteration of the action of insulin in cells, which do not respond adequately to this action, leading to an increase in blood glucose levels. IR produces a very diverse clinical picture and increases the cardiometabolic risk of the population that suffers from it. Among the factors that influence IR are genetics, unhealthy lifestyle habits, overweight, and obesity. The objective of this work was to determine how different sociodemographic variables and healthy habits influence the values of different scales that assess the risk of presenting IR in a group of Spanish workers. METHODS: An observational, cross-sectional, descriptive study was carried out in 386,924 workers from different Spanish regions. Different sociodemographic variables and lifestyle habits were studied (age, social class, educational level, smoking, Mediterranean diet, physical exercise) along with their association with four scales to evaluate the risk of insulin resistance (TyG index, TyG-BMI, METS-IR, TG/HDL-c). To analyse the quantitative variables, Student's t test was used, while the Chi-squared test was used for the qualitative variables. A multinomial logistic regression analysis was performed, calculating the odds ratio with its 95% confidence intervals. The accepted level of statistical significance was set at p < 0.05. RESULTS: In the multivariate analysis, all variables, except educational level, increased the risk of presenting high values on the IR risk scales, especially a sedentary lifestyle and low adherence to the Mediterranean diet. CONCLUSIONS: Our results demonstrate an association between the practice of regular physical exercise and a reduction in the risk of IR; a strong role of the Mediterranean diet as a protective factor for IR; an association between aging and increased IR, which has also been suggested in other studies; and, finally, a relationship between a low socioeconomic level and an increase in IR.

Relationship between Abdominal Volume Index and Body Adiposity Index and Scales of Insulin Resistance and Metabolic Syndrome.

Introduction, objectives: Obesity is a global health problem with a great negative impact on health. Among the pathologies caused by obesity are insulin resistance and metabolic syndrome, which constitute an increasingly common health problem in both developed and developing countries. The aim of this study was to examine the relationship between two scales that assess obesity-based on hip circumference-and metabolic syndrome (MetS) and insulin resistance risk scales as predictors of these alterations. MATERIALS, METHODS: A descriptive, cross-sectional study was carried out on 193,462 workers from different Spanish regions and work groups between January 2019 and September 2021. Abdominal volume index (AVI) and body adiposity index (BAI) were evaluated to assess obesity and its association with insulin resistance using three risk scales (TyG index, Triglycerides/HDL, and METS-IR), while their association with metabolic syndrome was determined using the NCEP ATP III, IDF, and JIS models. RESULTS: The results of the ROC curves to determine the predictive value of BAI and AVI in relation to the three criteria evaluated to calculate MetS in all instances presented a higher area under the curve (AUC) for AVI. The high values of AVI stand out for predicting MetS when applying the IDF criteria. The cut-off point in women was 13.70 with a Youden index of 0.802, whereas in men, the cut-off point was set at 17.59 with a Youden index of 0.672. Regarding the relationship of BAI and AVI with insulin resistance risk scales for both sexes, the AUC only revealed high values when using the METS-IR formula for both AVI and BAI. The AVI cut-off points to predict high values of insulin resistance risk scales in women were established at 13.12 with a Youden index of 0.722. In men, the cut-off point was 17.59, with a Youden index of 0.626. The BAI cut-off points in women were set at 33.88 with a Youden index of 0.748. In men, the cut-off point was 27.91, with a Youden index of 0.598. CONCLUSIONS: AVI demonstrated its value as a predictor of metabolic syndrome while exclusively applying the IDF criteria. AVI and BAI demonstrated their value as predictors of high values of insulin resistance risk scales only in the case of METS-IR. This predictive value is also higher in women.

Determination of the Level of Cardiovascular Risk in 172,282 Spanish Working Women.

