The prevalence and incidence rate of overweight and obesity among 2.5 million children and adolescents in Spain.

INTRODUCTION AND OBJECTIVES: Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. METHODS: This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. RESULTS: The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age. CONCLUSIONS: Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.

Flecainide and risk of skin neoplasms: Results of a large nested case-control study in Spain and Denmark.

Background: A previous study in Denmark suggested an increased melanoma risk associated with the use of flecainide. Objective: To study the association between flecainide use and the risk of melanoma and non-melanoma skin cancer in Spain and Denmark. Methods: We conducted a multi-database case-control study in (database/study period) Spain (SIDIAP/2005-2017 and BIFAP/2007-2017) and Denmark (Danish registries/2001-2018). We included incident cases of melanoma or non-melanoma skin cancer (NMSC) aged ≥18 with ≥2 years of previous data (≥10 years for Denmark) before the skin cancer and matched them to controls (10:1 by age and sex). We excluded persons with immunosuppression or previous cancer. We defined ever-use as any prescription fill and high-use as a cumulative dose of at least 200 g (reference: never-use). We categorized a cumulative dose for a dose-response assessment. We used conditional logistic regression to compute ORs (95% CI) adjusted for photosensitizing, anti-neoplastic, disease-specific drugs and comorbidities. Results: The total numbers of melanoma/NMSC cases included were 7,809/64,230 in SIDIAP, 4,661/31,063 in BIFAP, and 27,978/152,821 in Denmark. In Denmark, high-use of flecainide was associated with increased adjusted ORs of skin cancer compared with never-use [melanoma: OR 1.97 (1.38-2.81); NMSC: OR 1.34 (1.15-1.56)]. In Spain, an association between high-use of flecainide and NMSC was also observed [BIFAP: OR 1.42 (1.04-1.93); SIDIAP: OR 1.19 (0.95-1.48)]. There was a non-significant dose-response pattern for melanoma in Denmark and no apparent dose-response pattern for NMSC in any of the three databases. We found similar results for ever-use of flecainide. Conclusion: Flecainide use was associated with an increased risk of melanoma (Denmark only) and NMSC (Denmark and Spain) but without substantial evidence of dose-response patterns. Further studies are needed to assess for possible unmeasured confounders.

Major bleeding in users of direct oral anticoagulants in atrial fibrillation: A pooled analysis of results from multiple population-based cohort studies.

OBJECTIVE: To establish the risk of major bleeding in direct oral anticoagulant (DOAC) users (overall and by class) versus vitamin K antagonist (VKA) users, using health care databases from four European countries and six provinces in Canada. METHODS: A retrospective cohort study was performed according to a similar protocol. First-users of VKAs or DOACs with a diagnosis of non-valvular atrial fibrillation (NVAF) were included. The main outcome of interest was major bleeding and secondary outcomes included gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH). Incidence rates of events per 1000 person years were calculated. Hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using a Cox proportional hazard regression model. Exposure and confounders were measured and analysed in a time-dependant way. Risk estimates were pooled using a random effect model. RESULTS: 421 523 patients were included. The risk of major bleeding for the group of DOACs compared to VKAs showed a pooled HR of 0.94 (95% CI: 0.87-1.02). Rivaroxaban showed a modestly increased risk (HR 1.11, 95% CI: 1.06-1.16). Apixaban and dabigatran showed a decreased risk of respectively HR 0.76 (95% CI: 0.69-0.84) and HR 0.85 (95% CI: 0.75-0.96). CONCLUSIONS: This study confirms that the risk of major bleeding of DOACs compared to VKAs is not increased when combining all DOACs. However, we observed a modest higher risk of major bleeding for rivaroxaban, whereas for apixaban and dabigatran lower risks of major bleeding were observed compared to VKAs.

Use of hydrochlorothiazide and risk of skin cancer in a large nested case-control study in Spain.

