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Introduction and Objectives: The healthy and sustainable dietary recommendations for the Spanish population have recently been launched. We aimed to develop a food-based dietary index to measure adherence to these guidelines and assess its association with all-cause mortality., Methods: Data were drawn from 11 904 individuals, representative of the Spanish population aged 18 and older, recruited between 2008 and 2010, and followed-up until 2022. The Healthy and Sustainable Dietary Recommendations for the Spanish Population Index (HS-DRSI) includes 20 food components, scored dichotomously to reflect adherence to the recommendations. The association between the HS-DRSI and all-cause mortality was examined using Cox proportional hazard models adjusted for sociodemographic, lifestyle, and morbidity factors, within a retrospective cohort design., Results: The mean ± SE age of participants was 46.9 ± 0.3 years and 50.5% were female. After a median follow-up of 12.9 years, 939 all-cause deaths were recorded. Compared with participants in the lowest quartile of adherence (HS-DRSI range: 1-5), those in the highest quartile (HS-DRSI range: 9-17) had a lower risk of mortality (HR, 0.76; 95%CI, 0.60-0.96; P for trend = .02). A 2-point increase in the HS-DRSI was associated with a 7% lower risk of mortality (HR, 0.93; 95%CI, 0.86-1.00; P = .04). This protective association was also observed among participants without chronic diseases at baseline (HR per 2-point increment: HR, 0.80; 95%CI, 0.70-0.92; P = .002). Results were robust in sensitivity analyses., Conclusions: Higher adherence to the healthy and sustainable dietary recommendations for the Spanish population was associated with lower all-cause mortality., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Group A ß-hemolytic Streptococcus (S. pyogenes), also known as GAS, is a Gram-positive bacterium. It can be easily identified in the microbiology laboratory by its ability to hemolyse blood in culture media. This bacterium is highly virulent due to its production of enzymes and toxins, and its ability to cause immunologically mediated diseases such as rheumatic fever and post-streptococcal glomerulonephritis. GAS is the primary cause of bacterial pharyngotonsillitis, although it is typically a benign and non-invasive disease. However, it also has the potential to cause severe skin and soft tissue infections, necrotising fasciitis, bacteraemia and endocarditis, pneumonia and empyema, and streptococcal toxic shock syndrome, without any age or predisposition limits. The term invasive GAS disease (iGAS) is used to refer to this group of conditions. In more developed countries, iGAS disease has declined thanks to improved hygiene and the availability of antibiotics. For example, rheumatic fever has practically disappeared in countries such as Spain. However, recent data suggests a potential increase in some iGAS diseases, although the accuracy of this data is not consistent. Because of this, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has posed several questions about invasive GAS infection, especially its current situation in Spain. The committee has enlisted the help of several experts in the field to answer these questions. The following lines contain the answers that we have collaboratively produced, aiming to assist not only the members of ICOMEM but also anyone interested in this topic., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

The study of the microbiota and the microbiome, and specifically the intestinal one, has determined great interest due to the possible association of their alterations with numerous diseases. These include entities as diverse as Crohn's disease, autism, diabetes, cancer or situations as prevalent today as obesity. In view of this situation, different recommendations have been performed regarding the use of probiotics, prebiotics, and postbiotics as modulators of the microbiota and the microbiome, seeking both preventive and therapeutic effects, and faecal material transfer (FMT) is proposed as an alternative. The latter has emerged as the only proven beneficial intervention on the intestinal microbiome, specifically in the treatment of recurrent colitis associated with Clostridioides difficile (R-CDI). In the rest of the entities, the lowering of laboratory costs has favored the study of the microbiome, which is resolved by delivering reports with catalogs of microorganisms, metabolites or supposed biomarkers without consensus on their composition associated with healthy or diseased microbiota and the disease. There is still insufficient evidence in any disease for interventions on the microbiome beyond FMT and R-CDI. Multi- and multi-disciplinary work with extensive research and the application of artificial intelligence in this field may shed light on the questions raised currently. Ethical issues must also be resolved in light of possible interventions within the umbrella of personalized medicine., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Importance: Physical activity (PA) guidelines recommend the same amount of PA through adulthood to live longer., Objective: To explore whether there is an age-dependent association between PA and all-cause mortality and to investigate the age-dependent associations between other modifiable health factors (high educational level, not smoking, not regularly consuming alcohol, healthy body weight, and living without hypertension and diabetes) and mortality., Design, Setting, and Participants: This cohort study used a pooled analysis of 4 population-based prospective cohorts (National Health Interview Survey, 1997-2018; UK Biobank, 2006-2010; China Kadoorie Biobank, 2004-2008; and Mei Jau, 1997-2016). Data were analyzed from June 2022 to September 2024., Exposures: Self-reported leisure-time PA., Main Outcomes and Measures: The primary outcome was deaths identified through follow-up linkage to national death registries. Analyses were performed for the total sample and by age groups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years). Cox proportional hazards regression models with stratification by study were used to calculate mortality hazard ratios and their 95% CIs for the pooled dataset and by age group., Results: A heterogeneous sample of 2 011 186 individuals (mean [SD] age, 49.1 [14.3] years; age range, 20-97 years; 1 105 581 women [55.0%]) were included. After a median (IQR) follow-up of 11.5 (9.3-13.5) years, 177 436 deaths occurred. The association between PA and mortality in the total sample showed a nonlinear dose-response pattern, but age modified this association (P for interaction <.001); PA was consistently associated with a lower risk of mortality across all age groups, but the reduction in risk was greater in older vs younger age groups, especially at high levels of PA. The hazard ratio for mortality associated with meeting the recommended PA in the total sample was 0.78 (95% CI, 0.77-0.79). This inverse association between meeting PA recommendations and mortality was somewhat greater as age increased (P for interaction <.001). Age also modified the associations of the other modifiable health factors with mortality (all P for interaction <.001), but the magnitude of associations was greater in younger vs older age groups., Conclusions and Relevance: In this pooled analysis of cohort studies, the association between PA and mortality risk remained consistent across the adult lifespan, which contrasts with other modifiable health factors, for which associations with mortality risk diminished with age. Given these findings, the promotion of regular PA is essential at all stages of adult life.

