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Objectives. To evaluate the efficacy and safety of a mixed wavelength laser 10600 and 1540 nm using low-power 5 W CO2, on the vaginal maturation value (VMV) and genitourinary syndrome of menopause (GSM). Design. randomized single-blind sham-controlled trial. Setting. Hospital Universitari Sant Joan de Reus, Spain. Population. 31 postmenopausal women with GSM symptoms and VMV

[ES]: El estilo de vida es un concepto complejo que incluye los aspectos externos a nosotros mismos que pueden modular e influir en nuestra salud. Los conocimientos sobre la relación entre el estilo de vida y el riesgo cardiovascular están lejos de proporcionar los niveles de evidencia que se han conseguido con los ensayos clínicos con fármacos, debido a que los estudios son escasos, fundamentalmente de tipo observacional y en grandes cohortes, con la dificultad añadida de la no existencia de métodos seguros para conocer con precisión la ingesta diaria o lo largo de tiempo, así como la dificultad en la recogida de datos y en la medición de la adherencia debido a diferencias en la composición de los alimentos en distintas épocas y a la conducta alimentaria cambiante que posee el ser humano a lo largo del tiempo. En este documento nos hemos propuesto llevar a cabo una revisión actualizada y jerarquizada en base a las evidencias actuales, prestando atención a tres aspectos que tienen gran importancia patogénica y que podemos modificar directamente: la actividad física, el consumo de tabaco y el patrón de alimentación. Con ello pretendemos actualizar los nuevos conocimientos sobre su relación con el riesgo cardiovascular aportando evidencias útiles, constituyendo una herramienta sencilla dirigida especialmente a todos los profesionales de la salud implicados en el cuidado de personas con riesgo cardiovascular para trasladarlos a la práctica clínica, definiendo unas líneas de actuación sencillas y fáciles para ser transmitidas a las personas que reciban un consejo para la prevención primaria y secundaria de las enfermedades cardiovasculares., [EN]: Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases., ER ha recibido compensación económica por preparación de material didáctico y becas para investigación a través de su institución de la California Walnut Commission y es miembro no remunerado de su Comité Asesor Científico. FPJ, JLM, JDL y PPM han participado en actividades formativas financiadas por el Patrimonio Comunal Olivarero, España.

Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases.

This paper describes what are plant sterols, the chemical structure to understand their mechanism of cholesterol-lowering action, and indications and contraindications in clinical practice.

Mediterranian diet; Smoke; Lung function Dieta mediterránea; Fumar; Función pulmonar Dieta mediterrània; Fumar; Funció pulmonar Data on the association between lung function and some dietary patterns have been published. However, it is not yet well known if whether the Mediterranean Diet (MD) pattern can preserve or improve lung function. Our purpose is to evaluate the effect of increased MD adherence on lung function in smokers. A multicenter, parallel, cluster-randomized, controlled clinical trial is proposed. A total of 566 active smokers (>10 packs-year), aged 25-75 years will be included, without previous respiratory disease and who sign an informed consent to participate. Twenty Primary Care Centres in Tarragona (Spain) will be randomly assigned to a control or an intervention group (1:1). All participants will receive advice to quit smoking, and the intervention group, a nutritional intervention (2 years) designed to increase MD adherence by: (1) annual visit to deliver personalized nutritional education, (2) annual telephone contact to reinforce the intervention, and (3) access to an online dietary blog. We will evaluate (annually for 2 years): pulmonary function by forced spirometry and MD adherence by a 14-item questionnaire and medical tests (oxidation, inflammation and consumption biomarkers). In a statistical analysis by intention-to-treat basis, with the individual smoker as unit of analysis, pulmonary function and MD adherence in both groups will be compared; logistic regression models will be applied to analyze their associations. We hope to observe an increased MD adherence that may prevent the deterioration of lung function in smokers without previous respiratory disease. This population may benefit from a dietary intervention, together with the recommendation of smoking cessation.

Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases.

