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Martínez-Gómez J, de Cos-Gandoy A, Fernández-Alvira JM, Bodega P, de Miguel M, Tresserra-Rimbau A, Laveriano-Santos EP, Ramirez-Garza SL, Orrit X, Carvajal I, Estruch R, Lamuela-Raventós RM, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Cardiovascular Health Trajectories in Adolescence and Their Association With Sociodemographic and Cardiometabolic Outcomes in Spain. J Adolesc Health 2024; 74:1039-1048. [PMID: 38323971 DOI: 10.1016/j.jadohealth.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To determine cardiovascular health (CVH) trajectories and their association with sociodemographic and cardiometabolic outcomes in adolescence. METHODS One thousand eighty adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain were assessed at approximately 12, 14, and 16 years of age. CVH was assessed according to American Heart Association criteria based on seven metrics (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and blood glucose), and CVH trajectories were identified by latent class trajectory modeling. Associations between CVH trajectories, sociodemographic characteristics, and cardiometabolic outcomes were analyzed using generalized linear and Poisson models. RESULTS Five CVH trajectory groups were identified: poor-stable (27 adolescents [2.5%]), intermediate-substantial rise (79 [7.3%]), intermediate-substantial decline (63 [5.8%]), intermediate-mild decline (403 [37.3%]), and intermediate-mild rise (508 [47.1%]). Boys and adolescents from families with low-average income, low-intermediate educational attainment, and a migrant background more frequently belonged to groups with lower baseline CVH and poor or declining trajectories. The intermediate-substantial decline group had the highest prevalence ratio for overweight/obesity (3.84; 95% confidence interval: 2.86-5.16) and metabolic syndrome (4.93; 95% confidence interval: 1.21-20.04) at age 16, whereas prevalence was lowest in the intermediate-mild rise group. DISCUSSION Adolescent CVH trajectories differ according to socioeconomic characteristics and are associated with cardiometabolic outcomes. Primordial prevention interventions should be implemented early in life, taking into account CVH trajectories and with a particular focus on vulnerable populations.
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Affiliation(s)
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | | | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Emily P Laveriano-Santos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Sonia L Ramirez-Garza
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa María Lamuela-Raventós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Hospital Universitario Clinico San Carlos, Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain.
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de Cos-Gandoy A, Santos-Beneit G, Bodega P, Baxter J, Diaz-Munoz R, Hill CA, Carvajal I, Peyra C, Fernandez-Jimenez R, Fuster V. Impact of Socioeconomic Background on Cardiovascular Health Promotion in Early Childhood. J Am Coll Cardiol 2023; 82:1377-1379. [PMID: 37730295 DOI: 10.1016/j.jacc.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/22/2023]
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Martínez-Gómez J, Fernández-Alvira JM, de Cos-Gandoy A, Bodega P, de Miguel M, Tresserra-Rimbau A, Laveriano-Santos EP, Carral V, Carvajal I, Estruch R, Lamuela-Raventós RM, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Sleep duration and its association with adiposity markers in adolescence: a cross-sectional and longitudinal study. Eur J Prev Cardiol 2023; 30:1236-1244. [PMID: 37140006 DOI: 10.1093/eurjpc/zwad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
AIMS Large studies linking adolescents' objectively measured sleep duration and adiposity markers are lacking. We characterized sleep duration and its cross-sectional and longitudinal associations with adiposity markers in adolescence. METHODS AND RESULTS Seven-day accelerometry was performed in a cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain at approximately ages 12 (1216 adolescents, 49.6% girls), 14 (1026 adolescents, 51.3% girls), and 16 (872 adolescents, 51.7% girls) years. Participants were classified as very short sleepers (VSS; <7 h), short sleepers (SS; 7-<8 h), or recommended-time sleepers (RTS; 8-10 h). Adjusted associations between sleep duration and adiposity markers were analysed using generalized linear and Poisson models. At ∼12 years, 33.7% of adolescents met sleep recommendations, and this percentage decreased with advancing age (22.6% at ∼14 and 18.7% at ∼16 years). Compared with RTS, overweight/obesity prevalence ratios at ∼12, 14, and 16 years among SS were 1.19 [95% confidence interval (CI): 1.09-1.30], 1.41 (95% CI: 1.34-1.48), and 0.99 (95% CI: 0.77-1.26) and among VSS were 1.30 (95% CI: 1.28-1.32), 1.93 (95% CI: 1.41-2.64), and 1.32 (95% CI: 1.26-1.37). Compared with adolescents who always met sleep recommendations, the prevalence of overweight/obesity was ∼5 times higher in those never meeting recommendations or meeting them only once. Similar trends were observed for the waist-to-height ratio (P = 0.010) and fat mass index (P = 0.024). CONCLUSION Most adolescents did not meet sleep recommendations. Shorter sleep duration was independently associated with unfavourable adiposity markers, and such adverse impact was cumulative. Health promotion programmes should emphasize the importance of good sleep habits.