Introduction, objectives: Although cardiovascular events have been traditionally associated mainly with men, some data reflect an increase in women, which may even exceed their male counterparts, constituting the leading cause of death in working women in Spain. The objective of this present study was to analyze the level of cardiovascular risk in Spanish working women by assessing the influence of age, type of work, and tobacco consumption. MATERIAL, METHODS: A descriptive cross-sectional study was carried out in 172,282 working women from different Spanish geographical areas and from different companies between January 2018 and June 2020. A range of variables and risk factors were assessed and various cardiovascular risk scales were used to analyze the data. RESULTS: An increase in cardiovascular risk was observed in the least qualified work groups, mainly corresponding to blue-collar workers, when using the SCORE or REGICOR risk equation. The prevalence of altered values for all the parameters analyzed (overweight and obesity, hypertension, dyslipidemia, diabetes, fatty liver, hepatic fibrosis, atherogenic indexes, and cardiovascular risk scales) was higher among blue-collar women. Age was the only factor that influenced all the cardiovascular risk scales studied, increasing risk when comparing the group of women aged 50 years and older with the others. CONCLUSIONS: Aging and belonging to the blue-collar job category meant worse results in the cardiovascular risk scales and in all the parameters analyzed. This is in line with numerous studies that argue that age and zip code are more influential than genetic code.

[Predictive estimation of the Visceral Adiposity Index (VAI) and Dysfunctional Adiposity Index (DAI) for metabolic syndrome in a working population]. / Estimación predictiva en población laboral del Índice de adiposidad visceral (VAI) y adiposidad disfuncional (DAI) en síndrome metabólico.

OBJECTIVE: To evaluate metabolic syndrome using three methods proposed by  recognizedinternational institutions, and the visceral adiposity (VAI) and dysfunctional adiposity (DAI) indices for prediction and prevalence estimation in working populations. METHODS: Cross-sectional study in workers from different Spanish autonomous communities who underwent a health examination between January 2019 and September 2021 at four occupational risk prevention services. Metabolic syndrome was evaluated according to criteria from the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III), the International Diabetes Federation (IDF) and  the Joint Interim Statement (JIS). VAI and DAI values were calculated using their specific formulas and their predictive capacity was measured using ROC curves. The SPSS 27.0 program was used, with statistical significance level set at p< 0.05. RESULTS: 418 343 workers were included, mostly men (58.8%), average age between 30 and 49 years (58.0%), social class III, mostly manual workers (75.9%) and nonsmokers (66.9%). The prevalence of metabolic syndrome differed  depending on the criteria used, being higher in men with IDF and JIS, and in women with ATPIII. For the three definitions of metabolic syndrome, the values of the area under the curve were > 0.8 (>80%). The highest VAI was obtained with the JIS, and the highest DAI with the ATPIII. The highest confidence index was for ATPIII and JIS. CONCLUSIONS: The VAI and ICD adiposity indices show high predictive capacity in metabolic syndrome with all three criteria used and can be useful for prevention activities in occupational health.

Introducción: Evaluar el síndrome metabólico utilizando tres métodos propuestos por instituciones internacionales de referencia, y los índices de adiposidad visceral (VAI) y adiposidad disfuncional (DAI), en la predicción y estimación de la prevalencia en población laboral. Métodos: Estudio transversal en trabajadores de distintas comunidades autónomas españolas a los que se les realizó un examen de salud entre enero 2019 y septiembre 2021. Se evaluó el síndrome metabólico con criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III), International Diabetes Federation (IDF) y Joint Interin Statement (JIS). Se calcularon los valores de VAI y DAI mediante sus fórmulas específicas y su capacidad predictiva mediante curvas ROC. Se utilizó el programa SPSS 27.0, considerando significación estadística p< 0,05. Resultados: Se incluyeron 418 343 trabajadores, la mayoría hombres (58,8%), de edad media entre 30 y 49 años (58,0%), clase social III, tipo de trabajo manual (75,9%) y no fumadores (66,9%). La prevalencia de síndrome metabólico muestra diferencias según el criterio utilizado, siendo superior en hombres con IDF y JIS, y en mujeres con ATPIII. Para las tres definiciones de síndrome metabólico, los valores del área bajo la curva fueron > 0,8 (>80%). El VAI más elevado se obtuvo con JIS, y el DAI más alto con ATPIII. El índice de mayor confianza fue para ATPIII y JIS. Conclusiones: Los índices de adiposidad VAI y DAI muestran una elevada capacidad predictiva del síndrome metabólico con los tres criterios utilizados y pueden ser de utilidad preventiva en salud laboral.

