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Singh A, Schurman SH, Bektas A, Kaileh M, Roy R, Wilson DM, Sen R, Ferrucci L. Aging and Inflammation. Cold Spring Harb Perspect Med 2024; 14:a041197. [PMID: 38052484 PMCID: PMC11146314 DOI: 10.1101/cshperspect.a041197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Aging can be conceptualized as the progressive disequilibrium between stochastic damage accumulation and resilience mechanisms that continuously repair that damage, which eventually cause the development of chronic disease, frailty, and death. The immune system is at the forefront of these resilience mechanisms. Indeed, aging is associated with persistent activation of the immune system, witnessed by a high circulating level of inflammatory markers and activation of immune cells in the circulation and in tissue, a condition called "inflammaging." Like aging, inflammaging is associated with increased risk of many age-related pathologies and disabilities, as well as frailty and death. Herein we discuss recent advances in the understanding of the mechanisms leading to inflammaging and the intrinsic dysregulation of the immune function that occurs with aging. We focus on the underlying mechanisms of chronic inflammation, in particular the role of NF-κB and recent studies targeting proinflammatory mediators. We further explore the dysregulation of the immune response with age and immunosenescence as an important mechanistic immune response to acute stressors. We examine the role of the gastrointestinal microbiome, age-related dysbiosis, and the integrated stress response in modulating the inflammatory "response" to damage accumulation and stress. We conclude by focusing on the seminal question of whether reducing inflammation is useful and the results of related clinical trials. In summary, we propose that inflammation may be viewed both as a clinical biomarker of the failure of resilience mechanisms and as a causal factor in the rising burden of disease and disabilities with aging. The fact that inflammation can be reduced through nonpharmacological interventions such as diet and exercise suggests that a life course approach based on education may be a successful strategy to increase the health span with few adverse consequences.
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Affiliation(s)
- Amit Singh
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - Shepherd H Schurman
- Clinical Research Unit, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - Arsun Bektas
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - Mary Kaileh
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - Roshni Roy
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - David M Wilson
- Biomedical Research Institute, Hasselt University, Diepenbeek 3500, Belgium
| | - Ranjan Sen
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, Baltimore, Maryland 21224, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland 21224, USA
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Pitter JG, Zemplényi A, Babarczy B, Németh B, Kaló Z, Vokó Z. Frailty prevalence in 42 European countries by age and gender: development of the SHARE Frailty Atlas for Europe. GeroScience 2024; 46:1807-1824. [PMID: 37855861 PMCID: PMC10828249 DOI: 10.1007/s11357-023-00975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
Comparative frailty prevalence data across European countries is sparse due to heterogeneous measurement methods. The Survey of Health, Ageing and Retirement (SHARE) initiative conducted interviews with probability sampling of non-institutionalized elderly people in several European countries. Previous frailty analyses of SHARE datasets were limited to initial SHARE countries and did not provide age- and gender-stratified frailty prevalence. Our aim was to provide age- and gender-stratified frailty prevalence estimates in all European countries, with predictions where necessary. From 29 SHARE participating countries, 311,915 individual surveys were analyzed. Frailty prevalence was estimated by country and gender in 5-year age bands using the SHARE Frailty Instrument and a frailty index. Association of frailty prevalence with age, gender, and GDP per capita (country-specific economic indicator for predictions) was investigated in multivariate mixed logistic regression models with or without multiple imputation. Female gender and increasing age were significantly associated with higher frailty prevalence. Higher GDP per capita, with or without purchasing power parity adjustment, was significantly associated with lower frailty prevalence in the 65-79 age groups in all analyses. Observed and predicted data on frailty rates by country are provided in the interactive SHARE Frailty Atlas for Europe. Our study provides age- and gender-stratified frailty prevalence estimates for all European countries, revealing remarkable between-country heterogeneity. Higher frailty prevalence is strongly associated with lower GDP per capita, underlining the importance of investigating transferability of evidence across countries at different developmental levels and calling for improved policies to reduce inequity in risk of developing frailty across European countries.
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Affiliation(s)
- János G Pitter
- Syreon Research Institute, Budapest, Hungary
- Faculty of Pharmacy, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary
| | - Antal Zemplényi
- Syreon Research Institute, Budapest, Hungary
- Faculty of Pharmacy, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary
| | | | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary.
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
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D’Adamo CR, Kaplan MB, Campbell PS, McLaughlin K, Swartz JS, Wattles KR, Lukaczer D, Scheinbaum S. Functional medicine health coaching improved elimination diet compliance and patient-reported health outcomes: Results from a randomized controlled trial. Medicine (Baltimore) 2024; 103:e37148. [PMID: 38394515 PMCID: PMC11309605 DOI: 10.1097/md.0000000000037148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The objective of this study was to determine whether an elimination diet with virtually provided functional medicine health coaching support would be more effective than a typical self-guided elimination diet with respect to dietary compliance and patient-reported health and quality of life. METHODS A parallel arm, randomized controlled trial was conducted among a sample of healthcare professionals. Participants were randomized to either an elimination diet with 5 sessions of functional medicine health coaching support (intervention arm) or a self-guided elimination diet (control arm). Outcomes assessed at baseline and at the conclusion of the 10-week study included PROMIS Global Health (GH) and medical symptoms questionnaire (MSQ). Compliance with the elimination diet was assessed at the conclusion of the study. Baseline and end of study outcomes were compared within study arms via paired t tests and between study arms with unpaired t tests. Subgroup analysis of symptomatology at baseline was performed. RESULTS 125 randomized participants (n = 64 intervention, n = 61 control) provided baseline outcomes data. There were statistically and clinically significant within-group improvements in patient-reported outcomes in both the intervention arm (PROMIS GH-physical = 4.68, PROMIS GH-mental = 3.53, MSQ = 28.9) and control arm (PROMIS GH-physical = 48.4, PROMIS GH-mental = 3.18, MSQ = 24.1). There were no between-group differences in the primary analysis (P > .1). However, participants with more symptoms at baseline had statistically and clinically significant between-group differences in PROMIS GH-mental health (3.90, P = .0038) and MSQ (12.3, P = .047) scores that favored the functional medicine health coaching arm. CONCLUSIONS An elimination diet, whether self-guided or with functional medicine health coaching support, may improve patient-reported health outcomes among relatively healthy healthcare professionals. While studies in more diverse samples are needed, functional medicine health coaching support appears to be superior to a self-guided approach with regard to both dietary compliance and improving health outcomes among those with greater symptomatology.
