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Background and aims The consumption of tree nuts could reduce the risk of hypertension, but scarce research has been done to evaluate this potential association. We assessed the association between nut consumption and the incidence of hypertension among 9919 Spanish university graduates followed-up biennially for a median of 4.3 years. Methods and results Food habits were assessed with a validated 136-item food-frequency questionnaire. Nut consumption was classified into four categories: rarely/never, 1–3/month, 1/week, and 2+/week. A participant was classified as an incident case of hypertension when, being free of hypertension at baseline, he/she subsequently reported a physician-made diagnosis of hypertension in at least one of the follow-up questionnaires. The incidence of hypertension was 12.4 per 1000 person-years. We found no association between nut consumption and incidence of hypertension after adjusting for sex, age and other dietary and non-dietary potential confounders (hazard ratio [HR] for those in the highest vs. lowest nut consumption category=0.77 [IC 95%: 0.46–1.30] p =0.795). Results were not modified when we stratified them analyses according to sex or to body mass index. Conclusion Our data do not provide evidence for an inverse association between nut consumption and incident hypertension in our cohort. Further results from cohorts and trials with a higher baseline risk of hypertension should be obtained to test this relationship.

Introduccion y objetivos Se ha relacionado el consumo de aspirina y de otros analgesicos con cambios en la presion arterial. El objetivo de nuestro estudio fue valorar prospectivamente la asociacion del uso habitual de aspirina y otros analgesicos con la incidencia de hipertension arterial. Metodos El proyecto SUN es una cohorte prospectiva y dinamica que incluyo a 9.986 graduados universitarios espanoles inicialmente libres de hipertension, enfermedad cardiovascular, diabetes o cancer (media de edad, 36 anos). Fueron reclutados durante el periodo 1999-2005 y se los siguio prospectivamente durante una media de 51 meses. El uso habitual de aspirina y otros analgesicos, asi como la presencia de otros factores de riesgo de hipertension arterial, se valoro mediante un cuestionario basal. La incidencia de hipertension se valoro con cuestionarios de seguimiento bienales. Resultados Durante el seguimiento se identificaron 543 casos nuevos de hipertension arterial. El uso habitual de aspirina (2 o mas dias/semana) se asocio con un mayor riesgo de hipertension (hazard ratio [HR] = 1,45; intervalo de confianza [IC] del 95%, 1,02-2,04) tras ajustar por diversos factores de confusion. El uso habitual de otros analgesicos diferentes de la aspirina tambien se asocio a un mayor riesgo de hipertension arterial (HR = 1,69; IC del 95%, 1,28-2,23). Conclusiones El uso habitual tanto de aspirina como de otros analgesicos diferentes a la aspirina parece asociarse a mayor riesgo de hipertension arterial, independientemente de otros factores de riesgo.

ObjectiveTo evaluate the reproducibility of a semi-quantitative FFQ used in the Seguimiento Universidad de Navarra (SUN) project.DesignThe data that were analysed were collected from an FFQ answered twice by a 326-participant subsample of the SUN project (115 men, 35·3 %; 211 women, 64·7 %), with either less than 1 year or more than 1 year between responses. The questionnaire included 136 items. Pearson correlation coefficients (r) were calculated to evaluate the magnitude of the association between both measures after energy adjustment and correcting for within-person variability. We also evaluated misclassification by quintiles distribution.ResultsThe highest corrected correlations among participants who answered before 1 year were found for PUFA (r= 0·99). Among participants who answered after 1 year between both questionnaires, olive oil had the highest corrected correlation (r= 0·99). The highest percentage of gross misclassification, lowest quintile in FFQ1 and highest quintile in FFQ2 or highest quintile in FFQ1 and lowest quintile in FFQ2 was for cereals, fish or seafood, andn-3 fatty acids (7·6 %). Alcoholic drinks had the highest percentage of reasonable classification, same or adjacent quintile, in FFQ1 and FFQ2 (86·4 %).ConclusionsOur study suggests that FFQ reproducibility is acceptable for participants who answered the same questionnaire twice less than 1 year apart. Participants who answered FFQ more than 1 year apart showed worse values on reproducibility. We consider this Spanish FFQ as an important, valid and reproducible tool in nutritional epidemiology.

Introduccion y objetivos El objetivo de este estudio es evaluar prospectivamente la asociacion de dos factores de riesgo cardiovascular, el habito tabaquico y la ganancia de peso. Metodos Se evaluo prospectivamente a 7.565 participantes de una cohorte dinamica durante una mediana de seguimiento de 50 meses. El peso y la actividad fisica declarados fueron validados previamente. Como referencia se uso a los nunca fumadores, y se calcularon diferencias ajustadas de ganancia media de peso para diferentes exposiciones al tabaco. Resultados Tras ajustar por edad, indice de masa corporal inicial, sedentarismo, cambios de actividad fisica, ingesta energetica y de fibra, comidas entre horas, consumo de refrescos, de comida rapida y de alcohol, los participantes que dejaron de fumar durante el seguimiento presentaron una mayor ganancia relativa de peso: varones, +1,63 (intervalo de confianza [IC] del 95%, 1,07-2,19) kg; mujeres, +1,51 (IC del 95%, 1,11-1,91) kg. Los fumadores activos presentaron tambien mayor ganancia de peso que los nunca fumadores: varones, +0,49 (IC del 95%, 0,11-0,87) kg; mujeres, +0,36 (IC del 95%, 0,07-0,65) kg. Conclusiones Los participantes que dejaron de fumar durante el seguimiento y los fumadores activos experimentaron mayores ganancias de peso que los nunca fumadores. La asociacion de estos dos factores de riesgo cardiovascular debe ser tenida en cuenta en los programas de prevencion.

Introduction and objectives Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain. Methods We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to neversmokers (the reference group) was estimated for different levels of tobacco exposure. Results After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI], 1.07–2.19 kg), and women 1.51 kg (95% CI, 1.11–1.91 kg). In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11–0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg). Conclusions Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs.

ObjectiveThe traditional Mediterranean food pattern is more easily preserved when meals are eaten at home; however, as a result of recent socio-economic changes, away-from-home meal consumption has increased rapidly in Mediterranean countries. Little research has been conducted so far to investigate the long-term health effects of these changes in the Mediterranean area.DesignIn a prospective Spanish dynamic cohort of 9182 university graduates (the SUN Study; Seguimiento Universidad de Navarra, University of Navarra Follow-up) with a mean age of 37 years, followed up for an average of 4·4 years, we assessed the association between the frequency of eating out of home and weight gain or incident overweight/obesity. Dietary habits were assessed with an FFQ previously validated in Spain.ResultsDuring follow-up, eating-out consumers (two times or more per week) had higher average adjusted weight gain (+129 g/year, P < 0·001) and higher adjusted risk of gaining 2 kg or more per year (OR = 1·36; 95 % CI 1·13, 1·63) than non-eating-out consumers. Among participants with baseline BMI < 25 kg/m2, we observed 855 new cases of overweight/obesity. Eating away-from-home meals was significantly associated with a higher risk of becoming overweight/obese (hazard ratio = 1·33; 95 % CI 1·13, 1·57).ConclusionsA higher frequency of meals eaten out of home may play a role in the current obesity epidemic observed in some Mediterranean countries.