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Affiliation(s)
- Jesús Martínez-Gómez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
| | | | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, XIA, INSA, Universitat de Barcelona, Barcelona, Spain
| | - Emily P Laveriano-Santos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, XIA, INSA, Universitat de Barcelona, Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa María Lamuela-Raventós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
- Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Facultat de Farmàcia i Ciències de l'Alimentació, XIA, INSA, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 3 Melchor Fernández Almagro, Madrid 28029, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, s/n Profesor Martín Lagos, Madrid 28040, Spain
- Centro de Investigación Biomédica en Red en Enfermedades CardioVasculares (CIBERCV), 3-5 Monforte de Lemos (Pabellón 11), Madrid 28029, Spain
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Santos-Beneit G, Fernández-Alvira JM, Tresserra-Rimbau A, Bodega P, de Cos-Gandoy A, de Miguel M, Ramírez-Garza SL, Laveriano-Santos EP, Arancibia-Riveros C, Carral V, Orrit X, Rodríguez C, Carvajal I, Haro D, Peyra C, Martínez-Gómez J, Álvarez-Benavides A, Estruch R, Lamuela-Raventós RM, Fernández-Jiménez R, Fuster V. School-Based Cardiovascular Health Promotion in Adolescents: A Cluster Randomized Clinical Trial. JAMA Cardiol 2023; 8:816-824. [PMID: 37531100 PMCID: PMC10398546 DOI: 10.1001/jamacardio.2023.2231] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
Importance School-based interventions offer an opportunity for health promotion in adolescence. Objective To assess the effect of 2 multicomponent educational health promotion strategies of differing duration and intensity on adolescents' cardiovascular health (CVH). Design, Setting, and Participants The SI! Program for Secondary Schools is a 4-year cluster randomized clinical intervention trial conducted in 24 secondary schools from Barcelona and Madrid, Spain, from September 7, 2017, to July 31, 2021. Eligible participants were adolescents enrolled in the first grade of secondary school. Interventions Schools and their participants were randomized to receive a health promotion intervention (SI! Program) over 4 school years (long-term intervention [LTI], 8 schools, 412 adolescents) or 2 school years (short-term intervention [STI], 8 schools, 504 adolescents) or to receive the standard curriculum (control, 8 schools, 441 adolescents). Main outcome and Measures The primary end point was the between-group difference at 2 and 4 years in the change from baseline of the overall CVH score, as defined by the American Heart Association (range, 0-14 points, with a higher score indicating a healthier CVH profile). Intervention effects were tested with multilevel mixed-effects models. A complete-case intention-to-treat analysis was performed as the primary analysis. Results Of the randomized students, the study enrolled 1326 adolescents (684 [51.6%] boys, mean [SD] age, 12.5 [0.4] years at recruitment) with a study completion rate of 86.0%. Baseline overall CVH scores were 10.3 points in the LTI group, 10.6 points in the STI group, and 10.5 points in the control group. After 2 years, at halfway through the LTI and at the end of the STI, the difference in the CVH score change was 0.44 points (95% CI, 0.01-0.87; P = .04) between the LTI group and the control group and 0.18 points (95% CI, -0.25 to 0.61; P = .39) between the STI group and the control group. At 4 years, differences for the LTI and STI groups vs control were 0.12 points (LTI: 95% CI, -0.19 to 0.43; P = .42) and 0.13 points (STI: 95% CI, -0.17 to 0.44; P = .38). No adverse events were reported. Conclusions and Relevance Overall, the tested school-based health promotion strategies in this randomized clinical trial had a neutral effect on the CVH of the adolescents. Although there was evidence of a marginal beneficial effect at a point halfway through implementation in the LTI group, such a benefit was not noted at 4 years. Further research is warranted into the efficacy of school-based health promotion programs. Trial Registration ClinicalTrials.gov Identifier: NCT03504059.