In order to clarify the relation between deprivation and morbillity and mortality, in function of different residence places, we design this study. Main objective is to analyze the influence of place of residence on the incidence of cardiovascular events (CVD) and general mortality from any cause, in a cohort with metabolic syndrome.Prospective study to determine the incidence of CVD according to the place of residence (rural, urban) in individuals with different combinations of clinical features of Metabolic Syndrome (MS). Setting: Primary Care, Catalonia (Spain). Subjects: between 35-75 years of age fulfilling SM criteria, without CVD at the beginning of follow-up (2009). The population was stratified according to the MEDEA index in rural, and within urban areas in 5 subcategories (urban1 - urban5), according to their level of deprivation. We performed descriptive statistics, variance analysis and survival curves (Kaplan-Meier and Cox methods) in order to contrast data from different categories.We analyzed 401,743 subjects with MS (17.2% of the Catalan population); 20.1% resided in rural areas. Their average age ranged between 60.5 + 9.6 years in urban area 1 (most favored) and 59.6 + 10.4 years in urban area 5 (the most precarious). After 5 years of follow-up, the global incidence of CVD was 5.5%, being slightly lower in rural areas (5%) than in urban areas (between 5.5% -5.8%). On the other hand, mortality was higher in the rural area (859 deaths/100000 inhabitants-year) - than in the rest of the areas (minimum value in urban-3 (736 deaths/100000 inhabitants-year)).The place of residence is a risk marker, which is associated with the incidence of CVD but above all, with higher mortality from all causes in patients with MS. Undoubtedly and leaving aside the possible confounding factors, in the socioeconomically most disadvantaged areas, mortality is increased.Con el fin de evidenciar la posible relación entre deprivación y morbimortalidad, enmarcada en diferentes lugares de residencia, diseñamos el presente estudio. El objetivo de este trabajo fue analizar la influencia del lugar de residencia sobre la incidencia de eventos cardiovasculares (ECV) y de mortalidad general por cualquier causa, en una cohorte con síndrome metabólico.Estudio prospectivo para determinar la incidencia de ECV según el lugar de residencia (rural, urbano) en individuos con distintas combinaciones de rasgos clínicos de Síndrome Metabólico (SM). El emplazamiento del mismo fue la Atención Primaria de Cataluña (España). Los sujetos de estudio fueron personas de entre 35-75 años de edad, que cumplían los criterios de SM, sin ECV al inicio del seguimiento (2009). La población se estratificó según el índice MEDEA en rural, y dentro de áreas urbanas en 5 subcategorías (urbano1 – urbano5), según su nivel de deprivación. Se realizó estadística descriptiva, análisis de la varianza y curvas de supervivencia (Kaplan-Meier, método de Cox) para contrastar los diferentes grupos categóricos.Se analizaron 401.743 sujetos con SM (17,2% de la población catalana); 20,1% residían en áreas rurales. Su edad media osciló entre 60,5 + 9,6 años en área urbana 1 (la más favorecida) y 59,6 + 10,4 años en área urbana 5 (la más precaria). A los 5 años de seguimiento, la incidencia global de ECV fue del 5,5%, siendo ligeramente menor en ámbito rural (5%) que en los urbanos (entre 5,5-5,8%). En cambio, la mortalidad fue superior en el ámbito rural (859 casos/100000 habitantes-año) - que en el resto de áreas (mínimo valor en urbano-3 (736 casos/100000 habitantes-año)).El lugar de residencia constituye un marcador de riesgo, que se asocia a la incidencia de ECV pero sobre todo, a una mayor mortalidad por todas las causas, en pacientes con SM. Sin duda y dejando de lado los posibles factores de confusión, en las áreas socioeconómicamente más desfavorecidas, la mortalidad está aumentada.