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Affiliation(s)
- Christopher R. D’Adamo
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Dan Lukaczer
- The Institute for Functional Medicine, Federal Way, WA
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Zupo R, Castellana F, Piscitelli P, Crupi P, Desantis A, Greco E, Severino FP, Pulimeno M, Guazzini A, Kyriakides TC, Vasiliou V, Trichopoulou A, Soldati L, La Vecchia C, De Gaetano G, Donati MB, Colao A, Miani A, Corbo F, Clodoveo ML. Scientific evidence supporting the newly developed one-health labeling tool "Med-Index": an umbrella systematic review on health benefits of mediterranean diet principles and adherence in a planeterranean perspective. J Transl Med 2023; 21:755. [PMID: 37885010 PMCID: PMC10601192 DOI: 10.1186/s12967-023-04618-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Med-Index is a one-health front-of-pack (FOP) label, based on Mediterranean diet (MedDiet) principles, developed to summarize information about the nutritional properties and related-health benefits of any food as well as its sustainable production processes, and the associated food company's social responsibility parameters in a new "Planeterranean" perspective. Thus, Med-Index can be adopted in and by any European region and authority as well as worldwide; this is achieved by consumption and cooking of locally available and sourced foods that respect MedDiet principles, both in terms of healthy nutrition and sustainable production. The huge body of scientific evidence about the health benefits of the MedDiet model and principles requires a comprehensive framework to encompass the scientific reliability and robustness of this tool. A systematic review was carried out to examine the association between human health and adherence to MedDiet patterns upon which the "Med-Index" tool was subsequently developed. METHODS MEDLINE and PubMed databases were searched for eligible publications from 1990 to April 2023. Systematic literature reviews, with or without meta-analysis, of clinical trials and observational studies were screened by two independent investigators for eligibility, data extraction, and quality assessment. English language and the time interval 1990-2023 were applied. A registry code CRD42023464807 was generated on PROSPERO and approved for this search protocol. The corrected covered area (CCA), calculated to quantify the degree of overlap between reviews, gave a slight overlap (CCA = 4%). RESULTS A total of 84 systematic reviews out of 6681 screened records were selected. Eligible reviews included studies with predominantly observational designs (61/84, 72.6%%), of which 26/61 referenced studies of mixed observational and RCT designs, while 23/84 (27.4%) were RCT-only systematic reviews. Seventy-nine different entries were identified for health outcomes, clustered into 10 macro-categories, each reporting a statistically significant association with exposure to the MedDiet. Adherence to MedDiet was found to strongly benefit age-related chronic diseases (21.5%), neurological disorders (19%), and obesity-related metabolic features (12.65), followed by CVDs (11.4%), cancer (10.1%), diabetes (7.5%), liver health (6.3%), inflammation (5%), mortality (5%), and renal health (1.2%). The quality of the studies was moderate to high. CONCLUSION In the context of a "Planeterranean" framework and perspective that can be adopted in any European region and worldwide, MedDiet represents a healthy and sustainable lifestyle model, able to prevent several diseases and reduce premature mortality. In addition, the availability of a FOP, such as Med-Index, might foster more conscious food choices among consumers, paying attention both to human and planetary health.
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Affiliation(s)
- Roberta Zupo
- Department of Interdisciplinary Medicine (DIM), University "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Fabio Castellana
- Department of Interdisciplinary Medicine (DIM), University "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Prisco Piscitelli
- Italian Society of Environmental Medicine (SIMA), 20123, Milan, Italy.
- UNESCO Chair on Health Education and Sustainable Development, Federico II University, 80138, Naples, Italy.
| | - Pasquale Crupi
- Department of Interdisciplinary Medicine (DIM), University "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Addolorata Desantis
- Department of Interdisciplinary Medicine (DIM), University "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Enrico Greco
- Italian Society of Environmental Medicine (SIMA), 20123, Milan, Italy
| | - Franca Paola Severino
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50121, Florence, Italy
| | - Manuela Pulimeno
- Italian Society of Environmental Medicine (SIMA), 20123, Milan, Italy
| | - Andrea Guazzini
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50121, Florence, Italy
| | | | | | | | - Laura Soldati
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni De Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, Italy
| | | | - Annamaria Colao
- UNESCO Chair on Health Education and Sustainable Development, Federico II University, 80138, Naples, Italy
| | - Alessandro Miani
- Italian Society of Environmental Medicine (SIMA), 20123, Milan, Italy.
| | - Filomena Corbo
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - Maria Lisa Clodoveo
- Department of Interdisciplinary Medicine (DIM), University "Aldo Moro", Piazza Giulio Cesare 11, 70100, Bari, Italy
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Oei S, Millar CL, Nguyen Lily TN, Mukamal KJ, Kiel DP, Lipsitz LA, Hannan MT, Sahni S. Higher intake of dietary flavonols, specifically dietary quercetin, is associated with lower odds of frailty onset over 12 years of follow-up among adults in the Framingham Heart Study. Am J Clin Nutr 2023; 118:27-33. [PMID: 37061164 PMCID: PMC10447475 DOI: 10.1016/j.ajcnut.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Polyphenolic antioxidants derived from plant foods may reduce oxidative stress and frailty, but the effect of the polyphenol subclass of dietary flavonoids and their subclasses on frailty is uncertain. OBJECTIVES To determine the association between dietary flavonoids, their subclasses, quercetin (a specific flavonol), and frailty onset in adults. METHODS This prospective cohort study included individuals from the Framingham Heart Study with no frailty at baseline. Intake of total flavonoids, subclasses of flavonoids (flavonols, flavan-3-ols, flavonones, flavones, anthocyanins, and polymeric flavonoids), and quercetin were estimated via semi-quantitative FFQ along with frailty (Fried phenotype), and covariates at baseline (1998-2001). Frailty was re-evaluated in 2011-2014. Logistic regression estimated OR and 95% CIs for each flavonoid variable and frailty onset. RESULTS Mean age was 58.4 y (SD ± 8.3, n = 1701; 55.5% women). The mean total flavonoid intake was 309 mg/d (SD ± 266). After 12.4 (SD ± 0.8) y, 224 (13.2%) individuals developed frailty. Although total flavonoid intake was not statistically associated with frailty onset (adjusted OR: 1.00; 95% CI: 0.99-1.01), each 10 mg/d of higher flavonol intake was linked with 20% lower odds of frailty onset (OR: 0.80; 95% CI: 0.67-0.96). Other subclasses showed no association (P values range: 0.12-0.99), but every 10 mg/d of higher quercetin intake was associated with 35% lower odds of frailty onset (OR: 0.65; 95% CI: 0.48-0.88). CONCLUSIONS Although no association was observed between total flavonoid intake and frailty onset in adults, a higher intake of flavonols was associated with lower odds of frailty onset, with a particularly strong association for quercetin. This hypothesis-generating study highlights the importance of assessing specific subclasses of flavonoids and the potential of dietary flavonols and quercetin as a strategy to prevent the development of frailty.