Fundamento y objetivo El jamon curado es uno de los alimentos caracteristicos de la dieta mediterranea espanola. Sin embargo, no existe ningun estudio epidemiologico prospectivo que haya valorado sus efectos sobre la salud humana. Nuestro objetivo fue evaluar la asociacion entre el consumo de jamon curado y la incidencia de hipertension arterial, enfermedad cardiovascular o ganancia de peso. Sujetos y metodo En una cohorte epidemiologica prospectiva y dinamica de 13.293 graduados universitarios (proyecto SUN) se analizo la incidencia de la enfermedad cardiovascular, la hipertension arterial y la ganancia de peso durante un seguimiento maximo de 6 anos. Se ajustaron modelos de regresion de Cox para estimar el hazard ratio (riesgos relativos [RR]) tras ajustar por posibles factores de confusion. Resultados El consumo de jamon en los niveles mas altos (>4 raciones/semana) no presentaba asociacion con la incidencia de episodios cardiovasculares (RR=1,02; intervalo de confianza [IC] del 95%: 0,44�2,39), tras ajustar por edad, sexo, ingesta energetica total y patron dietetico mediterraneo, en comparacion con los consumos inferiores a una vez por semana. Al repetir esta comparacion para la hipertension, y tras ajustar por edad, sexo, ingesta energetica total y patron de dieta mediterranea, se encontro un RR de 0,74 (IC del 95%: 0,55�1,01). En la comparacion del cambio de peso medio anual entre estas categorias extremas de consumo (

Introduccion y objetivos Evaluar prospectivamente la asociacion entre el consumo de alcohol, incluidas la bebida alcoholica preferida y la frecuencia semanal de consumo, y el riesgo de hipertension en una cohorte mediterranea. Metodos Se siguio de manera prospectiva a 9.963 varones y mujeres espanoles inicialmente libres de hipertension. La informacion recogida sobre dieta y diagnostico de hipertension arterial fue la declarada por los pacientes y luego validada. Resultados Durante el seguimiento (mediana [intervalo intercuartilico], 4,2 [2,5-6,1] anos) se identificaron 554 casos incidentes de hipertension entre 43.562 personasano. La hazard ratio (HR) de hipertension para un consumo de alcohol ≥ 5 dias por semana fue 1,28 (intervalo de confianza [IC] del 95%, 0,97-1,70) comparados con abstemios. Entre consumidores de alcohol al menos 5 dias por semana, la HR de hipertension para consumos ≥ 1 copa al dia fue 1,45 (IC del 95%, 1,06-2) comparados con los abstemios. El consumo de cerveza y licores, pero no de vino, se asocio con mayor riesgo de hipertension. La HR para el consumo diario de mas de 0,5 copas de cerveza y licores, en comparacion con los no bebedores, fue 1,53 (IC del 95%, 1,18-1,99). En cambio, la asociacion entre el consumo de vino tinto y el riesgo de hipertension fue inversa pero no significativa. Conclusiones En esta poblacion mediterranea, el consumo de cerveza y licores, pero no de vino, se asocio con mayor riesgo de hipertension. El patron de consumo semanal de alcohol, sin embargo, no tuvo un impacto significativo en el riesgo de hipertension.

Background and objectives Although health risks associated to excessive body fat increase with small increases in body weight, measurement of body fat is usually grouped in very few categories. The aim of our study was to assess whether the risk for a combined end-point including the incidence of either hypertension and/or type 2 diabetes mellitus and/or the metabolic syndrome was elevated even within the “normal” limits of body-mass index (BMI). Material and methods We followed up 10,639 initially healthy university graduates participating in the SUN dynamic cohort for a variable period ranging 2 to 6 years. Baseline BMI and physical activity were the major exposures. The combined end-point was defined by the incidence of either hypertension and/or type 2 diabetes and/or the metabolic syndrome during the follow-up period. We fitted non-conditional logistic regression models and nonparametric regression models (restricted cubic splines). Results We observed 768 incident cases of the combined outcome (incidence of 16/1000 person-years) and found a monotonic linear association between BMI and the combined end-point. The multivariate-adjusted odds ratios for the combined end-point were 1.4 (95% CI: 1.1–1.7) for BMI 22–24.9 kg/m 2 , 2.7 (2.1–3.5) for 25–29.9 kg/m 2 and 4.0 (2.8–5.6) for ⩾30 kg/m 2 . We observed a threshold effect in the association between physical activity and the combined end-point multivariate-adjusted odds ratio=0.8 (0.7–0.9) for >15 METs-h/week. Conclusions Our findings suggest that the incidence of metabolic risk factors (hypertension, diabetes mellitus and/or metabolic syndrome) is already increased at a BMI of 22 kg/m 2 in young adults. These results deserve consideration for judging whether the cut-off point for “normal” weight should be lowered.

Recent evidence supports the cardioprotective role of a Mediterranean food pattern. The major findings of the Greek and EPIC-Elderly cohort, the SUN study, the Medi-RIVAGE and the PREDIMED trials are reviewed. Definitive answers will come from ongoing primary prevention trials that assess clinical events as outcomes.

BASTERRA-GORTARI, F. J., M. BES-RASTROLLO, M. PARDO-FERNANDEZ, L. FORGA, J. A. MARTINEZ, and M. A. MARTINEZ-GONZALEZ. Changes in Weight and Physical Activity over Two Years in Spanish Alumni. Med. Sci. Sports Exerc. ,V ol. 41, No. 3, pp. 516-522, 2009. Purpose: To investigate the relationship between baseline leisure-time physical activity and changes in leisure activity during follow-up on long-term weight changes. Methods: We evaluated prospectively 11,974 participants (university graduates) who participated in a dynamic cohort (Seguimiento Universidad de Navarra cohort) with an average follow-up of 27 months. Self-reported data from validated mailed questionnaires were used. Baseline leisure activity was assessed with a previously validated questionnaire. Results: After adjusting for age, hours sitting down, smoking status, snacking, fiber intake, and consumption of sugar- sweetened beverages, fast food, and alcohol, participants who decreased their leisure activity during follow-up experienced a significant increase in body mass index (BMI; relative change): for men, 0.9% (95% confidence interval (CI) = 0.5-1.2%); for women, 1.0% (95% CI = 0.6-1.3%). Participants who increased their leisure activity during follow-up experienced a significant reduction (relative change) in BMI: for men, j0.8% (95% CI = j1.1% to j0.5%); for women, j0.6% (95% CI = j0.9% to j0.4%). This inverse association between changes in leisure activity and weight gain was significantly stronger for participants with a baseline BMI Q25 kgIm j2 , but the absolute magnitude of this interaction effect was trivial. Baseline physical activity was not significantly associated with weight changes after 2-yr of follow-up. Conclusion: Longitudinal changes in leisure activity during follow-up were inversely associated with changes in body weight. The true relationships between leisure activity and body weight are likely to have been larger than observed, owing to

The aim of this study was to assess the association between work hours and incidence of hypertension in 8779 participants of a Spanish dynamic prospective cohort of university graduates.The baseline questionnaire included information about the weekly number of hours the participants devoted to work and to home chores. The work hours were grouped into four categories: 39 or less, 40-49, 50-59, and at least 60 for men; 29 or less, 30-39, 40-49, and at least 50 for women. We added up the number of hours working and spent in home chores in what we called 'total activity hours' that was categorized in quartiles, specific by sex. A participant was classified as an incident case of hypertension if he/she was initially free of hypertension at baseline and reported a physician-made diagnosis of hypertension in at least one of the follow-up questionnaires. The associations between work hours or 'total activity hours' and incidence of hypertension were estimated by calculating the multivariable-adjusted odds ratio and its 95% confidence interval, using logistic regression models.The cumulative incidence of hypertension during 4.2 years median follow-up was 5.8%. No association was found between work hours or 'total activity hours' and incidence of hypertension in either sex.The results of our study do not support any association between work hours and incidence of hypertension. Further longitudinal studies in the general population should be conducted to test this relationship.