PURPOSE: Hydrochlorothiazide (HCTZ) use has been linked to skin cancer in northern European countries. We assessed the association between HCTZ exposure and risk of malignant melanoma (MM) and keratinocyte carcinoma (KC) in a European Mediterranean population. METHODS: Two parallel nested case-control studies were conducted in Spain using two electronic primary healthcare databases, each one providing data on both exposure and outcomes: SIDIAP and BIFAP. Cancer cases were matched to 10 controls by age and gender through risk-set sampling. The ORs and 95% CI for MM and KC associated with previous HCTZ use were estimated using conditional logistic regression. In BIFAP, KC cases were further identified as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). RESULTS: In adjusted analyses, both ever and cumulative high (≥50,000 mg) use of HCTZ were associated with an increased risk of KC. The risk estimates for high use were 1.30 (1.26-1.34) in SIDIAP and 1.20 (1.12-1.30) in BIFAP, with a lower risk for BCC (1.11 [1.02-1.21]) than for SCC (1.71 [1.45-2.02]). A dose-response relationship was observed between cumulative doses of HCTZ and KC risk. Inconsistent results were found for high use of HCTZ and risk of MM: 1.25 (1.09-1.43) in SIDIAP and 0.85 (0.64-1.13) in BIFAP. CONCLUSIONS: In this European Mediterranean population, a high cumulative use of HCTZ was related to an increased risk of KC with a clear dose-response pattern.

Comparing risk of major bleeding between users of different oral anticoagulants in patients with nonvalvular atrial fibrillation.

AIMS: The introduction of direct oral anticoagulants (DOACs) has broadened the treatment arsenal for nonvalvular atrial fibrillation, but observational studies on the benefit-risk balance of DOACs compared to vitamin K antagonists (VKAs) are needed. The aim of this study was to characterize the risk of major bleeding in DOAC users using longitudinal data collected from electronic health care databases from 4 different EU-countries analysed with a common study protocol. METHODS: A cohort study was conducted among new users (≥18 years) of DOACs or VKAs with nonvalvular atrial fibrillation using data from the UK, Spain, Germany and Denmark. The incidence of major bleeding events (overall and by bleeding site) was compared between current use of DOACs and VKAs. Cox regression analysis was used to calculate hazard ratios and 95% confidence intervals (CI) and adjust for confounders. RESULTS/CONCLUSION: Overall, 251 719 patients were included across the 4 study cohorts (mean age ~75 years, % females between 41.3 and 54.3%), with overall hazard ratios of major bleeding risk for DOACs vs VKAs ranging between 0.84 (95% CI: 0.79-0.90) in Denmark and 1.13 (95% CI 1.02-1.25) in the UK. When stratifying according to the bleeding site, risk of gastrointestinal bleeding was increased by 48-67% in dabigatran users and 30-50% for rivaroxaban users compared to VKA users in all data sources except Denmark. Compared to VKAs, apixaban was not associated with an increased risk of gastrointestinal bleeding in all data sources and seemed to be associated with the lowest risk of major bleeding events compared to dabigatran and rivaroxaban.

Alcohol consumption and all-cause mortality in older adults in Spain: an analysis accounting for the main methodological issues.

BACKGROUND AND AIMS: Observational evidence that light-to-moderate alcohol consumption lowers mortality is questioned because of potential selection biases and residual confounding. We assess the association between alcohol intake and all-cause death in older adults after accounting for those methodological issues. METHODS: Data came from 3045 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Participants were recruited in 2008-10, when they reported current and life-time alcohol intake; drinkers were classified as occasional (< 1.43 g/day), light (≥ 1.43 but < 20 g/day for men and ≥ 1.43 but < 10 g/day for women), moderate (≥ 20 but < 40 g/day for men and ≥ 10 but < 20 g/day for women) or heavy (≥ 40 g/day for men and ≥ 24 g/day for women)/binge. Participants were followed-up to 2017 to assess vital status. In analyses, ex-drinkers were removed from the abstainer group and were classified according to their life-time intake to address the 'abstainer bias'. Moreover, analyses were replicated in individuals without functional limitations, and excluded deaths in the first year of follow-up, to address reverse causation. Also, occasional drinkers were used as reference in some analyses to reduce the 'healthy drinker/survivor' bias. Results were adjusted for many covariates to minimize residual confounding. RESULTS: Compared with never-drinkers, the hazard ratio (95% confidence interval) of mortality for light drinkers was 1.05 (0.71-1.56) and 1.20 (0.72-2.02) in those without functional limitations. Corresponding values for moderate drinkers were 1.28 (0.81-2.02) and 1.55 (0.87-2.75) and for heavy/binge drinkers 1.85 (1.07-3.23) and 2.15 (1.09-4.22). Results were consistent when occasional drinkers were used as reference. Among drinkers without functional limitations, the hazard ratio (95% confidence interval) of mortality per 10 g/day of alcohol was 1.12 (1.02-1.23). CONCLUSION: After accounting for potential biases, light-to-moderate drinking among people 60+ years of age appears to have no statistically significant benefit on mortality compared with abstention from alcohol. By contrast, heavy/binge drinking shows a higher death risk compared with abstention from alcohol. Alcohol intake appears to have a positive dose-response with mortality among drinkers.