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Affiliation(s)
- Steven Oei
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Courtney L Millar
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | | | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - Lewis A Lipsitz
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - Marian T Hannan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - Shivani Sahni
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.
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Poursalehi D, Lotfi K, Saneei P. Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: A systematic review and dose-response meta-analysis with GRADE assessment. Ageing Res Rev 2023; 87:101903. [PMID: 36871780 DOI: 10.1016/j.arr.2023.101903] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Several studies have explored the association between Mediterranean diet and frailty, but reported inconsistent results. This systematic review and dose-response meta-analysis summarized the existing evidence on the relationship between Mediterranean diet and risk of frailty and pre-frailty in elderly adults. METHODS A systematic search on MEDLINE (PubMed), Scopus, Institute for Scientific Information (ISI) Web of Science and Google Scholar was conducted up to January 2023. Study selection and data extraction were performed by two reviewers working in parallel. Epidemiologic studies reporting relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for frailty/pre-frailty in relation to Mediterranean diet (as a priori dietary pattern) were considered. The overall effect size was determined using a random effects model. The body of evidence was assessed by the GRADE approach. RESULTS A total of 19 studies (12 cohorts and 7 cross-sectionals) were included. In cohort studies (89,608 participants/ 12,866 cases), the highest versus lowest category of Mediterranean diet was inversely associated with frailty (RR: 0.66; 95%CI: 0.55, 0.78; I2:52.4%, PQ-test=0.02). This association was also significant in cross-sectional studies with 1093 cases among 13,581 participants (OR: 0.44; 95%CI: 0.28, 0.70; I2:81.8%, PQ-test<0.001). Moreover, each 2-point increase in Mediterranean diet score was related to decreased risk of frailty in cohort (RR: 0.86; 95%CI: 0.80, 0.93) and cross-sectional (OR: 0.79; 95%CI: 0.65, 0.95) studies. Nonlinear association showed a decreasing slope in curve, sharper at high scores for cohort studies and a steadily reduction for cross-sectional studies. The certainty of the evidence was graded as high in both cohort and cross-sectional studies. Combining 4 effect sizes of 4 studies (12,745 participants/ 4363 cases), the highest adherence to Mediterranean diet was linked to a lower risk of pre-frailty, as well (pooled OR: 0.73; 95%CI: 0.61, 0.86; I2:40.9%, PQ-test=0.17). CONCLUSION Adherence to Mediterranean diet is inversely associated with risk of frailty and pre-frailty in older adults and thus, has a considerable impact on health of this population.
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Affiliation(s)
- Donya Poursalehi
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keyhan Lotfi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Tanaka T, Kafyra M, Jin Y, Chia CW, Dedoussis GV, Talegawkar SA, Ferrucci L. Quality Specific Associations of Carbohydrate Consumption and Frailty Index. Nutrients 2022; 14:5072. [PMID: 36501101 PMCID: PMC9736578 DOI: 10.3390/nu14235072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The quality of carbohydrate consumed may influence the risk of frailty. In this study, we tested the hypothesis that indices of carbohydrate intake are associated with trajectories of frailty in participants of the Baltimore Longitudinal Study of Aging (BLSA). Methods: Cross sectional and longitudinal analyses were conducted in 1024 BLSA participants to examine the association between usual intake of carbohydrate and frailty index. Seven measures of carbohydrate consumption were estimated using data derived from Food Frequency Questionnaires (FFQs) and examined in association with a 43-item Frailty Index (FI). Results: In cross-sectional analyses, there was a significant, positive association between higher tertiles of total carbohydrate, glycemic load, and non-whole grains and FI. Conversely, higher tertiles of fiber-to-carbohydrate ratio was associated with lower FI. These differences persisted over the follow-up period of up to 13.8 years. Women in the highest tertile of the fiber-to-carbohydrate ratio showed a less steep increase in FI over time. Conclusions: Carbohydrate intake was positively associated with increased frailty risk in the BLSA participants, whereas a higher fiber-to-carbohydrate ratio was related to reduced risk for frailty.
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Affiliation(s)
- Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - Maria Kafyra
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Chee W. Chia
- Clinical Research Core, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, MD 21224, USA
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Sameera A. Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
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D’Adamo CR, Workman K, Barnabic C, Retener N, Siaton B, Piedrahita G, Bowden B, Norman N, Berman BM. Culinary Medicine Training in Core Medical School Curriculum Improved Medical Student Nutrition Knowledge and Confidence in Providing Nutrition Counseling. Am J Lifestyle Med 2022; 16:740-752. [PMID: 36389046 PMCID: PMC9644147 DOI: 10.1177/15598276211021749] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2023] Open
Abstract
Background: Elective culinary medicine education has become popular to help fill important gaps in physician nutrition training. The implementation and outcomes among the inaugural cohort of medical students who received culinary medicine training as a required component of medical school curriculum at the University of Maryland School of Medicine are described. Methods: Following a series of elective pilot sessions, culinary medicine training was provided to all first-year medical students in the 2019-2020 academic year. The 3-hour training included evidence-based nutrition lecture, cooking simple recipes, and group discussion of the application to personal and patient care. Pre-/postsession questionnaires assessed nutrition knowledge, skills, and attitudes as well as nutritional counseling confidence. Paired t-tests estimated mean differences in outcomes pre- and posttraining. Qualitative data were subjected to thematic analysis. Results: Overall, 119 of 125 (95.2%) students provided pre- and posttraining outcomes data. All nutritional and patient counseling outcomes improved (P < .05). Themes of being better prepared to address healthy eating barriers in patient care and personal ability to make healthy dietary changes were noted in qualitative analysis. Conclusion: One session of culinary medicine training in core medical student curriculum was feasible and improved medical student nutrition knowledge, skills, and attitudes and confidence in patient nutrition counseling.
