Search

To evaluate the trend in the prevalence in Spain of obesity, diabetes mellitus, hypertension and hypercholesterolemia.The Spanish National Health Surveys (ENS) of 1997, 2001, 2003, which select representative samples of the Spanish general population were used. In total, 49,113 participants of both sexes were included. Self-reported data about weight and height were used to estimate the body mass index. The prevalence of diabetes, hypertension and hypercholesterolemia was estimated. Linear trend chi2 tests and multivariate logistic regression models adjusted for age, sex and educational level, were estimated.A significant increasing temporal trend for the prevalence of obesity, diabetes, hypertension and hypercholesterolemia was found for the studied period (1997-2003) according to the ENS. We found that the increased trend in obesity prevalence was restricted to younger participants with a significant interaction.The prevalence of obesity, diabetes mellitus, hypertension and hypercholesterolemia has increased in Spain between 1997 and 2003.

Scientific evidence from different sources suggests a positive association between sedentary behaviors and the incidence of hypertension. However, no previous prospective study corroborated this potential relationship in an adult population. Our objective was to assess prospectively the association of different sedentary behaviors (interactive and noninteractive sedentary activity, television viewing, and sleeping) with the incidence of hypertension.In this prospective, dynamic cohort study (the SUN Study), 11,837 Spanish university graduates, with a mean age of 36 years, were followed for an average of 40 months, from 1999 to 2006. Sedentary behavior was assessed with a questionnaire at baseline, and the incidence of hypertension was assessed with validated, biennial questionnaires.We identified 291 new cases of hypertension among 6742 participants who remained after excluding those with self-reported hypertension, cardiovascular disease, diabetes, and cancer at baseline. Self-reported total sedentary behavior was directly associated with a higher risk of hypertension (hazard ratio, 1.48; 95% confidence interval, 1.01 to 2.18, comparing those in the upper and lower quartiles; P for trend = .03). In subtype analyses, interactive sedentary behavior (driving and computer use), but not noninteractive sedentary behavior (television viewing and sleeping), was associated with a higher risk of hypertension.Interactive sedentary behaviors appear to be an independent risk factor for incident hypertension. Noninteractive sedentary behaviors (television viewing and sleeping) did not show a significant association with incident hypertension.

To evaluate posterior capsule opacification (PCO) and the impact of different intraocular lens (IOL) models on PCO characteristics using optical coherence tomography (OCT).Eighty-three eyes with PCO (fibrosis or pearl type) and 32 pseudophakic eyes without PCO were included. Horizontal 3.0 mm long OCT scans of the posterior capsule were obtained. Measurements and means of the peak posterior capsule intensity (PCI) and posterior capsule thickness (PCT) (distance between 2 spikes at posterior capsule) at 3 scan points were recorded. The PCI and PCT were compared with best corrected visual acuity (BCVA) and IOL data.The PCT was high for IOLs with a rounded edge (P = .001) and with poly(methyl methacrylate) (PMMA) IOLs (P.001). If the IOL optic was concave-convex, the PCT was higher than if the optic was biconvex (P = .001). The PCT of hydrophilic acrylic IOLs was higher than of hydrophobic acrylic IOLs (P = .04). Multivariate analysis of PCT showed that PMMA was the only factor statistically associated with PCT (P = .02). The worse logMAR BCVA correlated significantly with a higher PCT value (P.001) but not with PCI (P = .42). An IOL size of 12.5 mm was related to fibrosis-type PCO (odds ratio, 3.14; P = .04).The PCT was most affected by IOL characteristics. Poly(methyl methacrylate) IOLs and IOLs with rounded edges were associated with higher PCT. Hydrophilic acrylic IOLs were associated with greater PCT than hydrophobic IOLs. Posterior capsule thickness was a factor in decreased BCVA.

Background The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. Methods Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101%) as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. Results A ≥ 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08–3.03). Patients who required continuous renal replacement therapy in the ≥ 101% increment group presented a higher increase of in-hospital mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00–7.21). Patients in the ≥ 101% increment group had a higher mean serum creatinine level with respect to their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92% (95% CI: 13.05–84.79) more serum creatinine than in the < 101% increment group. Conclusion In this cohort, patients who had presented an increment in serum level of creatinine of ≥ 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a < 101% increment. This finding may provide more information about the factors involved in the prognosis of ARF. Furthermore, the calculation of relative serum creatinine increase could be used as a practical tool to identify those patients at risk, and that would benefit from an intensive therapy.

Karnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (>or=80, 70, 60 and or=80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95% CI 1.04-7.68), for Karnofsky groups of

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.We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population.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.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 gainedor =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.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.

ObjectiveThe adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients.DesignCross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression.ResultsFolate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake.ConclusionsThe adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.

We assessed the association between fiber intake and fruit/vegetable consumption with the likelihood of weight gain in the previous 5 y in a Mediterranean population.We conducted a cross-sectional analysis of participants (5094 men and 6613 women) in a multipurpose prospective cohort (Seguimiento Universidad de Navarra Study). Diet was measured by using a semiquantitative food-frequency questionnaire that was previously validated in Spain. We calculated the odds ratios of weight gain in the previous 5 y according to quintiles of energy-adjusted fiber intake and quintiles of energy-adjusted of fruit/vegetable consumption. We also considered the joint exposure to fiber intake and fruit/vegetable consumption.Multivariate-adjusted odds ratios for weight gain across quintiles 1 to 5 of fiber intake were 1.00 (reference), 0.86, 0.86, 0.70, and 0.52 (P for trend0.001) among men and 1.00 (reference), 0.99, 1.08, 1.05, and 0.72 (P for trend = 0.005) among women. We also observed a significant inverse association between total fruit/vegetable consumption and weight gain, but only among men (adjusted odds ratios, 0.78, 0.89, 0.70, and 0.54 for quintiles 2 to 5, P for trend0.001). The inverse association between fruit/vegetable consumption and weight gain in the previous 5 y was more evident among those with a high intake of total fiber, and the benefit of total fiber was more evident among those with a high consumption of fruits and vegetables.This study provides additional support to the inverse association between fiber or fruit/vegetable consumption and weight gain, thus emphasizing the importance of replacing some dietary compounds by such foods and fiber-rich products, which may help to avoid weight gain.

Background. Some cross-sectional studies suggest that fiber and protein intake can be associated with lower levels of blood pressure, but results from prospective cohorts are scarce and none has been conducted outside the U.S. Methods. The SUN cohort followed-up prospectively 5880 Spanish men and women older than 20 years of age, all university graduates. Dietary information was gathered at baseline with a previously validated semiquantitative food frequency questionnaire. New cases of medically diagnosed hypertension (HT) were identified through responses to a mailed questionnaire after at least 2 years from recruitment. Results. One hundred and eighty new cases of HT were ascertained after a median follow-up of 28 months. After adjustment for potential confounders and several dietary factors, participants in the highest quintile of vegetable protein intake had a lower risk of incident HT compared with those in the lowest quintile ½hazard ratio (HR) 5 0.5, 95% confidence interval (CI) 0.220.9, p for trend 5 0.06� . Similarly, fiber from cereals was inversely associated with a lower risk of HT (HR comparing fifth vs. first quintile 5 0.6, 95% CI 0.3–1.0, p for trend 5 0.05). Risk reduction was more important among men and obese and older individuals. Total or animal protein and total fiber as well as fiber from other sources different from cereal were not associated with the risk of HT. Conclusions. In this Mediterranean cohort, dietary intake of vegetable protein and fiber from cereals was associated with a lower risk of HT when other nutrients were also taken into consideration. 2006 IMSS. Published by Elsevier Inc.