Objectives: Magnesium deficiency is common in older adults and has been associated with reduced muscle functionality and several age-related diseases. Evidence of its relationship with frailty is scarce. We aimed to explore the association of magnesium intake with incident frailty in the Seniors-ENRICA-1 cohort., Design: Prospective longitudinal cohort study., Setting and Participants: The ENRICA study is a population-based study (N = 13,105) that includes a representative sample of the noninstitutionalized Spanish population aged 18 years and older. For the present analyses, we used data from the community-dwelling participants aged 60 years and older at baseline (n = 2519). After exclusions, we included data from 1900 participants of the Seniors-ENRICA-1 cohort (mean age 68.7 ± 6.4 years; 51.7% women)., Methods: Food consumption was assessed at baseline with a validated, computer-based, face-to-face dietary history (DH-ENRICA), from which magnesium intake was estimated. Frailty was defined as having 3 or more of Fried criteria: exhaustion, low physical activity, slow gait speed, weakness, and weight loss. Analyses were performed with logistic regression adjusted for potential confounders., Results: During a mean follow-up of 3.5 years, 136 new cases (7.2%) of frailty occurred. Compared with the lowest sex-specific quartile of magnesium intake, the fully adjusted odds ratio (95% CI) for incident frailty across increasing quartiles of intake was 0.62 (0.36, 1.07), 0.53 (0.28, 0.98), and 0.43 (0.21, 0.86), respectively (P-trend = .016). Corresponding results for slow gait speed were 0.68 (0.47, 1.01), 0.58 (0.37, 0.89), and 0.52 (0.32-0.84), respectively (P-trend = .008). Other Fried criteria showed a similar tendency to reduced frailty incidence with increasing magnesium intake, without achieving statistical significance in the fully adjusted model., Conclusions and Implications: Higher magnesium intake was inversely and independently associated with lower frailty risk, especially of slow gait speed, in community-dwelling older adults, suggesting that adequate intake of this vital ion could help prevent unhealthy aging., Competing Interests: Disclosure The authors declare no conflicts of interests., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: Falls and fear of falling (FoF) are relevant contributors to disability and institutionalization among older adults. The aim was to examine the association between multimorbidity and falls/FoF among community-dwelling older adults, exploring the mediating effect of physical function and the use of sleeping pills and pain relievers., Desing: Longitudinal analyses., Setting and Participants: A total of 1824 adults aged ≥65 years from the Seniors-ENRICA II cohort (Spain)., Methods: Multimorbidity was defined as having ≥2 diseases from a predefined list of 13 chronic conditions extracted from clinical records. Falls were self-reported and FoF was estimated using the Short Falls Efficacy Scale International. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between multimorbidity/duration of multimorbidity and incident falls/FoF using logistic regression models. The mediating effects of physical function, the use of sleeping pills, and pain relievers were explored using the Karlson Holm Breen method., Results: Multimorbidity was associated with a higher risk of falls (OR, 1.44; 95% CI, 1.14-1.82) and FoF (OR, 1.88; 95% CI, 1.48-2.39). Positive dose-response associations were found between the duration of multimorbidity and the risk of falls (P-trend = .003) and FoF (P-trend = .001). Physical function mediated 5.67% and 5.25% of these associations, respectively, and the use of sleeping pills explained a larger proportion of the associations (9.27% and 11.61%). Last, the mediation effect of pain relievers on the association between multimorbidity and falls was 3.05% and 9.31% in the multimorbidity-FoF association., Conclusions and Implications: Multimorbidity was associated with a higher risk of falls/FoF among Spanish community-dwelling older adults. Use of sleeping pills was a relevant mediator, suggesting that interventions on sleep problems have the potential to reduce the burden of falls/FoF and their consequences among older adults with multimorbidity., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: The aim was to examine the association between social frailty and diet quality in adults over 65 years of age, and whether results differed by sex., Design: Population-based cross-sectional study using data from the Spanish National Health Survey., Participants: 5,071 community-dwelling people ≥65 years from Spain., Measurements: Social frailty was deemed to exist when the person both lived alone and had low social support, measured with the Duke-UNC scale. Diet was assessed with the Spanish Healthy Eating Index (S-HEI), ranging from 0 to 100 points (highest diet quality). Means and 95% confidence intervals of the S-HEI score for each social frailty group were calculated using linear regressions, with socially robust people as reference. Analyses were adjusted for main confounders, including sociodemographic, lifestyle and morbidity variables., Results: There were no differences in the S-HEI adjusted mean of socially frail (74.3 points, 95%CI: 73.4-75.2) compared to socially robust older adults (75.4 points; 95%CI: 75.1-75.7). In sex-stratified analyses, the S-HEI adjusted mean of socially frail men (71.9 points; 95%CI: 70.6-73.2) was lower than robust men (74.8 points; 95%CI: 74.4-75.3). Specifically, social frailty was associated with lower consumption of vegetables, fruits, dairy and lower diet variety in men. Differences were not observed according to social frailty among older women., Conclusions: Social frailty was associated with poor diet quality in community-dwelling older men, but not in women in Spain. Gender differences in self-care could partly explain this association. Sex-specific interventions are required to minimize the impact of social frailty on diet quality., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: People with HIV-1 (PWH) age differently than the general population. Blood telomere length (BTL) attrition is a surrogate biomarker of immunosenescence and aging in PWH. BTL is reduced immediately after HIV-1 infection and recovers in PWH with long-term virologic suppression, but the extent of this recovery is unknown., Methods: This prospective 6-year observational study assessed the evolution of BTL in PWH who were virologically suppressed. A cross-sectional analysis additionally compared BTL with age- and sex-matched blood donors and sex-matched persons older than 60 years from a general population cohort. DNA from whole blood was isolated, and relative BTL was determined by monochrome quantitative multiplex polymerase chain reaction assay and expressed as the ratio of telomere to single-copy gene (T/S)., Results: A total of 128 PWH were included in the prospective 6-year observational study. These same 128 PWH (median age, 55 years; 27.3% women) were compared cross-sectionally at 6-year follow-up with 128 age- and gender-matched blood donors (median age, 55 years) and 128 gender-matched individuals older than 60 years from a general population cohort (median age, 70 years). An inverse correlation between age and BTL was observed. The median BTL of PWH was shorter than their matched blood donors (T/S, 1.07 [IQR, 0.95-1.17] vs 1.28 [IQR, 1.12-1.48]; P < .001) but longer than the elderly population (T/S, 0.89 [IQR, 0.77-0.98], P < .001). PWH experienced a BTL increase at 6 years of 2.9% (T/S, 1.04 vs 1.07; P = .002). In PWH, age was associated with a shorter BTL (coefficient, -0.007 45, SE = 0.002 04, P = .002) and baseline lower CD4 count with a gain in BTL (coefficient, -0.000 06, SE = 0.000 02, P = .004). Shorter baseline BTL (odds ratio, 0.91 [95% CI, .87-.94]; P < .001) and higher glucose levels (odds ratio, 1.04 [95% CI, 1.02-1.07]; P = .003) were associated with a greater similarity of BTL to the elderly population., Conclusions: PWH with long-term virologic suppression experience a trend toward an increased BTL after 6 years of follow-up. Middle-aged people with long-term controlled HIV-1 have a shorter BTL than expected for their chronologic age but longer than that of people 15 years older in the general population., Competing Interests: Potential conflicts of interest. J. C. reports personal fees from Gilead, Pfizer, and GSK outside the submitted work. B. R. declares personal fees from Gilead and nonfinancial support from ViiV Healthcare outside the submitted work. J. R. A. reports personal fees from Viiv, Janssen, Gilead, MSD, and Aelix outside the submitted work. R. M. reports personal fees from Gilead and ViiV outside the submitted work. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

