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Introduction: Introduction: vitamin D is involved in recovery after an osteoporotic hip fracture (OHF). Previous studies have reported decreased serum vitamin D levels during fracture healing. Objectives: our aim was to evaluate: a) serum 25-hydroxyvitamin D3 (25OHD3) levels in patients with OHF at hospital admission and 8 days post-admission, and b) the relationship between 25OHD levels and clinical outcomes. Methods: a prospective study including 66 patients aged over 65 years hospitalized for OHF. We gathered data on baseline demographic characteristics, medical history, Mini Mental State (MMS) assessment, Activities of Daily Living (ADL) results, nutritional assessment, and type of fracture and surgery. Laboratory results were collected on bone biomarkers, albumin, 25OHD3, and IL6. Clinical outcomes included length of stay, complications, and mortality. In the statistical analysis, a t-test was used for continuous variables and a chi-square test for qualitative variables. Linear regression models were used for the multivariate analysis, adjusted for covariates. Results: our study population had low serum vitamin D levels at admission, with a mean [(standard error of the mean (SEM)] of 12.04 (1.03) ng/mL. Both 25OHD3 and interleukin 6 (IL-6) levels significantly declined (p < 0.001) during the early post-fracture phase. A greater decline in 25OHD3 levels was significantly associated with longer hospital stay (p = 0.042, multivariate analysis). Serum 25OHD3 levels were also associated with cognitive status as assessed using the MMS exam. Conclusions: 25OHD3 levels were reduced in OHF patients at admission, and significantly decreased during the first 8 days post-admission. 25OHD3 levels were associated with MMS-assessed cognitive status. A greater decline in serum 25OHD3 was associated with a longer hospital stay.

Purpose: Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort., Methods: All PREDIMED-Plus participants (6874 men and women aged 55-75 years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF., Results: Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90-0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89-0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90-0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87-0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS) in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures., Conclusions: Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease.

Objective: The aim of this study was to assess whether diet variables can neutralize the risk produced by three well-known risk factors for being small for gestational age: smoking, body mass index (BMI) ˂20 kg/m 2 , and having a previous preterm/low birth weight (LBW) newborn., Methods: A matched case control study was conducted (518 cases and 518 controls of pregnant women) in Spain. We collected data on demographic characteristics, socioeconomic status, toxic habits, and diet. Dietary intake during pregnancy was assessed using a validated food frequency questionnaire, categorized into quintiles. Adjusted odds ratios (aORs) and their 95% confidence intervals (CI) were estimated by conditional regression logistic models., Results: Women who smoked during pregnancy had a 78% increased risk for having an SGA newborn (aOR, 1.78; 95% CI, 1.28-2.74). Lean women (BMI ˂ 20 kg/m 2 before pregnancy) augmented the risk 139% (aOR, 2.39; 95% CI, 1.68-3.40), and those with a previous SGA-LBW an increase of 160% (aOR, 2.60; 95% CI, 1.53-4.37). Smoking in women with a fruit intake of ≥421 g/d was not associated with a higher risk for SGA versus non-smoking women with the same fruit intake (aOR, 0.98; 95% CI, 0.41-2.33). A BMI <20 kg/m 2 with an intake of ≥33 g/d of legumes did not increase the risk for SGA versus women with a BMI ≥20 kg/m 2 with the same legume intake (aOR, 1.35; 95% CI, 0.54-3.37). Diet did not modify the risk by having a previous SGA-LBW newborn., Conclusions: Smoking and leanness increased the SGA risk; nevertheless foods such as fruit, fish, and legumes, as well as intake of vitamins D and B 3 and ω-3 marine fatty acids, may "at" least partially counteract this increase., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study assessed the effect of maternal age on satisfaction at each stage of pregnancy, childbirth and puerperium, and globally. An observational study was carried out in five hospitals of the Andalusian public health system with older primiparous women, from May 2016 to May 2018. Using a pre-piloted questionnaire, information was collected on pregnancy, childbirth, puerperium, newborn variables and degree of satisfaction with the care received. Crude and adjusted mean differences and the standard error of the mean were calculated. A total of 373 women participated. In total, 43.0% of the sample were very satisfied with the care received during pregnancy, and 74.2% with the care received during childbirth. During the puerperium, the highest percentage (60.4%) was found among the women who reported being quite satisfied, although the results were not significant in any of these stages ( p > 0.05). No significant differences were established between women's different age strata and maternal satisfaction. However, the average given by women regarding their satisfaction with the process, on a scale from 0 to 4, was: 3.5 ± 0.5 in general, 3.2 ± 0.8 regarding pregnancy, 3.7 ± 0.5 in childbirth and 3.1 ± 0.6 in the postpartum period. The woman's satisfaction with the follow up and health care received during pregnancy, childbirth and puerperium is independent of the mother's age.

Background & Aims: Few studies have compared micronutrient intake and fulfilment of average requirements (EAR) in non-diabetic, pre-diabetic and diabetic adults at high cardiovascular risk. We assessed these variables in a large sample of participants in the PREDIMED-PLUS randomized trial of primary cardiovascular prevention with diet and physical activity., Design: Baseline assessment of nutritional adequacy in n = 5792 men and women, aged 55-75 years, with overweight/obesity and some metabolic syndrome features., Methods: Participants were categorised as non-diabetic (n = 2390), pre-diabetic (n = 1322) or diabetic (n = 2080) by standard criteria. Food and nutrient intake were assessed using a validated food frequency questionnaire. Micronutrients examined were vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine. The proportion of micronutrient inadequacy was evaluated using the EAR or adequate intake (AI) cut-offs. Diet quality was also determined using a 17-item energy-restricted Mediterranean diet (MedDiet) questionnaire., Results: Compared to non-diabetic participants, those with pre-diabetes had lower intakes of total carbohydrates (CHO) and higher intakes of total fat and saturated fatty acids (SFA) and were more likely to be below EAR for folic, while diabetic participants had lower intakes of total CHO and higher intakes of protein, total fat, monounsaturated fatty acids, SFA and cholesterol and were less likely to be below EAR for vitamins B2, and B6, Ca, Zn and iodine. Diabetic participants disclosed higher adherence to the MedDiet than the other two groups., Conclusions: Older Mediterranean individuals with metabolic syndrome and diabetes had better nutrient adequacy and adherence to the MedDiet than those with pre-diabetes or no diabetes., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD)., Objective: We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program., Methods: Prospective analysis of 5373 overweight/obese Spanish adults (aged 55-75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD., Results: During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD -0.20; 95% CI -0.26, -0.15), HbA1c (SD -0.16; 95% CI -0.23, -0.10), weight (SD -0.12; 95% CI -0.14, -0.09), systolic BP (SD -0.11; 95% CI -0.19, -0.02) and diastolic BP (SD -0.11; 95% CI -0.19, -0.04)., Conclusions: Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870., (Copyright © The Author(s) 2019.)