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Affiliation(s)
- Christopher R. D’Adamo
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology & Public Health,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Kayli Workman
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Christine Barnabic
- Department of Family & Community Medicine,
University of Maryland School of Medicine, Baltimore, Maryland
| | - Norman Retener
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
| | - Bernadette Siaton
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
| | | | - Brandin Bowden
- The Institute for Integrative Health,
Baltimore, Maryland
| | - Nicola Norman
- Department of Medicine, University of Maryland
School of Medicine, Baltimore, Maryland
- The Institute for Integrative Health,
Baltimore, Maryland
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9
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Hynicka LM, Piedrahita G, Barnabic C, Rambob I, Berman BM, D'Adamo CR. Interprofessional Culinary Medicine Training Enhanced Nutrition Knowledge, Nutrition Counseling Confidence, and Interprofessional Experience. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:811-820. [PMID: 35834608 DOI: 10.1089/jicm.2022.0573] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Culinary medicine training combining evidence-based nutrition instruction with experiential cooking application has improved nutrition knowledge, skills, and attitudes in the professional and personal lives of medical students. However, interprofessional culinary training remains largely unstudied among professional students who will be involved in collaborative patient care. The goal of this study was to evaluate the feasibility and effectiveness of an elective interprofessional culinary medicine course for students in the medical, pharmacy, social work, nursing, law, and dentistry schools at the University of Maryland, Baltimore. Methods: The interprofessional culinary medicine course was offered in-person at the teaching kitchen of the Nova Institute for Health in 2020 and virtually in 2021 during the COVID pandemic. The training featured five workshops combining instruction in a variety of popular diets, cooking a meal inspired by the diet in focus, and group discussion. Paired t tests were utilized to evaluate changes in pre-/post-training nutrition and interprofessional experience outcomes. Linear regression models were constructed to compare outcomes between in-person and virtual delivery. Results: A total of 62 students participated in the culinary medicine training. Confidence in all nutrition knowledge, skills, and attitudes, as well as interprofessional experience outcomes, improved after the training (p < 0.05). Similar improvements were noted in most outcomes with in-person and virtual delivery in linear regression modeling. Discussion: Interprofessional culinary medicine training is feasible, and virtual delivery may help enhance replicability in other settings.
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Affiliation(s)
- Lauren M Hynicka
- Pharmacy Practice and Science Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Christine Barnabic
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isabel Rambob
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Brian M Berman
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Millar CL, Costa E, Jacques PF, Dufour AB, Kiel DP, Hannan MT, Sahni S. Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study. Am J Clin Nutr 2022; 116:630-639. [PMID: 35551593 PMCID: PMC9437990 DOI: 10.1093/ajcn/nqac130] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The benefit of a Mediterranean-style diet in reducing frailty is not well established in older Americans. OBJECTIVES We sought to determine associations of a Mediterranean-style dietary pattern and related antioxidants with frailty onset and worsening of the Fried phenotype in adults. METHODS This prospective study included 2384 nonfrail adults from the Framingham Offspring Study with a Mediterranean-style dietary pattern score (MSDPS) and data on antioxidant intakes (vitamin C, E, and total carotenoids) estimated from an FFQ at the index examination (1998-2001) and 1 prior examination (if available), as well as a frailty assessment at the index examination and at least 1 follow-up. Frailty onset was defined as ≥3 of 5 Fried frailty phenotype criteria at follow-up and the worsening of the Fried frailty phenotype was defined as an increased number of frailty criteria over follow-up (yes or no). Logistic regression with generalized estimating equations estimated ORs and 95% CIs, adjusting for confounders. Analyses were stratified by age (<60 and ≥60 years) for significant interactions. RESULTS The mean ± SD age was 60 ± 9 years (range, 33-86 years) and 55% were female. In adjusted models, a 1-unit higher MSDPS reduced the odds of frailty by 3% (OR, 0.97; 95% CI: 0.96-0.99). Each 10-mg higher total carotenoid and vitamin E intake reduced the odds of frailty by 16% (OR, 0.84; 95% CI: 0.73-0.98) and 1% (OR, 0.99; 95% CI: 0.98-1.00), respectively. No association with vitamin C (P = 0.36) was observed. The associations among participants aged <60 years of age were stronger for each 1-unit higher MSDPS (OR, 0.93; 95% CI: 0.89-0.96) and total carotenoid intake (OR, 0.59; 95% CI: 0.41-0.82) than those observed in older individuals [ORs, 0.98 (95% CI: 0.97-1.00) and 0.92 (95% CI: 0.79-1.08), respectively]. CONCLUSIONS Our findings suggest that adherence to a Mediterranean-style diet and higher total carotenoid intake are associated with frailty prevention over time, particularly in adults <60 years.
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Affiliation(s)
- Courtney L Millar
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elise Costa
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paul F Jacques
- Nutritional Epidemiology Program, Jean Mayer, USDA Human Nutrition Research Center on Aging, Tufts University, Friedman School of Nutrition, Boston, MA, USA
| | - Alyssa B Dufour
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marian T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Crowder SL, Hoogland AI, Welniak TL, LaFranchise EA, Carpenter KM, Li D, Rotroff DM, Mariam A, Pierce CM, Extermann M, Kim RD, Tometich DB, Figueiredo JC, Muzaffar J, Bari S, Turner K, Weinstock GM, Jim HS. Metagenomics and chemotherapy-induced nausea: A roadmap for future research. Cancer 2022; 128:461-470. [PMID: 34643945 PMCID: PMC8776572 DOI: 10.1002/cncr.33892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
Uncontrolled chemotherapy-induced nausea and vomiting can reduce patients' quality of life and may result in premature discontinuation of chemotherapy. Although nausea and vomiting are commonly grouped together, research has shown that antiemetics are clinically effective against chemotherapy-induced vomiting (CIV) but less so against chemotherapy-induced nausea (CIN). Nausea remains a problem for up to 68% of patients who are prescribed guideline-consistent antiemetics. Despite the high prevalence of CIN, relatively little is known regarding its etiology independent of CIV. This review summarizes a metagenomics approach to the study and treatment of CIN with the goal of encouraging future research. Metagenomics focuses on genetic risk factors and encompasses both human (ie, host) and gut microbial genetic variation. Little work to date has focused on metagenomics as a putative biological mechanism of CIN. Metagenomics has the potential to be a powerful tool in advancing scientific understanding of CIN by identifying new biological pathways and intervention targets. The investigation of metagenomics in the context of well-established demographic, clinical, and patient-reported risk factors may help to identify patients at risk and facilitate the prevention and management of CIN.