Background: Little is known about the long-term effects of dietary energy density (ED) on weight gain. Objective: The objective was to assess the long-term relation between changes in dietary ED and age-related weight gain. Design: We conducted a prospective study of 50 026 women (x ± SD age: 36.5 ± 4.6 y) in the Nurses' Health Study II followed from 1991 to 1999. Dietary ED and body weight were ascertained in 1991, 1995, and 1999. Total dietary ED was calculated by dividing each subject's daily energy intake (kcal) by the reported weight (g) of all foods consumed. Results: Dietary ED was positively correlated with saturated fat (r = 0.16), trans fat (r = 0.15), and the glycemic index (r = 0.16), but was inversely correlated with vegetable protein (r = -0.30), vegetables (r = -0.27), and fruit (r = -0.17). ED was not significantly correlated with total fat intake as a percentage of energy (r = 0.08). Women who increased their dietary ED during follow-up the most (5th quintile) had a significantly greater multivariate-adjusted weight gain than did those who decreased their dietary ED (1st quintile) (8-y time period: 6.42 kg compared with 4.57 kg; P for trend < 0.001). However, the amount of weight change over time varied considerably according to the ED values of individual foods and beverages. Conclusion: A high dietary ED reflects a dietary pattern higher in saturated and trans fats and refined carbohydrates. Increases in dietary ED were associated with greater weight gain among middle-aged women during 8 y of follow-up. However, public health recommendations cannot be made simply on the basis of ED values of individual foods and beverages.

We evaluated the prognostic value of prealbumin (transthyretin) levels in patients with acute kidney injury (AKI).This was a longitudinal, single-center, observational cohort study.The setting was a university-affiliated hospital.One hundred and sixty-one consecutive patients with AKI matched at least one of the Risk, Injury, Failure, Loss, End Stage (RIFLE) criteria for increased serum creatinine, and had requested a nephrology consultation between April 2000 and March 2006.We conducted a computer-assisted review of all cases of AKI seen by a nephrologist between April 2000 and March 2006. We used Cox proportional hazards models to estimate the risk of in-hospital mortality associated with serum prealbumin level at the beginning of the nephrology consultation.Clinicopathologic variables were compared between patients with a serum prealbumin level11 mg/dL (the exposed group; cutoff point, median) and patients with a serum prealbumin levelor =11 mg/dL (the control group). In-hospital mortality rates associated with prealbumin levels were 45.0% for11 mg/dL, and 19.8% foror =11 mg/dL (P = .001). After adjusted analysis, the presence of a serum prealbumin level11 mg/dL was significantly associated with increased in-hospital mortality (hazard ratio, 2.10; 95% confidence interval, 1.08 to 4.08), compared with patients with the same Liano scoring, the same RIFLE classes, and the same treatment for AKI, but with a serum prealbumin levelor =11 mg/dL. In addition, each increment of 5 mg/dL of serum prealbumin was associated with an adjusted 29% decrease of in-hospital mortality (hazard ratio, 0.71; 95% confidence interval, 0.52 to 0.96).Serum prealbumin levels11 mg/dL were strongly associated with a higher risk of death, independent of AKI severity, comorbid illnesses, serum C-reactive protein levels, and other possible confounders. The measurement of serum prealbumin levels may be an inexpensive and useful tool in the evaluation of the risk profiles of AKI patients.

Purpose To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain. Methods We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ≥6 DRI or ≥8 DRI were estimated to assess nutritional adequacy according to quintiles of each index. Results The lowest prevalence of inadequate micronutrient intake (≥8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend

Diet plays a role in the onset and progression of metabolic disorders, including metabolic syndrome (MetS). We aimed to systematically review and conduct a quantitative meta-analysis of results from observational cross-sectional and prospective cohort studies on adherence to the Mediterranean dietary pattern and risk of MetS. Literature databases including PubMed, SCOPUS and EMBASE were searched from the beginning to May 2016. Eight cross-sectional and four prospective studies were included in this meta-analysis, accounting for a total of 33,847 individuals and 6342 cases of MetS. High adherence to the Mediterranean diet was associated with a risk of MetS (RR: 0.81, 95%CI: 0.71, 0.92). Regarding individual components of the MetS, the inverse associations were significant for waist circumference, blood pressure and low HDL-C levels. In conclusion, adoption of a Mediterranean dietary pattern was associated with lower risk of the MetS and it can be proposed for the primary prevention of the MetS.

Background Residence at high altitude has been associated with lower obesity rates probably due to hypoxia conditions. However, there is no evidence of this association in a free-living population. Objectives We assessed the association between the altitude where each participant of a Spanish cohort (the SUN Project) was living and the incidence of overweight/obesity. Methods The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with a retention rate of 89%. We included in the analysis 9 365 participants free of overweight/obesity at baseline. At the baseline questionnaire, participants reported their postal code and the time they had been living in their city/village. We imputed the altitude of each postal code according to the data of the Spanish National Cartographic Institute and categorized participants in tertiles. We used Cox regression models to adjust for potential confounding variables. Results During a median follow-up of 10 years, we identified 2 156 incident cases of overweight/obesity. After adjusting for sex, age, time of residence at current city, baseline body mass index, physical activity, sedentarism and years of education (≤ 3 years, ≥ 4 years, Master/PhD), those participants in the third tertile (>456 m) exhibited a statistically significant 14% reduction in the risk of developing overweight/obesity in comparison to those in the first tertile (

Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (

Fundamento y objetivo Validar los diagnosticos de diabetes mellitus, hipertension arterial e hipercolesterolemia declarados en la Encuesta Nacional de Salud (ENS). Material y metodo Se selecciono a 147 participantes del Servicio de Salud Laboral (edad media ± desviacion estandar, 51,6 ± 13,5 anos) a quienes se les realizaron las preguntas para diagnostico de diabetes mellitus, hipertension arterial e hipercolesterolemia que se usan en la ENS. A continuacion, y tras obtener el consentimiento informado, se procedio a la determinacion de la presion arterial, asi como de la glucemia y la colesterolemia plasmaticas. Con estas mediciones, el consumo de farmacos y los antecedentes del paciente, se consideraba si el participante tenia o no las condiciones que se estaban estudiando. Se calculo la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y el indice kappa de los datos declarados frente al estandar. Para todos los datos se calculo el intervalo de confianza. Resultados La diabetes mellitus declarada presento una sensibilidad del 80% y una especificidad del 100%. La hipertension arterial declarada tuvo una sensibilidad del 53,8% (punto de corte, 140/90 mmHg) o del 83,3% (punto de corte, 160/100 mmHg), siendo en ambos casos la especificidad fue superior al 97%. Finalmente, la sensibilidad hallada para la hipercolesterolemia declarada fue del 44,1% (punto de corte: colesterol total, 220 mg/dl) o del 70% (punto de corte: colesterol total, 240 mg/dl y lipoproteinas de baja densidad, > 130 mg/dl). En ambos casos la especificidad de la hipercolesterolemia declarada fue superior al 91%. Conclusiones Los datos declarados son un modo eficiente de obtener informacion sobre diagnosticos de diabetes mellitus, hipertension arterial e hipercolesterolemia. Sin embargo, infradiagnostican, sobre todo, los casos de hipertension arterial de grado 1 o hipercolesterolemia leve.