We examined associations between nighttime sleep and midday nap duration with all-cause mortality according to adherence to moderate-to-vigorous physical activity (MVPA) recommendations in older adults. We used data from 3518 and 3273 older adults recruited in the Seniors-ENRICA-1 and 2 cohorts, respectively. Nighttime sleep time was classified as short (< 7 h), middle (≥ 7 and < 8 h), and long (≥ 8 h), and midday napping as no nap, short (≤ 30 min), long (> 30 and ≤ 60 min), and very long (> 60 min). Time spent in MVPA was classified as meeting (i.e., ≥ 150 min/week) or not the MVPA recommendations. All-cause mortality was the main outcome. Analyses were performed with Cox regression and adjusted for the main confounders. Overall, compared with middle nighttime sleep, both short (HR 1.20; 95% CI 1.03-1.39) and long (HR 1.30; 95% CI 1.12-1.52) were associated with higher mortality. Among participants who did not meet MVPA recommendations, the association between short (HR 1.22; 95% CI 1.01-1.48) and long (HR 1.46; 95% CI 1.21-1.77) sleeping duration mortality remained. Short napping was associated with lower mortality (HR 0.83; 95% CI 0.71-0.96) and very long with higher mortality (HR 1.29; 95% CI 1.04-1.59), compared to those who did not nap. Among participants not meeting MVPA recommendations, only very long napping was associated with increased mortality (HR 1.32; 95% CI 1.01-1.73). No associations were identified between nighttime sleep or midday napping with mortality among participants meeting MVPA recommendations. Meeting MVPA recommendations can attenuate the risks associated with short or long sleep duration., (© 2024. The Author(s), under exclusive licence to American Aging Association.)