Metabolic syndrome and insulin resistance are associated with frailty in older adults: a prospective cohort study.

Background: diabetes increases the risk of frailty that is a leading cause of disability and premature mortality in older people. Metabolic syndrome (MS) and insulin resistance (IR) are strong risk factors for diabetes and could, thus, lead to frailty. However, the association between MS or IR and frailty has barely been investigated. Methods: data were obtained from a cohort of 1,499 community-dwelling individuals aged ≥60, who were free of diabetes at 2008-10 and were followed up for 3.5 years. At baseline, MS was ascertained according to the harmonised definition, and IR with the Homoeostatic Model Assessment for IR index (HOMA-IR). Frailty was defined as having three or more of the Fried's criteria: exhaustion, low physical activity, slow walking, unintentional weight loss and low grip strength. Statistical analyses were performed with logistic regression, and adjusted for the main confounders. Results: in 2012, 84 cases of incident frailty were identified. Compared with subjects without MS, those with MS showed increased risk of frailty (multivariate odds ratio [OR]: 1.85; 95% confidence interval [CI] 1.12-3.05). The association persisted after further adjustment for fibrinogen and C-reactive protein. When the frailty criteria were considered individually, low grip strength was the criterion that showed a stronger association with MS (OR: 1.67; 95% CI: 1.25-2.21). Higher HOMA-IR values were also associated with higher risk of frailty. Conclusion: MS and IR were associated with increased risk of frailty. This work extends the spectrum of harmful consequences of MS, and suggests that preventing or controlling MS may serve to delay frailty.

Desigualdades sociales en los factores de riesgo cardiovascular de los adultos mayores de España: estudio ENRICA-Seniors / Social inequalities in cardiovascular risk factors among older adults in Spain: The Seniors-ENRICA study

Introducción y objetivos: Examinar la distribución de los principales factores de riesgo cardiovascular (FRCV) de los adultos mayores de España según su nivel socioeconómico (NSE). Métodos: Estudio transversal realizado en 2008-2010 sobre 2.699 personas representativas de la población española no institucionalizada de edad ≥ 60 años. El NSE se valoró mediante el nivel educativo, la ocupación de los individuos y la ocupación del padre. Los FRCV se midieron de manera estandarizada e incluyeron factores tanto conductuales como biológicos. Resultados: En análisis ajustados por sexo y edad, el mayor nivel educativo se asoció con mayor frecuencia de consumo de alcohol y actividad física en tiempo libre moderados y menos tiempo mirando la televisión. Se observó un gradiente educativo inverso en la frecuencia de obesidad (estudios universitarios frente a primarios o menos, odds ratio [OR] = 0,44; intervalo de confianza del 95% [IC95%], 0,33-0,57; p de tendencia < 0,01), síndrome metabólico (OR = 0,56; IC95% 0,43-0,71; p de tendencia < 0,01), diabetes (OR = 0,68; IC95%, 0,49-0,95; p de tendencia < 0,05) y enfermedad cardiovascular (OR = 0,52; IC95%, 0,29-0,91; p de tendencia < 0,05). La ocupación manual se asoció a mayor frecuencia de muchos FRCV que la ocupación no manual; esta asociación era más fuerte que la observada con la ocupación del padre. Las diferencias en los FRCV según el NSE habitualmente eran mayores en las mujeres que en los varones. Conclusiones: Existen importantes desigualdades en los FRCV de los adultos mayores en España. Reducir estas desigualdades acercando los niveles de los FRCV de los sujetos de menor NSE a los de mayor NSE podría disminuir sustancialmente la prevalencia de FRCV en los adultos mayores (AU)

Introduction and objectives: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. Methods: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. Results: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. Conclusions: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population (AU)

Social Inequalities in Cardiovascular Risk Factors Among Older Adults in Spain: The Seniors-ENRICA Study.