Relationship between Atherogenic Dyslipidaemia and Lipid Triad and Scales That Assess Insulin Resistance.

BACKGROUND: Atherogenic dyslipidaemia (AD) and lipid triad (LT) are characterised by high triglyceride levels together with low HDL and normal or high LDL cholesterol and are favoured by a persistent state of insulin resistance (IR), which increases the release of free fatty acids from abdominal adipose tissue. This alteration in the lipid profile favours the accelerated development of atherosclerosis, which is the most important cause of morbidity and mortality in all countries in the developed and developing world. One of the elements that plays a major role in the genesis of AD is IR. The aim of this study was to determine the relationship between variables that assess atherogenic risk (AD and LT) and scales that assess the risk of presenting insulin resistance. METHODS: A descriptive cross-sectional study of 418,343 workers was conducted to evaluate atherogenic dyslipidaemia and lipid triad; a relationship with three insulin resistance risk scales (Triglycerides/HDL, TyG index, METS-IR) was established. The usefulness of IR risk scales for predicting AD and LT was calculated by applying ROC curves, obtaining the area under the curve (AUC) and cut-off points with their sensitivity, specificity, and Youden index. Multivariate analysis was performed by binary logistic regression. RESULTS: The prevalence of high-risk values for insulin resistance with all of the scales is much higher in people with AD and LT compared to those without. The ROC curves present us with an AUC with the three insulin resistance risk scales for the two dyslipidaemias studied with figures ranging between 0.856 and 0.991, which implies that the results are good/very good. CONCLUSIONS: A relationship between atherogenic dyslipidaemia and the three insulin resistance risk scales assessed is revealed, with higher IR mean values and prevalence in people with atherogenic dyslipidaemia and lipid triad. The three scales make it possible to adequately classify the presence of AD and LT. The highest AUC is presented by the triglycerides/HDL scale, with a result close to 1. METS-IR is the most recommended formula to estimate insulin resistance.

MAFLD and glomerular hyperfiltration in subjects with prediabetes, visceral obesity and "preserved" kidney function: A cross-sectional study.

AIMS: To investigate the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) in prediabetes, visceral obesity, and preserved kidney function, and explore whether MAFLD is associated with hyperfiltration. METHODS: We analyzed data from 6697 Spanish civil servants, aged 18-65 years, with fasting plasma glucose ≥ 100 and ≤ 125 mg/dL (prediabetes, ADA), waist circumference ≥ 94 cm in men and ≥ 80 cm in women (visceral obesity, IDF) and de-indexed estimated glomerular filtration rate (eGFR) ≥ 60 ml/min, collected during occupational health visits. The association between MAFLD and hyperfiltration (eGFR > age- and sex-specific 95th percentile) was tested by multivariable logistic regression analyses. RESULTS: Overall, 4213 patients (62.9%) had MAFLD, and 330 (4.9%) were hyperfiltering. MAFLD was more frequent in hyperfiltering than in non-hyperfiltering subjects (86.4% vs 61.7%, P < 0.001). BMI, waist circumference, systolic, diastolic, mean arterial pressure, and prevalence of hypertension were higher in hyperfiltering than in non-hyperfiltering subjects (P < 0.05). MAFLD was independently associated with hyperfiltration, even after adjusting for common confounders [OR (95% CI): 3.36 (2.33-4.84), P < 0.001]. In stratified analyses MAFLD potentiated age-related eGFR decline vs. non-MAFLD (P < 0.001). CONCLUSIONS: More than half of subjects with prediabetes, visceral obesity and eGFR ≥ 60 ml/min presented MAFLD that was associated with hyperfiltration and potentiated the age-related eGFR decline.

Determination of cardiovascular risk in Spanish veterinarians using different scaling methods.