In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The Planetary Health Diet index (PHDI) prioritizes the well-being of both individuals and the planet but has yielded mixed results on cardiovascular disease (CVD). Our aim was to assess the association between the PHDI and risk of CVD., Methods: A cohort of 118,469 individuals aged 40-69 years from the UK Biobank, who were free of CVD at 2009-2012 and followed-up to 2021. The PHDI was calculated using at least two 24-h dietary assessments and included 14 food groups, with a possible range from 0 to130 points. CVD incidence was defined as primary myocardial infarction or stroke and obtained from clinical records and death registries., Results: During a 9.4-year follow-up, 5,257 incident cases of CVD were ascertained. When comparing the highest (89.9-128.5 points) versus the lowest quartile (21.1-71.1 points) of PHDI adherence, the multivariable-adjusted hazard ratio (95% confidence interval) was 0.86 (0.79, 0.94) for CVD, 0.88 (0.80, 0.97) for myocardial infarction, and 0.82 (0.70, 0.97) for stroke. The association was linear until a plateau effect was reached at 80 points of adherence to PHDI. Results remained robust when excluding participants with type 2 diabetes, including only those with three or more diet assessments, or excluding CVD cases in the first three years of follow-up. The food group components of the PHDI more strongly associated with reduced CVD risk were higher consumption of whole grains, whole fruits, fish and lower consumption of added sugars and fruit juices., Conclusion: In this large cohort of middle-aged and older British adults, adherence to the PHDI was associated with lower risk of CVD. These results provide empirical evidence that this dietary pattern, thought to be environmentally sustainable, benefits cardiovascular health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: It is unknown whether growth differentiation factor 15 (GDF-15) is associated with chronic musculoskeletal pain (CMP) and whether or not its association with incident cardiovascular disease (CVD) changes according to CMP status., Methods: In total, 1 957 randomly selected adults aged ≥65 years without prior CVD were followed up between 2015 and 2023. CMP was classified according to its intensity, frequency, and interference with daily activities. The association between GDF-15 levels and CMP was assessed using linear models with progressive inclusion of potential confounders, whereas the association between GDF-15 and CVD risk was evaluated with Cox proportional hazard models with similar adjustment and interaction terms between GDF-15 and CMP. The incremental predictive performance of GDF-15 over standard predictors was evaluated using discrimination and risk reclassification metrics., Results: GDF-15 concentrations were 6.90% (95% confidence interval [CI]: 2.56; 11.25) higher in individuals with CMP, and up to 8.89% (4.07; 15.71) and 15.79% (8.43; 23.16) higher in those with ≥3 CMP locations and interfering pain. These increased levels were influenced by a higher prevalence of cardiometabolic risk factors, functional impairments, depressive symptoms, and greater levels of inflammation in individuals with CMP. In fully adjusted models, a twofold increase in GDF-15 was associated with a 1.49 increased risk (95% CI: 1.08; 2.05) of a CVD event in individuals with CMP, but not among those without CMP (1.02 [0.77; 1.35]); p-interaction 0.041. Adding GDF-15 to models including the Framingham Risk Score improved predictive performance among individuals with CMP., Conclusions: We provide evidence that GDF-15 could serve as a biomarker to assess CMP, as well as to predict CVD incidence in individuals with CMP., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors., Objective: To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors., Design, Setting, and Participants: This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024., Exposure: According to their mean alcohol intake in grams per day, participants' drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d)., Main Outcomes and Measures: Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences., Results: A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking., Conclusions and Relevance: In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.

Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Importance: Avoiding high protein intake in older adults with chronic kidney disease (CKD) may reduce the risk of kidney function decline, but whether it can be suboptimal for survival is not well known., Objective: To estimate the associations of total, animal, and plant protein intake with all-cause mortality in older adults with mild or moderate CKD and compare the results to those of older persons without CKD., Design, Setting, and Participants: Data from 3 cohorts (Study on Cardiovascular Health, Nutrition and Frailty in Older Adults in Spain 1 and 2 and the Swedish National Study on Aging and Care in Kungsholmen [in Sweden]) composed of community-dwelling adults 60 years or older were used. Participants were recruited between March 2001 and June 2017 and followed up for mortality from December 2021 to January 2024. Those with no information on diet or mortality, with CKD stages 4 or 5, or undergoing kidney replacement therapy and kidney transplant recipients were excluded. Data were originally analyzed from June 2023 to February 2024 and reanalyzed in May 2024., Exposures: Cumulative protein intake, estimated via validated dietary histories and food frequency questionnaires., Main Outcomes and Measures: The study outcome was 10-year all-cause mortality, ascertained with national death registers. Chronic kidney disease was ascertained according to estimated glomerular filtration rates, urine albumin excretion, and diagnoses from medical records., Results: The study sample consisted of 8543 participants and 14 399 observations. Of the 4789 observations with CKD stages 1 to 3, 2726 (56.9%) corresponded to female sex, and mean (SD) age was 78.0 (7.2) years. During the follow-up period, 1468 deaths were recorded. Higher total protein intake was associated with lower mortality among participants with CKD; adjusted hazard ratio (HR) for 1.00 vs 0.80 g/kg/d was 0.88 (95% CI, 0.79-0.98); for 1.20 vs 0.80 g/kg/d, 0.79 (95% CI, 0.66-0.95); and for 1.40 vs 0.80 g/kg/d, 0.73 (95% CI, 0.57-0.92). Associations with mortality were comparable for plant and animal protein (HRs, 0.80 [95% CI, 0.65-0.98] and 0.88 [95% CI, 0.81-0.95] per 0.20-g/kg/d increment, respectively) and for total protein intake in participants younger than 75 years vs 75 years or older (HRs, 0.94 [95% CI, 0.85-1.04] and 0.91 [95% CI, 0.85-0.98] per 0.20-g/kg/d increment in total protein intake, respectively). However, the hazards were lower among participants without CKD than in those with CKD (HRs, 0.85 [95% CI, 0.79-0.92] and 0.92 [95% CI, 0.86-0.98] per 0.20-g/kg/d increment, respectively; P = .02 for interaction)., Conclusions and Relevance: In this multicohort study of older adults, higher intake of total, animal, and plant protein was associated with lower mortality in participants with CKD. Associations were stronger in those without CKD, suggesting that the benefits of proteins may outweigh the downsides in older adults with mild or moderate CKD.