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Affiliation(s)
| | | | | | | | | | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center
| | - Daniel M. Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Richard D. Kim
- Department of Hematology Oncology, Moffitt Cancer Center
| | | | | | - Jameel Muzaffar
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center
| | - Shahla Bari
- Department of Hematology Oncology, Moffitt Cancer Center
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| | | | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
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12
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Struijk EA, Fung TT, Sotos-Prieto M, Rodriguez-Artalejo F, Willett WC, Hu FB, Lopez-Garcia E. Red meat consumption and risk of frailty in older women. J Cachexia Sarcopenia Muscle 2022; 13:210-219. [PMID: 34755477 PMCID: PMC8818608 DOI: 10.1002/jcsm.12852] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Red meat is a nutrient-dense source of protein fundamental for older adults; however, red meat is also high in detrimental components, including saturated fat. It is unclear whether habitual red meat consumption is associated with risk of frailty. This study aimed to examine the prospective association between the consumption of total, unprocessed, and processed red meat and the risk of frailty in older adults. METHODS We analysed data from 85 871 women aged ≥60 participating in the Nurses' Health Study. Consumption of total, unprocessed, and processed red meat was obtained from repeated food frequency questionnaires administered between 1980 and 2010. Frailty was defined as having at least three of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses, and unintentional weight loss ≥5%. The occurrence of frailty was assessed every four years from 1992 to 2014. RESULTS During 22 years of follow-up (median follow-up 14 years), we identified 13 279 incident cases of frailty. Women with a higher intake of red meat showed an increased risk of frailty after adjustment for lifestyle factors, medication use, and dietary factors. The relative risk (95% confidence interval) for one serving/day increment in consumption was 1.13 (1.08, 1.18) for total red meat, 1.08 (1.02, 1.15) for unprocessed red meat, and 1.26 (1.15, 1.39) for processed red meat. When each component of the frailty syndrome was individually examined, each of them was positively associated with total red meat consumption, except for the weight loss criterion. Replacing one serving/day of unprocessed red meat with other protein sources was associated with significantly lower risk of frailty; the risk reduction estimates were 22% for fish and 14% for nuts, while for replacement of processed red meat, the percentages were 33% for fish, 26% for nuts, 13% for legumes, and 16% for low-fat dairy. CONCLUSIONS Habitual consumption of unprocessed and processed red meat was associated with a higher risk of frailty. Replacement of red meat by other protein sources might reduce the risk of frailty. These findings are in line with dietary guidelines promoting diets that emphasize plant-based sources of protein.
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Affiliation(s)
- Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,IMDEA/Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA/Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA/Food Institute, CEI UAM + CSIC, Madrid, Spain
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13
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van Assen MALM, Helmink JHM, Gobbens RJJ. Associations between lifestyle factors and multidimensional frailty: a cross-sectional study among community-dwelling older people. BMC Geriatr 2022; 22:7. [PMID: 34979945 PMCID: PMC8722011 DOI: 10.1186/s12877-021-02704-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or delay frailty, more knowledge of its determinants is necessary; one of these determinants is lifestyle. The aim of this study is to determine the association between lifestyle factors smoking, alcohol use, nutrition, physical activity, and multidimensional frailty. METHODS This cross-sectional study was conducted in two samples comprising in total 45,336 Dutch community-dwelling individuals aged 65 years or older. These samples completed a questionnaire including questions about smoking, alcohol use, physical activity, sociodemographic factors (both samples), and nutrition (one sample). Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). RESULTS Higher alcohol consumption, physical activity, healthy nutrition, and less smoking were associated with less total, physical, psychological and social frailty after controlling for effects of other lifestyle factors and sociodemographic characteristics of the participants (age, gender, marital status, education, income). Effects of physical activity on total and physical frailty were up to considerable, whereas the effects of other lifestyle factors on frailty were small. CONCLUSIONS The four lifestyle factors were not only associated with physical frailty but also with psychological and social frailty. The different associations of frailty domains with lifestyle factors emphasize the importance of assessing frailty broadly and thus to pay attention to the multidimensional nature of this concept. The findings offer healthcare professionals starting points for interventions with the purpose to prevent or delay the onset of frailty, so community-dwelling older people have the possibility to aging in place accompanied by a good quality of life.
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Affiliation(s)
- Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands. .,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands. .,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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14
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Wang Y, Huang Y, Wu H, He G, Li S, Chen B. Association between Dietary Patterns and Frailty Prevalence in Shanghai Suburban Elders: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010852. [PMID: 34682612 PMCID: PMC8535511 DOI: 10.3390/ijerph182010852] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between dietary patterns with frailty phenotypes in an elderly Chinese population. METHODS A cross-sectional study was performed in 780 Shanghai suburban elders aged 65-74 in 2019. Dietary data were collected using a food frequency questionnaire. Adherence to a priori dietary patterns, including the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean Diet (MD) were calculated. Three a posteriori dietary patterns were identified by factor analysis, namely, "protein-rich"; "vegetables"; and "sugar, oil, and condiments". Frailty was defined using the Fried frailty phenotype scale. Ordinal multiple logistic regression was applied to examine the associations between dietary patterns and frailty prevalence. RESULTS The prevalences of pre-frailty and frailty were 47.69% and 3.85%, respectively. Participants with a higher DASH score had a lower frailty prevalence in the sex- and age-adjusted models of the 780 subjects (OR = 0.97 (95% CI: 0.94-0.99), p < 0.05). The association slightly strengthened in the multivariate adjusted model of the 555 subjects after excluding the participants with chronic diseases may influence frailty (OR = 0.96 (95% CI: 0.92-1.00), p < 0.05). High "protein-rich" dietary pattern scores were negatively associated with frailty prevalence in the multivariate adjusted model of the 780 subjects (OR = 0.82 (95% CI: 0.69-0.98), p < 0.05). The association attenuated in the sex- and age-adjusted model of the 555 subjects (OR = 0.84 (95% CI: 0.69-1.00, p = 0.056). CONCLUSION A better diet quality as characterized by DASH and "protein-rich" was associated with a reduced prevalence of frailty in Shanghai suburban elders. The correlation of CHEI, MD or a posteriori dietary patterns with the development of frailty in Chinese older people remains to be explored.