Background: Fertility in recent decades in European countries such as Norway, Spain or United Kingdom has declined, while in others such as Portugal, it has remained relatively constant, and in others such as Germany fertility rated have risen. The determinants of this change in reproductive pattern can be explained by the cultural, social, and economic changes that took place in our society. Objective: to identify the principal reasons and independent determinants associated with the postponement of motherhood and document any association between the time taken to achieve successful pregnancy and maternal age, as well as the level of anxiety of these women., Methods: An observational study, including 326 women, was conducted in Spain with primiparous women, in which data was collected on sociodemographic, health, and pregnancy-related factors. Comparison of means (t-test or analysis of variance) and the analysis of covariance was used to estimate adjusted means for potential confounders., Results: Women in stable relationships became mothers at older ages (31.83±0.29) than those who were not (28.75±0.78) (p<0.001). Women who delayed motherhood for medical reasons had a mean age of 34.15 ± 0.88 years, compared to a mean of 30.52±0.36 years for personal reasons, and 27.51±1.39 years for other reasons. Mothers with an older age had a higher level of anxiety (p<0.05). The average time required to achieve pregnancy increased as maternal age increased, with an average time of 24 months for women with a mean age of 35.23±0.71 years compared to <3 months for women with a mean age of 29.44±0.39 years. Women ≥ 35 years were more likely to need medical assistance to achieve pregnancy (aOR = 12.07, 95% CI: 1.50-97.05; p = 0.019)., Conclusions: Medical reasons were among those cited for delaying motherhood. The postponement of motherhood was associated with difficulty to achieve a successful pregnancy and a higher level of anxiety., Competing Interests: The authors have declared that no competing interests exist.

Maternal nutrition is recognized as one of the main determinants of fetal growth. We analyzed the risk of having a Small for Gestational Age (SGA) newborn according to maternal dairy intake during pregnancy. A matched case-control study was conducted in Spain. Dietary intake during pregnancy was assessed using a validated Food Frequency Questionnaire. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated using conditional logistic regression models. 518 cases (SGA) and 518 controls (adequate birth weight) were included. Most study participants did not meet the current recommendations for dairy intake (78.6% cases and 80.2% controls). Intake of dairy products was not associated with a lower frequency of SGA, aOR Q4 vs. Q1  = 1.12 (95% CI 0.73, 1.70), and aOR Q5 vs. Q1  = 1.44 (95% CI 0.92, 2.26). Our results suggest that a low dairy intake during pregnancy is not associated with an increased risk of SGA; possibly due to the low consumption of dairy in both groups.

Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77-19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03-1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94-7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10-1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04-1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05-1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29-2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.

Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.

Objective: To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities., Design: A descriptive multicentre study assessing medical consultations video recording., Location: Eight Primary Healthcare centres in Jaen (Andalucia)., Participants: Seventy-three resident physicians (4th year) filmed and observed with patients., Principal Measurements: Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed., Results: Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10)., Conclusions: Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Importance: High-quality dietary patterns may help prevent chronic disease, but limited data exist from randomized trials about the effects of nutritional and behavioral interventions on dietary changes., Objective: To assess the effect of a nutritional and physical activity education program on dietary quality., Design, Setting, and Participants: Preliminary exploratory interim analysis of an ongoing randomized trial. In 23 research centers in Spain, 6874 men and women aged 55 to 75 years with metabolic syndrome and no cardiovascular disease were enrolled in the trial between September 2013 and December 2016, with final data collection in March 2019., Interventions: Participants were randomized to an intervention group that encouraged an energy-reduced Mediterranean diet, promoted physical activity, and provided behavioral support (n = 3406) or to a control group that encouraged an energy-unrestricted Mediterranean diet (n = 3468). All participants received allotments of extra-virgin olive oil (1 L/mo) and nuts (125 g/mo) for free., Main Outcomes and Measures: The primary outcome was 12-month change in adherence based on the energy-reduced Mediterranean diet (er-MedDiet) score (range, 0-17; higher scores indicate greater adherence; minimal clinically important difference, 1 point)., Results: Among 6874 randomized participants (mean [SD] age, 65.0 [4.9] years; 3406 [52%] men), 6583 (96%) completed the 12-month follow-up and were included in the main analysis. The mean (SD) er-MedDiet score was 8.5 (2.6) at baseline and 13.2 (2.7) at 12 months in the intervention group (increase, 4.7 [95% CI, 4.6-4.8]) and 8.6 (2.7) at baseline and 11.1 (2.8) at 12 months in the control group (increase, 2.5 [95% CI, 2.3-2.6]) (between-group difference, 2.2 [95% CI, 2.1-2.4]; P < .001)., Conclusions and Relevance: In this preliminary analysis of an ongoing trial, an intervention that encouraged an energy-reduced Mediterranean diet and physical activity, compared with advice to follow an energy-unrestricted Mediterranean diet, resulted in a significantly greater increase in diet adherence after 12 months. Further evaluation of long-term cardiovascular effects is needed., Trial Registration: isrctn.com Identifier: ISRCTN89898870.

Osteoporosis results from an imbalance in bone remodeling, which is known to follow a circadian rhythm determined by a functional relationship between intestine and bone tissue. Specific intestinal peptides have been identified as mediators. Glucagon-like peptide 1 and glucagon-like peptide 2, have been associated with bone health. Our main objective was to determine whether postprandial plasma levels of glucagon-like peptide 1, glucagon-like peptide 2 and dipeptidyl-peptidase 4 activity, are associated with osteoporosis in non-diabetic postmenopausal women. We studied non-diabetic postmenopausal women with osteoporosis diagnosed by dual-energy X-ray absorptiometry (cases, n = 43) and age-matched (±1 yr) controls without osteoporosis or a history of osteoporotic fracture (n = 43). We measured postprandial plasma levels of glucagon-like peptide 1, glucagon-like peptide 2, and dipeptidyl-peptidase 4 activity, bone mineral density, and baseline levels of bone remodeling markers and analyzed the food intake using a food-frequency questionnaire. Postprandial glucagon-like peptide 1 values were lower (p < 0.001) in cases, μ (SEM) = 116.25 (2.68), than in controls, μ (SEM) = 126.79 (2.68). Glucagon-like peptide 1 was associated with reduced osteoporosis risk in the crude logistic regression analysis [OR (95% CI) = 0.724 (0.53-0.97), p = 0.031] and adjusted analysis [OR = 0.603 (0.38-0.94), p = 0.027]. We found no association of glucagon-like peptide 2, or dipeptidyl-peptidase 4 activity with osteoporosis. Postprandial glucagon-like peptide 1 levels are related to osteoporosis and osteoporosis risk in non-diabetic postmenopausal women. Further studies are required to verify these findings.