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Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Anna Tresserra-Rimbau
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Bodega
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Sonia L. Ramírez-Garza
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
| | - Emily P. Laveriano-Santos
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Camila Arancibia-Riveros
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Domenec Haro
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Carles Peyra
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Antonio Álvarez-Benavides
- Departamento de Sociología III: Tendencias Sociales, Facultad de Ciencias Políticas y Sociología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Rosa M. Lamuela-Raventós
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro de Investigación Biomédica En Red en enfermedades CardioVasculares, Madrid, Spain
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Valentín Fuster
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Mut F, Carvajal I, Camilletti J, Erriest J, Alexanderson E, Grossman GB. Cardiac amyloidosis in Latin America: Gaps and opportunities to increase awareness of the disease. Findings from the AMILO-LATAM research group. J Nucl Cardiol 2023; 30:1592-1601. [PMID: 35641695 PMCID: PMC9154028 DOI: 10.1007/s12350-022-03005-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is an under-diagnosed disease presenting as a restrictive cardiomyopathy with high morbidity and mortality. Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is mostly seen in elderly patients, with increasing prevalence as life expectancy is growing. New diagnostic imaging techniques and treatments allow for a better prognosis, but lack of clinical awareness delays timely diagnosis and appropriate management. Our purpose was to investigate the knowledge of clinicians regarding ATTR-CM and to assess the availability of imaging resources in the Latin-American region. METHODS AND RESULTS Two online surveys were distributed among clinicians and nuclear medicine professionals, respectively: one asking about awareness of CA in different clinical scenarios, and the other about the availability of diagnostic resources and studies performed. 406 responses were received for the first survey and 82 for the second, representing 17 and 14 countries, respectively. A significant lack of awareness was identified among clinicians, although appropriate diagnostic resources are generally available. Survey data showed that very few patients are evaluated for ATTR-CM in most Latin-American countries. CONCLUSIONS The surveys demonstrated the need for educational programs and other measures to increase clinical awareness and early detection of CA, so patients receive timely treatment and management of the disease.
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Affiliation(s)
- Fernando Mut
- Nuclear Medicine Service, Italian Hospital, Montevideo, Uruguay
| | - Isabel Carvajal
- National Institute of Cardiology “Ignacio Chavez”, Juan Badiano 1, colonia Belisario Domínguez Secc 16, delegación Tlalpan, 14080 Mexico City, Mexico
- Hospital de Cardiologia Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | | | - Juan Erriest
- Nuclear Medicine Service, Italian Hospital, La Plata, Argentina
| | - Erick Alexanderson
- National Institute of Cardiology “Ignacio Chavez”, Juan Badiano 1, colonia Belisario Domínguez Secc 16, delegación Tlalpan, 14080 Mexico City, Mexico
- PET/CT Unit, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
- Department of Physiology, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Gabriel Blacher Grossman
- Nuclear Medicine Department, Moinhos de Vento Hospital, Porto Alegre, Brazil
- Cardionuclear Clinic, Porto Alegre, Brazil
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Martinez-Gomez J, Fernandez-Alvira JM, De Cos-Gandoy A, Bodega P, De Miguel M, Carral V, Laveriano-Santos EP, Tresserra-Rimbau A, Carvajal I, Estruch R, Lamuela-Raventos RM, Santos-Beneit G, Fuster V, Fernandez-Jimenez R. Sleep duration and its association with cardiometabolic outcomes among adolescents enrolled in the SI Program in Spain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sleep duration has been inversely associated with increased prevalence of overweight/obesity in childhood and adolescence [1, 2]. However, large studies linking over time objectively measured sleep duration and other cardiometabolic outcomes in adolescence are lacking.
Purpose
To evaluate sleep duration and its association with cardiometabolic outcomes in a large cohort of adolescents aged 12 to 16 years from the SI! Program for Secondary Schools trial in Spain [3], together with its relationship with sociodemographic variables.
