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Purpose: The health benefits of the Mediterranean diet (MedDiet) have been widely studied. However, controversy remains for one of its components: alcohol intake. We aimed to assess the joint effect of adherence to the MedDiet and alcohol-drinking pattern on all-cause mortality. Methods: We used data from 20,506 subjects from a prospective cohort of Spanish university graduates, the Seguimiento Universidad de Navarra (SUN) cohort. Adherence to the MedDiet was operationalized using four different dietary indexes and then categorized in low or high adherence, according to the median score. Alcohol-drinking pattern was evaluated with the previously defined the Mediterranean alcohol-drinking pattern (MADP), grouped into three categories of adherence (low, moderate and high adherence) and a fourth category for abstainers. The outcome was all-cause mortality. Results: During a median follow-up of 12.1 years, we observed 460 deaths. No statistically significant supra-multiplicative interaction between the two exposures was found. Low adherence to both the MedDiet and MADP was associated with higher all-cause mortality compared to high adherence to both exposures [multivariable-adjusted hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.33–3.07]. Similar results were found for cancer mortality and cardiovascular mortality. Conclusions: Although the combined effect of the MedDiet and MADP was not significantly higher than the product of their individual effects, a low adherence to both the MedDiet and MADP was associated with higher rates of all-cause mortality. This report also shows the usefulness of the dietary pattern approach applied to alcohol intake and of including the drinking pattern as another component of the MedDiet. [ABSTRACT FROM AUTHOR]

Background and Aims: Polyphenols are secondary metabolites present in small quantities in plant-based food and beverages, with antioxidant and anti-inflammatory properties. Main groups of polyphenols include flavonoids, phenolic acids, stilbenes, and lignans, but their association with mortality has barely been examined. We aimed to assess the association between the intake of 23 polyphenol subgroups and all-cause, cardiovascular, and cancer mortality in a representative sample of the Spanish adult population., Methods: Population-based cohort study conducted with 12,161 individuals aged 18+ recruited in 2008-2010 and followed-up during a mean of 12.5 years. At baseline, food consumption was obtained with a validated dietary history, and the Phenol-Explorer database was used to estimate polyphenol intake. Associations were examined using Cox regression adjusted for main confounders., Results: During follow-up, 967 all-cause deaths occurred, 219 were cardiovascular, and 277 cancer. Comparing extreme categories of consumption, hazard ratios (95% CI) of total mortality for subgroups were: dihydroflavonols 0.85 (0.72-1.00; p-trend:0.046); flavonols 0.79 (0.63-0.97; p-trend:0.04); methoxyphenols 0.75 (0.59-0.94; p-trend:0.021); tyrosols 0.80 (0.65-0.98; p-trend:0.044); alkylmethoxyphenols 0.74 (0.59-0.93; p-trend:0.007); hydroxycinnamic acids 0.79 (0.64-0.98; p-trend:0.014); and hydroxyphenilacetic acids 0.82 (0.67-0.99; p-trend:0.064). For cardiovascular mortality, hazard ratios were: methoxyphenols 0.58 (0.38-0.89; p-trend:0.010); alkylmethoxyphenols 0.59 (0.39-0.90; p-trend:0.011); hydroxycinnamic acids 0.63 (0.42-0.94; p-trend:0.020); and hydroxyphenilacetic acids 0.69 (0.48-0.99; p-trend:0.044), when comparing extreme tertiles of consumption. No statistically significant associations were observed for cancer. The main food sources for these polyphenol subgroups were red wine, leafy green vegetables, olive oil, green olives, and coffee (the latter being the major contributor of methoxyphenols, alkylmethoxyphenols, and hydroxycinnamic acids)., Conclusions: In the Spanish adult population, intake of specific polyphenol subgroups was prospectively associated with a 20% lower all-cause mortality risk. This decrease was mainly due to a 40% lower cardiovascular mortality risk over time., Competing Interests: Conflicts of interest The authors have no conflict of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Predicting the future burden of cancer is a key issue for health services planning, where a method for selecting the predictive model and the prediction base is a challenge. A method, named here Goodness-of-Fit optimal (GoF-optimal), is presented to determine the minimum prediction base of historical data to perform 5-year predictions of the number of new cancer cases or deaths. Methods: An empirical ex-post evaluation exercise for cancer mortality data in Spain and cancer incidence in Finland using simple linear and log-linear Poisson models was performed. Prediction bases were considered within the time periods 1951-2006 in Spain and 1975-2007 in Finland, and then predictions were made for 37 and 33 single years in these periods, respectively. The performance of three fixed different prediction bases (last 5, 10, and 20 years of historical data) was compared to that of the prediction base determined by the GoF-optimal method. The coverage (COV) of the 95% prediction interval and the discrepancy ratio (DR) were calculated to assess the success of the prediction. Results: The results showed that (i) models using the prediction base selected through GoF-optimal method reached the highest COV and the lowest DR and (ii) the best alternative strategy to GoF-optimal was the one using the base of prediction of 5-years. Conclusions: The GoF-optimal approach can be used as a selection criterion in order to find an adequate base of prediction. [ABSTRACT FROM AUTHOR]