The study of nutritional interventions in humans is difficult to assess because the induced metabolic changes are lower than the natural biological variability between subjects. Due to its holistic approach, 1H NMR is one of the preferred technologies for this type of studies, even though it has a very low sensitivity. This work shows how the use of several chemometric algorithms on the measured data compensates for these drawbacks and allows the study of the effects of the nutritional intervention isolating them from the natural variability inherent to human studies. Mild to moderate hypercholesterolemic patients received either placebo or soluble fiber in a low saturated fat diet. Plasma samples were collected at week 0 and week 8. Spectra obtained with NMR equipment were processed with ANOVA simultaneous component analysis (ASCA). The application of clustering techniques revealed different responses based on the patient's basal state, which allowed the identification of responders from non-responders. Results showed a triglyceride level reduction of up to 15% (p = 0.0032), with a higher reduction for those patients with a higher initial lipid profile. Moreover, line-shape fitting techniques applied to the NMR spectra allowed the conclusion that LDL (and VLDL) lipoprotein particles, and more noticeably triglycerides, moved to a profile configuration associated with lower cardiovascular risk. Results shed light on some of the metabolic modifications that husk fiber induces in humans which could not be seen with more conventional data analysis approaches. Our conclusion is that by using the right chemometric techniques it is possible to assess nutritional intervention effects in human NMR human studies despite the low sensitivity and selectivity that the technique offers today.

This paper describes what are plant sterols, the chemical structure to understand their mechanism of cholesterol-lowering action, and indications and contraindications in clinical practice.

Background: The aim of this study was to assess the association of key adiposity markers with lung function in smokers without respiratory disease in a Mediterranean population. Methods: We performed a cross-sectional study with baseline data from a representative sample of the ESPITAP study in Spain. Participants were 738 smokers (52.3% men) without respiratory disease, aged 35 to 70, selected from 12 primary health care centres. We assessed weight, height, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). The pulmonary functional parameters were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC ratio. Results: In this cohort of smokers, 22.2% of individuals had central obesity. FVC% was inversely associated with all anthropometric measures (BMI, WC and WHtR) in the overall population and in men; in women, only BMI was associated with FVC%. FEV1% was inversely associated to BMI and WC in the overall population, and to all anthropometric measures in men. Furthermore, both BMI and obesity were positively associated with FEV1/FVC ratio overall and when stratified by sex; this suggests a restrictive pattern explained by the altered ventilator mechanics experienced by people with obesity. Conclusion: In a Mediterranean population of smokers without respiratory symptoms, abdominal obesity, evaluated not only by BMI and WC but also WHtR, is inversely associated with lung function. Fat distribution appears more strongly related to pulmonary function parameters in men than in women. In smokers with high values for WC, WHtR and BMI, assessment of lung function is recommended. Trial registration: Current Controlled Trials NCT01194596. Registered 2 September 2010.

Background: Diet can help preserve lung function in smokers, in addition to avoidance of smoking. The study aimed to evaluate associations between dietary patterns and lung function in smokers without respiratory disease. Methods: This cross-sectional study analysed baseline data from randomised representative smokers without respiratory disease (n=207, aged 35-70 years), selected from 20 primary health-care centres. Participants completed a validated semi-quantitative food-frequency questionnaire. Dietary patterns were identified by Principal Component Analysis (PCA). Impaired lung function was defined as FVC

Spirometry is the recommended method of evaluating pulmonary function when respiratory disease is suspected in smokers. Nonetheless, no evidence exists of the usefulness of information obtained from this test as a motivational strategy for smoking cessation. The primary objective of this study is to evaluate the effectiveness of a motivational intervention based on spirometry results in achieving long-term smoking cessation. We propose a multicenter randomized clinical trial in the primary care setting. Study subjects: We will recruit active smokers of both sexes, aged 35-70 years, with a cumulated smoking habit exceeding 10 packs/year and who consult for any reason with their primary care physician in the 20 health centers in the province of Tarragona (Spain). Patients with a history of lung disease or who have undergone exploratory measures of pulmonary function in the preceding 12 months will be excluded. All patients who agree to participate will provide signed informed consent prior to their inclusion. A total of 1000 smokers will be consecutively randomized to a control or intervention group (1:1). Intervention: Participants in both groups will receive brief (5-minute) health counseling, in accordance with usual clinical practice. In a consultation lasting about 15 minutes, participants in the intervention group will also receive detailed, personalized information about the results of a spirometry test and about their lung age compared with their chronological age. Both groups will be followed up for 12 months. Main variables and analysis: The main variable will be sustained smoking abstinence at 12 months after the intervention, as confirmed by CO breath testing and urine cotinine test. Results will be analyzed based on intention to treat, using the chi-square test and logistical regression if necessary to adjust for confounding variables. We expect the rate of prolonged smoking abstinence in the intervention group will be at least 5 % higher than in the control group. If this strategy proves effective, it could easily be included in the health promotion activities offered in primary care settings. ClinicalTrials.gov Identifier: NCT02153047 . Registered on 28/05/2014