Maira Bes-Rastrollo and colleagues examine whether financial conflicts of interest are likely to bias conclusions from systematic reviews that investigate the relationship between sugar-sweetened beverages and weight gain or obesity. Please see later in the article for the Editors' Summary, Background Industry sponsors' financial interests might bias the conclusions of scientific research. We examined whether financial industry funding or the disclosure of potential conflicts of interest influenced the results of published systematic reviews (SRs) conducted in the field of sugar-sweetened beverages (SSBs) and weight gain or obesity. Methods and Findings We conducted a search of the PubMed, Cochrane Library, and Scopus databases to identify published SRs from the inception of the databases to August 31, 2013, on the association between SSB consumption and weight gain or obesity. SR conclusions were independently classified by two researchers into two groups: those that found a positive association and those that did not. These two reviewers were blinded with respect to the stated source of funding and the disclosure of conflicts of interest. We identified 17 SRs (with 18 conclusions). In six of the SRs a financial conflict of interest with some food industry was disclosed. Among those reviews without any reported conflict of interest, 83.3% of the conclusions (10/12) were that SSB consumption could be a potential risk factor for weight gain. In contrast, the same percentage of conclusions, 83.3% (5/6), of those SRs disclosing some financial conflict of interest with the food industry were that the scientific evidence was insufficient to support a positive association between SSB consumption and weight gain or obesity. Those reviews with conflicts of interest were five times more likely to present a conclusion of no positive association than those without them (relative risk: 5.0, 95% CI: 1.3–19.3). An important limitation of this study is the impossibility of ruling out the existence of publication bias among those studies not declaring any conflict of interest. However, the best large randomized trials also support a direct association between SSB consumption and weight gain or obesity. Conclusions Financial conflicts of interest may bias conclusions from SRs on SSB consumption and weight gain or obesity. Please see later in the article for the Editors' Summary, Editors' Summary Background In our daily lives, we frequently rely on the results of scientific research to make decisions about our health. If we are healthy, we may seek out scientific advice about how much exercise to do to reduce our risk of a heart attack, and we may follow dietary advice issued by public health bodies to help us maintain a healthy weight. If we are ill, we expect our treatment to be based on the results of clinical trials and other studies. We assume that the scientific research that underlies our decisions about health-related issues is unbiased and accurate. However, there is increasing evidence that the conclusions of industry-sponsored scientific research are sometimes biased. So, for example, reports of drug trials sponsored by pharmaceutical companies sometimes emphasize the positive results of trials and “hide” unwanted side effects deep within the report or omit them altogether. Why Was This Study Done? Although the effects of company sponsors on the conclusions of pharmaceutical research have been extensively examined, little is known about the effects of industry sponsorship on nutrition research, even though large commercial entities are increasingly involved in global food and drink production. It is important to know whether the scientific evidence about nutrition is free of bias because biased information might negatively affect the health of entire populations. Moreover, scientific evidence from nutrition research underlies the formulation of governmental dietary guidelines and food-related public health interventions. In this systematic review, the researchers investigate whether the disclosure of potential financial conflicts of interest (for example, research funding by a beverage company) has influenced the results of systematic reviews undertaken to examine the association between the consumption of highly lucrative sugar-sweetened beverages (SSBs) and weight gain or obesity. Systematic reviews identify all the research on a given topic using predefined criteria. In an ideal world, systematic reviews provide access to all the available evidence on specific exposure–disease associations, but publication bias related to authors' conflicts of interest may affect the reliability of the conclusions of such studies. What Did the Researchers Do and Find? The researchers identified 18 conclusions from 17 systematic reviews that had investigated the association between SSB consumption and weight gain or obesity. In six of these reviews, a financial conflict of interest with a food industry was disclosed. Among the reviews that reported having no conflict of interest, 83.3% of the conclusions were that SSB consumption could be a potential risk factor for weight gain. By contrast, the same percentage of reviews in which a potential financial conflict of interest was disclosed concluded that the scientific evidence was insufficient to support a positive association between SSB consumption and weight gain, or reported contradictory results and did not state any definitive conclusion about the association between SSB consumption and weight gain. Reviews in which a potential conflict of interest was disclosed were five times more likely to present a conclusion of no positive association between SSB consumption and weight gain than reviews that reported having no financial conflict of interest. What Do These Findings Mean? These findings indicate that systematic reviews that reported financial conflicts of interest or sponsorship from food or drink companies were more likely to reach a conclusion of no positive association between SSB consumption and weight gain than reviews that reported having no conflicts of interest. A major limitation of this study is that it cannot assess which interpretation of the available evidence is truly accurate. For example, the scientists involved in the systematic reviews that reported having no conflict of interest may have had preexisting prejudices that affected their interpretation of their findings. However, the interests of the food industry (increased sales of their products) are very different from those of most researchers (the honest pursuit of knowledge), and recent randomized trials support a positive association between SSB consumption and overweight/obesity. Thus, these findings draw attention to possible inaccuracies in scientific evidence from research funded by the food and drink industry. They do not imply that industry sponsorship of nutrition research should be avoided entirely. Rather, as in other research areas, clear guidelines and principles (for example, sponsors should sign contracts that state that they will not be involved in the interpretation of results) need to be established to avoid dangerous conflicts of interest. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001578. The Research Ethics Program at the University of California, San Diego provides an overview of conflicts of interest for researchers and details of US regulations and guidelines The PLOS Medicine series on Big Food examines the activities and influence of the food industry in global health A PLOS Medicine Research Article by Basu et al. uses mathematical modeling to investigate whether SSB taxation would avert obesity and diabetes in India A 2012 policy brief from the Yale Rudd Center for Food Policy and Obesity discusses current evidence regarding SSB taxes The US National Institutes of Health has regulations on financial conflicts of interest for institutions applying to receive funding Wikipedia has pages on conflict of interest, reporting bias, systematic review, and SSBs (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)