Delaying motherhood is becoming increasingly common, raising questions of the possible influence that maternal age may have on newborn health. Therefore, the objective of this study was to determine the association between maternal age and different newborn health parameters. An observational study was conducted in Spain on primiparous women and their infants. Data were collected on newborn health variables, breastfeeding, and different clinical practices that are beneficial for child health and development. Crude and adjusted mean differences were calculated along with the standard error of the mean. A total of 373 women and their children participated. In terms of early commencement skin-to-skin contact, the mean age of women that did skin-to-skin contact was 29.95 ± 0.31 years compared to 31.49 ± 0.66 years in those that did not ( p = 0.042). In terms of other newborn parameters, such as preterm birth, health problems or complications, or the need for hospital admission, these were more frequent in the oldest group of mothers, but the differences found were not significant ( p > 0.05). Hence, indicators of newborn morbidity were not found to be significantly associated with maternal age; however, beneficial practices such as early commencement skin-to-skin contact were found to be significantly associated with maternal age.

The Mediterranean diet is considered as the foremost dietary regimen and its adoption is associated with the prevention of degenerative diseases and an extended longevity. The preeminent features of the Mediterranean diet have been agreed upon and the consumption of olive oil stands out as the most peculiar one. Indeed, the use of olive oil as the nearly exclusive dietary fat is what mostly characterizes the Mediterranean area. Plenty of epidemiological studies have correlated that the consumption of olive oil was associated with better overall health. Indeed, extra virgin olive oil contains (poly)phenolic compounds that are being actively investigated for their purported biological and pharma-nutritional properties. On 18 and 19 May 2018, several experts convened in Jaen (Spain) to discuss the most recent research on the benefits of olive oil and its components. We reported a summary of that meeting (reviewing several topics related to olive oil, not limited to health) and concluded that substantial evidence is accruing to support the widespread opinion that extra virgin olive oil should, indeed, be the fat of choice when it comes to human health and sustainable agronomy., Competing Interests: The authors declare no conflict of interest.

Parity is associated with the incidence of problems in pregnancy, delivery and the puerperium. The influence of parity in the postpartum period has been poorly studied and the results are incongruous. The objective of this study was to identify the association between parity and the existence of distinct discomfort and problems during the postpartum period. Cross-sectional study with puerperal women in Spain. Data was collected on demographic and obstetric variables and maternal manifestations of discomfort and problems during the postpartum period. An ad hoc online questionnaire was used. Crude odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. 1503 primiparous and 1487 multiparous participated in the study. 53.4% (803) of the primiparous women affirmed to have feelings of sadness, as opposed to 36.2% (539) of multiparous women (aOR: 1.60; 95% CI: 1.35-1.89). 48.3% (726) of primiparous had lactation problems vs 24.7% (367) of multiparous (aOR: 2.46; 95% CI: 2.05-2.94). 37.2% (559) of primiparous reported anxiety, while the percentage in multiparous was 25.7% (382) (aOR: 1.34; 95% CI: 1.12-1.61). 22.2% (333) of primiparous had depressive symptoms, and 11.6% (172) of multiparous (aOR: 1.65; CI 95%: 1.31-2.06). Faecal incontinence was more present in primiparous than in multiparous, 6.5% (97) and 3.3% (49) respectively (aOR: 1.60; 95% CI: 1.07-2.38). Parity is associated with the presence of certain problems in the postpartum period. Thus, primiparous are more likely to have lactation problems, depressive symptoms, anxiety, sadness, and faecal incontinence.

Background: The CUN-BAE (Clínica Universidad de Navarra-Body adiposity estimator) index is an anthropometric index based on age, sex and body mass index (BMI) for a refined prediction of body fatness in adults. CUN-BAE may help detect metabolically unhealthy individuals with otherwise normal weight according to BMI or waist circumference (WC). The aim of this study was to evaluate whether CUN-BAE, independent of its components (BMI, age and sex), was associated with cardiometabolic conditions including arterial hypertension, diabetes mellitus and metabolic syndrome (MetS)., Methods: The ENRICA study was based on a cross-sectional sample of non-institutionalized men and women representative of the adult Spanish population. Body weight, height, and WC were measured in all participants. The residual of CUN-BAE (rCUN-BAE), i.e. the part of the index not explained by its components, was calculated. The associations of CUN-BAE, rCUN-BAE, BMI and WC with hypertension, diabetes and MetS were analysed by multivariate logistic regression, and the Akaike information criterion (AIC) was calculated., Results: The sample included 12,122 individuals. rCUN-BAE was associated with hypertension (OR 1.14, 95% CI 1.07-1.21) and MetS (OR 1.48, 1.37-1.60), but not with diabetes (OR 1.05, 0.94-1.16). In subjects with a BMI < 25 kg/m 2 , CUN-BAE was significantly associated with all three outcome variables. CUN-BAE was more strongly associated with the cardiometabolic conditions than BMI and WC and fit similar AICs., Conclusions: The CUN-BAE index for body fatness was positively associated with hypertension, diabetes and MetS in adults independent of BMI or WC. CUN-BAE may help to identify individuals with cardiometabolic conditions beyond BMI, but this needs to be confirmed in prospective settings.

Research examining associations between objectively-measured napping time and type 2 diabetes (T2D) is lacking. This study aimed to evaluate daytime napping in relation to T2D and adiposity measures in elderly individuals from the Mediterranean region. A cross-sectional analysis of baseline data from 2190 elderly participants with overweight/obesity and metabolic syndrome, in the PREDIMED-Plus trial, was carried out. Accelerometer-derived napping was measured. Prevalence ratios (PR) and 95% confidence intervals (CI) for T2D were obtained using multivariable-adjusted Cox regression with constant time. Linear regression models were fitted to examine associations of napping with body mass index (BMI) and waist circumference (WC). Participants napping ≥90 min had a higher prevalence of T2D (PR 1.37 (1.06, 1.78)) compared with those napping 5 to <30 min per day. Significant positive associations with BMI and WC were found in those participants napping ≥30 min as compared to those napping 5 to <30 min per day. The findings of this study suggest that longer daytime napping is associated with higher T2D prevalence and greater adiposity measures in an elderly Spanish population at high cardiovascular risk.

Delaying maternity is becoming more common, resulting in questions regarding the influence age may have on obstetric results. Therefore, we proposed the objective to determine the association between maternal age and different health variables during pregnancy, childbirth and the puerperium. We conducted an observational study in Spain with primiparous women in which data was collected on sociodemographic, health and obstetric variables. Crude and adjusted mean differences were calculated with their corresponding 95% confidence intervals. The study included a final sample of 373 women. The mean age of women presenting with hypertension during pregnancy was 34.54 years (95% CI: 31.80-37.27) compared with a mean of 30.11 (95% CI: 29.56-30.66) in women that did not ( p = 0.002). Women who had a eutocic delivery were also younger: 29.17 years (95% CI: 28.48-29.86) compared with 31.90 years (95% CI: 31.05-32.74; p < 0.001) for those that had a dystocic delivery. The duration of dilatation was longer in those ≥35 years ( p = 0.001). In conclusion, an advanced maternal age is associated with a higher incidence of pathology during pregnancy and dystocic labor.