Our objective was to investigate whether there might be excess cancer mortality in the vicinity of Spanish installations for the production of cement, lime, plaster, and magnesium oxide, according to different categories of industrial activity. An ecologic study was designed to examine municipal mortality due to 33 types of cancer (period 1997–2006) in Spain. Population exposure to pollution was estimated on the basis of distance from town to industrial facility. Using spatial Besag–York–Mollié regression models with integrated nested Laplace approximations for Bayesian inference, we assessed the relative risk of dying from cancer in a 5-km zone around installations, analyzed the effect of category of industrial activity according to the manufactured product, and conducted individual analyses within a 50-km radius of each installation. Excess all cancer mortality (relative risk, 95% credible interval) was detected in the vicinity of these installations as a whole (1.04, 1.01–1.07 in men; 1.03, 1.00–1.06 in women), and, principally, in the vicinity of cement installations (1.05, 1.01–1.09 in men). Special mention should be made of the results for tumors of colon–rectum in both sexes (1.07, 1.01–1.14 in men; 1.10, 1.03–1.16 in women), and pleura (1.71, 1.24–2.28), peritoneum (1.62, 1.15–2.20), gallbladder (1.21, 1.02–1.42), bladder (1.11, 1.03–1.20) and stomach (1.09, 1.00–1.18) in men in the vicinity of all such installations. Our results suggest an excess risk of dying from cancer, especially in colon–rectum, in towns near these industries. [ABSTRACT FROM AUTHOR]

Abstract: Background: Waste treatment plants release toxic emissions into the environment which affect neighboring towns. Objectives: To investigate whether there might be excess cancer mortality in towns situated in the vicinity of Spanish-based incinerators and installations for the recovery or disposal of hazardous waste, according to the different categories of industrial activity. Methods: An ecologic study was designed to examine municipal mortality due to 33 types of cancer, across the period 1997–2006. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Using Besag–York–Mollié (BYM) regression models with Integrated Nested Laplace approximations for Bayesian inference, and Mixed Poisson regression models, we assessed the risk of dying from cancer in a 5-kilometer zone around installations, analyzed the effect of category of industrial activity, and conducted individual analyses within a 50-kilometer radius of each installation. Results: Excess cancer mortality (BYM model: relative risk, 95% credible interval) was detected in the total population residing in the vicinity of these installations as a whole (1.06, 1.04–1.09), and, principally, in the vicinity of incinerators (1.09, 1.01–1.18) and scrap metal/end-of-life vehicle handling facilities, in particular (1.04, 1.00–1.09). Special mention should be made of the results for tumors of the pleura (1.71, 1.34–2.14), stomach (1.18, 1.10–1.27), liver (1.18, 1.06–1.30), kidney (1.14, 1.04–1.23), ovary (1.14, 1.05–1.23), lung (1.10, 1.05–1.15), leukemia (1.10, 1.03–1.17), colon–rectum (1.08, 1.03–1.13) and bladder (1.08, 1.01–1.16) in the vicinity of all such installations. Conclusions: Our results support the hypothesis of a statistically significant increase in the risk of dying from cancer in towns near incinerators and installations for the recovery or disposal of hazardous waste. [Copyright &y& Elsevier]