INTRODUCTION AND OBJECTIVES: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. METHODS: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. RESULTS: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. CONCLUSIONS: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population.

Caracterización de la corioamnionitis en pacientes atendidas en el Hospital Susana López de Valencia (Popayán, Colombia) entre junio de 2013 y junio de 2014 / Chorioamnionitis characterization in patients treated in Hospital Susana Lopez de Valencia (Popayan, Colombia) between june 2013 and june 2014

Introducción: la corioamnionitis es la infección de las membranas del saco amniótico, el corion y el amnios. Objetivo: caracterizar clínicamente a las pacientes con diagnóstico de corioamnionitis atendidas en el Hospital Susana López de Valencia, en la ciudad de Popayán (Colombia), entre junio de 2013 y junio de 2014. Metodología: se realizó un estudio descriptivo de corte transversal basado en los registros de las historias clínicas de la institución cuyo diagnóstico fue corioamnionitis durante el periodo de estudio establecido. Resultados: se incluyeron 268 pacientes con edades promedio entre 19 y 34 años. El cuadro clínico más frecuente asociado a corioamnionitis fue la ruptura prematura de membranas (35,82%). Las pacientes fueron diagnosticadas clínicamente en su mayoría (77,24%) en el periodo posparto (hasta los primeros tres días después del parto), al presentar leucocitosis mayor que 15.000/µL (47,83%) y cavidad hipertérmica (40,58%). Finalmente, se realizó un cruce de variables para establecer cuál síntoma se había presentado conjuntamente con la fiebre de acuerdo a lo establecido en los criterios de Gibbs, en el que se demostró que durante el anteparto y el posparto la leucocitosis (68,18% y 76%, respectivamente) y la taquicardia materna (73% y 76%, respectivamente) fueron los dos síntomas más prevalentes. Conclusiones: la prevalencia indirecta de corioamnionitis en la muestra seleccionada fue del 8,05%. El principal factor de riesgo para esta enfermedad lo constituyó la ruptura prematura de membranas ovulares y su diagnóstico se hizo principalmente en el periodo posparto con la ayuda de los criterios de Gibbs. (AU)

Introduction: Chorioamnionitis is the infection of the membranes of the amniotic sac, chorion and amnion. Objetive: To characterize clinally the patients diagnosed with chorioamnionitis who were treated at the hospital Susana López de Valencia in the city of Popayan (Colombia) during June 2013 and June 2014 Methodology: A cross-sectional descriptive study was performed based on records of institutional clinical records with has diagnosis of chorioamnionitis during the established study period. Results: A total of 268 patients were included with an average age between 19 and 34 years old. The most frequent clinical syntomatology associated with chorioamnionitis was premature rupture of membranes (35.82%). Most patients (77.24%) were clinical diagnosed at the postpartum period (up to the first three days postpartum) presenting leukocytosis greater than 15,000/µL (47.83%) and hyperthermic cavity (40.58%). Finally, to establish which symptoms had been presented in conjunction with fever according with Gibbs criteria a cross-variable was performed, which stablishes that during antepartum and postpartum the leukocytosis (68.18% and 76%, respectively) and maternal tachycardia (73% and 76%, respectively) were the most two prevalent symptoms. Conclusions: The indirect prevalence of chorioamnionitis in the study sample was 8.05%. The main risk factor for this disease was the premature rupture of ovary membranes and their diagnosis was made mainly in the postpartum period with the help of Gibbs criteria. (AU)

Correction: Mediterranean Diet and Health-Related Quality of Life in Two Cohorts of Community-Dwelling Older Adults.

[This corrects the article DOI: 10.1371/journal.pone.0151596.].

Unhealthy eating behaviors and weight gain: A prospective study in young and middle-age adults.