Introduction: Cardiovascular diseases are responsible for a significant morbimortality rate around the world. Due to the characteristics of their work, health care professionals, including veterinarians, are more prone to present this type of pathology. Objectives: To determine the level of cardiovascular risk using different scales in a group of veterinarians. Methods: A descriptive and cross-sectional study of 610 Spanish veterinarians was conducted to assess cardiovascular risk scores, including 14 overweight and obesity scales, six fatty liver scales, six cardiovascular risk scales, four atherogenic indices, and three metabolic syndrome scales. Results: The prevalence of obesity among women was 7.95%, and 17.53% among men. Hypertension was present in 15.23% of women and 24.68% of men. Dyslipidemia affected 45% of women and 58.64% of men. The prevalence of metabolic syndrome according to the International Diabetes Federation criteria was slightly over 10% while 10.90% of women and 14.93% of men showed moderate to high values on the Registre Gironí del Cor scale. Conclusions: There is a moderate to high level of cardiovascular risk among veterinarians in this group.

Introdução: As doenças cardiovasculares são responsáveis por uma taxa de morbimortalidade significativa no mundo. Devido às características do seu trabalho, os profissionais de saúde, incluindo veterinários, são mais propensos a apresentar este tipo de patologia. Objetivos: Determinar o nível de risco cardiovascular utilizando diferentes escalas num grupo veterinários. Métodos: Estudo descritivo e transversal em 610 veterinários em que foram avaliadas diferentes escalas relacionadas com o risco cardiovascular, incluindo 14 escalas de excesso de peso e obesidade, seis de fígado gordo, seis de risco cardiovascular, quatro índices aterogênicos e três de síndrome metabólica. Resultados: A prevalência da obesidade foi de 7,95% nas mulheres e 17,53% nos homens. A hipertensão estava presente em 15,23% das mulheres e 24,68% dos homens. A dislipidemia afetou 45% das mulheres e 58,64% dos homens. A prevalência da síndrome metabólica com critérios da International Diabetes Federation foi ligeiramente superior a 10% enquanto valores moderados ou elevados da escala Registre Gironí del Cor foram encontrados em 10,90% das mulheres e 14,93% dos homens. Conclusões: Neste grupo de veterinários, o nível de risco cardiovascular pode ser considerado de moderado a elevado.

Dietary Intervention on Overweight and Obesity after Confinement by COVID-19.

BACKGROUND: Obesity has become a public health problem in our society and is associated with many diseases, including type 2 diabetes mellitus, cardiovascular diseases, dyslipidemia, respiratory diseases, and cancer. Several studies relate weight loss in obese patients to improved anthropometric measurements and cardiometabolic risk. The objective of our study was to evaluate anthropometric changes, analytical parameters, insulin resistance, fatty liver, and metabolic scales, after a personalized weight loss program, through dietary advice to increase adherence to the Mediterranean diet and a motivational booster via mobile SMS messaging. METHODS: Intervention study on a sample of 1964 workers, in which different anthropometric parameters were evaluated before and after dietary intervention: the metabolic score of insulin resistance; non-alcoholic fatty liver disease using different scales; metabolic syndrome; atherogenic dyslipidemia; and the cardiometabolic index. A descriptive analysis of the categorical variables was performed, by calculating the frequency and distribution of the responses for each one. For quantitative variables, the mean and standard deviation were calculated, since they followed a normal distribution. Bivariate association analysis was performed by applying the chi-squared test (corrected by Fisher's exact statistic when conditions required it) and Student's t-test for independent samples (for comparison of means). RESULTS: The population subjected to the Mediterranean diet improved in all the variables evaluated at 12 months of follow-up and compliance with the diet. CONCLUSIONS: Dietary advice on a Mediterranean diet and its reinforcement with reminder messages through the use of mobile phones may be useful to improve the parameters evaluated in this study and reduce the cardiometabolic risk of patients.

Waist Circumference Is an Essential Factor in Predicting Insulin Resistance and Early Detection of Metabolic Syndrome in Adults.