Residential proximity to industrial facilities that release pollutants is a source of exposure to a high number of toxics, many of them known or suspected carcinogens. The objective of the study was to analyze the association between lung, larynx, bladder, and kidney cancer mortality and deprivation in areas proximate to polluting industrial facilities in Cadiz, a highly industrialized province in Spain. An ecological study at census tract level was carried out to estimate the mortality rates associated with deprivation and proximity to polluting industrial facilities (1-5 km) using the Besag-York-Mollié model. The results show a negative social gradient for lung and larynx cancers in males and greater risk of lung cancer was observed in the least deprived areas in females. These associations were found regardless the distance to industrial facilities. Increasing excess risk (relative risk; 95% credibility interval) of lung cancer for males (1.09; 1.02-1.16 at 5 km vs 1.24; 1.08-1.41 at 1 km) and bladder cancer for males (1.11; 1.01-1.22 at 5 km vs 1.32; 1.08-1.60 at 1 km) and females (1.32; 1.04-1.69 at 4 km vs 1.91; 1.28-2.86 at 1 km) was found as proximity to polluting industrial facilities increased. For kidney cancer, high risks were observed near such facilities for both sexes. Knowing the possible influence of industrial pollution and social inequalities over cancer risk allows the definition of policies aimed at reducing the risk.

The 2015-2020 Dietary Guidelines for Americans (DGA) was issued in early 2016. It remains untested if adherence to these guidelines could reduce mortality risk. Using a modified version of the 2015 Dietary Guidelines for American Index (2015 DGAI), we investigated if adherence to the new DGA is associated with mortality in a Spanish (the Seguimiento Universidad de Navarra, SUN) cohort. We assessed the habitual diet of 16,866 participants of this cohort recruited between 1999 and 2014 and calculated their adherence scores to the new DGA using the modified 2015 DGAI (0-21points). Mortality data was determined from the yearly National Death Index reports. After adjusting for demographic and lifestyle confounders, high adherence scores (fourth quartile) were found to be associated with reduced all-cause, cardiovascular and cancer mortality risk, hazard ratios (HR) (95% confidence intervals [CI]) 0.42 (0.25-0.70), 0.30 (0.10-0.90) and 0.46 (0.22-0.96), respectively, compared to low adherence scores (first quartile). A 2-point increase in the 2015 DGAI score was linearly inversely associated with all-cause mortality (HR [95% CI] 0.78 [0.67-0.92]). Main sources of variability in the adherence scores were whole-fat dairy products, red/orange vegetables, fresh fruits, red meat, and dark green vegetables. In conclusion, higher adherence to 2015-2020 Dietary Guidelines for Americans was inversely associated with total, cardiovascular and cancer mortality risk in a Spanish cohort., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Changes in the burden of cancer mortality are expected to be observed among Spanish women. We predict those changes, in Spain, for breast cancer (BC), colorectal cancer (CRC), lung cancer (LC) and pancreatic cancer (PC) from 2013 to 2022., Methods: Bayesian age-period-cohort modeling was used to perform projections of the cancer burden in 2013-2022, extrapolating the trend of cancer mortality data from 1998 to 2012. We assessed the time trends of the crude rates (CRs) during 1998-2012, and compared the number of cancer deaths between the periods 2008-2012 and 2018-2022 to assess the contribution of demographic changes and changes in the risk factors for cancer., Results: During 1998-2012, CRs of cancer decreased for BC (0.3% per year) and increased for LC (4.7%), PC (2%) and CRC (0.7%). During 2013-2022, CRs might level off for CRC, whereas the time trends for the remaining cancers might continue at a similar pace. During 2018-2022, BC could be surpassed by CRC as the most frequent cause of cancer mortality among Spanish women, whereas LC could be the most common cause of cancer mortality among women aged 50-69 years (N/year=1960 for BC versus N/year=1981 for LC). Comparing 2018-2022 and 1998-2012, changes in the risk factors for cancer could contribute 37.93% and 18.36% to the burden of LC and PC, respectively, and demographic shifts - mainly due to ageing (19.27%) - will drive the burden of CRC., Conclusions: During 2018-2022, demographic changes (ageing) and changes in risk factors could have a different impact on the lifetime risk of cancer among Spanish women., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Despite the tendency to confluence that shows the frequency of cancer in European countries, Spain presents some peculiarities that are discussed briefly. On the basis of low rates of incidence and mortality by most common tumours in men and women, in women, lung cancer mortality, from 1994 shows a 3% annual increase. Bladder cancer mortality in men is a somewhat special case. While in most European countries, there is a clear decrease in their rates, in Spain the evolution pattern is different, showing the highest rates since 2000. Geographical distribution of mortality patterns is very marked and shows great stability to over the years. However, there are some changes that are discussed briefly, as well as the possible influence of industrial pollution in these patterns.