Importance: No prior systematic review and meta-analysis has specifically verified the association of Mediterranean diet (MedDiet)-based interventions with biomarkers of cardiometabolic health in children and adolescents., Objective: To review and analyze the randomized clinical trials (RCTs) that assessed the effects of MedDiet-based interventions on biomarkers of cardiometabolic health among children and adolescents., Data Sources: Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) from database inception to April 25, 2024., Study Selection: Only RCTs investigating the effect of interventions promoting the MedDiet on cardiometabolic biomarkers (ie, systolic blood pressure [SBP], diastolic blood pressure [DBP], triglycerides [TGs], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], glucose, insulin, and homeostatic model assessment for insulin resistance [HOMA-IR]) among children and adolescents (aged ≤18 years) were included., Data Extraction and Synthesis: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted from the studies by 2 independent reviewers. Results across studies were summarized using random-effects meta-analysis., Main Outcome and Measures: The effect size of each trial was computed by unstandardized mean differences (MDs) of changes in biomarker levels (ie, SBP, DBP, TGs, TC, HDL-C, LDL-C, glucose, insulin, HOMA-IR) between the intervention and the control groups. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach., Results: Nine RCTs were included (mean study duration, 17 weeks; range, 8-40 weeks). These studies involved 577 participants (mean age, 11 years [range, 3-18 years]; 344 girls [59.6%]). Compared with the control group, the MedDiet-based interventions showed a significant association with reductions in SBP (mean difference, -4.75 mm Hg; 95% CI, -8.97 to -0.52 mm Hg), TGs (mean difference, -16.42 mg/dL; 95% CI, -27.57 to -5.27 mg/dL), TC (mean difference, -9.06 mg/dL; 95% CI, -15.65 to -2.48 mg/dL), and LDL-C (mean difference, -10.48 mg/dL; 95% CI, -17.77 to -3.19 mg/dL) and increases in HDL-C (mean difference, 2.24 mg/dL; 95% CI, 0.34-4.14 mg/dL). No significant associations were observed with the other biomarkers studied (ie, DBP, glucose, insulin, and HOMA-IR)., Conclusions and Relevance: These findings suggest that MedDiet-based interventions may be useful tools to optimize cardiometabolic health among children and adolescents.

Background: Oral vitamin C supplementation has been associated with lower risk of chronic postsurgical pain. However, the effect of dietary vitamin C on pain in a nonsurgical setting is unknown. We aimed to investigate the association between dietary vitamin C intake and changes over time in chronic pain and its characteristics in community-dwelling adults aged 60 + years., Methods: We pooled data from participants of the Seniors-ENRICA-1 (n = 864) and Seniors-ENRICA-2 (n = 862) cohorts who reported pain at baseline or at follow up. Habitual diet was assessed with a face-to-face diet history and dietary vitamin C intake was estimated using standard food composition tables. Pain changes over time were the difference between scores at baseline and follow up obtained from a pain scale that considered the frequency, severity, and number of pain locations. Multivariable-adjusted relative risk ratios were obtained using multinomial logistic regression., Results: After a median follow-up of 2.6 years, pain worsened for 696 (40.3%) participants, improved for 734 (42.5%), and did not change for 296 (17.2%). Compared with the lowest tertile of energy-adjusted vitamin C intake, those in the highest tertile had a higher likelihood of overall pain improvement (RRR 1.61 [95% confidence interval 1.07-2.41], p-trend .02). Higher vitamin C intake was also associated with lower pain frequency (1.57 [1.00-2.47], p-trend = .05) and number of pain locations (1.75 [1.13-2.70], p-trend = .01)., Conclusions: Higher dietary vitamin C intake was associated with improvement of pain and with lower pain frequency and number of pain locations in older adults. Nutritional interventions to increase dietary vitamin C intake with the aim of improving pain management require clinical testing., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Glyphosate is the most widely used herbicide worldwide, both in domestic and industrial settings. Experimental research in animal models has demonstrated changes in muscle physiology and reduced contractile strength associated with glyphosate exposure, while epidemiological studies have shown associations between glyphosate exposure and adverse health outcomes in critical biological systems affecting muscle function., Methods: This study used data from a nationally representative survey of the non-institutionalized U.S. general population (NHANES, n = 2132). Urine glyphosate concentrations were determined by ion chromatography with tandem mass spectrometry. Hand grip strength (HGS) was measured using a Takei Dynamometer, and relative strength estimated as the ratio between HGS in the dominant hand and the appendicular lean mass (ALM) to body mass index (ALMBMI) ratio. Low HGS and low relative HGS were defined as 1 sex-, age- and race-specific SD below the mean. Physical function limitations were identified as significant difficulty or incapacity in various activities., Results: In fully-adjusted models, the Mean Differences (MD) and 95% confidence intervals [95%CI] per doubling increase in glyphosate concentrations were -0.55 [-1.09, -0.01] kg for HGS in the dominant hand, and -0.90 [-1.58. -0.21] kg for HGS/ALMBMI. The Odds Ratios (OR) [95% CI] for low HGS, low relative HGS and functional limitations by glyphosate concentrations were 1.27 [1.03, 1.57] for low HGS; 1.43 [1.05; 1.94] for low relative HGS; 1.33 [1.08, 1.63] for stooping, crouching or kneeling difficulty; 1.17 [0.91, 1.50] for lifting or carrying items weighting up to 10 pounds difficulty; 1.21 [1.01, 1.40] for standing up from armless chair difficulty; and 1.47 [1.05, 2.29] for ascending ten steps without pause difficulty., Conclusions: Glyphosate exposure may be a risk factor for decreased grip strength and increased physical functional limitations. More studies investigating the influence of this and other environmental pollutants on functional aging are needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