BACKGROUND: Metabolic syndrome (Met-S) is considered one of the most important health problems of the 21st century. It includes a group of metabolic disorders that increase the risk of cardiovascular diseases such as overweight and obesity, elevated lipid profile and blood pressure and insulin resistance (IR). Based on the information mentioned above in which there seems to be a relationship between IR and Met-S, the objective of this work was twofold: on the one hand, to assess the relationship between the values of different insulin resistance risk scales and Met-S determined with three different scales, and on the other, to determine whether any of the components of Met-S predispose more to the appearance of IR. METHODS: A descriptive cross-sectional study of 418,343 workers. Waist circumference was measured and evaluated together with six formulas to assess the insulin resistance index. Categorical variables were evaluated by calculating the frequency and distribution of each one. For quantitative variables, mean and standard deviation were determined, and Student's t-test was applied, while for qualitative variables, the chi-square test was performed. The usefulness of the different risk scales for insulin resistance for predicting metabolic syndrome was evaluated using ROC curves, the area under the curve (AUC), as well as their cut-off points for sensitivity, specificity, and the Youden index. RESULTS: People with metabolic syndrome applying any criteria had higher values in the IR risk scales. The different IR scales made it possible to adequately classify people with metabolic syndrome. Of the three definitions of Met-S, the one that showed the greatest relationship with IR was IDF. CONCLUSIONS: Most risk scales for insulin resistance enable the presence of metabolic syndrome to be adequately classified, finding the best ones if the International Diabetes Federation (IDF) criteria are applied. Of the elements included in the Met-S, the one that seems to increase the risk of presenting IR the most is waist circumference; hence, the Met-S definition that is most related to IR is that of the IDF, which is the only one of the three in which a high value of waist circumference is necessary to be able to diagnose Met-S. Waist circumference can be considered the central essential component for detecting insulin resistance and, therefore, the early detection of metabolic syndrome.

Determination of cardiovascular risk in 192,711 underweight and normal weight workers.

BACKGROUND: The aim of this study was to determine the prevalence of cardiovascular risk factors (CVRF) and the level of cardiovascular risk (CVR), determined with different scales (REGICOR, SCORE, ERICE, vascular age...) in people with low and normal weight. METHODS: A total of 192,711 underweight and normal weight Spanish workers participated. CVR parameters included were weight, abdominal circumference, blood pressure, glycemia (high >125 mg/dL or under hypoglycemic treatment) and lipids (cutoff points: total cholesterol 200 mg/dL, LDL 130 mg/dL, triglycerides 150 mg/dL) were obtained by automated enzymatic methods. Body mass index (BMI) was calculated, considering underweight 18.5 and normal weight 18.5-24.9. A descriptive analysis of the categorical variables was carried out. RESULTS: The values of analytical, anthropometric and clinical parameters were more unfavorable in the normal weight group. Also, the prevalence of alterated values of CVR seen with different scales show higher risk in this group and in all cases the values in men are worse. It was seen that the variable with the greatest influence on the appearance of altered values of the cardiovascular risk scales (CVRS), influencing all of them was the age. DISCUSSION: All the CVRS analyzed showed higher values in the group of people with normal weight compared to those with underweight. Age, followed by sex, were the variables that most influence the appearance of high CVR values.

Relationship between Insulin Resistance Risk Scales and Non-Alcoholic Fatty Liver Disease and Liver Fibrosis Scales in 219,477 Spanish Workers.

Insulin resistance (IR) has been identified as a key factor in the appearance of non-alcoholic fatty liver disease (NAFLD) as it is related through a complex molecular biochemical and immunological mechanism. Our aim was to evaluate the relationship between different scales that estimate the risk of IR and scales that determine the risk of NAFLD. This descriptive and cross-sectional study was performed in 219,477 Spanish workers from different sectors and Spanish regions. The prevalence of high values of all the IR scales increases as the values of the NAFLD and liver fibrosis scales increase. In the multivariate analysis, the risk of presenting high values in the IR scales increases greatly as the values of the NAFLD and hepatic fibrosis scales increase, with particularly high OR values when using the Metabolic Score for Insulin Resistance (METS-IR) scale (LAP high OR 42.20 (95% CI (39.10-45.56) and FLI high OR 32.35 (95% CI 31.10-33.61)). We can conclude that there is a direct relationship between the values of the IR scales and the NAFLD and liver fibrosis scales in our population.

Influence of Educational Level and Healthy Habits on the Prevalence of Diabesity in a Spanish Working Population.