Methods
Seven-day actigraphic recording was performed in 1229 adolescents at baseline (49.7% girls; 12.5 (0.4) years), 1058 at first follow-up (51.1% girls; 13.9 (0.4) years), and 895 at second follow-up (52.3% girls; 15.8 (0.4) years). Three groups were defined: very short sleep duration (<7 h), short sleep duration (7 to 8 h), and reference sleep duration (≥8 h) [4]. Overweight/obesity were determined according to BMI age- and sex-adjusted percentiles. Continuous Metabolic Syndrome (MetS) score was calculated as the sum of the age-and-gender specific z-scores of mean arterial pressure (MAP) (MAP = ((systolic BP − diastolic BP)/3) + diastolic BP), waist circumference, and fasting blood measures of high-density lipoprotein cholesterol (HDL-c) levels multiplied by −1, triglycerides, and glucose levels [5]. Associations between sleep duration and cardiometabolic outcomes were analyzed using generalized linear and Poisson distribution adjusted models.
Results
At 12 years of age, only 34.2% of the adolescents met sleep recommendations (sleep hours ≥8), and this percentage decreased with advancing age (23.4% and 19.4% at approximately 14 and 16 years of age, respectively) (Figure 1). Boys and individuals from migrant families tended to sleep shorter. Moreover, sleep duration was directly associated with sleep quality and efficiency. After adjusting for potential cofounders, very short sleepers (<7h) had a higher prevalence ratio (PR) of overweight/obesity at baseline (PR: 1.21 [95% CI: 1.16 to 1.27]) and at first follow-up (PR: 1.72 [95% CI: 1.08 to 2.74]) than the reference group (≥8 h) (Figure 2). Similarly, very short sleepers showed higher mean MetS scores at baseline (0.98 [95% CI: 0.43 to 1.54] and at first follow-up (0.76 [95% CI: 0.24 to 1.27]) as compared with the reference group. Short sleepers showed similar trends with associations of weaker magnitude, as they were the overall associations between sleep duration and cardiometabolic outcomes at second follow-up.
Conclusions
Most adolescents, and particularly those with a migrant background, did not meet sleep recommendations. Moreover, a shorter sleep duration was associated with cardiometabolic outcomes, particularly at 12 and 14 years of age and when sleeping less than 7 hours. Health promotion programs should emphasize the importance of good sleep habits.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Fundaciό la Maratό de TV3.2. SHE Foundation and “la Caixa” Foundation.
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Affiliation(s)
- J Martinez-Gomez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab , Madrid , Spain
| | | | | | - P Bodega
- SHE Foundation , Barcelona , Spain
| | | | - V Carral
- SHE Foundation , Barcelona , Spain
| | - E P Laveriano-Santos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences , Barcelona , Spain
| | - A Tresserra-Rimbau
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences , Barcelona , Spain
| | | | - R Estruch
- Barcelona Hospital Clinic, Department of Internal Medicine , Barcelona , Spain
| | - R M Lamuela-Raventos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences , Barcelona , Spain
| | | | - V Fuster
- Spanish National Centre for Cardiovascular Research , Madrid , Spain
| | - R Fernandez-Jimenez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab , Madrid , Spain
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Martinez-Gomez J, De Cos-Gandoy A, Santos-Beneit G, Tresserra-Rimbau A, Bodega P, De Miguel M, Laveriano-Santos EP, Ramirez-Garza SL, Fernandez-Alvira JM, Orrit X, Carvajal I, Estruch R, Lamuela-Raventos RM, Fuster V, Fernandez-Jimenez R. Cardiovascular health trajectories among adolescents enrolled in the SI Program in Spain: a longitudinal study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation.
Background
There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories.
Purpose
To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables.
Methods
This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership.
Results
Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory.
Conclusions
In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.