Objective: The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention., Research Design and Methods: Overweight/obese adults with metabolic syndrome aged 55-75 years ( n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively., Results: Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001), a mean difference of -2.5 kg (95% CI -3.1 to -1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG ( P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants ( P < 0.002). Reductions in insulin resistance, HbA 1c , and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants ( P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts., Conclusions: PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes., (© 2018 by the American Diabetes Association.)

Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55-75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80-39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55-18.65), fruits OR = 11.62 (95% CI 6.81-19.81), dairy products OR = 6.54 (95% CI 4.64-9.22) and protein foods OR = 6.60 (95% CI 1.96-22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s.

Introduction: Introduction: different diets during pregnancy might have an impact on the health as reflected by the birth weight of the newborn. The consumption of meat and meat products during pregnancy and its relationship with the newborn health status have been studied by several authors. The studies carried out show inconsistent results. Objective: to analyse the association between maternal dietary intake of meat and meat products and the risk of small for gestational age (SGA) newborn. Methods: a matched case-control study of 518 cases and controls of pregnant women was performed in Spain. Cases were women with a SGA newborn. Data about demographic characteristics and diet were collected. Meat consumption was gathered through a validated food frequency questionnaire. Meat and meat products intakes were categorized in quintiles (Q1-Q5).The association between maternal meat and meat product intakes and SGA was assessed by logistic regression models with adjustment for confounding factors. Results: an intake of meat products above 6.8 g/day was associated with a lower risk of SGA delivery (OR = 0.7; 95% CI, 0.53-0.93) after adjusting for smoking, body mass index, previous preterm-low birth weight, newborn gender and adherence to Mediterranean diet. Conclusions: meat consumption was not associated with SGA, whereas meat products showed a moderate protective relationship.

Mental disorders are consistently and closely related to psychological distress. At the start of the university period, the relationship between a student's psychological distress, family support, and employment status is not well-known. The aims of this study were: To determine the prevalence of psychological distress in first-year university students and to analyze its relationship with family support and the student's employment status. Data from 4166 first-year university students from nine universities across Spain were considered. The prevalence of psychological distress was obtained using the GHQ-12, a valid and reliable screening tool to detect poor mental health. To analyze the relationship between psychological distress, family support, and employment status, logistic regression models were fitted. Regarding the prevalence found, 46.9% of men and 54.2% of women had psychological distress. In both genders, psychological distress levels increased as family support decreased. Among women, psychological distress was associated with their employment status. The prevalence of psychological distress among first-year university students in Spain is high. In addition, family support, and employment status for women, could be factors to take into account when developing psychological distress prevention strategies at the beginning of the university period.

The aim of the study was to evaluate sleep duration and sleep variability in relation to serum uric acid (SUA) concentrations and SUA to creatinine ratio. This is a cross-sectional analysis of baseline data from 1842 elderly participants with overweight/obesity and metabolic syndromein the (Prevención con Dieta Mediterránea) PREDIMED-Plus trial. Accelerometry-derived sleep duration and sleep variability were measured. Linear regression models were fitted to examine the aforementioned associations. A 1 hour/night increment in sleep duration was inversely associated with SUA concentrations (β = 0.07, p = 0.047). Further adjustment for leukocytes attenuated this association (p = 0.050). Each 1-hour increment in sleep duration was inversely associated with SUA to creatinine ratio (β = 0.15, p = 0.001). The findings of this study suggest that longer sleep duration is associated with lower SUA concentrations and lower SUA to creatinine ratio.

Background: Nut consumption has been associated with improved nutrient adequacy and diet quality in healthy adult populations but this association has never been explored in individuals at high cardiovascular risk., Objective: to assess the associations between consumption of nuts and nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk., Design: baseline assessment of nutritional adequacy in participants ( n = 6060, men and women, with ages 55⁻75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary cardiovascular prevention randomized trial., Methods: nut intake was assessed using a validated food frequency questionnaire. Participants who reported consuming zero quantity of nuts were classified as 'non-nut consumers'. 'Nut consumers' were participants who reported consuming any quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI)., Results: eighty-two percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile range: 6.0⁻25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D, E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence to the Mediterranean diet (Mediterranean diet score, MDS)., Conclusions: nut consumers had better nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.

The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women ( n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11⁻2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35⁻0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81⁻3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03⁻1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09⁻2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33⁻2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers ( p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.

The World Health Organization (WHO) considers quality of life a fundamental indicator. The effect of birth on women's long-term quality of life (QoL) has barely been studied. The purpose of this study was to determine the factors related with the pregnancy, delivery and puerperium, and assess women's QoL after giving birth. A cross-sectional study with Spanish puerperal women was carried out; it collected data on socio-demographic variables, obstetric variables, newborn data, and several quality of life parameters. An ad hoc online questionnaire, including SF-36 (validated instrument to measure QoL), was used. Crude mean differences (MD) and adjusted mean differences (aMD) were estimated by multiple linear regression. A total of 2990 women participated whose overall QoL lowered with time until three years postpartum ( p = 0.045). Caesarean section (aMD = -3.61, 95% confidence interval (CI): -5.07, -2.15), mother admitted to ICU (aMD = -4.81, 95% CI: -9.56, -2.68), newborn hospitalized (aMD = -2.10, 95% CI: -4.31, -0.13) or third/fourth degree perineal tears (aMD = -6.87 95%CI: -9.93, -3.82) were detected as risk factors that affect negatively and significantly on postpartum QoL scores. Women's postpartum QoL worsens with time. Some determining factors negatively influence postpartum QoL: Caesarean section, a mother´s admission to an intensive care unit (ICU) or a premature newborn.

Dietary guidelines universally advise adherence to plant-based diets. Plant-based foods confer considerable health benefits, partly attributable to their abundant micronutrient (e.g., polyphenol) content. Interest in polyphenols is largely focused on the contribution of their antioxidant activity to the prevention of various disorders, including cardiovascular disease and cancer. Polyphenols are classified into groups, such as stilbenes, flavonoids, phenolic acids, lignans and others. Lignans, which possess a steroid-like chemical structure and are defined as phytoestrogens, are of particular interest to researchers. Traditionally, health benefits attributed to lignans have included a lowered risk of heart disease, menopausal symptoms, osteoporosis and breast cancer. However, the intake of naturally lignan-rich foods varies with the type of diet. Consequently, based on the latest humans' findings and gathered information on lignan-rich foods collected from Phenol Explorer database this review focuses on the potential health benefits attributable to the consumption of different diets containing naturally lignan-rich foods. Current evidence highlight the bioactive properties of lignans as human health-promoting molecules. Thus, dietary intake of lignan-rich foods could be a useful way to bolster the prevention of chronic illness, such as certain types of cancers and cardiovascular disease.