Fundamento y objetivo Evaluar la tendencia de la prevalencia en Espana de la obesidad, diabetes mellitus, hipertension e hipercolesterolemia. Material y metodo Se usaron las Encuestas Nacionales de Salud (ENS) de 1997, 2001 y 2003, todas ellas representativas de la poblacion espanola. Sumando las bases de datos se valoro en total a 49.113 personas de ambos sexos. Para calcular el indice de masa corporal se uso la informacion referente al peso y la talla autorreferidos. Se estimo la prevalencia de diabetes, hipertension e hipercolesterolemia. Se realizaron tests de la χ 2 de tendencia lineal y regresiones logisticas multivariantes para ajustar por edad, sexo y nivel educativo. Resultados Se estimo una tendencia temporal significativa de incremento de la prevalencia de obesidad, diabetes, hipertension arterial e hipercolesterolemia en el periodo estudiado (1997-2003). Se observo que el incremento de la prevalencia de obesidad solo afecta a los participantes mas jovenes, con una interaccion significativa. Conclusiones La prevalencia de obesidad, diabetes mellitus, hipertension e hipercolesterolemia ha aumentado en Espana entre los anos 1997 y 2003.

Background: The spontaneous reporting system is the most efficient warning system of adverse drug reactions (ADRs). Pharmacists can play an important role in the detection and reporting of ADRs. The factors that affect under-reporting among these professionals are unknown in Spain. Objective: To identify the factors that influence community pharmacists’ ADR under-reporting in Navarra, a Northern Spanish region. Methods: A case-control study was conducted on a population of 802 community pharmacists working in Navarra. Cases were pharmacists who had reported at least two ADRs to the region’s drug surveillance unit between 2003 and 2005 and who agreed to participate in the study (18/20; 90%). A random sample of 60 controls was selected from the 762 pharmacists who had not reported any ADR during the same period of time. Results: Factors positively associated with ADR reporting were age, years of work experience as a pharmacist, participation in educational activities related to the detection and resolution of drug-related problems, the habit of detecting ADRs as part of pharmacists’ duties, having the basic knowledge needed to report ADRs, and disagreement with the common belief among healthcare professionals that ’to report an ADR it is necessary to be sure that the reaction is related to the use of a particular drug’. The most frequently mentioned reasons for not reporting ADRs were the ADR is not serious, the ADR is already known, uncertainty concerning the causal relationship between the ADR and the drug, forgetting to report the ADR and a lack of time. Conclusions: Pharmacists’ knowledge, beliefs, behaviour and motivation play an important role in ADR reporting. Under-reporting might be improved through activities focused on modifying such factors.

Meat consumption has been consistently associated with the risk of diabetes in different populations. The aim of our study was to investigate the incidence of type 2 diabetes according to baseline total meat consumption in a longitudinal assessment of a middle-aged Mediterranean population. We followed 18,527 participants (mean age: 38 years, 61% women) in the SUN Project, an open-enrolment cohort of a highly educated population of middle-class Spanish graduate students. All participants were initially free of diabetes. Diet was assessed at baseline using a semi-quantitative food frequency questionnaire of 136-items previously validated. Incident diabetes was defined according to the American Diabetes Association’s criteria. We identified 146 incident cases of diabetes after a maximum of 14 years of follow-up period (mean: 8.7 years). In the fully adjusted model, the consumption of ≥3 servings/day of all types of meat was significantly associated with a higher risk of diabetes (HR: 1.85; 95% CI: 1.03–3.31; p for trend = 0.031) in comparison with the reference category (

Prerequisite programs are considered the most efficient tool for a successful implementation of self-control systems to ensure food safety. The main objective of this study was to evaluate the implementation of these programs in 15 catering services located in Navarra and the Basque Country (regions in northern Spain), through on-site audits and microbiological analyses. The implementation of the prerequisite program was incomplete in 60% of the sample. The unobserved temperature control during both the storage and preparation of meals in 20% of the kitchens reveals misunderstanding in the importance of checking these critical control points. A high level of food safety and hygiene (absence of pathogens) was observed in the analyzed meals, while 27.8% of the tested surfaces exceeded the established limit for total mesophilic aerobic microorganisms (≤100 CFU/25 cm²). The group of hand-contact surfaces (oven door handles and aprons) showed the highest level of total mesophilic aerobic microorganisms and Enterobacteriaceae, and the differences observed with respect to the food-contact surfaces (work and distribution utensils) were statistically significant (P0.001). With regard to the food workers' hands, lower levels of microorganisms were observed in the handlers wearing gloves (that is, for Staphylococcus spp we identified 43 CFU/cm2 on average compared with 4 CFU/cm2 (P0.001) for those not wearing and wearing gloves, respectively). For a proper implementation of the prerequisites, it is necessary to focus on attaining a higher level of supervision of activities and better hygiene training for the food handlers, through specific activities such as informal meetings and theoretical-practical sessions adapted to the characteristics of each establishment.

To conduct a comprehensive literature review in the field of added-sugar consumption on weight gain including the effect of fructose-containing caloric sweeteners and sugar taxation.A search of three databases was conducted in the time period from the inception of the databases to August 2015. Sensitive search strategies were used in order to retrieve systematic reviews (SR) of fructose, sucrose, or sugar-sweetened beverages (SSBs) on weight gain and metabolic adverse effects, conducted on humans and written in English, Spanish, or French. In addition, a review about SSB taxation and weight outcomes was conducted.The search yielded 24 SRs about SSBs and obesity, 23 SRs on fructose or SSBs and metabolic adverse effects, and 24 studies about SSB taxation and weight control.The majority of SRs, especially the most recent ones, with the highest quality and without any disclosed conflict of interest, suggested that the consumption of SSBs is a risk factor for obesity. The effect of fructose-containing caloric sweeteners, on weight gain is mediated by overconsumption of beverages with these sweeteners, leading to an extra provision of energy intake. The tax tool alone on added sugars appears insufficient to curb the obesity epidemic, but it needs to be included in a multicomponent structural strategy.