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Affiliation(s)
- J Martinez-Gomez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab, Madrid, Spain
| | | | | | - A Tresserra-Rimbau
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - P Bodega
- SHE Foundation, Barcelona, Spain
| | | | - EP Laveriano-Santos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - SL Ramirez-Garza
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - JM Fernandez-Alvira
- Spanish National Centre for Cardiovascular Research, Cardiovascular Imaging and Population Studies, Madrid, Spain
| | - X Orrit
- SHE Foundation, Barcelona, Spain
| | | | - R Estruch
- Barcelona Hospital Clinic, Department of Internal Medicine, Barcelona, Spain
| | - RM Lamuela-Raventos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - V Fuster
- Spanish National Centre for Cardiovascular Research, Cardiovascular Imaging and Population Studies, Madrid, Spain
| | - R Fernandez-Jimenez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab, Madrid, Spain
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Fernández-Alvira JM, Fernández-Jiménez R, de Miguel M, Santos-Beneit G, Bodega P, Hill CA, Carral V, Rodríguez C, Carvajal I, Orrit X, de Cos-Gandoy A, Dal Re M, Robledo T, Fuster V. The challenge of sustainability: Long-term results from the Fifty-Fifty peer group-based intervention in cardiovascular risk factors. Am Heart J 2021; 240:81-88. [PMID: 34147462 DOI: 10.1016/j.ahj.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Fifty-Fifty trial demonstrated that a peer-group-based intervention was able to improve healthy behaviors in individuals with cardiovascular (CV) risk factors immediately post-intervention. OBJECTIVES To determine the long-term sustainability of a one-year peer-group-based intervention focused on CV health and behavior. METHODS A total of 543 adults aged 25 to 50 years with at least 1 CV risk factor were screened and recruited, received initial training through workshops, and were then randomized 1:1 to a peer-group-based intervention group (IG) or a self-management control group (CG) for 12 months. At a median of 52 months from baseline, 321 participants were re-assessed (~60% retention). The primary outcome was the mean change in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco use (Fuster-BEWAT score [FBS], range 0-15). Intervention effects were assessed using linear-mixed effects models. RESULTS The mean age of retained participants was 48.0 years (SD: 5.4), and 73% were female. Consistent with previous results, the change of overall FBS was significantly greater in the IG than in the CG at 12-month follow-up (between-group difference, 0.60 points; 95% CI, 0.08-1.12; P = .025). Assessment of long-term sustainability (52-month follow-up) showed that there were no between-group differences in the mean overall FBS (IG mean score, 8.52; 95% CI, 7.97-9.07 vs CG mean score, 8.51; 95% CI, 7.93-9.10; P = .972) or in the change of overall FBS from screening (IG mean change, 0.64; 95% CI, 0.00-1.28; CG mean change, 0.46; 95% CI, -0.20-1.12; P = .497). CONCLUSIONS A one-year peer-group-based intervention showed favorable results at immediate post-intervention but did not demonstrate significant differences between the IG and CG at 52 months. Combination of an initial training period (workshops) with the maintenance of peer-support groups or other re-intervention strategies may be required to achieve sustained effects on healthy behaviors. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02367963. Registered (https://clinicaltrials.gov/show/NCT02367963).
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Affiliation(s)
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Christopher A Hill
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Marian Dal Re
- Spanish Agency for Food Safety and Nutrition (AESAN), Madrid, Spain
| | - Teresa Robledo
- Spanish Agency for Food Safety and Nutrition (AESAN), Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Carvajal I, Berrios-Barcenas E, C-Guerra E, Barajas-Paulin A, Luna-Alvarez Amezquita A, Canseco-Leon N, Alexanderson-Rosas E. Transthyretin cardiac amyloidosis scintigraphy, experience in a reference cardiology center. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8411385 DOI: 10.1093/ehjci/jeab111.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Instituto Nacional
de Cardiologia Ignacio Chavez Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive
disease that significantly reduces patients" quality of life and survival.1 In our
country there are no statistics of this disease, only isolated cases. The ability to
diagnose it has dramatically improved since the 2019 Multisociety Consensus for
Multimodality Imaging.2,3 The study aimed to know patients" demographic and imaging
characteristics in suspected ATTR-CA and the prevalence of positive cases in a reference
Cardiology Center using 99mTc-pyrophosphate scintigraphy (99mTc-PYP). Methods Prospective, observational study approved by Institutional
committees. We studied with 99mTc-PYP patients from November 2019 to December 2020 sent
to the Nuclear Cardiology Department with clinical suspicion of ATTR-CA and negative
light chain quantification. We included parameters as red flags, ECHO suggestive
findings (septal thickness >12 mm, diastolic dysfunction), and MRI suggestive
findings. ATTR-CA was diagnosed by clinical suspicious, positive scintigraphy, and
negative serum studies. 99mTc-PYP were acquired according to current recommendations.