OBJECTIVE: Guidelines for obesity prevention recommend reducing certain unhealthy eating behaviors (UEB). However, the association between UEB and weight gain is uncertain. METHODS: Prospective cohort with 1,638 individuals aged 18-60 years was recruited in 2008-2010. UEB assessed at baseline were: not planning how much to eat, consuming pre-cooked/canned food, buying snacks, eating in fast-food restaurants, not choosing low-calorie foods, not removing visible fat from meat or skin from chicken, and eating while watching TV or seating on a sofa. Participants were followed up through 2012 to assess weight change. RESULTS: Compared to reporting 0-2 UEB, the multivariate odds ratios (95% confidence interval) for gaining ≥3 kg were 0.97 (0.74-1.28) for 3-4 UEB and 1.61 (1.09-2.39) for ≥5 UEB, P-trend = 0.07. Results were similar for gaining ≥5 kg. The three UEB with the strongest associations with weight gain were: 1) not planning the amount of food to eat, 2) eating at fast-food restaurants, and 3) eating while watching TV; compared to having none of these three behaviors, the odds ratio (95% confidence interval) for gaining ≥3 kg was 1.54 (0.77-3.08) for 1 UEB, 1.70 (0.85-3.37) for 2 UEB, and 2.75 (1.28-5.90) for 3 UEB, P-trend = 0.007. Similar results were obtained for gaining ≥5 kg. CONCLUSIONS: Several UEB are associated with weight gain.

Mediterranean Diet and Health-Related Quality of Life in Two Cohorts of Community-Dwelling Older Adults.

INTRODUCTION: In older adults, the Mediterranean diet is associated with lower risk of chronic diseases, but its association with health-related quality of life (HRQL) is still uncertain. This study assessed the association between the Mediterranean diet and HRQL in 2 prospective cohorts of individuals aged ≥60 years in Spain. METHODS: The UAM-cohort (n = 2376) was selected in 2000/2001 and followed-up through 2003. At baseline, diet was collected with a food frequency questionnaire, which was used to develop an 8-item index of Mediterranean diet (UAM-MDP). The Seniors-ENRICA cohort (n = 1911) was recruited in 2008/2010 and followed-up through 2012. At baseline, a diet history was used to obtain food consumption. Mediterranean diet adherence was measured with the PREDIMED score and the Trichopoulou's Mediterranean Diet Score (MSD). HRQL was assessed, at baseline and at the end of follow-up, with the physical and mental component summaries (PCS and MCS) of the SF-36 questionnaire in the UAM-cohort, and the SF-12v.2 questionnaire in the Seniors-ENRICA cohort. Analyses were conducted with linear regression, and adjusted for the main confounders including baseline HRQL. RESULTS: In the UAM-cohort, no significant associations between the UAM-MDP and the PCS or the MCS were found. In the Seniors-ENRICA cohort, a higher PREDIMED score was associated with a slightly better PCS; when compared with the lowest tertile of PREDIMED score, the beta coefficient (95% confidence interval) for PCS was 0.55 (-0.48 to 1.59) in the second tertile, and 1.34 (0.21 to 2.47) in the highest tertile. However, the PREDIMED score was non-significantly associated with a better MCS score. The MSD did not show an association with either the PCS or the MCS. CONCLUSIONS: No clinically relevant association was found between the Mediterranean diet and HRQL in older adults in Spain.

Patterns of Alcohol Consumption and Risk of Frailty in Community-dwelling Older Adults.

BACKGROUND: Consumption of moderate-to-heavy amounts of alcohol has been associated with lower risk of cardiovascular disease and diabetes. Although both diseases are main causes of the frailty syndrome, no previous study has assessed the association between alcohol-drinking patterns and risk of frailty in older adults. METHODS: A prospective cohort study of 2,086 community-dwelling individuals aged 60 and older, recruited in 2008-2010, and followed through 2012, was carried out. Drinking patterns were self-reported at baseline. Moderate drinking was defined as alcohol intake less than 40 g/day for men and less than 24 g/day for women. A Mediterranean drinking pattern was defined as moderate alcohol intake, with wine preference (≥80% of alcohol proceeds from wine) and drinking only with meals. Study participants were followed through 2012 to ascertain incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Analyses were performed with logistic regression and adjusted for the main confounders. RESULTS: After a mean follow-up of 3.3 (SD = 0.6) years, 292 participants with incident frailty were identified. Compared with nondrinkers, the odds ratio and its 95% confidence interval of frailty was 0.90 (0.65-1.25) for moderate drinkers. The corresponding results were 0.74 (0.48-1.16) for wine versus other beverage preference and 0.53 (0.31-0.92) for drinking only with meals versus only outside meals. Finally, compared with nondrinkers, the odds ratio (95% confidence interval) of frailty was 0.68 (0.47-0.99) for those adhering to the Mediterranean drinking pattern. CONCLUSIONS: Certain drinking patterns, in particular drinking only with meals and the Mediterranean drinking pattern, are associated with a lower risk of frailty in older adults.