Background The consumption of prebiotics (fermentable and nondigestible carbohydrates) has been proposed as a potentially protective factor against overweight and obesity. However, to our knowledge, no previous prospective studies have assessed the association between the consumption of prebiotics and the incidence of overweight or obesity. Objective We evaluated the association between prebiotic consumption [fructans and galacto-oligosaccharides (GOSs)] and the incidence of overweight [body mass index (BMI; in kg/m(2)) ≥25] in the SUN (Seguimiento Universidad de Navarra) Project, which is a prospective cohort of Spanish, middle-aged university graduates with initial BMI Design The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with an overall retention rate of 90%. The study population encompassed 8569 Spanish university graduates (mean age: 37 y) who were initially free of overweight or obesity. Self-reported weight (previously validated) was collected at baseline and updated every 2 y during the follow-up period. Fructan consumption and GOS consumption were assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire and were updated after 10 y. Time-dependent Cox proportional hazards models were used to estimate HRs and 95% CIs for incident overweight and to adjust for potential confounding factors. Results During follow-up (median: 9 y), 1964 incident cases of overweight were identified. After potential confounders were adjusted for, risk of overweight was 15% lower in participants in the highest quartile of fructan consumption (≥2.3 g/d) (95% CI: 0.74, 0.97; P-trend = 0.019). Subjects in the highest quartile of GOS consumption (≥0.45 g/d) had 17% lower risk of overweight (95% CI: 0.74, 0.94; P-trend = 0.001). Conclusions Higher prebiotic consumption was associated with lower risk of overweight in a cohort of initially normal-weight, middle-aged adults. This potential protection has been previously scarcely assessed; therefore, additional longitudinal studies are needed to confirm our results.

Our aim was to evaluate the association between adherence to the Mediterranean Diet (MedDiet) and cognitive function in 823 participants (62 ± 6 years at baseline) from a Spanish prospective cohort (SUN project). A validated 136-item food frequency questionnaire was used to assess the adherence to the MedDiet at baseline. The 10-point (0 to 9) MedDiet Score was used to categorize adherence to MedDiet. Cognitive function was assessed twice at follow-up with a mean follow-up time between exposure and outcome assessment of 6 and 8y using the Telephone Interview of Cognitive Status-modified (TICS-m, range 0 to 54 points). ANCOVA models were used to assess the association between adherence to the MedDiet and cognitive decline. In the multivariable-adjusted analysis of 2-year changes, a higher cognitive decline was observed among participants with low or moderate baseline adherence to the MedDiet than among those with better adherence (adjusted difference = −0.56 points in TICS-m, 95% CI = −0.99 to −0.13). A higher adherence to the MedDiet might be associated with better cognitive function. However, observed differences were of small magnitude and further studies are needed to confirm this finding.

Polychlorinated biphenyls are persistent organic pollutants that are consumed because of their bioaccumulation through the food chain. Evidence from different sources suggests a positive association between polychlorinated biphenyls exposure and the incidence of hypertension. However, no previous prospective study has investigated this potential relationship in adults. We prospectively assessed the association between dietary intake of polychlorinated biphenyls and the incidence of hypertension in a large cohort. The Seguimiento Universidad de Navarra project is a Spanish cohort of university graduates, most of them health professionals. We included 14521 participants, initially free of hypertension, who were followed-up for a median of 8.3 years. Dietary intake of polychlorinated biphenyls was assessed at baseline through a previously validated 136-item semiquantitative food frequency questionnaire. The published concentration levels of polychlorinated biphenyls measured in samples of food consumed in Spain were used to estimate dietary intake. Multivariable Cox regression models were fitted to estimate hazard ratios and 95% confidence interval for incident hypertension. During follow-up, 1497 incident cases of medically diagnosed hypertension were identified. After adjusting for total energy intake and for potential confounders, participants in the fifth quintile of total polychlorinated biphenyls intake were at higher risk of developing hypertension (adjusted hazard ratio, 1.43 [95% confidence interval, 1.09–1.88; P for trend 0.017]) compared with those in the first quintile. In this Mediterranean cohort, dietary intake of polychlorinated biphenyls, estimated using a food frequency questionnaire, was associated with a higher risk of developing hypertension during follow-up. Nevertheless, further longitudinal studies are needed to confirm our results.

The aim of this dynamic prospective follow-up study was to assess the association between olive oil consumption and the likelihood of weight gain or the incidence of overweight or obesity in a large Mediterranean cohort of 7,368 male and female Spanish university graduates (the SUN Project) who were followed for a median period of 28.5 mon. A validated Food Frequency Questionnaire was administered at baseline, and respondents also completed a follow-up questionnaire after 28.5 mon. Changes in participants' consumption of olive oil and their weight were assessed during follow-up. A higher baseline consumption of olive oil was associated with a lower likelihood of weight gain, although the differences were not statistically significant. The adjusted difference in weight gain (kg) was -0.16 [95% confidence interval (CI): -0.42 to +0.11] for participants in the upper quintile of olive oil consumption (median: 46 g/d) compared with those in the lowest quintile (median: 6 g/d). For participants with a high baseline consumption of olive oil whose olive oil consumption also increased during follow-up, we found a slightly increased but nonsignificant risk of incidence of overweight or obesity (adjusted odds ratio = 1.19, 95% CI: 0.73 to 1.95). Our study, carried out in a sample of free-living people, shows that a high amount of olive oil consumption is not associated with higher weight gain or a significantly higher risk of developing overweight or obesity in the context of the Mediterranean food pattern.

BACKGROUND: High consumption of sugar-sweetened drinks has been associated with weight gain and obesity in the United States. This trend may also be affecting populations with different eating patterns who increasingly are adopting typical US dietary patterns. OBJECTIVE: We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population. DESIGN: This was a prospective cohort analysis of 7194 men and women with a mean age of 41 y who were followed-up for a median of 28.5 mo with mailed questionnaires. Dietary exposure was assessed with a previously validated semiquantitative food-frequency questionnaire. RESULTS: During follow-up, we observed that 49.5% of the participants increased their weight (x weight gain: 0.64 kg; 95% CI: 0.55, 0.73 kg). In the participants who had gained [>/=]3 kg in the 5 y before baseline, the adjusted odds ratio of subsequent weight gain for the fifth quintile compared with the first quintile of sugar-sweetened soft drink consumption was 1.6 (95% CI: 1.2, 2.1; P for trend = 0.02). This association was absent in the participants who had not gained weight in the 5-y period before baseline. The consumption of hamburgers, pizza, and sausages (as a proxy for fast-food consumption) was also independently associated with weight gain (adjusted odds ratio for the fifth compared with the first quintile = 1.2; 95% CI: 1.0, 1.4; P for trend = 0.05). We also found a significant, but weaker, association between weight gain and both red meat and sweetened fruit juice consumption. CONCLUSION: In a Mediterranean cohort, particularly in the participants who had already gained weight, an increased consumption of sugar-sweetened soft drinks and of hamburgers, pizza, and sausages was associated with a higher risk of additional subsequent weight gain.