Frequency distribution of categorical variables were reported as frequencies and
percentages; continuous variables are presented in mean. Mann-Whitney U tests were
conducted for continuous variables, while Fisher"s exact test was performed for
categorical variables. Results Due to the Covid-19 pandemic, our Cardiology Hospital reconverted
to covid attention; we studied a reduced number, and they were mainly inpatients: total
35 (28-inpatients, 7-outpatients). 21 (60%) were male, 14 (40%) were female, average age
was 56.5 yo. 31%-heart failure diagnosis, 6%-history of carpal tunnel syndrome and
3%-spinal stenosis. ECHO: 26% had suggestive imaging, 43% with diastolic dysfunction,
and 37% had a septal thickness >12mm. MRI: 42.9% had suggestive CA findings. No
significant differences were found in the characteristics of suspicion between positive
and negative patients. Regarding of the 35 patients scintigraphy, 7 (20%) were
positives, establishing ATTR-CA diagnosis, 28 (80%) were negatives. The positivity
probability was significant by H/Cl ratio, Perugini score, and SPECT findings (p 0.001).
Until this protocol started and we share it among hospital physicians, we had never been
asked to acquired this type of scintigraphy. Our study shows that if we purposely search
for the disease, it can be found. The sample is small due to the limitations we had in
the face of the pandemic; however, the study findings are significant for ATTR-CA
diagnosis. It is striking that the ECHO and MRI suggestive findings were not
statistically significant for the diagnosis. Conclusions We present the initial experience of the first study of
cardiac amyloidosis in our country, to show the disease"s presence and that the
diagnosis can be made effectively, quickly, economically, and non-invasively by nuclear
medicine scintigraphy.
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Affiliation(s)
- I Carvajal
- Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | | | - E C-Guerra
- National Autonomous University of Mexico, PECEM, Faculty of Medicine, Mexico City, Mexico
| | - A Barajas-Paulin
- Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | | | - N Canseco-Leon
- Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
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Fernandez-Jimenez R, Santos-Beneit G, de Cos-Gandoy A, Fernández-Alvira JM, Tresserra-Rimbau A, Storniolo C, Domènech M, Laveriano-Santos EP, Bodega P, de Miguel M, Rodríguez C, Carvajal I, Ibañez B, Estruch R, Lamuela-Raventós RM, Fuster V. Prevalence and correlates of cardiovascular health among early adolescents enrolled in the SI! Program in Spain: a cross-sectional analysis. Eur J Prev Cardiol 2020; 29:e7-e10. [PMID: 33624055 DOI: 10.1093/eurjpc/zwaa096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | | | - Anna Tresserra-Rimbau
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Carolina Storniolo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Mónica Domènech
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Emily P Laveriano-Santos
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Department of Cardiology, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa Maria Lamuela-Raventós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Division of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Fernández-Jiménez R, Briceño G, Céspedes J, Vargas S, Guijarro J, Baxter J, Hunn M, Santos-Beneit G, Rodríguez C, Céspedes MP, Bagiella E, Moreno Z, Carvajal I, Fuster V. Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old. J Am Coll Cardiol 2020; 75:1565-1578. [PMID: 32241373 DOI: 10.1016/j.jacc.2020.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/03/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. OBJECTIVES This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). METHODS In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. RESULTS In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). CONCLUSIONS Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).
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Affiliation(s)
- Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro de Investigación Biomedica En Red en enfermedades CardioVasculares, Madrid, Spain
| | - German Briceño
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Jaime Céspedes
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia; Universidad del Rosario, Bogotá, Colombia.