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Affiliation(s)
- Yingchuan Wang
- Department of Nutrition and Food Hygiene, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (H.W.); (G.H.); (S.L.)
| | - Yue Huang
- Department of Food Science and Nutrition, Shanghai Business School, Shanghai 200235, China
- Correspondence: (Y.H.); (B.C.); Tel./Fax: +86-21-5423-7146 (B.C.)
| | - Han Wu
- Department of Nutrition and Food Hygiene, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (H.W.); (G.H.); (S.L.)
| | - Gengsheng He
- Department of Nutrition and Food Hygiene, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (H.W.); (G.H.); (S.L.)
| | - Shuguang Li
- Department of Nutrition and Food Hygiene, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (H.W.); (G.H.); (S.L.)
| | - Bo Chen
- Department of Nutrition and Food Hygiene, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (H.W.); (G.H.); (S.L.)
- Correspondence: (Y.H.); (B.C.); Tel./Fax: +86-21-5423-7146 (B.C.)
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15
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Association of Adherence to a Mediterranean Diet with Excess Body Mass, Muscle Strength and Physical Performance in Overweight or Obese Adults with or without Type 2 Diabetes: Two Cross-Sectional Studies. Healthcare (Basel) 2021; 9:healthcare9101255. [PMID: 34682935 PMCID: PMC8535373 DOI: 10.3390/healthcare9101255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/17/2022] Open
Abstract
Overweight and obesity in older adults is associated with disability and is exacerbated by the presence of type 2 diabetes (T2DM). There is emerging evidence that adherence to a Mediterranean diet (MedDiet) reduces adiposity and attenuates physical disability. These cross-sectional studies explored the associations of adherence to a MedDiet with body mass index (BMI), adiposity, muscle strength, and physical performance in older adults without diabetes and in middle-aged or older adults with T2DM. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener. Fat mass and percent body fat were assessed by dual energy X-ray absorptiometry. Muscle strength was assessed using hand-grip strength, while physical performance was assessed using the Short Physical Performance Battery and gait speed. A total of n = 87 participants with T2DM (T2DM sample: 71.2 ± 8.2 years, BMI: 29.5 ± 5.9) and n = 65 participants without diabetes (non-T2DM sample: 68.7 ± 5.6 years, BMI: 33.7 ± 4.9) were included in these analyses. In the T2DM sample, when controlled for age, gender, and appendicular lean mass index, adherence to a MedDiet was inversely associated with BMI, fat mass, and percent body fat. However, this was no longer maintained in the fully adjusted models. Although, adherence to a MedDiet was positively associated with gait speed (β = 0.155; p = 0.050) independent of all covariates used. Adherence to a MedDiet may be a suitable dietary strategy for preserving lower body physical function in middle-aged and older adults with T2DM. However, these findings should be further investigated using well-designed randomised controlled trials and prospective cohort studies with a wider range of adherence scores to investigate temporal associations.
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17
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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18
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Moradi S, Hadi A, Mohammadi H, Asbaghi O, Zobeiri M, Marx W, Entezari MH. Dietary Inflammatory Index and the Risk of Frailty Among Older Adults: A Systematic Review and Meta-Analysis. Res Aging 2020; 43:323-331. [PMID: 32815464 DOI: 10.1177/0164027520948176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A systematic review and meta-analysis was conducted to comprehensively examine the association between Dietary Inflammatory Index (DII®) score and risk of frailty. Frailty risk were available from five studies comprising 13,908 older adults. Furthermore, frailty related parameters were extacted from two studies with 7,539 individuals. A pooled adjusted odds ratio analysis indicated that there was an association between DII® score and frailty risk (OR = 1.24, 95%CI: 1.6-1.33, P < 0.001, I2 = 0.0%). The results of frailty related parameters demonstrated that DII® score was associated with weakness risk (OR = 1.12, 95%CI: 1.05-1.19, P = 0.014, I2 = 0.0%), but not other frailty-related parameters including exhaustion, low BMI or low physical activity. The results of this meta-analysis suggest that older adults who exhibit higher DII® scores have an increased frailty risk. Further prospective cohort studies with longer follow-up periods, are needed to support this possible association between DII® score and frailty risk.
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Affiliation(s)
- Sajjad Moradi
- Department of Clinical Nutrition, School of Nutrition and Food Science, 48455Isfahan University of Medical Sciences, Iran
| | - Amir Hadi
- Halal Research Center of IRI, FDA, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, 48455Isfahan University of Medical Sciences, Iran
| | - Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Zobeiri
- Department of Internal Medicine, School of Medicine, Kermanshah University of Medical Sciences, Iran
| | - Wolfgang Marx
- School of Medicine, Barwon Health, IMPACT (the Institute for Mental and Physical Health and ClinicalTranslation), Food & Mood Centre, Deakin University, Melbourne, Victoria, Australia
| | - Mohammad Hassan Entezari
- Department of Clinical Nutrition, School of Nutrition and Food Science, 48455Isfahan University of Medical Sciences, Iran
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19
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Baptista LC, Sun Y, Carter CS, Buford TW. Crosstalk Between the Gut Microbiome and Bioactive Lipids: Therapeutic Targets in Cognitive Frailty. Front Nutr 2020; 7:17. [PMID: 32219095 PMCID: PMC7078157 DOI: 10.3389/fnut.2020.00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cognitive frailty is a geriatric condition defined by the coexistence of cognitive impairment and physical frailty. This "composite" aging phenotype is associated with a higher risk of several adverse health-related outcomes, including dementia. In the last decade, cognitive frailty has gained increased attention from the scientific community that has focused on understanding the clinical impact and the physiological and pathological mechanisms of development and on identifying preventive and/or rehabilitative therapeutic interventions. The emergence of gut microbiome in neural signaling increased the interest in targeting the gut-brain axis as a modulation strategy. Multiple studies on gastroenteric, metabolic, and neurodegenerative diseases support the existence of a wide bidirectional communication network of signaling mediators, e.g., bioactive lipids, that can modulate inflammation, gut permeability, microbiota composition, and the gut-brain axis. This crosstalk between the gut-brain axis, microbiome, and bioactive lipids may emerge as the basis of a promising therapeutic strategy to counteract cognitive frailty. In this review, we summarize the evidence in the literature regarding the link between the gut microbiome, brain, and several families of bioactive lipids. In addition, we also explore the applicability of several bioactive lipid members as a potential routes for therapeutic interventions to combat cognitive frailty.