To investigate the association between eating- away-from-home (EAFH) and a) the quality of dietary carbohydrate intake and b) the quality of fat intake.We assessed 19,371 participants in the SUN cohort who completed a validated baseline food frequency questionnaire. Quality indices of carbohydrate (CQI) and fat (FQI) were used. Multiple regression models were fitted to determine the association between the frequency of EAFH (4 categories) and both indices. Logistic regression analysis was used to assess the association between the frequency of EAFH and low CQI or FQI ((25th percentile).Participants showed an average CQI and FQI of 11,3 (SD 3,2) and 1,7 (SD 0,5), respectively. A higher frequency of EAFH (≥ 2 times/week) was associated with a poorer CQI and a poorer FQI. For CQI, the adjusted mean difference was -0,29, 95%CI: -0,41, -0,17 (p for trend0,001), and for FQI it was -0,02, 95%CI: -0,03, -0,001 (p for trend 0,03). Participants with a highest frequency (≥ 2 times/week) of EAFH had higher adjusted risk of a poorer CQI, (adjusted OR 1,31, 95%CI 1,17, 1,46, p for trend0,001), but this habit (EAFH) was unrelated to FQI (adjusted OR 0,93, 95%CI: 0,83, 1,03, p for trend 0,194).A higher frequency of EAFH was associated with a poorer quality of dietary fat, and particularly, dietary carbohohydrate. These findings highlight the importance of nutritional education addressed to consumers who frequently do out-of-home meals.Objetivo: Investigar la asociación entre la frecuencia de comidas fuera de casa (CFC) con a) la calidad de hidratos de carbono y b) la calidad de grasas. Materiales y métodos: Se evaluaron 19.371 participantes de la cohorte SUN que completaron un cuestionario basal de frecuencia de consumo de alimentos previamente validado. Se utilizaron los índices de calidad de hidratos de carbono (ICHC) en una escala de 4 a 20 y de grasas (ICG) en una escala de 0,62 a 5,92. En ambos casos, a mayor puntuación mayor calidad. Se utilizó la regresión lineal múltiple para determinar la asociación entre la frecuencia de CFC (4 categorías) y la puntuación de ambos índices, y la regresión logística para medir la asociación entre la frecuencia de CFC y un bajo ICHC o ICG (

Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis. We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case–control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease. The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25–75: 2.63–4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1–2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case–control study. High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research. SUN project is supported by the Spanish Government (Instituto de Salud Carlos III, Fondode InvestigacionesSanitarias; grants PI10/02658, PI10/02293, RD06/0045, G03/140, and 87/2010), the Navarra Regional Government (project PI 45/2011), and the University of Navarra SI

Habiendo leído con atención la editorial de la Dra. Marti y el Dr. Martínez acerca de la necesidad imperiosa de actuar de forma inmediata en la alimentación del adolescente, queremos mostrar nuestro máximo acuerdo con los autores cuando urgen a frenar el avance de la obesidad mediante la adquisición de hábitos de vida saludable en edades tempranas de la vida.

Background Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN (“Seguimiento Universidad de Navarra”) longitudinal study. Methods We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. Results We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25–39 points) vs. low (11–24) category 0.43 [95% confidence interval (CI) 0.21,0.89]; and for high (40–60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). Conclusions The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM and also as an educational tool for laypeople to help them in self-assessing their future risk for developing diabetes.

Background/ Objectives: To evaluate the association between the carbohydrate quality (CQI) and weight change or incident overweight/obesity (BMI≥25 kg/m2) in the “Seguimiento Universidad de Navarra (SUN)” cohort. Subjects/ Methods: 8 741 participants initially free of overweight/obesity were followed‐up for a median of 7.9 years. We evaluated at baseline the CQI following 4 criteria: dietary fibre intake, glycemic index (GI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Subjects were classified into quintiles according to CQI. Weight was recorded at baseline and updated every 2 years during follow‐up. Results: Increasing CQI of diet was not significantly associated with lower weight gain, although participants in the highest quintile had the lowest average crude weight gain (+211 g/year). We observed 1 862 incident cases of overweight/obesity during followup. CQI was significantly associated (p for trend 0.006) with lower risk of overweight/obesity: adjusted OR for the 4rd and 5th quintiles: 0.81 (95% CI 0.66 to 0.99), and 0.74 (95% CI 0.60 to 0.92), respectively. Conclusions: In this Mediterranean cohort, CQI showed a significant inverse association with the incidence of overweight/obesity, which highlights that carbohydrate intake guidelines related to obesity prevention should be focused in improving the CQI of the diet.

Background: We assessed the still unclear effect of the overall alcohol-drinking pattern, beyond the amount of alcohol consumed, on the incidence of cardiovascular clinical disease (CVD). Methods: We followed 14,651 participants during up to 14 years. We built a score assessing simultaneously seven dimensions of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, preference for wine, red wine consumption, wine consumed during meals and avoidance of binge drinking. Results: During 142,177 person-years of follow-up, 127 incident cases of CVD (myocardial infarction, stroke or cardiovascular mortality) were identified. Compared with the category of better conformity with the MADP, the low-adherence group exhibited a non-significantly higher risk (HR) of total CVD ((95% CI) = 1.55 (0.58–4.16)). This direct association with a departure from the traditional MADP was even stronger for cardiovascular mortality (HR (95% CI) = 3.35 (0.77–14.5)). Nevertheless, all these associations were statistically non-significant. Conclusion: Better conformity with the MADP seemed to be associated with lower cardiovascular risk in most point estimates, however, no significant results were found and more powered studies are needed to clarify the role of the MADP on CVD.

Resumen La obesidad, especialmente la obesidad morbida, incrementa el riesgo cardiovascular y de otras enfermedades. Nuestro objetivo es valorar las tendencias de la obesidad morbida en Espana de 1993 a 2006 usando datos representativos de 106.048 participantes (Encuestas Nacionales de Salud). Se realizo un modelo de regresion de Poisson usando la presencia de obesidad morbida como variable dependiente, estratificando por sexo y ajustando por edad. Se observo un incremento de la prevalencia de obesidad morbida de mas del 200%, pues se paso de 1,8 a 6,1/1.000 habitantes. La prevalencia de obesidad morbida es superior en mujeres. Tras ajustar por edad, en ambos sexos se incremento significativamente la prevalencia de obesidad morbida: el incremento relativo anual fue del 4% en mujeres y el 12% en varones. Estos incrementos hacen que las medidas preventivas resulten prioritarias.

The adherence to a Mediterranean Dietary Pattern is associated with a morbi-mortality reduction, and with a better quality of life.To evaluate a nutritional intervention among independent elderly people enrolled in an educational program to increase the knowledge of the food and daily diets, promoting a healthy dietary pattern.Quasi-experimental design conducted in elderly participants who lived in foster home apartments owned by the City Council of Pamplona (n = 41). The intervention was based on six group sessions and an individual motivational session in a period of three months. Adherence to Mediterranean diet was evaluated through a 14-point scale previously validated.Eighty point five per cent of participants were women, with a median age of 79 years, the majority of them widowed (48.8%) and with primary education (58.5%). After the nutritional intervention the percentage of participants who consumed two or more servings of vegetables increased significantly versus the control group (p = 0.042). Similarly, in comparison with the control group, there was an increase in the percentage of participants who consumed three servings per week of legumes (p = 0.042), three or more servings per week of nuts (p = 0.003), and those who consumed preferably meat from chicken, turkey, or rabbit instead of veal, pork, hamburgers, or sausages (p = 0.011).An intervention based on individual and group sessions improved significantly several parameters of a Mediterranean dietary pattern.INTRODUCCIÓN: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida.Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. MÉTODOS: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado.El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011). DISCUSIÓN: Una intervención basada en educación nutricional individual y grupal consiguió una mejora significativa en diversos parámetros de adhesión a un patrón de Dieta Mediterránea.