To examine whether physical activity can mitigate the mortality risk associated with disability in activities of daily living and instrumental activities in daily living among older adults. This analysis comprised 177,360 US participants (104,556 women), aged ≥ 60 years, with valid data from the 1997 through 2018 waves of the US National Health Interview Survey. Participants reported the frequency and duration of leisure-time PA, and their disabilities in activities of daily living and instrumental activities in daily living. Mortality data were obtained from the National Death Index. Over a mean (SD) follow-up of 8.02 (5.43) years, 66,694 deaths occurred from all-cause, 22,673 from cardiovascular disease, and 13,845 from cancer. Among people with disability in activities in daily living, those reaching physical activity recommendations had 25%, 24% and 33% lower risk of all-cause mortality, cardiovascular diseases, and cancer death, respectively, compared with those who do not meet physical activity recommendations. Values were 23%, 22% and 24% for those with disability in instrumental activities in daily living. Risk reductions associated with reaching the recommended physical activity ranged 16% to 29% for people without disability. Combining disability type and compliance with physical activity, individuals with disability in activities of daily living or instrumental activities in daily living who meet the recommended physical activity had moderately higher mortality than those without disability who did not achieve the recommended physical activity. Compliance with physical activity recommendations can partially mitigate excess mortality resulting from disability in activities in daily living or instrumental activities in daily living in older adults., (© 2024. The Author(s).)

Objectives: Growth differentiation factor 15 (GDF-15) levels increase due to systemic inflammation and chronic disease burden. Since these biological processes are pathogenic factors of malnutrition, we examined the prospective association between GDF-15 serum levels and subsequent malnutrition in older adults., Methods: We used data from 723 women and 735 men aged ≥65 years [mean age (SD): 71.3 (4.18) years] participating in the Seniors-ENRICA-2 cohort, who were followed-up for 2.2 years. Malnutrition was assessed with the Mini Nutritional Assessment-Short form (MNA-SF), where a 12-14 score indicates normal nutritional status, an 8-11 score indicates at risk of malnutrition, and a 0-7 score malnutrition. Associations of GDF-15 and malnutrition were analyzed, separately in women and men, using linear and logistic regression and adjusted for the main potential confounders., Results: The mean (SD) MNA-SF score at baseline was 13.2 (1.34) for women and 13.5 (1.13) for men. Incident malnutrition (combined endpoint "at risk of malnutrition or malnutrition") over 2.2 years was identified in 55 (9.7%) of women and 38 (5.4%) of men. In women, GDF-15 was linearly associated with a decrease in the MNA-SF score; mean differences (95% confidence interval) in the MNA-SF score were -0.07 (-0.13; -0.01) points per 25% increase in GDF-15, and -0.49 (-0.83; -0.16) for the highest versus lowest quartile of GDF-15. Also in women, GDF-15 was linearly associated with a higher malnutrition incidence, with odds ratio (95% confidence interval) of 1.24 (1.06; 1.46) per 25% increment in GDF-15 and of 3.05 (1.21; 7.65) for the highest versus lowest quartile of GDF-15. Results were similar after excluding subjects with cardiovascular disease and diabetes. No association of GDF-15 with changes in MNA score or malnutrition incidence was found in men., Conclusion: Higher serum GDF-15 concentrations are associated with worsening nutritional status in older women. Further studies should elucidate the reasons for the sex differences in this association and explore the therapeutic potential of modifying GDF-15 to prevent malnutrition., (Copyright © 2024. Published by Elsevier Masson SAS.)

Objective: To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults., Study Design: Cross-sectional study., Setting: A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined., Methods: Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders., Results: In multivariable analyses, the PTA was associated with higher nighttime systolic BP [β coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); β (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]., Conclusion: PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives., (© 2024 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background: The role of diet quality on malnutrition in older adults is uncertain, due the paucity of the research conducted and the use of use of screening tools that did not consider phenotypic criteria of malnutrition., Objective: To evaluate the association of two indices of diet quality, namely the Mediterranean Diet Adherence Screener (MEDAS) and the Alternative Healthy Eating Index (AHEI-2010), with malnutrition among community-dwelling older adults in Spain., Methods: Cross-sectional analysis of data from 1921 adults aged ≥ 60 years from the Seniors-ENRICA-1 (SE-1) study, and 2652 adults aged ≥ 65 years from the Seniors-ENRICA-2 (SE-2) study. Habitual food consumption was assessed through a validated diet history. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) phenotypic criteria. Statistical analyses were performed with logistic regression with adjustment for socioeconomic and lifestyle variables as well as for total energy and protein intake., Results: The prevalence of malnutrition in the SE-1 study was 9.5% (95% confidence interval: 8.2 to 10.9) and 11.7% (10.5 to 13.9) in the SE-2. Adherence to the MEDAS score was associated with lower prevalence of malnutrition [pooled odds ratio for high (≥ 9 points) vs. low adherence (< 7 points): 0.64 (0.48-0.84); p-trend < 0.001]. Higher adherence to the AHEI-2010 also showed an inverse association with malnutrition (pooled odds ratio for quartile 4 vs. 1: 0.65 (0.49-0.86); p-trend 0.006). Among the individual components, higher consumption of fish and long-chain n-3 fatty acids in MEDAS and AHEI-2010, and of vegetables and nuts and legumes in AHEI-2010, and lower intake of trans-fat and sugar-sweetened beverages and fruit juice in AHEI-2010 were independently associated with lower odds of malnutrition., Conclusion: Adherence to high diet-quality patterns was associated with lower frequency of malnutrition among older adults., Clinical Trial Registry: ClinicalTrials.gov identifier: NCT02804672. June 17, 2016.; ClinicalTrials.gov NCT03541135. May 30, 2018., (© 2024. The Author(s).)