BACKGROUND: Diabesity is a growing problem internationally. Taking into account the importance of physical activity and diet in its prevention and treatment, the objective of this study was to delve into the impact of healthy habits on diabesity. METHODS: A descriptive, cross-sectional study was carried out in 386,924 Spanish adult workers. Obesity was determined according to eleven different formulas. Life habits were also valued; sociodemographic variables; and educational level; as well as analytical and clinical variables such as blood pressure and blood glucose levels. The association between the different variables was performed using the chi-square and the Student's t-tests when the samples were independent. A multivariate analysis was performed using the multinomial logistic regression test by calculating the odds ratio and a 95% confidence interval. The Hosmer-Lemeshow goodness-of-fit test was also performed. RESULTS: The overall prevalence of diabesity ranged between 0.3% (95% CI 0.3-0.4) when obesity was assessed according to the abdominal volume index and 8.3% (95% CI 8.2-8.4) when evaluated according to the CUN-BAE (Clínica Universitaria de Navarra Body Adiposity Estimator) formula. The prevalence of diabesity was also higher in workers with a non-heart-healthy diet and in those who did not exercise regularly. CONCLUSIONS: The most disadvantaged socioeconomic classes are those with the highest prevalence of diabesity. It is important to prioritise prevention in populations and communities with the most unfavourable social and environmental conditions to reduce the burden of diabesity.

Relationship between Atherogenic Dyslipidaemia and Lipid Triad with Different Scales of Overweight and Obesity in 418,343 Spanish Workers.

Obesity induces alterations in lipid biochemistry, evolving toward dyslipidaemia atherogenesis, a critical factor in the development of cardiovascular events. Two relevant forms of lipid abnormalities are atherogenic dyslipidaemia (AD) and lipid triad (LT), which involve alterations in triglyceride levels, HDL-c, and LDL-c. The aim of this study was to assess the linkage of atherogenic AD and LT with different scales of overweight and obesity. We carried out a cross-sectional study including 418,343 Spanish adult workers, recruited from workplace health assessments. Atherogenic dyslipidaemia was defined as triglyceride levels ≥ 150 mg/dL, HDL values < 40 mg/dL in men and <45 mg/dL in women, and normal LDL. Additionally, if LDL levels were >160 mg/dL, LT was considered. Subjects affected by AD and LT in the study exhibited significantly higher mean values than those without AD and LT in all overweight, obesity, and body fat related scales studied. VAI (visceral adiposity index) was the strongest predictor of AD (AUC = 0.934, 95% CI: 0.933 to 0.936) and LT (AUC = 0.926, 95% CI: 0.923 to 0.928). Atherogenic dyslipidaemia and LT positively correlate with different scales of overweight and obesity. Further studies should aim to identify other contributory factors. Our obtained data might be useful in laying the groundwork for future works on AD and LT.

Impact of COVID-19 Lockdown on Non-Alcoholic Fatty Liver Disease and Insulin Resistance in Adults: A before and after Pandemic Lockdown Longitudinal Study.

BACKGROUND: Non-alcoholic fatty liver disease is a chronic disease caused by the accumulation of fat in the liver related to overweight and obesity, insulin resistance, hyperglycemia, and high levels of triglycerides and leads to an increased cardiovascular risk. It is considered a global pandemic, coinciding with the pandemic in 2020 caused by the "coronavirus disease 2019" (COVID-19). Due to COVID-19, the population was placed under lockdown. The aim of our study was to evaluate how these unhealthy lifestyle modifications influenced the appearance of metabolic alterations and the increase in non-alcoholic fatty liver disease. METHODS: A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. RESULTS: Differences in the mean values of anthropometric and clinical parameters before and after lockdown were revealed. There was a statistically significant worsening in non-alcoholic fatty liver disease (NAFLD) and in the insulin resistance scales, with increased body weight, BMI, cholesterol levels with higher LDL levels, and glucose and a reduction in HDL levels. CONCLUSIONS: Lockdown caused a worsening of cardiovascular risk factors due to an increase in liver fat estimation scales and an increased risk of presenting with NAFLD and changes in insulin resistance.