Background Sedentary behaviors have been directly associated with all‐cause mortality. However, little is known about different types of sedentary behaviors in relation to overall mortality. Our objective was to assess the association between different sedentary behaviors and all‐cause mortality. Methods and Results In this prospective, dynamic cohort study (the SUN Project) 13 284 Spanish university graduates with a mean age of 37 years were followed‐up for a median of 8.2 years. Television, computer, and driving time were assessed at baseline. Poisson regression models were fitted to examine the association between each sedentary behavior and total mortality. All‐cause mortality incidence rate ratios ( IRR s) per 2 hours per day were 1.40 (95% confidence interval ( CI ): 1.06 to 1.84) for television viewing, 0.96 (95% CI : 0.79 to 1.18) for computer use, and 1.14 (95% CI : 0.90 to 1.44) for driving, after adjustment for age, sex, smoking status, total energy intake, Mediterranean diet adherence, body mass index, and physical activity. The risk of mortality was twofold higher for participants reporting ≥3 h/day of television viewing than for those reporting IRR : 2.04 [95% CI 1.16 to 3.57]). Conclusions Television viewing was directly associated with all‐cause mortality. However, computer use and time spent driving were not significantly associated with higher mortality. Further cohort studies and trials designed to assess whether reductions in television viewing are able to reduce mortality are warranted. The lack of association between computer use or time spent driving and mortality needs further confirmation.

Background - The PREDIMED (Prevención con Dieta Mediterránea) randomized primary prevention trial showed that a Mediterranean diet enriched with either extravirgin olive oil or mixed nuts reduces the incidence of stroke, myocardial infarction, and cardiovascular mortality. We assessed the effect of these diets on the incidence of atrial fibrillation in the PREDIMED trial. Methods and Results - Participants were randomly assigned to 1 of 3 diets: Mediterranean diet supplemented with extravirgin olive oil, Mediterranean diet supplemented with mixed nuts, or advice to follow a low-fat diet (control group). Incident atrial fibrillation was adjudicated during follow-up by an events committee blinded to dietary group allocation. Among 6705 participants without prevalent atrial fibrillation at randomization, we observed 72 new cases of atrial fibrillation in the Mediterranean diet with extravirgin olive oil group, 82 in the Mediterranean diet with mixed nuts group, and 92 in the control group after median follow-up of 4.7 years. The Mediterranean diet with extravirgin olive oil significantly reduced the risk of atrial fibrillation (hazard ratio, 0.62; 95% confidence interval, 0.45-0.85 compared with the control group). No effect was found for the Mediterranean diet with nuts (hazard ratio, 0.89; 95% confidence interval, 0.65-1.20). Conclusions - In the absence of proven interventions for the primary prevention of atrial fibrillation, this post hoc analysis of the PREDIMED trial suggests that extravirgin olive oil in the context of a Mediterranean dietary pattern may reduce the risk of atrial fibrillation. © 2014 American Heart Association, Inc., The PREDIMED trial was supported by the Official funding agency for Biomedical Research of the Spanish Government (Spanish analogous institution to the NIH: Instituto de Salud Carlos III, through grants provided to research networks specifically developed for the trial: RTIC G03/140 (Coordinator: R Estruch, MD, PhD), and RTIC RD 06/0045 (Coordinatos: MA Martínez-González, MD, PhD). All investigator of the PREDIMED t rial belong to Centro de Investigación Biomédica en Red (CIBER), an initiative of Instituto de Salud Carlos III. We also acknowledge the grants from NIH 1R01HL118264-01, Fondo de Investigación Sanitaria - Fondo Europeo de Desarrollo Regional (PI04/0233, PI05/0976, PI07/0240 , PI10/01407, PI10/02658 and PI11/00049) and Consejería de Salud de la Junta de Andalucía (PI0105/2007).

Background The role of yogurt consumption in the development of metabolic syndrome (MetS) is not fully understood and the available epidemiologic evidence is scarce. The aim of our study was to assess the association between total, whole-fat, or low-fat yogurt consumption and the risk of developing MetS. Methods Yogurt consumption was assessed at baseline through a 136-item validated FFQ. MetS was defined following the harmonized definition for MetS according to the AHA and the IDF criteria. Logistic regression models were used. Results During the first 6-y of follow-up of the SUN cohort, 306 incident cases of MetS were identified. Frequent consumption [≥875 g/week (≥7 servings/week) versus ≤ 250 g/week (2 servings/week)] of total, whole-fat and low-fat yogurt consumption showed non-significant inverse associations with MetS [OR = 0.84 (95% CI: 0.60-1.18); 0.98 (95% CI: 0.68-1.41); and 0.63 (95% CI: 0.39-1.02) respectively]. Only one component of the MetS, central adiposity, was inversely associated with total and whole-fat yogurt consumption [OR = 0.85 (95% CI: 0.74-0.98) and 0.85 (95% CI: 0.73-0.99) respectively]. In the joint assessment of exposure to total yogurt consumption and fruit consumption, those in the highest category of total yogurt consumption, and having a high fruit consumption (above the median ≥264.5 g/day) exhibited a significantly lower risk of developing MetS [OR = 0.61 (95% CI: 0.38-0.99)] compared with those in the lowest category of total yogurt consumption and had fruit consumption below the study median. Conclusion No significant association between yogurt consumption and MetS was apparent. Only one component out of the 5 MetS criteria, central adiposity, was inversely associated with high yogurt consumption. The combination of high consumption of both yogurt and fruit was inversely associated with the development of MetS.

Epidemiological studies on the association between yogurt consumption and the risk of overweight/obesity are scarce. We prospectively examined the association of yogurt consumption with overweight/obesity and average annual weight gain.Prospective cohort study of 8516 men and women (mean age 37.1, SD: 10.8 y). Participants were followed-up every two years. Participants were classified in 5 categories of yogurt consumption at baseline: 0-2,2-5, 5-7, 7 and ≥ 7 servings/week. Outcomes were: 1) average yearly weight change during follow-up; and 2) incidence of overweight/obesity. Linear regression models and Cox models were used to adjust for potential confounders. After a median follow-up of 6.6 years, 1860 incident cases of overweight/obesity were identified. A high (7 servings/week) consumption of total and whole-fat yogurt was associated with lower incidence of overweight/obesity [multivariable adjusted hazard ratios = 0.80 (95% CI: 0.68-0.94); and 0.62 (0.47-0.82) respectively] in comparison with low consumption (0-2 servings/week). This inverse association was stronger among participants with higher fruit consumption.In this Mediterranean cohort, yogurt consumption was inversely associated with the incidence of overweight/obesity, especially among participants with higher fruit consumption.