Introduction Infertility affects approximately 15% of couples during their reproductive lifetime. We aimed to investigate associations between different dietary patterns (DP) and difficulty for getting pregnant in the SUN Project. Methods Using data from the SUN (Seguimiento Universidad de Navarra) dynamic prospective cohort of university graduates, we conducted a nested case-control analysis of 485 cases and 1670 controls aged 20–45 years. Cases were female participants who referred having consulted a doctor due to difficulties for getting pregnant. Controls were female participants not having consulted for this reason and having at least one child. Cases and controls were matched according to age. We performed principal component analyses with orthogonal varimax rotation to determine the main DPs in our cohort. We divided our sample according to quartiles of the empirically-identified DPs and conducted conditional logistic regression models. Results Out of 9811 women enrolled with 20–45 years of age, 485 referred having consulted a doctor due to difficulty to getting pregnant. Two main DPs were identified: a Western DP and a Mediterranean-type DP. Once potential confounders were adjusted for, no significant association was observed for a higher adherence to the Western DP (OR 1.09 (95% CI 0.75 to 1.57)). After adjusting for potential confounders, women with a higher adherence to the Mediterranean-type DP had a lower risk for consulting for difficulty to getting pregnant (OR 0.62 (95%: 0.39 to 0.99)). Conclusion Our data suggest that a higher adherence to the Mediterranean-type DP might have a protective effect on infertility.

We appreciate the comments raised by Giugliano, Ceriello, and Esposito (1) on our study (2). When we wrote that participants in the highest score of the Mediterranean food pattern had lower levels of risk factors, we meant in terms of comparisons between extreme values (score = 0 vs. score = 9), not grouped categories (as shown in Table 1 of our study). Average levels of factors (all of them considerably below the cut-off point for the metabolic syndrome) across grouped …

BES-RASTROLLO, MAIRA, JOAN SABATE ´ , ENRIQUE GOMEZ-GRACIA, ALVARO ALONSO, J. ALFREDO MARTINEZ, AND MIGUEL ANGEL MARTINEZ- GONZALEZ. Nut consumption and weight gain in a Mediterranean cohort: the SUN study. Obesity. 2007;15: 107-116. Objective: To assess the association, in a Mediterranean population, between nut consumption and risk of weight gain (at least 5 kg) or the risk of becoming overweight/ obese. Research Methods and Procedures: The Seguimiento Uni- versidad de Navarra project is a prospective cohort of 8865 adult men and women who completed a follow-up ques- tionnaire after a median of 28 months. Dietary habits were assessed with a previously validated semiquantitative food- frequency questionnaire. Results: Nine hundred thirty-seven participants reported a weight gain of 5 kg at follow-up. After adjusting for age, sex, smoking, leisure time physical activity, and other known risk factors for obesity, participants who ate nuts two or more times per week had a significantly lower risk of weight gain (odds ratio: 0.69; 95% confidence interval: 0.53 to 0.90, p for trend 0.006) than those who never or almost never ate nuts. Participants with little nut consumption (never/almost never) gained an average of 424 grams (95% confidence interval: 102 to 746) more than frequent nut eaters. Nut consumption was not significantly associated with incident overweight/obesity in the cohort. Discussion: Frequent nut consumption was associated with a reduced risk of weight gain (5 kg or more). These results support the recommendation of nut consumption as an im- portant component of a cardioprotective diet and also allay fears of possible weight gain.