Background: Substantial evidence supports the inverse association between adherence to healthy dietary patterns and frailty risk. However, the role of plant-based diets, particularly their quality, is poorly known., Objective: To examine the association of two plant-based diets with incidence of physical frailty in middle-aged and older adults., Design: Prospective cohort., Setting: United Kingdom., Subjects: 24,996 individuals aged 40-70 years, followed from 2009-12 to 2019-22., Methods: Based on at least two 24-h diet assessments, we built two diet indices: (i) the healthful Plant-based Diet Index (hPDI) and (ii) the unhealthful Plant-based Diet Index (uPDI). Incident frailty was defined as developing ≥3 out of 5 of the Fried criteria. We used Cox models to estimate relative risks (RR), and their 95% confidence interval (CI), of incident frailty adjusted for the main potential confounders., Results: After a median follow-up of 6.72 years, 428 cases of frailty were ascertained. The RR (95% CI) of frailty was 0.62 (0.48-0.80) for the highest versus lowest tertile of the hPDI and 1.61 (1.26-2.05) for the uPDI. The consumption of healthy plant foods was associated with lower frailty risk (RR per serving 0.93 (0.90-0.96)). The hPDI was directly, and the uPDI inversely, associated with higher risk of low physical activity, slow walking speed and weak hand grip, and the uPDI with higher risk of exhaustion., Conclusions: In British middle-age and older adults, greater adherence to the hPDI was associated with lower risk of frailty, whereas greater adherence to the uPDI was associated with higher risk., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The role of diet quality in the accumulation of multiple chronic conditions is mostly unknown. This study examined diet quality in association with the number of chronic conditions and the rate of multimorbidity development among community-dwelling older adults., Methods: We used data from 2 784 adults aged ≥65 years from the Seniors-ENRICA 2 cohort. Diet quality was assessed at baseline (2015-17) with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Mediterranean Diet Adherence Screener (MEDAS). Information on medical diagnoses was obtained from electronic clinical records up to 2021., Results: Higher adherence to the AHEI-2010 was associated with a lower number of total chronic conditions (β [95% CI] quartile 4 vs 1: -0.57 [-0.86 to 0.27], p trend < .001] and cardiometabolic conditions (-0.30 [-0.44 to -0.17], p trend < .001) at baseline, while higher adherence to the MEDAS was associated with a lower number of total chronic conditions (-0.30 [-0.58 to -0.02], p trend = .01) and neuropsychiatric and neurodegenerative conditions (-0.09 [-0.17 to -0.01], p trend = .01). After a median follow-up of 5.2 years (range: 0.1-6.1 years) higher adherence to the AHEI-2010 was associated with a lower increase in chronic conditions (β [95% confidence interval] quartile 4 vs 1: -0.16 [-0.30 to -0.01], p trend = .04) and with lower rate of chronic disease accumulation., Conclusions: Higher diet quality, as measured by the AHEI-2010, was associated with a lower number of chronic health conditions and a lower rate of multimorbidity development over time., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction and Objectives: The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death., Methods: We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression., Results: In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89)., Conclusions: A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the association of physical activity (PA) with cause-specific cardiovascular disease (CVD) mortality among people with preexisting CVD and to analyze the relationship of PA with CVD-related mortality in people without CVD as well as the association of PA with nonspecific CVD mortality in both populations., Participants and Methods: Of the total participants in the 1997 through 2018 US National Health Interview Survey waves, 87,959 adults with CVD and 527,185 without CVD were included. Leisure-time PA was self-reported; based on frequency and duration, minutes per week in PA were calculated and subsequently classified into: (1) none: 0 min/wk, (2) insufficient: 1 to 149.9 min/wk, (3) recommended: 150 to 300 min/wk, and (4) additional: more than 300 min/wk. Mortality data were obtained through link to records from the National Death Index. Statistical analyses were performed with Cox regression adjusted for potential confounders., Results: During a mean follow-up of 8.5 years, 12,893 participants with CVD, 9943 with coronary heart disease (CHD), and 843 with stroke died of CVD mortality, diseases of heart mortality, and cerebrovascular mortality, respectively. In fully adjusted models, compared with no PA, insufficient, recommended, and additional PA were associated with 25.9%, 37.1%, and 42.0% lower risk of diseases of heart mortality among people with prior CHD, respectively. Among people with stroke, recommended and additional PA was related to 30.7% and 59.3% lower risk of cerebrovascular mortality, respectively. The protective effect of PA on cause-specific CVD mortality was greater in people with CVD than in those without prior CVD. Moreover, PA was more markedly inversely associated with cause-specific CVD mortality than with nonspecific CVD mortality in people with CVD., Conclusion: Physical activity was strongly associated with lower risk of CVD-, CHD-, and stroke-related mortality among people with a history of these specific diseases. Health care professionals should emphasize the importance of a physically active lifestyle in patients with CVD., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population., Patients and Methods: We studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) "Mediterranean food consumption," (2) "Mediterranean dietary habits," and (3) "physical activity, rest, social habits, and conviviality." Death information was retrieved from death register records. Cox regression models were used to analyze the study associations., Results: During a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality., Conclusion: Higher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle., (Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain., (©The Author 2024. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Nutri-Score is a front-of-package (FOP) labeling designed to assist consumers in selecting healthier options at the point of purchase and ultimately enhance their health. This study aims to evaluate the association between the Nutri-Score system and incident abdominal obesity (AO) in community-dwelling older adults. A prospective cohort of 628 individuals aged ≥ 60 were recruited in Spain between 2008-2010 and were reexamined between 2015-2017. Dietary intake was evaluated utilizing a validated computerized dietary history. Food was categorized based on the Nutri-Score system into five levels from A (green, representing the best quality) to E (red, representing the poorest quality). A five-color Nutri-Score dietary index (5-CNS DI) in g/day/kg was calculated for each participant. AO was determined by a waist circumference (WC) of ≥102 cm for men and ≥88 cm for women. Logistic regression models were adjusted for the main potential confounders. During a mean six-year follow-up, 184 incident cases of AO occurred. The odds ratio (OR) and 95% confidence interval (CI) for AO, when comparing the highest and lowest quartiles of the 5-CNS DI, were 2.45 (1.17-5.14), with a p -value for trend of 0.035. In sensitivity analyses, the OR was 2.59 (1.22-5.52, p -trend: 0.032) after adjustment for WC at baseline, and 1.75 (0.74-4.18, p -trend: 0.316) after adjustment for ultra-processed food consumption. In conclusion, less favorable food-consumption ratings in the Nutri-Score are associated with incident AO in the elderly. These findings support the use of this FOP system to potentially improve metabolic health.