Chocolate and health-related quality of life: a prospective study.

BACKGROUND: Chocolate consumption has been associated with a short-term reduction in blood pressure and cholesterol, and improvement of insulin sensitivity; however, participants could not be aware of presenting hypertension or hypercholesterolemia. Moreover, the effect of chocolate on mental health is uncertain. This study assessed the association of regular chocolate consumption with the physical (PCS) and mental (MCS) components of health-related quality of life (HRQL). MATERIALS AND METHODS: We analyzed data from a cohort of 4599 individuals recruited in 2008-2010 and followed-up once prospectively to January 2013 (follow-up mean: 3.5 years). Regular chocolate consumption was assessed at baseline with a validated diet history. HRQL was assessed with the SF-12 v.2 at baseline and at follow-up. Analyses were performed with linear regression and adjusted for the main confounders, including HRQL at baseline. RESULTS: At baseline, 72% of the study participants did not consume chocolate, 11% consumed ≤10 g/day and 17% >10 g/day. Chocolate consumption at baseline did not show an association with PCS and MCS of the SF-12 measured three years later. Compared to those who did not consume chocolate, the PCS scores were similar in those who consumed ≤10 g/day (beta: -0.07; 95% confidence interval (95% CI): -0.94 to 0.80) and in those who consumed >10 g/day (beta: 0.02; 95% CI:-0.71 to 0.75); corresponding figures for the MCS were 0.29; 95% CI: -0.67 to 1.26, and -0.57; 95%CI: -1.37 to 0.23. Similar results were found for sex, regardless of obesity, hypertension, hypercholesterolemia, diabetes or depression. CONCLUSIONS: No evidence was found of an association between chocolate intake and the physical or mental components of HRQL.

Obesity, fat distribution, and risk of frailty in two population-based cohorts of older adults in Spain.

OBJECTIVE: To evaluate for the first time the longitudinal relationship between abdominal obesity and the onset of frailty. METHODS: Study based on results from two population-based cohorts, the Seniors-ENRICA, with 1801 individuals aged ≥60, and the Toledo Study for Healthy Ageing (TSHA), with 1289 participants ≥65 years. Incident frailty was assessed with the Fried criteria. RESULTS: During 3.5 years of follow-up, 125 individuals with incident frailty in Seniors-ENRICA and 162 in TSHA were identified. After adjustment for the main confounders, the pooled odds ratio (pooled OR) for general obesity and risk of frailty was 1.73 (95% confidence interval [CI]: 1.18-2.28). Abdominal obesity was also associated with frailty (pooled OR: 1.67; 95% CI: 1.09-2.25). Compared with individuals with BMI <25 kg/m(2) and no abdominal obesity, the risk of frailty was highest among individuals with concurrent general and abdominal obesity (pooled OR: 2.55; 95% CI: 1.23-3.86). General obesity was associated with increased risk of exhaustion (pooled OR: 1.66; 95% CI: 1.11-2.21), low physical activity (pooled OR: 1.57; 95% CI: 1.08-2.05), and weakness (pooled OR: 1.63; 95% CI: 1.12-2.05). For abdominal obesity, results were in the same direction, although they showed statistical significance only for weakness (OR: 1.46; 95% CI: 1.11-1.80). CONCLUSIONS: General and abdominal obesity are associated with incident frailty in the elderly.

Major dietary patterns and risk of frailty in older adults: a prospective cohort study.