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Affiliation(s)
- Liliana C. Baptista
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yi Sun
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christy S. Carter
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Christy S. Carter
| | - Thomas W. Buford
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States,Thomas W. Buford ; Twitter: @twbuford
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Amiri S, Behnezhad S. Systematic review and meta-analysis of the association between smoking and the incidence of frailty. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2019; 33:198-206. [PMID: 31300971 DOI: 10.1007/s40211-019-0315-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Cigarette smoking is one of the main causes of health problems in the world and can also lead to an increased risk of frailty. Our goal is to perform a systematic review and meta-analysis of the relationship between smoking and frailty. METHODS Researchers searched PubMed, Scopus, Google Scholar and Research Gate by using keywords through December 2018. Eligible articles were merged and a meta-analysis was conducted using the random effects method. Finally an analysis was done based on smoking status, and publication bias was assessed as well. RESULTS The population analyzed comprised 61,905 people. The risk ratio (RR) of frailty based on smoking was 1.22 with a confidence interval (CI) of 1.12-1.33 (p < 0.001). In current smokers, the RR was 1.63 (p < 0.001). No significant difference was found in former smokers. The results indicated a publication bias in the studies included into the meta-analysis. DISCUSSION Smoking increases the risk of disability; therefore, the provision of cigarette smoking cessation treatment can reduce this risk. As the results also showed, former smokers are less likely to be frail.
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Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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21
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Anker MS, Anker SD, Coats AJ, von Haehling S. The Journal of Cachexia, Sarcopenia and Muscle stays the front-runner in geriatrics and gerontology. J Cachexia Sarcopenia Muscle 2019; 10:1151-1164. [PMID: 31821753 PMCID: PMC6903443 DOI: 10.1002/jcsm.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of CardiologyCharité Campus Benjamin FranklinBerlinGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center GöttingenUniversity of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
- German Center for Cardiovascular Medicine (DZHK), partner site GöttingenGöttingenGermany
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22
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McClure R, Villani A. Greater adherence to a Mediterranean Diet is associated with better gait speed in older adults with type 2 diabetes mellitus. Clin Nutr ESPEN 2019; 32:33-39. [DOI: 10.1016/j.clnesp.2019.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
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23
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Osuka Y, Kojima N, Yoshida Y, Kim M, Won CW, Suzuki T, Kim H. Exercise and/or Dietary Varieties and Incidence of Frailty in Community-Dwelling Older Women: A 2-Year Cohort Study. J Nutr Health Aging 2019; 23:425-430. [PMID: 31021359 DOI: 10.1007/s12603-019-1166-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Exercise and dietary habits rich in variety may reduce the risk of frailty incident, but such association remains unexamined. This study aimed to examine the longitudinal associations between exercise and/or dietary varieties and incidence of frailty in older women. DESIGN A 2-year population-based prospective cohort study. SETTING AND PARTICIPANTS Six hundred and four community-dwelling older Japanese women aged ≥75 years with non-frailty at baseline survey. MEASUREMENTS Frailty was assessed using Fried's frailty criteria composed of shrinking, weakness, slowness, low activity, and exhaustion at both baseline and follow-up surveys. Frailty incident was defined as the presence of ≥3 components at the follow-up survey. At baseline, information about exercise and dietary habits were obtained from all participants through a face-to-face interview. Participants were grouped into two categories, high (≥2) and low (<2) exercise varieties, assessed by the number of participations in 17 exercise types. By dietary variety, assessed using Dietary Variety Score (range, 0 to 10), participants were grouped into two, high (≥4 points) and low (<4 points) dietary varieties. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) of the incidence of frailty in the 4 groups (low-exercise and low-dietary varieties [low EV + low DV] as reference; low-exercise and high-dietary varieties [low EV + high DV]; high-exercise and low-dietary varieties [high EV + low DV]; and high-exercise and high-dietary varieties [high EV + high DV]). RESULTS Frailty incidence rate was 9.3% over the 2-year follow-up period. Incidence rates of frailty in the 4 groups were as follows: 23.7%, 10.1%, 6.5%, and 7.7% in the low EV + low DV, low EV + high DV, high EV + low DV, and high EV + high DV groups, respectively. After adjustment for covariates, only the high EV + high DV group was associated with a significantly lower OR (0.38; 95% CI 0.15-0.92) of frailty incidence compared with the low EV + low DV group. CONCLUSION Higher variety of exercise and diet was significantly associated with lower incidence of frailty. Thus, the combination of variety-rich exercise and dietary program may be useful in preventing the incidence of frailty in older women.
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Affiliation(s)
- Y Osuka
- Yosuke Osuka, Ph.D. Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan, E-mail: , Phone: +81-3-3964-3241, Fax: +03-3579-4776
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24
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He B, Ma Y, Wang C, Jiang M, Geng C, Chang X, Ma B, Han L. Prevalence and Risk Factors for Frailty among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2019; 23:442-450. [PMID: 31021361 DOI: 10.1007/s12603-019-1179-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To systematically assess the prevalence of frailty, including prefrailty, stratified prevalence according to frailty criteria, gender, age, and region, and the risk factors for frailty in China. DESIGN We conducted a systematic literature review and meta-analysis using articles available in 8 databases including PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP). SETTING Cross-sectional and cohort data from Chinese community. PARTICIPANTS Community-dwelling adults aged 65 and older. MEASUREMENTS Two authors independently extracted data based upon predefined criteria. Where data were available we conducted a meta-analysis of frailty parameters using a random-effects model. RESULTS We screened 915 different articles, and 14 studies (81258 participants) were ultimately included in this analysis. The prevalence of frailty and prefrailty in individual studies varied from 5.9% to 17.4% and from 26.8% to 62.8%, respectively. The pooled prevalence of frailty and prefrailty were 10% (95% CI: 8% to 12%, I2 = 97.4%, P = 0.000) and 43% (95% CI: 37% to 50%, I2 = 98.0%, P = 0.000), respectively. The pooled frailty prevalence was 8% for the Fried frailty phenotype, 12% for the frail index, and 15% for the FRAIL scale. Age-stratified meta-analyses showed the pooled prevalence of frailty to be 6%, 15%, and 25% for those aged 65-74, 75-84, and ≥85 years old, respectively. The pooled prevalence of frailty was 8% for males and 11% for females. The pooled prevalence of frailty in Mainland China, Taiwan, and Hong Kong was 12%, 8%, and 14%, respectively. The pooled frailty prevalence was 10% in urban areas and 7% in rural areas. After controlling for confounding variables, increasing age (OR = 1.28, 95% CI: 1.2 to 1.36, I2 = 98.0%, P = 0.000), being female (OR = 1.29, 95% CI: 1.16 to 1.43, I2 =92.7%, P=0.000), activities of daily living (ADL) disability (OR = 1.72, 95% CI: 1.57 to 1.90, I2 = 99.7%, P = 0.000), and having three or more chronic diseases (OR = 1.97, 95% CI: 1.78 to 2.18, I2 = 97.5%, P = 0.000) were associated with frailty. CONCLUSIONS These findings of this review indicate an overall pooled prevalence of frailty among Chinese community-dwelling older people of 10%. Increasing age, being female, ADL disability, and having three or more chronic diseases were all risk factors for frailty. Further research will be needed to identify additional frailty risk factors in order to better treat and prevent frailty in the community.