Department of Food Sciences and Physiology, School of Pharmacy, University ofNavarra, Pamplona, SpainSubmitted 10 May 2013: Final revision received 30 September 2013: Accepted 19 December 2013AbstractObjective: To assess the association between the consumption of sugar-sweetenedcarbonated beverages (SSCB) and obesity in children and adolescents from Navarra(Spain).Design: We used a matched case–control study design. The exposure, SSCB con-sumption (1 serving: 200ml), was measured with a previously validated FFQ.Anthropometrical measuresweretakenusing standardized protocols. Theoutcome,obesity, was defined as BMI above the age- and sex-specific 97th percentileaccording to the Spanish reference charts. In the analysis we used conditionallogistic regression. Potential confounders were controlled using a multivariablemodel.Setting: Subjects were recruited in the paediatric departments of the Universidad deNavarra Clinic and the Navarra Hospital Complex, and in three primary healthcentres of Navarra. Controls were recruited when attending for a routine medicalexamination or vaccination.Subjects: One hundred and seventy-four obese children and 174 individuallysex- and age-matched controls, 52?87% boys, with a mean age of 11?6years.Exclusion criteria were dietary interventions, exposure to hormone treatment,development of secondary obesity due to endocrinopathy and serious intercurrentillness.Results: Independently of other factors, high consumption of SSCB (.4servings/week) was significantly associated with obesity (OR53?46; 95% CI 1?24, 9?62;P50?01). Besides, each additionaldaily serving of SSCB was associated with a 69%relative increase in the risk of obesity (OR51?69; 95% CI 1?04, 2?73; P50?03).Conclusions: We found a strong and significant association between SSCB con-sumption and obesity risk. Our results suggest a monotonic dose–response linearshape for this association in children and adolescents (P for trend50?02).KeywordsSoft drinksSodaChildrenObesityObesity is a chronic disease that results from an imbalanceof energy homeostasis. The mechanisms underlying thismetabolic disorder reflect complex interactions of genetic,environmental and behavioural factors. Many studies sug-gest that obesity increases the risk of many other chronicdiseases such as type 2 diabetes, metabolic syndrome orsome types of cancer, and that becoming obese earlier inlife clearly amplifies that risk. The increasing prevalence ofobesity among children and adolescents has become animportant public health problem and a priority issue forauthorities

There is some evidence of the beneficial role of food patterns and lifestyles on metabolic syndrome (1,2). The Mediterranean food pattern (MFP) has acquired an emerging role in cardiovascular epidemiology (3). It is characterized by a high consumption of fruits, vegetables, legumes, grains, moderate alcohol intake, a moderate-to-low consumption of dairy products and meats/meat products, and a high monounsaturated–to–saturated fat ratio. Although some cross-sectional studies have suggested that the MFP (or some of its components) may reduce the incidence of the metabolic syndrome (1,4), there are no prospective studies assessing this association. Our aim was to prospectively assess the relationship between adherence to the MFP and the subsequent development of metabolic syndrome in the Seguimiento Universidad de Navarra (SUN) dynamic cohort, composed of Spanish university graduates followed up for 6 years (5). The SUN Study uses methodology similar to that of large American cohorts (6), but recruitment is permanently open (it is designed as a dynamic cohort). Baseline assessment of participants consists of a self-administered questionnaire sent by postal mail, gathering information on lifestyle factors and including a 136-item validated food frequency questionnaire (7). Biennially mailed follow-up questionnaires are used to collect a wide variety of information about diet, lifestyle, and medical conditions (5). Among the 18,000 graduates currently participating in the SUN cohort, 5,360 members were recruited …

Moderate alcohol intake has been related to lower mortality. However, alcohol use includes other dimensions beyond the amount of alcohol consumed. These aspects have not been sufficiently studied as a comprehensive entity. We aimed to test the relationship between an overall alcohol-drinking pattern and all-cause mortality. In a Mediterranean cohort study, we followed 18 394 Spanish participants up to 12 years. A validated 136-item FFQ was used to assess baseline alcohol intake. We developed a score assessing simultaneously seven aspects of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, wine preference, red wine consumption, wine consumed during meals and avoidance of binge drinking. During the follow-up, 206 deaths were identified. For each 2-point increment in a 0–9 score of adherence to the MADP, we observed a 25 % relative risk reduction in mortality (95 % CI 11, 38 %). Within each category of alcohol intake, a higher adherence to the MADP was associated with lower mortality. Abstainers (excluded from the calculations of the MADP) exhibited higher mortality (hazard ratio 1·82, 95 % CI 1·14, 2·90) than participants highly adherent to the MADP. In conclusion, better adherence to an overall healthy alcohol-drinking pattern was associated with reduced mortality when compared with abstention or departure from this pattern. This reduction goes beyond the inverse association usually observed for moderate alcohol drinking. Even moderate drinkers can benefit from the advice to follow a traditional MADP. The present study, as part of the SUN Project, was supported by Instituto de Salud Carlos III (PI01/0619, PI030678, PI040233, PI042241, PI050976, PI070240, PI070312, PI081943, PI080819, PI1002658, PI1002293, PI1300615, RD06/ 0045, 2010/087, G03/140 and Rio Hortega CM10/00072 to E. T.), the Navarra Regional Government (36/2001, 43/2002, 41/2005, 45/2011 and 36/2008), the University of Navarra (PIUNA 9923), CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III and Ministerio de Educación, Cultura y Deporte (A. G., FPU) 3.453 JCR (2014) Q1, 18/77 Nutrition & dietetics UEM

Objective: Few studies have related nutritional factors with quality of life in healthy populations. Our aim was to analyze the relationship between commercial bakery, fast food or soft drinks consumption and mental and physical quality of life. Study Design: This analysis included 8335 participants from the "Seguimiento Universidad de Navarra" (SUN) Project (a multipurpose, dynamic cohort). Methods: The consumption of commercial bakery, fast food and soft drinks was assessed through a validated food-frequency questionnaire at baseline. Quality of life was measured after 4 years of follow-up with the Short-Form 36 (SF-36) Health Survey. Generalized Linear Models were fit to assess the regression coefficients (b) and their 95% confidence intervals (95% CI) for the association between commercial bakery, fast food and soft drinks consumption and each domain and the two standardized measures of the SF-36. Results: As compared to the participants in the lowest quintile of consumption, those participants in the highest quintile of consumption of commercial bakery, fast food and soft drinks showed a score significantly lower (>2 points) for vitality (b = −2.14, 95% CI = −3.31 to −0.96), role emotional (b = −2.23, 95% CI = −4.33 to −0.13), and role physical (b = −2.31, 95% IC = −4.26 to −0.36) domains with statistically significant dose-response relationships (p for trend < 0.05). When the food groups were analysed separately, significant inverse associations were found only for commercial bakery and fast-food consumption. Conclusions: The results suggest that high consumption of commercial bakery, fast-food and soft drinks at baseline was associated with worse scores on self-perceived quality of life. This association was stronger for the mental domains of the SF-36.

Background To evaluate prospectively the relationship between white, or whole grain bread, and glycemic index, or glycemic load from diet and weight change in a Mediterranean cohort. Methods We followed-up 9 267 Spanish university graduates for a mean period of 5 years. Dietary habits at baseline were assessed using a semi-quantitative 136-item food-frequency questionnaire. Average yearly weight change was evaluated according to quintiles of baseline glycemic index, glycemic load, and categories of bread consumption. We also assessed the association between bread consumption, glycemic index, or glycemic load, and the incidence of overweight/obesity. Results White bread and whole-grain bread were not associated with higher weight gain. No association between glycemic index, glycemic load and weight change was found. White bread consumption was directly associated with a higher risk of becoming overweight/obese (adjusted OR (≥2 portions /day) versus (≤1 portion /week): 1.40; 95% CI: 1.08-1.81; p for trend: 0.008). However, no statistically significant association was observed between whole-grain bread, glycemic index or glycemic load and overweight/obesity. Conclusions Consumption of white bread (≥2 portions /day) showed a significant direct association with the risk of becoming overweight/obese.

Background: Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. Methods: The prospective dynamic ‘‘Seguimiento Universidad de Navarra’’ (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0–3 servings/month), intermediate (.3 servings/month and #2 servings/week) and high (.2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. Results: We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81–2.13) and 1.86 (95% CI: 1.13–3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). Conclusion: Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.