Background There is evidence of an association between pulmonary function and various nutrients, although no association has been observed in our setting between the Mediterranean Diet (MD) eating pattern and improved lung function. The objective of this study is to evaluate the effect of an intervention designed to increase MD adherence on lung function in smokers with no previous respiratory disease. Methods/design Randomized, controlled, parallel clinical trial. Setting: primary health care centers in Catalonia (Spain). Participants: Current smokers (cumulative > 10 pack-years) aged 35–70 years, with Internet access, who provide signed informed consent to participate. Intervention: A nutritionist will conduct a 2-year multicomponent intervention to increase MD adherence, based on: 1) a personalized dietary-nutritional education intervention, 2) a Web 2.0 approach, the DIET Blog of nutritional information, and 3) group sessions to increase motivation to increase MD adherence and motivation to make changes in eating habits. Annually, an office visit and one group session will reinforce the nutritional intervention. The control group will follow their usual diet, with general nutritional counselling. In both groups, a 14-item questionnaire will evaluate individual MD dietary patterns and forced spirometry will assess lung function. Analysis: Intention to treat. The unit of analysis will be the individual smoker. Primary outcome is lung function indicated by spirometry, FVC, FEV1 and FEV1/FVC %. Lung function parameters in both groups will be compared by adherence to the MD pattern. Discussion The DIET study could contribute data on a protective action of the MD pattern on lung function in smokers. If so, this population may benefit from a nutritional intervention, along with the fundamental recommendation to stop smoking. Trial registration ClinicalTrials.gov: NCT02151669. Registered 26 May 2014.

Background: Elevated ferritin levels have been associated with single cardiovascular risk factors but the relationship to the presence of metabolic syndrome is inconclusive.The aim of this systematic review and meta-analysis of published observational studies was to estimate the association between serum ferritin levels and metabolic syndrome in adults. Methods. The Pubmed, SCOPUS and the Cochrane Library databases were searched for epidemiological studies that assessed the association between ferritin levels and metabolic syndrome and were published before September 2013. There were no language restrictions. Two investigators independently selected eligible studies. Measures of association were pooled by using an inverse-variance weighted random-effects model. The heterogeneity among studies was examined using the I 2 index. Publication bias was evaluated using the funnel plot. Results: Twelve cross-sectional, one case-control and two prospective studies met our inclusion criteria including data from a total of 56,053 participants. The pooled odds ratio (OR) for the metabolic syndrome comparing the highest and lowest category of ferritin levels was 1.73 (95% CI: 1.54, 1.95; I2 = 75,4%). Subgroup analyses indicate that pooled OR was 1.92 (95% CI: 1.61, 2.30; I 2 = 78%) for studies adjusting for C-reactive protein (CRP), and 1.52 (95% CI:1. 36, 1.69; I2 = 41%) for studies that did not adjust for CRP (P = 0.044). This finding was remarkably robust in the sensitivity analysis. We did not find publication bias. Conclusions: The meta-analysis suggests that increased ferritin levels are independently and positively associated with the presence of the metabolic syndrome with an odds ratio higher than 1.73. © 2014Abril-Ulloa et al.; licensee BioMed Central Ltd.

Although dietary fat and its role in cardiovascular prevention has been one of the most extensively studied nutritional topics, it continues to be an ever-expanding research area. Particularly thanks to studies on Mediterranean diet, we now know that fat quality is more relevant than the amount of fat we eat in the diet. Thus, saturated and trans fats have been found to increase the risk of atherogenic disease. This is why it is recommended to substitute complex carbohydrates or unsaturated fat for unsaturated and trans fats with the aim of reducing saturated and trans fat intake to