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Affiliation(s)
- B He
- Lin Han, Ph.D. Professor of Nursing, Nursing department, Gansu Provincial Hospital, No.204 donggang west road, chengguan district, Lanzhou, China; School of Nursing, Lanzhou University, No.28 yanxi road, chengguan district, Lanzhou, China (730000), E-mail:
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25
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Cano-Ibáñez N, Bueno-Cavanillas A, Martínez-González MA, Corella D, Salas-Salvadó J, Zomeño MD, García-de-la-Hera M, Romaguera D, Martínez JA, Barón-López FJ, García-Ríos A, Estruch R, García-Molina L, Alonso Gómez Á, Tur JA, Tinahones F, Serra-Majem L, Cubelos-Fernández N, Lapetra J, Vázquez C, Pintó X, Vidal J, Daimiel L, Gaforio JJ, Matía P, Ros E, Diez-Espino J, Fernández-Carrión R, Basora J, Fitó M, Zazo JM, Colom A, Toledo E, Díaz-López A, Muñoz MÁ, Ruiz-Canela M, Gea A. Dietary Intake in Population with Metabolic Syndrome: Is the Prevalence of Inadequate Intake Influenced by Geographical Area? Cross-Sectional Analysis from PREDIMED-Plus Study. Nutrients 2018; 10:E1661. [PMID: 30400355 PMCID: PMC6266979 DOI: 10.3390/nu10111661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022] Open
Abstract
Inadequate diet influences chronic diseases such as cardiovascular disease (CVD), the leading cause of death in Spain. CVD figures vary from one geographical region to another; this could be associated with different food choices. Our aim was to analyse the influence of geographical area on nutrient intakes among the Spanish adult population with Metabolic Syndrome (MetS). We analysed cross-sectional baseline data from the PREDIMED-Plus study: 6646 Spanish adults, aged 55⁻75 years, with overweight/obesity and MetS in four geographical areas. A validated 143-item Food Frequency Questionnaire (FFQ) was used to assess energy and nutrient intakes. The prevalence of inadequate nutrient intake was estimated according to Dietary Reference Intakes (DRIs). Multivariable-adjusted logistic regression was used to assess the relationship between geographical area (North, Central, East and South areas) and inadequate nutrient intake. People in the North area consumed significantly lower amounts of vegetables and fish but more sugar and alcohol (p < 0.001) than other areas. Dietary fibre, vitamin A, E, calcium and magnesium intakes were all lower among men of North area than in the other areas (p < 0.001). Sex (women), non-smoker and physical activity were also associated to adequate nutrient intake. Geographical area influences nutrient intakes. Its effect on dietary quality should be taken into account when planning food policies.
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Grants
- FPU14/03630 Ministerio de Educación, Cultura y Deporte
- PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14-00696, PI14/01206, PI14/01919, PI14/00853 Instituto de Salud Carlos III
- Advanced Research Grant 2013-2018; 340918 European Research Council
- 2013ACUP00194 Recercaixa
- PI0458/2013 Consejería de Salud, Junta de Andalucía
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Affiliation(s)
- Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, Medical School, University of Navarre, 31008 Pamplona, Spain.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Dolores Corella
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain.
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Universitat Rovira i Virgili, 43002 Reus, Spain.
| | - M Dolors Zomeño
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d'Investigació Médica (IMIM), 08003 Barcelona, Spain.
- Human Nutrition Unit, Blanquerna-Ramon Llull University, 08001 Barcelona, Spain.
| | - Manoli García-de-la-Hera
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
- Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain.
| | - Dora Romaguera
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain.
| | - J Alfredo Martínez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Nutrition, Food Sciences and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain.
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain.
| | - F Javier Barón-López
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Public Health, University of Málaga-IBIMA, 29016 Málaga, Spain.
| | - Antonio García-Ríos
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain.
| | - Ramón Estruch
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
| | - Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Ángel Alonso Gómez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country (UPV/EHU), 48940 Vitoria-Gasteiz, Spain.
| | - Josep A Tur
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain.
| | - Francisco Tinahones
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Virgen de la Victoria Hospital, Department of Endocrinology, University of Málaga, 29010 Málaga, Spain.
| | - Lluis Serra-Majem
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Institute for Biomedical Research, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain.
| | | | - José Lapetra
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria, 41013 Sevilla, Spain.
| | - Clotilde Vázquez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Endocrinology, Fundación Jiménez-Díaz, 28040 Madrid, Spain.
| | - Xavier Pintó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Josep Vidal
- Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain.
| | - José Juan Gaforio
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
- Centro de Estudios Avanzados en Olivar y Aceites de Oliva, University of Jaén, 23071 Jaén, Spain.
| | - Pilar Matía
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
| | - Emilio Ros
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigació Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain.
| | - Javier Diez-Espino
- Department of Preventive Medicine and Public Health, Medical School, University of Navarre, 31008 Pamplona, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Servicio Navarro de Salud, Osasunbidea, 31002 Pamplona, Spain.
| | - Rebeca Fernández-Carrión
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain.
| | - Josep Basora
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Universitat Rovira i Virgili, 43002 Reus, Spain.
| | - Montse Fitó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del mar de Investigaciones Médicas Municipal d'Investigació Médica (IMIM), 08003 Barcelona, Spain.
| | - Juan Manuel Zazo
- CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, 28029 Madrid, Spain.
- Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain.
| | - Antoni Colom
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain.
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, Medical School, University of Navarre, 31008 Pamplona, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Andrés Díaz-López
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
- Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Universitat Rovira i Virgili, 43002 Reus, Spain.
| | - Miguel Ángel Muñoz
- Primary Care Division of Barcelona, Institut Català de la Salud-IDIAP Jordi Gol, 08007 Barcelona, Spain.
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, Medical School, University of Navarre, 31008 Pamplona, Spain.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, Medical School, University of Navarre, 31008 Pamplona, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Institute of Health, 28029 Madrid, Spain.
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