Objective: To assess the prevalence of illegal drug use in college students on any previous occasion, during the previous year and the previous month, and to analyze the relationship between illegal drug use and family support and other factors., Methods: A cross-sectional study using data from students participating in the uniHcos project (n = 3767) was conducted. The prevalence and age of onset of consumption of cannabis, non-prescription sedatives, stimulants and depressants was evaluated. Polyconsumption was also assessed. The independent variables were: family support, age, residence, and employment status. To determine the factors related to drug use multivariate logistic regression models stratified by gender were fitted., Results: Differences between men and women in prevalence of illegal drug use except non-prescription sedatives were observed. In both genders, less family support was associated with higher consumption of all drugs, except depressants, and with polyconsumption. To be studying and looking for work was related to cannabis and stimulant use and to polyconsumption among women, but only to cannabis use among men., Conclusions: These results support the notion that the start of university studies is a particularly relevant stage in the onset of illegal drug use and its prevention, and that consumption may be especially associated with family support., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

In randomized clinical trials (RCTs) with teriparatide, the number of patients with incident hip fractures was small and insufficiently powered to show statistically significant differences between groups. We, therefore, conducted a systematic review and meta-analysis of the efficacy of teriparatide in the reduction of hip and upper limb fractures in women and men with osteoporosis. A comprehensive search of databases until 22 November 2017 was conducted for RCTs of at least 6-month duration that reported non-spine fractures (hip, humerus, forearm, wrist), either as an efficacy or safety endpoint. Only RCTs that included patients with the approved treatment indications and dose for use of teriparatide were included; trials with off-label use of teriparatide were excluded. Two independent reviewers performed study selection and data extraction. Statistical procedures included Peto's method and Mantel-Haenszel with empirical correction, as most of the RCTs reported zero events in at least one of the treatment arms. Study results are expressed as odds ratios (OR) with 95% confidence intervals (CI). Publication bias and heterogeneity were evaluated with standard statistical tests. Twenty-three RCTs were included, 19 with an active-controlled arm (representing 64.9% of the patients included in the control group) and 11 double-blind, representing data on 8644 subjects, 3893 of them treated with teriparatide. Mean age (SD) was 67.0 (4.5) years, median treatment duration 18 months (range: 6 to 24 months). A total of 34 incident hip, 31 humerus, 31 forearm, and 62 wrist fractures were included. Meta-analysis results showed an OR (95% CI) for hip fractures of 0.44 (0.22-0.87; p = 0.019) in patients treated with teriparatide compared with controls. The effects on the risk of humerus [1.02 (0.50-2.08)], forearm [0.53 (0.26-1.08)] and wrist fractures [1.21 (0.72-2.04)] were not statistically significant (p > 0.05). This meta-analysis provides evidence of efficacy of teriparatide in reducing hip fractures by 56% in patients with osteoporosis., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to assess the relationship between consumption of different types of carbohydrates (CHO) during pregnancy and the risk of having a small for gestational age (SGA) newborn. A retrospective matched case⁻control design was carried out with a total of 518 mother-offspring pairs. A total of 137 validated items were included in the food frequency questionnaire (FFQ). Conditional logistic regression models were used to calculate crude odds ratios (cORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Having more than 75 g/day of brown bread showed an inverse association with SGA (aOR = 0.64, CI 0.43⁻0.96). In contrast, an intake of industrial sweets more than once a day (aOR = 2.70, CI 1.42⁻5.13), or even 2⁻6 times a week (aOR = 1.84, CI 1.20⁻2.82), increased the odds of having a SGA newborn. During pregnancy, the higher the increase of wholegrain cereal and bread, the lower the possibility of having a SGA newborn, but the opposite occurred with refined sugar products-just consuming industrial bakery products or pastries twice a week increased the odds of having an SGA infant. Case⁻control studies cannot verify causality and only show associations, which may reflect residual confusion due to the presence of unknown factors. It is possible that a high consumption of sugary foods is a marker of a generally poor lifestyle.

Background : Discomfort during the puerperium period is very frequent in the lives of women but the influence of this discomfort on the women's quality of life has been little studied. The objective of this study is to establish the association between discomfort and frequent problems of women in the puerperium and their quality of life score. Methods : A cross-sectional study on postpartum Spanish women was performed. Women older than 18 years and who had had a live birth were included. Less than 1% of women refused to participate in the study. Data were collected on socio-demographic, obstetric and newborn variables, on maternal problems/ discomfort in the postnatal period and on parameters that are quality of life indicators. An ad hoc online questionnaire which included the SF-36 Health Survey was used. Crude mean difference (cMD) and adjusted mean difference (aMD) were calculated through multiple linear regression. Results : 2990 women participated in the study. The greater problems causing quality of life loss were depressive symptoms (aMD = -12.40, CI 95%: -10.79, -14.01), lactation problems (aMD = -4.30, CI 95%: -2.97, -5.63), problems for sexual intercourse after childbirth (aMD = -6.34, CI 95%: -5.07, -7.60) and urinary incontinence (aMD = -4.97, CI 95%: -6.30, -3.65), among others. These have been detected as risk factors that affect the quality of life of the postpartum woman. Conclusions : The discomfort and problems manifested in the 6 weeks after childbirth have an influence that deeply affects the quality of life of postpartum women.

Background: The aim of this analysis was to ascertain the type of relationship between fish and seafood consumption, omega-3 polyunsaturated fatty acids (ω-3 PUFA) intake, and depression prevalence., Methods: Cross-sectional analyses of the PREDIMED-Plus trial. Fish and seafood consumption and ω-3 PUFA intake were assessed through a validated food-frequency questionnaire. Self-reported life-time medical diagnosis of depression or use of antidepressants was considered as outcome. Depressive symptoms were collected by the Beck Depression Inventory-II. Logistic regression models were used to estimate the association between seafood products and ω-3 PUFA consumption and depression. Multiple linear regression models were fitted to assess the association between fish and long-chain (LC) ω-3 PUFA intake and depressive symptoms., Results: Out of 6587 participants, there were 1367 cases of depression. Total seafood consumption was not associated with depression. The odds ratios (ORs) (95% confidence intervals (CIs)) for the 2nd, 3rd, and 4th quintiles of consumption of fatty fish were 0.77 (0.63⁻0.94), 0.71 (0.58⁻0.87), and 0.78 (0.64⁻0.96), respectively, and p for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5⁻1 g/day) was significantly associated with a lower prevalence of depression., Conclusion: In our study, moderate fish and LC ω-3 PUFA intake, but not high intake, was associated with lower odds of depression suggesting a U-shaped relationship.