ResumenObjetivosValorar la validez de los datos autodeclarados sobre los criterios de síndrome metabólico, en la cohorte SUN (Seguimiento Universidad de Navarra).MétodosEl proyecto SUN es una cohorte abierta multidisciplinaria formada por más de 20.000 graduados universitarios seguidos mediante cuestionarios enviados por correo cada 2 años. En una muestra de 287 participantes de la cohorte se valoró el acuerdo entre sus datos autodeclarados para el perímetro de la cintura, la presión arterial, los triglicéridos, el colesterol HDL y la glucemia, con los datos obtenidos por análisis de muestras biológicas o medidos por personal médico especializado. Para cada variable se calcularon coeficientes de correlación intraclase (CCI) con intervalos de confianza del 95% (IC95%), el error relativo medio y el porcentaje de valores dentro de los límites de acuerdo al 95% según el método de Altman y Bland.ResultadosSe encontraron correlaciones intraclase altas para los valores del perímetro de la cintura (CCI=0,86, IC95%: 0,80-0,90) y la trigliceridemia (CCI=0,71, IC95%: 0,61-0,79). Se halló una consistencia moderada (CCI entre 0,46 y 0,63) para el resto de los factores que se usan como criterios para definir el síndrome metabólico. Los errores relativos medios nunca superaron el 2,5%, y el porcentaje de valores dentro de los límites de acuerdo superó en todos los casos el 91%.ConclusionesLos resultados obtenidos sugieren que los valores autodeclarados sobre los criterios del síndrome metabólico obtenidos en la cohorte SUN poseen una validez moderada y pueden tenerse en cuenta, aunque con ciertas precauciones, en estudios epidemiológicos.AbstractObjectivesTo assess the accuracy of self-reported data needed to constitute the metabolic syndrome in the University of Navarra Follow-Up [Seguimiento Universidad de Navarra (SUN)] cohort.MethodsThe SUN project is a multi-purpose prospective cohort, formed by more than 20,000 university graduates, followed-up using surface mail questionnaires every 2 years. In a sample of 287 cohort participants, self-reported data on the criteria needed to define the metabolic syndrome (waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol and glucose) were compared with the same biometric data obtained by blood tests or measured by trained medical staff. Intra-class correlation coefficients with 95% confidence intervals (95% CI), relative mean error and agreement limits according to the method proposed by Bland and Altman were calculated for each variable studied.ResultsHigh intraclass correlations were found for the values of waist circumference (r=0.86, 95% CI: 0.80-0.90) and triglycerides (r=0.71, 95%CI: 0.61-0.79). Moderate intraclass correlations were found (between 0.46 and 0.63) for the other factors. Relative mean errors were always91% of values were within the limits of agreement for all variables.ConclusionsThe results suggest that self-declared data on the criteria of metabolic syndrome obtained in the SUN cohort, though with some caution, are sufficiently accurate to be used in epidemiological studies.

Background Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset during pregnancy, is increasing worldwide, mostly because obesity among women of reproductive age is continuously escalating. GDM is associated with adverse maternal and fetal outcomes. The aim of this article was to systematically review literature on the effectiveness of nutritional factors before or during pregnancy to prevent GDM. Methods We assessed the primary prevention of GDM through nutritional factors, as diet and supplements. We searched on PubMed, Cochrane Databases and ClinicalTrials.gov from inception to June 2016. Clinical trials and adjusted prospective cohort studies were included. Results Eight clinical trials and twenty observational studies assessing the association between dietary factors and primary prevention of GDM were included. Furthermore, six clinical trials and two observational studies related to supplements were also added. Only two nutritional interventions were found to significantly reduce the incidence of GDM, besides the supplements. However, the observational studies showed that a higher adherence to a healthier dietary pattern can prevent the incidence of GDM, especially in high risk population before getting pregnant. Conclusions The results indicate that there may be some benefits of some nutritional factors to prevent GDM. However, better-designed studies are required to generate higher quality evidence. At the moment, no strong conclusions can be drawn with regard to the best intervention for the prevention of GDM. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1205-4) contains supplementary material, which is available to authorized users.