Obesidad, hábitos de vida y riesgo de hígado graso en la población laboral española durante la pandemia por COVID-19 / Obesity, life habits and fatty liver risk evaluation in the Spanish working population during the COVID-19 pandemic

Antecedentes: el hígado graso no alcohólico es la enfermedad hepática más común en el mundo, habitualmente asintomática y manifestación hepática del síndrome metabólico. Objetivo: estimar el riesgo de hígado graso mediante el índice de hígado graso (FLI, Fatty Liver Index) y su relación con el índice de masa corporal (IMC), indicadores de adiposidad, hábitos de vida y variables sociodemográficas. Material y métodos: estudio descriptivo transversal realizado con 815 trabajadores de entre 18-66 años, durante la vigilancia de la salud de las empresas participantes, desde marzo de 2020 hasta junio de 2021.Se utiliza la calculadora FLI y se establecen relaciones con variables sociodemográficas, índices de adiposidad, hábitos de alimentación y actividad física con el uso de los cuestionarios PREDIMED e IPAQ. Resultados: el FLI > 60 se relaciona significativamente con el IMC, el perímetro de la cintura y el índice cintura-cadera. El IMC incrementa el riesgo casi 20 veces (odds ratio 19,87; IC 95% 10,84-36,44) de sufrir la enfermedad. Los valores altos son más perjudiciales en hombres y el riesgo aumenta con la edad. Un FLI en rango medio/alto (> 30) muestra una relación significativa con la adherencia a MedDiet y con la actividad física realizada, con diferencias entre géneros (p < 0,0001). Conclusión: el riesgo de hígado graso aumenta con la obesidad y con los hábitos de vida no saludables, con valores más desfavorables entre los hombres. Destaca la importancia de valorar, junto con el IMC, los indicadores de adiposidad.(AU)

Background: non-alcoholic fatty liver disease is the most common liver disease globally. It is usually asymptomatic with a liver manifestation of metabolic syndrome. Aim: to estimate the risk of fatty liver by means of the FLI index and its relationship with BMI, adiposity indicators, lifestyle habits and socio-demographic variables. Material and Methods: cross-sectional descriptive study in 815 workers aged 18-66 years during the health monitoring of companies taking part from March 2020-June 2021.The fatty liver index-FLI calculator was used and relationships were established with sociodemographic variables, adiposity indices, eating habits and physical activity using PREDIMED and IPAQ questionnaires. Results: FLI > 60 is significantly related to BMI, waist circumference and waist hip index. BMI increases the risk almost 20 times (odds ratio 19.87, 95% CI 10.84-36.44). Values are worse in men and risk increases with age. A medium to high FLI > 30 reveals a significant relationship with adherence to MedDiet and with physical activity performed. There are differences between the sexes (P < 0.0001). Conclusion: fatty liver risk increases with obesity and unhealthy lifestyle habits. Values are more unfavourable among men. It highlights the importance of evaluating adiposity indicators together with BMI.(AU)

Occupational and Leisure Physical Activity on Cardiovascular Risk and Body Composition Among Courier Workers.

OBJECTIVE: There is some controversy about the beneficial effects of occupational physical activity (OPA) on cardiovascular risk (CVR). The main aim of this study was to explore the effect of the combination of different frequencies of leisure-time physical activity (LTPA) and two types of OPA on CVR and body composition, and whether the association between physical activity (PA) and CVR was mediated by visceral adipose tissue (VAT). METHODS: This cross-sectional study included data from 2516 couriers living in Spain, delivering either by motorbike or foot, and practicing LTPA never, occasionally, or regularly. Couriers were classified into six categories according to LTPA and OPA; body composition was assessed by Bioelectrical Impedance, and CVR by the Framingham equation. General linear models were performed to explore the association between different categories with each outcome (CVR and body composition) and the possible role of VAT as a mediator between PA and CVR. RESULTS: Compared with the most sedentary group (motorbike couriers that never practice PA), walking couriers who practice regular PA presented the lowest CVR [ß -1.58 (95% CI -2.31; -0.85)] and the lowest VAT [ß -2.86 (95% CI -3.74; -1.98) followed by the motorbike couriers who practiced regular PA [ß -0.51 (95% CI -1.00; -0.03) for CVR and ß -2.33 (95% CI -2.91; -1.75) for VAT]. The association between PA and CVR was partially mediated by VAT. CONCLUSION: The present results indicated that both OPA and LTPA are protective factors for CVR and play an important role on VAT accumulation.