BACKGROUND: There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults. METHODS: This is a prospective cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010. At baseline, food consumption was obtained with a validated diet history and, by using factor analysis, two dietary patterns were identified: a 'prudent' pattern, characterized by high intake of olive oil and vegetables, and a 'Westernized' pattern, with a high intake of refined bread, whole dairy products, and red and processed meat, as well as low consumption of fruit and vegetables. Participants were followed-up until 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss). RESULTS: Over a 3.5-year follow-up, 96 cases of incident frailty were ascertained. The multivariate odds ratios (95% confidence interval) of frailty among those in the first (lowest), second, and third tertile of adherence to the prudent dietary pattern were 1, 0.64 (0.37-1.12), and 0.40 (0.2-0.81), respectively; P-trend = 0.009. The corresponding values for the Westernized pattern were 1, 1.53 (0.85-2.75), and 1.61 (0.85-3.03); P-trend = 0.14. Moreover, a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss. CONCLUSIONS: In older adults, a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components. Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailty.

Patterns of alcohol consumption in the older population of Spain, 2008-2010.

BACKGROUND: Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe. OBJECTIVE: The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010. MAIN OUTCOME MEASURE: Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2. STATISTICAL ANALYSIS PERFORMED: The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design. RESULTS: The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake. CONCLUSIONS: Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

Mediterranean diet and risk of frailty in community-dwelling older adults.

BACKGROUND AND OBJECTIVE: Low intake of certain micronutrients and protein has been associated with higher risk of frailty. However, very few studies have assessed the effect of global dietary patterns on frailty. This study examined the association between adherence to the Mediterranean diet (MD) and the risk of frailty in older adults. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008-2010 in Spain. MEASUREMENTS: At baseline, the degree of MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS) score and the Mediterranean Diet Score, also known as the Trichopoulou index. In 2012, individuals were reassessed to detect incident frailty, defined as having at least 3 of the following criteria: exhaustion, muscle weakness, low physical activity, slow walking speed, and weight loss. The study associations were summarized with odds ratios (OR) and their 95% confidence interval (CI) obtained from logistic regression, with adjustment for the main confounders. RESULTS: Over a mean follow-up of 3.5 years, 137 persons with incident frailty were identified. Compared with individuals in the lowest tertile of the MEDAS score (lowest MD adherence), the OR (95% CI) of frailty was 0.85 (0.54-1.36) in those in the second tertile, and 0.65 (0.40-1.04; P for trend = .07) in the third tertile. Corresponding figures for the Mediterranean Diet Score were 0.59 (0.37-0.95) and 0.48 (0.30-0.77; P for trend = .002). Being in the highest tertile of MEDAS was associated with reduced risk of slow walking (OR 0.53; 95% CI 0.35-0.79) and of weight loss (OR 0.53; 95% CI 0.36-0.80). Lastly, the risk of frailty was inversely associated with consumption of fish (OR 0.66; 95% CI 0.45-0.97) and fruit (OR 0.59; 95% CI 0.39-0.91). CONCLUSIONS: Among community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.

The association of major patterns of physical activity, sedentary behavior and sleep with health-related quality of life: a cohort study.

OBJECTIVE: To examine the prospective association of patterns of physical activity, sedentary behavior and sleep with health-related quality of life (HRQL) in the general population of Spain. METHODS: A cohort study with 4271 individuals aged ≥ 18 years was recruited in 2008-2010 and followed-up prospectively through 2012. Activity patterns were derived from factor analysis. HRQL was assessed with the SF-12 questionnaire, and suboptimal HRQL was defined as a score below the sex-specific sample median. RESULTS: Three main activity patterns were identified. A higher adherence to the pattern named "vigorous activity-seated at the computer" was inversely associated with a suboptimal score in the physical-composite summary (PCS) of the SF-12 (multivariate adjusted odds ratio [aOR] for the highest vs. the lowest quartile 0.71; 95% confidence interval [IC] 0.55-0.90; p-trend=0.003). The "light activity-seated for reading" pattern was inversely associated with a suboptimal score in the mental-composite summary (aOR=0.73; 95% CI=0.61-0.89; p-trend=0.002). However, a higher adherence to the "seated for watching TV-daytime sleeping" pattern was directly associated with suboptimal PCS (aOR=1.35; 95% CI=1.10-1.66; p-trend=0.008). CONCLUSION: Patterns including any physical activity were associated with better physical or mental HRQL. However, a pattern defined by sedentary behavior with diurnal sleep showed worse HRQL and should be a priority target of preventive interventions.