Introduction: The impact of residential green spaces on cardiovascular health in older adults remains uncertain., Methods: Cohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF-15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92)., Results: After adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of -5.56 % (95 %CI: -9.77; -1.35), -5.05 % (-9.58; -0.53), -4.24 % (-8.19, -0.19), and -4.16 % (-7.59; -0.74), respectively; and mean differences in hs-TnT among diabetic participants of -8.03 % (95 %CI: -13.30; -2.77), -9.52 % (-16.08; -2.96), -8.05 % (-13.94, -2.16) and -5.56 % (-10.75; -0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes., Conclusion: Increased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To examine the independent relationships of lifestyle and social and economic factors with all-cause and cardiovascular disease (CVD) mortality in a large representative sample of the US adult population. Furthermore, the association between the combination of lifestyle and social and economic factors with mortality was analyzed in detail., Methods: The sample included 103,314 participants with valid records and eligible for mortality follow-up, and information on lifestyle factors and social and economic disadvantages (NHIS waves 2000, 2005, 2010, and 2015). An unhealthy lifestyle score was constructed using information on physical activity, alcohol consumption, diet, and smoking status. Social and economic disadvantages were assessed using information on education, receipt of dividends, employment, family's home, and access to private health. Information on mortality data was determined by the National Death Index records., Results: Compared with favorable lifestyle, unfavorable lifestyle was associated with higher all-cause (HR 2.07; 95% CI 1.97-2.19) and CVD (HR 1.84; 95% CI 1.68-2.02) mortality. Higher social and economic disadvantages were also associated with higher all-cause (HR 2.44; 95% CI 2.30-2.59) and CVD mortality (HR 2.44; 95% CI 2.16-2.77), compared to low social and economic disadvantages. In joint associations, participants in the high social and economic disadvantage and unfavorable lifestyle showed a greater risk of all-cause (HR 4.06; 95% CI 3.69-4.47) and CVD mortality (HR 3.98; 95% CI 3.31-4.79)., Conclusion: Lifestyle and social and economic disadvantages are associated with all-cause and CVD mortality. The risk of mortality increases as the number of social and economic disadvantages and unhealthy lifestyles increases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Duarte Junior, Pintos Carrillo, Martínez-Gómez, Sotos Prieto, Rodríguez-Artalejo and Cabanas Sánchez.)

Aims: The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin., Methods and Results: We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]., Conclusion: The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

In 2023, the algorithm underlying the Nutri-Score front-of-pack label was updated to better align with food-based dietary guidelines (FBDGs) across countries engaged in the system. On the basis of a comparison of FBDGs and literature reviews with the current Nutri-Score classification, modification scenarios were developed and tested in nutritional composition databases of branded products in four countries. The updated Nutri-Score nutrient profile model allows a better discrimination between products, in closer alignment with FBDGs, while the updated algorithm adopts a stricter approach for products that are high in components of concern (including non-nutritive sweeteners) and low in favourable dietary components. The updated Nutri-Score algorithm increases the alignment between the front-of-pack label system and FBDGs, strengthening its potential as a complementary public health tool in an international perspective., (© 2024. Springer Nature Limited.)

Background: Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown., Methods: Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces., Results: At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities., Conclusions: Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age., (© 2024. The Author(s).)

Objective: To investigate the association between hearing function, as approached with the functional auditory capacity, and multimorbidity., Study Design: Cross-sectional study., Setting: The UK Biobank was established from 2006 to 2010 in the United Kingdom. This cross-sectional analysis included 165,524 participants who provided baseline information on hearing function., Methods: Functional auditory capacity was measured with a digit triplet test. Three categories were defined according to the speech reception threshold in noise (SRTn): normal (SRTn < -5.5 dB signal-to-noise ratio [SNR]), insufficient (SRTn ≥ -5.5 to ≤ -3.5 dB SNR) and poor hearing function (SRTn > -3.5 dB SNR). To define multimorbidity, 9 chronic diseases were considered, including chronic obstructive pulmonary disease, dementia, Parkinson's disease, stroke, cancer, depression, osteoarthritis, coronary heart disease, and diabetes; multimorbidity was defined as the coexistence of 2 or more in the same individual. Analyses were conducted using logistic models adjusted for relevant confounders., Results: Among the study participants, 54.5% were women, and the mean (range) age was 56.7 (39-72) years. The prevalence of insufficient and poor hearing function and multimorbidity was 13% and 13.2%, respectively. In comparison with having a normal SRTn, the odds ratio (95% confidence interval) of multimorbidity associated with insufficient SRTn was 1.13 (1.08-1.18), and with poor SRTn was 1.25 (1.14-1.37)., Conclusion: Insufficient and poor hearing function was associated with multimorbidity. This association suggests common biological pathways for many of the considered morbidities., (© 2023 The Authors. Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.)