ObjectiveOur aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression.DesignIn a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed.ResultsAfter a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped).ConclusionsModerate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.

Background The assessment of changes in dietary habits provides interesting information on whether or not the observed trends are in line with accepted nutritional guidelines. The objective was to evaluate within-subject longitudinal changes in food consumption and nutrient intake and in a 10-year follow-up study. Methods The SUN (Seguimiento Universidad de Navarra) project is a prospective Spanish cohort study. Diet was assessed using a 136-item food-frequency questionnaire (FFQ), previously validated in Spain. The participants were 3036 university graduates (55.8 % women) of Spain and the main outcome measures the changes in dietary quality and in food consumption and nutrient intake. Paired t-tests and conditional logistic regression models were used to evaluate within-subject longitudinal dietary changes and the risk of inadequacy respectively, after 10 years of follow-up. Results During follow-up, participants showed a relevant and significant increase (p

Introduction and objectives To assess prospectively the association between alcohol consumption, including alcoholic beverage preference and weekly pattern of consumption, and the risk of hypertension in a Mediterranean cohort. Methods We prospectively followed 9963 Spanish men and women initially without hypertension. Self-reported and validated data on diet and hypertension diagnoses were collected. Results During follow-up (median [interquartile range], 4.2 [2.5-6.1] years), 554 incident cases of hypertension were identified over a total of 43 562 person-years. The hazard ratio for hypertension among those who consumed alcohol on ≥5 days per week was 1.28 (95% confidence interval, 0.97-1.7) compared to abstainers. Among those who drank alcohol ≥5 days per week, the hazard ratio for hypertension associated with consuming ≥1 drink per day was 1.45 (95% confidence interval, 1.06-2) compared to abstainers. The consumption of beer or spirits, but not wine, was associated with an increased risk of hypertension. The hazard ratio associated with consuming >0.5 drinks of beer per day was 1.53 (95% confidence interval, 1.18-1.99) compared with abstainers. In contrast, there is a nonsignificant inverse association between red wine intake and the risk of hypertension. Conclusions In this Mediterranean population, the consumption of beer or spirits, but not wine, was associated with a higher risk of developing hypertension. However, the weekly pattern of alcohol consumption did not have a significant impact on the risk of hypertension.

OBJECTIVES: Provegetarian diets (i.e., preference for plant-derived foods) have been associated with a reduced risk of long-term weight gain and could be more easily embraced than strict vegetarian diets. However, not all plant-derived foods are equally healthy. The objective was to identify the association between provegetarian food patterns and the incidence of overweight/obesity. METHODS: The analysis included 11,554 participants with a baseline BMI

Summary Background & aims There is scarce evidence from long-term prospective studies relating the consumption of fried foods with the incidence of Metabolic Syndrome (MS). The aim of this study was to assess the association between fried food consumption and the incidence of MS. Methods We followed 8289 participants (2813 men and 5476 women, mean age = 35.9 y, SD = 10.4) during a median period of 8.3-y. They were initially free of any MS criteria. MS was defined according to the American Heart Association and the International Diabetes Federation criteria as outlined in the harmonized definition for MS. Each component of the MS was assessed at the 6th and 8th-y of follow-up. The outcome was defined as the presence of ≥3 of the components of MS after ≥6 years of follow-up. Results During 65335 person-years, 420 incident cases of MS were identified. Frequent consumption of fried foods was not associated with the incidence of MS [HR = 0.98 (95% CI: 0.77–1.26) p for trend = 0.862]. However, two components of the MS, central adiposity and high blood pressure were positively associated with fried food consumption [HR for consumption >4 times/week compared with ≤2 times/week = 1.10 (95% CI: 1.01–1.19) ( p for trend 0.022) and HR = 1.16 (95% CI: 1.02–1.32) ( p for trend 0.011), respectively] after multivariable adjustment. Conclusions In this Mediterranean cohort of relatively young adults, frequent consumption of fried foods was not associated with MS. Two out of five components of MS (central adiposity and high blood pressure) were positively associated with frequent fried food consumption.