Background: Different diets during pregnancy might have an impact on the health, reflected in the birthweight of newborns. The consumption of fruits and vegetables during pregnancy and the relationship with newborn health status have been studied by several authors. However, these studies have shown inconsistent results., Purpose: We assessed whether certain foods were related to the risk of small for gestational age (SGA)., Methods: A matched by age (± 2 years) and hospital 1:1 case-control study of 518 pairs of pregnant Spanish women in five hospitals was conducted. The cases were women with an SGA newborn at delivery (neonates weighting less than the 10th percentile, adjusted for gestational age at delivery and sex, were diagnosed as SGA). The control group comprised women giving birth to babies adequate for gestational age (AGA). Mothers who gave birth to babies large for gestational age (LGA) were excluded. Data were gathered concerning demographic characteristics, socioeconomic status, toxic habits and diet. A food frequency questionnaire (FFQ) comprising 137 items was completed by all participants. The intake of vegetables, legumes and fruits was categorized in quintiles (Q1-Q5). Crude values and and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The variables for adjustment were as follows: preeclampsia, education, smoking, weight gain per week during pregnancy, fish intake and previous preterm/low birthweight newborns., Results: Total pulse intake showed an inverse association with the risk of SGA (trend p = 0.02). Women with an intake of fruits above 420 g/day (Q5), compared with women in Q1 (≤ 121 g/day) showed a decreased risk of SGA (AOR = 0.63, 95% CI = 0.40-0.98). The total consumption of vegetables was not associated with the risk of SGA. The intake of selenium was assessed: a protective association was observed for Q3-5; a daily intake above 60 μg was associated with a lower risk of SGA (AOR = 0.39, 95% CI: 0.22-0.69)., Conclusions: Fruits, pulses and selenium reduce the risk of SGA in Spanish women.

Background: Olive oil, as fundamental fat in the Mediterranean diet, has contributed to a decrease in obesity in several epidemiological studies. It is unknown whether olive oil itself can decrease the weight independently of the diet used. The objective of this work was to determine the efficacy of olive oil in reducing weight., Methods: Systematic review of meta-analysis of randomized controlled trials (RCTs) of at least 12 weeks of intervention on adults without previous cardiovascular events to estimate the effect of an olive-enriched diet on weight, waist and body mass index. The search was performed in PubMed, Embase, Cochrane plus, Web of Science, Ovid, Scopus, Virtual Health Library (BVS), Theses and Dissertations Online (TDX) until December 2016. No language, gender or underlying pathology was restricted. We used Stata14 SE for data synthesis., Results: 490 studies were identified, of which only 11 studies met the inclusion criteria. A diet enriched in olive oil reduced weight more than control diet: -0.92 kg, 95% CI (-1.16, -0.67), p heterogeneity = 0.1; decreased waist circumference in -0.60 cm, 95% CI (-1.17, -0.04), p heterogeneity = 0.6; and diminished BMI in -0.90, 95% CI (-0.91, -0.88), p heterogeneity < 0.001. The benefits were seen when olive oil was supplemented in its natural state and not when capsules were given., Conclusions: A diet enriched with olive oil can be an important weight control strategy in people without previous cardiovascular events.

In this review the usual methods applied in systematic reviews and meta-analyses are outlined. The ideal hypothesis for a systematic review should be generated by information not used later in meta-analyses. The selection of studies involves searching in web repertories, and more than one should be consulted. A manual search in the references of articles, editorials, reviews, etc. is mandatory. The selection of studies should be made by two investigators on an independent basis. Data collection on quality of the selected reports is needed, applying validated scales and including specific questions on the main biases which could have a negative impact upon the research question. Such collection also should be carried out by two researchers on an independent basis. The most common procedures for combining studies with binary outcomes are described (inverse of variance, Mantel-Haenszel, and Peto), illustrating how they can be done using Stata commands. Assessment of heterogeneity and publication bias is also illustrated with the same program., (Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

To quantify the effect of a Mediterranean dietary pattern, as well as the consumption of olive oil (OO), on the risk of having a small for gestational age infants (SGA), a matched case-control study was conducted in Spain. Dietary intake during pregnancy was assessed using a validated food frequency questionnaire. Three indices were used to evaluate the adherence to Mediterranean diet (MD) (Predimed, Trichopoulou and Panagiotakos). Crude odds ratios (cOR) and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using conditional logistic regression models. Results were stratified by severity of SGA: moderate (percentiles 6⁻10), and severe (percentiles ≤5). For moderate, four or more points in the Predimed´s index was associated with a 41% reduction of having SGA compared with women with a score ≤3, aOR = 0.59 (95% CI 0.38⁻0.98); for severe, the reduction in risk was not statistically significant. Similar results were found when the other MD indexes were used. An intake of OO above 5 g/day was associated with a lower risk of SGA (aOR = 0.53, 95% CI 0.34⁻0.85); statistical significance was observed for moderate SGA (aOR = 0.53, 95% CI 0.30⁻0.96), but not for severe SGA (aOR = 0.51, 95% CI 0.24⁻1.07), although the magnitude of ORs were quite similar. Adherence to a MD and OO intake is associated with a reduced risk of SGA.

Objective: To investigate the relationship between seafood consumption during pregnancy and the risk of delivering a small for gestational age (SGA) newborn., Design: This case-control study included women with SGA newborns and controls matched 1:1 for maternal age (±2 years) and hospital., Setting: Five hospitals in Eastern Andalusia, Spain., Participants: 518 pairs of pregnant Spanish women. The SGA group included women who delivered SGA newborns: SGA was defined as a birth weight below the 10th percentile of infants at a given gestational age. Controls were women who delivered newborns with adequate birth weights., Interventions: We collected data on demographic characteristics, socioeconomic status, toxic habits and diet. Midwives administered a 137-item Food Frequency Questionnaire., Outcome Measures: We calculated quintiles of seafood intake and applied conditional logistic regression to estimate ORs and 95% CIs., Results: Shellfish intake more than once/week yielded a significant protective effect against an SGA newborn (OR 0.25, 95% CI 0.08 to 0.76, after adjusting for energy, educational level, smoking, prepregnancy body mass index, weight and a history of preterm or low birthweight newborn). The risk of an SGA newborn was lower among women who consumed >121 g/day fish compared with women who consumed ≤56 g (adjusted OR 0.63, 95% CI 0.41 to 0.98; p=0.025 for a trend). Similarly, the risk of an SGA newborn was lower among women who consumed >1 g/day of marine n-3 polyunsaturated fatty acids compared with those who consumed ≤0.4 g/day (adjusted OR 0.58, 95% CI 0.38 to 0.90; p=0.025 for a trend)., Conclusion: An average seafood intake of at least 121 g/day during pregnancy, equivalent to 3-4 servings/week, reduced the risk of an SGA newborn, compared with an average seafood intake of less than 56 g/day., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We assessed if a 17-item score capturing adherence to a traditional Mediterranean diet (MedDiet) was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome. We analyzed baseline data from 6430 men and women (age 55-70 years) participating in the PREDIMED-Plus study. PREDIMED-Plus is a multi-centre randomized trial testing an energy-restricted MedDiet combined with promotion of physical activity and behavioral therapy for primary cardiovascular prevention compared to a MedDiet alone. Participants answered a 36-item questionnaire about health-related quality of life (HRQoL) and a 17-item questionnaire that assessed adherence to an MedDiet. We used ANCOVA and multivariable-adjusted linear regression models to compare baseline adjusted means of the quality of life scales according to categories of adherence to the MedDiet. Higher adherence to the MedDiet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of > = 3 points between the highest and the lowest dietary adherence groups to the MedDiet were observed for vitality, emotional role, and mental health and of > = 2 points for the other dimensions. In conclusion, this study shows a positive association between adherence to a MedDiet and several dimensions of quality of life., Competing Interests: The authors have declared that no competing interests exist.