Obesity is a major epidemic for developed countries in the 21st century. The main cause of obesity is energy imbalance, of which contributing factors include a sedentary lifestyle, epigenetic factors and excessive caloric intake through food and beverages. A high consumption of caloric beverages, such as alcoholic or sweetened drinks, may particularly contribute to weight gain, and lower satiety has been associated with the intake of liquid instead of solid calories. Our objective was to evaluate the association between the substitution of a serving per day of water for another beverage (or group of them) and the incidence of obesity and weight change in a Mediterranean cohort, using mathematical models. We followed 15,765 adults without obesity at baseline. The intake of 17 beverage items was assessed at baseline through a validated food-frequency questionnaire. The outcomes were average change in body weight in a four-year period and new-onset obesity and their association with the substitution of one serving per day of water for one of the other beverages. During the follow-up, 873 incident cases of obesity were identified. In substitution models, the consumption of water instead of beer or sugar-sweetened soda beverages was associated with a lower obesity incidence (the Odds Ratio (OR) 0.80 (95% confidence interval (CI) 0.68 to 0.94) and OR 0.85 (95% CI 0.75 to 0.97); respectively) and, in the case of beer, it was also associated with a higher average weight loss (weight change difference = 􀀀328 g; (95% CI 􀀀566 to 􀀀89)). Thus, this study found that replacing one sugar-sweetened soda beverage or beer with one serving of water per day at baseline was related to a lower incidence of obesity and to a higher weight loss over a four-year period time in the case of beer, based on mathematical models.

ResumenIntroducciónLa investigación aporta la salud pública la importante base de la evidencia científica. Nuestro objetivo fue comparar el actual apoyo de investigación en salud pública en los países europeos.MétodosEn el marco del estudio colaborativo SPHERE (Strengthening Public Health Research in Europe) se desarrolló un cuestionario vía correo electrónico que fue enviado a 93 representantes de las asociaciones nacionales miembros de la Asociación Europea de Salud Pública. Se compararon las respuestas en tres macroáreas: norte, sur y este de Europa.ResultadosSe obtuvo respuesta de 23 de los 39 países europeos (tasa de respuesta por países: 56%). Las prioridades nacionales actuales fueron: servicios de salud y seguridad del paciente en el norte de Europa; enfermedades infecciosas, servicios de salud y enfermedad cardiovascular en el sur de Europa; y seguridad alimentaria y nutrición, salud medioambiental y ocupacional en los países del este de Europa. Los encuestados dieron menos prioridad a la investigación internacional. En el norte, las prioridades enfatizadas fueron la promoción de la salud, la prevención y la educación (26,3%), junto con los accidentes y los hábitos alcohólicos (26,3%).ConclusiónEl apoyo para la investigación en salud pública difiere en los países europeos, y el no disponer de unas buenas infraestructuras y de personal suficiente fueron barreras para llevar a cabo mejor investigación. Las asociaciones de salud pública nacionales y las autoridades sanitarias deberían cooperar para encontrar respuestas efectivas a problemas comunes.AbstractIntroductionResearch provides the important evidence base for public health practice. We sought to compare the current support for public health research within European countries.MethodsWithin a collaborative study SPHERE (Strengthening Public Health Research in Europe), we developed an e-mail questionnaire and sent it to 93 representatives of national member associations of the European Public Health Association. We compared the answers with reference to tree macro-areas: Northern, Southern and Eastern Europe.ResultsWe gained responses for 22 of 39 European countries (56% country response rate). Current priorities at national level were: health service and patient safety for Northern Europe; infectious disease, health service and cardiovascular disease for Southern Europe; and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents gave fewer priorities for international research. In the North Europe the priorities empathized were health promotion, prevention and education (26.3%) together the injuries and alcohol habits (26.3%).ConclusionSupport for public-health research differs across Europe, and barriers to undertaking better research include structures and sufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.