A vaccine has recently been approved in the EU against meningococcal serogroup B, the main cause of meningococcal disease. There is a fierce debate about the decision regarding a universal vaccination in infants older than 2 months, as recommended by the majority of scientific societies. In western Europe the only country to have included the universal vaccination is the United Kingdom, with a lower incidence of the disease than Ireland. Other countries have also adopted it, such as the Czech Republic, Cuba and certain regions of Italy. Numerous cost-effectiveness studies have been published regarding the vaccination with different assumptions, which have supported the decision not to implant the universal vaccination because it exceeds the will to pay for a health benefit. We discuss the pros and cons of the universal vaccination against meningococcal B, recommended by the Sociedad Española de Pediatría (Spanish Society of Paediatrics), which as yet has not been implemented., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Pregnancy increases the requirements of certain nutrients, such as vitamins, to provide nutrition for the newborn. The aim was to analyze the association between dietary intake of vitamins during pregnancy and risk of having a small for gestational age (SGA) newborn. A matched case-control study was conducted (518 cases and 518 controls of pregnant women) in Spain. Dietary vitamin intake during pregnancy was assessed using a validated food frequency questionnaire, categorized into quintiles. Odds ratios (ORs) and their 95% confidence intervals (CI) were estimated with conditional regression logistic models. A protective association was observed between maternal dietary intake of vitamins A and D and SGA. For vitamin B3 and B6, the observed protective effect was maintained after adjusting for potential confounding factors. For vitamin B9, we found only an effect in quintiles 3 and 4 (OR = 0.64; 95% CI, 0.41-1.00; OR = 0.58; 95% CI, 0.37-0.91). Protective effect for vitamin B12 was observed in 4th and 5th quintiles (OR = 0.61; 95% CI, 0.39-0.95; OR = 0.68; 95% CI, 0.43-1.04). No associations were detected between dietary intake of vitamins B2, E and C intake and SGA. Our results suggest a positive association between dietary vitamin intake during pregnancy and the weight of the newborn, although more studies are necessary and there could be a ceiling effect for higher intakes of some vitamins cannot be discarded., Competing Interests: The authors declare no conflict of interest.

Circulating tumor cells (CTCs) have been recently accepted as prognostic markers in metastatic prostate cancer (PCa). However, very few studies have analyzed their role in early-stage PCa. The aim of this research is to study the value of CTCs at the moment of PCa diagnosis and to identify different subpopulations of CTCs. Patients with PSA value > 4 ng/ml and clinical suspicion of PCa were included. Samples were collected immediately before prostatic biopsy. CTCs were isolated by immunomagnetic technique using a multi-CK specific antibody. Molecular expression of EGFR and AR in the tissue was analysed by real-time PCR. Up to eight different SNPs in patients' blood DNA were studied. In a total of 86 patients, the CTC detection rate was 18.6%. The sensitivity, specificity, positive and negative predictive values of CTCs to detect PCa was 14.2%, 78.4%, 31.2% and 57.4%, respectively. Up to 75% of CTC-positive patients were AR-negative. A direct association was found between the expression of AR in the prostatic tissue and the presence of CTCs in blood (p<0.05). We observed an inverse relation between the expression of EGFR in the tissue and the expression of AR in the CTCs. No significant association between SNPs and CTCs was found. The low detection rate of CTCs in early-stage PCa limits their role as a diagnostic marker. Nevertheless, we show that they may hide important prognostic information. Overexpression of AR in the prostate may facilitate cell dissemination., Competing Interests: CONFLICTS OF INTEREST None of the authors has any potential financial conflict of interest related to this manuscript.

Objectives: More than 20% of lung cancer patients develop a recurrence, even after curative resection. We hypothesized that relapse may arise from the dissemination of circulating tumour cells (CTCs). This study evaluates the significance of CTC detection as regards the recurrence of non-small-cell lung cancer (NSCLC) in surgically resected patients. Secondly, we investigated the association between CTCs and the uptake of 18 F-fluorodeoxyglucose (FDG) by the primary tumour on a positron emission tomographic (PET) scan., Methods: In this single-centre prospective study, blood samples for analysis of CTCs were obtained from 102 patients with Stage I-IIIA NSCLC both before (CTC1) and 1 month after (CTC2) radical resection. CTCs were isolated using immunomagnetic techniques. The presence of CTCs was correlated with the maximum standardized uptake value (SUVmax) measured on preoperative FDG PET/computed tomographic scans. Recurrence free survival (RFS) analysis was performed., Results: CTCs were detected in 39.2% of patients before and in 27.5% 1 month after the operation. The presence of CTCs after the operation was significantly correlated with SUVmax on PET scans, pathological stage and surgical approach. Only SUVmax was an independent predictor for the presence of CTC2 on multivariate analysis. Postoperative CTCs were significantly correlated with a shorter RFS ( P  = 0.005). In multivariate analysis, the presence of CTC2 was associated with RFS, independent of disease staging., Conclusions: Detection of CTCs 1 month after radical resection might be a useful marker to predict early recurrence in Stage I-III NSCLC. The SUVmax value of the primary tumour on preoperative PET scans was associated with the presence of CTC 1 month after the operation., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Limited data exists on the interrelationships between physical activity (PA), sedentary behaviors and sleep concerning cardiometabolic risk factors in aged adults at high cardiovascular disease risk. Our aim was to examine independent and joint associations between time spent in leisure-time PA, sedentary behaviors and sleep on the prevalence of obesity, type 2 diabetes (T2D) and components of the metabolic syndrome (MetS) in Mediterranean individuals at high cardiovascular risk. Cross-sectional analyses were performed on baseline data from 5776 Spanish adults (aged 55-75y in men; 60-75y in women) with overweight/obesity and MetS, from October 2013 to October 2016, in the PREDIMED-PLUS trial. Employing multivariable-adjusted Cox regression with robust variance and constant time (given the cross-sectional design), higher prevalence of obesity, T2D and abdominal obesity as component of the MetS were associated with greater time in TV-viewing (Relative Risk, RR: 1.02, 95%CI: 1.01, 1.03; RR:1.04, 95%CI: 1.02, 1.06 and RR: 1.01 95%CI: 1.00, 1.02; respectively, all P < .01). Conversely, greater time in moderate-vigorous PA (MVPA) was associated with lower prevalence of obesity, T2D, abdominal obesity and low HDL-cholesterol (RR: 0.95, 95%CI: 0.93, 0.97; RR: 0.94, 95%CI: 0.89, 0.99; RR: 0.97, 95%CI: 0.96, 0.98; and RR: 0.95, 95%CI: 0.91, 0.99, respectively, all P < .05). For these outcomes, theoretically substituting 1-h/day of MVPA for 1-h/day TV-viewing was also significantly associated with lower prevalence (RR 0.91 to 0.97, all P < .05). Similar lower RR in these outcomes was observed when substituting 1-h/day of MVPA for 1-h/day of sleeping. Longer time watching TV and not meeting MVPA recommendations were jointly associated with higher RR of the prevalence of obesity and T2D. We concluded that, in senior individuals at high cardiovascular risk, greater time spent on MVPA and fewer on sedentary behaviors was inversely associated with prevalence of obesity, T2D, and some of the components of MetS.

Aim: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient., Design: A descriptive multicentre study., Location: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva., Participants: 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients., Principal Measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed., Results: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: -0.1)., Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Background: Smoking may facilitate influenza virus infections and their severity. The objective was to investigate the risk of hospitalization due to influenza in Spanish smokers and ex-smokers., Methods: We carried out a multicentre, case-control study in 2011. Cases [patients ≥ 18 years hospitalized > 24 h with real time polymerase chain reaction (RT-PCR)-confirmed influenza] were selected from 29 Spanish hospitals. For each case, we selected an outpatient aged ≥ 18 years with RT-PCR-confirmed influenza matched by age (±5 years), date of hospitalization of the case (±10 days) and province of residence. We collected epidemiological variables, comorbidities and the smoking history. The risk of hospitalization due to smoking was determined by the adjusted odds ratio (aOR) using logistic regression., Results: We studied 471 hospitalized cases and 476 outpatient cases. Hospitalized cases had a higher frequency of influenza risk factors compared with outpatient cases. Hospitalized cases had a higher frequency of smoking (30.9% vs. 17.1%) and being ex-smokers (29.3% vs. 25.3%). Current smoking (aOR = 2.18, 95% CI: 1.23-3.87) and being an ex-smoker (aOR = 1.73, 95% CI: 1.07-2.82) were associated with the risk of hospitalization., Conclusions: Smoking may increase the risk of hospitalization in smokers and ex-smokers when infected by the influenza virus. Smoking prevention could reduce hospitalizations. Influenza vaccination is recommended for smokers., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Consumption of virgin olive oil (VOO) has been associated with a low breast cancer incidence. Pinoresinol is a phytoestrogen that is typically found in VOO. Considering the role of oestrogen in breast cancer development and progression, we investigated the potential antitumor activity of pinoresinol in breast cancer cells., Methods: To address this question, we treated MDA-MB-231 (oestrogen receptor [ER] negative) and MCF7 (ER+) human breast tumour cells and MCF10A human mammary epithelial cells (ER-) with different concentrations of pinoresinol. The cytotoxic activity, cell proliferation, cell cycle profile, apoptosis induction, reactive oxygen species production and DNA damage were assessed., Results: Pinoresinol showed cytotoxic, anti-proliferative and pro-oxidant activity in human breast tumour cells, independent of their oestrogen receptor status. In addition, pinoresinol exerted antioxidant activity and prevented DNA damage associated with oxidative stress in human mammary epithelial cells., Conclusions: Overall, the results suggest that pinoresinol may have antitumor activity in human breast cancer cells independently of oestrogen receptor status. Furthermore, the results show that the pinoresinol has the typical characteristics of a chemopreventive compound.

Introduction: Obesity has emerged as a significant independent predictor of severity in pandemic influenzaA (H1N1)pdm09. The aim of this study was to investigate the association between body mass index (BMI) and the risk of hospitalization due to influenza., Methods: Hospitalized patients (n=755) with laboratory-confirmed influenza were individually matched by age, admission/visit date, and province with an outpatient (n=783) with laboratory-confirmed influenza and an outpatient control (n=950). We compared the BMI using conditional logistic regression adjusted for potential confounding factors (aOR). The population attributable fraction (PAF) was calculated., Results: A higher BMI was associated with an increased risk of hospitalization compared to both outpatient cases (aOR=1.11; 95%CI: 1.07-1.16) and outpatient controls (aOR=1.04; 95%CI: 1.01-1.07). Compared with normal weight, obesity type I, obesity type II and obesity type III was associated with a greater likelihood of hospitalization compared with outpatient cases (aOR=1.85, 95%CI: 1.05-3.26; aOR=5.24, 95%CI: 1.94-14.15 and aOR=44.38, 95%CI: 4.47-440.5). Compared with normal weight, obesity type II and obesity type III was associated with a greater likelihood of hospitalization compared with outpatient controls (aOR=4.37, 95%CI: 1.79-10.69 and aOR=4.95, 95%CI: 1.45-16.87). In persons without influenza vaccination, all categories of BMI≥30kg/m(2) were associated with a greater likelihood of hospitalization compared with normal weight in both outpatient cases and outpatient controls. The PAF of hospitalization by influenza due to BMI ranged from 21.9% to 8.5%; in the case of unvaccinated against influenza between 20.5% to 16.9%., Conclusion: A high BMI is associated with an increased risk of hospitalization due to influenza. High percentage of hospital admissions are attributable to their BMI, especially in non vaccinated., (Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background: The aim of this paper was to assess the association between the attendance to a health education program for pregnant women and the outcome of the newborn (low birth weight [LBW], preterm delivery, small for gestational age [SGA]) and other conditions frequency in the first two months of life of newborn., Methods: An observational study on primiparous women in four hospitals of southern Spain was conducted in 2011. Data on socio-demographic variables, obstetric parameters, and newborn characteristics were collected through interviews and clinical chart review. In the analysis, crude and adjusted (by logistic regression) odds ratios (aOR) were estimated. Means and their standard errors were computed for continuous variables, applying analysis of covariance in multivariate analyses., Results: Five hundred and twenty primiparous women were recruited. Health education of pregnant women did not show any influence on newborns' Apgar Score. The frequency of LBW in mothers attending the program during the pregnancy was 2.82% versus 8.43% in those who did not attend it (aOR=0.27, 95% CI, 0.11 to 0.66). Health education during pregnancy was unrelated to the risk of SGA (aOR=0.84, 95% CI, 0.53 to 1.33)., Conclusions: Health education during pregnancy was associated to a lower risk of LBW, but not was associated with other newborn outcomes.