| | - Sarha Vargas
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | | | | | - Marilyn Hunn
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | | | - Emilia Bagiella
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zorayda Moreno
- Fundación CardioInfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Bodega P, Fernández-Alvira JM, Santos-Beneit G, de Cos-Gandoy A, Fernández-Jiménez R, Moreno LA, de Miguel M, Carral V, Orrit X, Carvajal I, Storniolo CE, Tresserra-Rimbau A, Doménech M, Estruch R, Lamuela-Raventós RM, Fuster V. Dietary Patterns and Cardiovascular Risk Factors in Spanish Adolescents: A Cross-Sectional Analysis of the SI! Program for Health Promotion in Secondary Schools. Nutrients 2019; 11:E2297. [PMID: 31561533 PMCID: PMC6835512 DOI: 10.3390/nu11102297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/31/2023] Open
Abstract
Previous studies on the association between dietary habits and cardiovascular risk factors (CVRF) in adolescents have generated conflicting results. The aim of this study was to describe dietary patterns (DP) in a large sample of Spanish adolescents and to assess their cross-sectional relationship with CVRF. In total, 1324 adolescents aged 12.5 ± 0.4 years (51.6% boys) from 24 secondary schools completed a self-reported food frequency questionnaire. DPs were derived by cluster analysis and principal component analysis (PCA). Anthropometric measurements, blood pressure, lipid profile, and glucose levels were assessed. Linear mixed models were applied to estimate the association between DPs and CVRF. Three DP-related clusters were obtained: Processed (29.2%); Traditional (39.1%); and Healthy (31.7%). Analogous patterns were obtained in the PCA. No overall differences in CVRF were observed between clusters except for z-BMI and z-FMI values, total cholesterol, and non-HDL cholesterol, with the Processed cluster showing the lowest mean values. However, differences were small. In conclusion, the overall association between DPs, as assessed by two different methods, and most analyzed CVRF was weak and not clinically relevant in a large sample of adolescents. Prospective analysis may help to disentangle the direction of these associations.
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Affiliation(s)
- Patricia Bodega
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | | | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain.
| | - Luis Alberto Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Science, University of Zaragoza, 50009 Zaragoza, Spain.
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain.
| | - Carolina E Storniolo
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, 08028 Barcelona, Spain.
| | - Anna Tresserra-Rimbau
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Hospital Universitari Sant Joan de Reus, Institut d'Investigació Pere Virgili (IISPV), 43201 Reus, Spain.
| | - Mónica Doménech
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
| | - Rosa María Lamuela-Raventós
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, 08028 Barcelona, Spain.
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Fernandez-Jimenez R, Santos-Beneit G, Tresserra-Rimbau A, Bodega P, de Miguel M, de Cos-Gandoy A, Rodríguez C, Carral V, Orrit X, Haro D, Carvajal I, Ibañez B, Storniolo C, Domènech M, Estruch R, Fernández-Alvira JM, Lamuela-Raventós RM, Fuster V. Rationale and design of the school-based SI! Program to face obesity and promote health among Spanish adolescents: A cluster-randomized controlled trial. Am Heart J 2019; 215:27-40. [PMID: 31277052 DOI: 10.1016/j.ahj.2019.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
Unhealthy habits in adolescents are increasing at an alarming rate. The school offers a promising environment in which to implement effective preventive strategies to improve adolescents' lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based health-promotion intervention aimed at all stages of compulsory education in Spain. We present the study design of the SI! Program for Secondary Schools, targeting adolescents aged 12 to 16 years. AIM The main goal of this study is to evaluate the impact of the SI! Program educational intervention on adolescent lifestyle behaviors and health parameters. METHODS The study was designed as a cluster-randomized controlled intervention trial and enrolled 1326 adolescents from 24 public secondary schools in Spain, together with their parents/caregivers. Schools and their students were randomly assigned to the intervention group (the SI! curriculum-based educational program over 2 or 4 academic years) or to the control group (usual curriculum). The primary endpoint will be the change from baseline at 2-year and 4-year follow-up in the composite Ideal Cardiovascular Health (ICH) score, consisting of four health behaviors (body mass index, dietary habits, physical activity, and smoking) and three health factors (blood pressure, total cholesterol, and glucose). Secondary endpoints will include 2-year and 4-year changes from baseline in ICH score subcomponents, the Fuster-BEWAT health scale, adiposity markers (waist circumference and body composition), polyphenol and carotenoid intake, and emotion management. DISCUSSION The overarching goal of the SI! Program is to instill healthy behaviors in children and adolescents that can be sustained into adulthood. The SI! Program for Secondary School is a comprehensive health-promotion intervention targeting 12-16-year-old adolescents and their immediate environment. The present study addresses the optimal timing and impact of the educational intervention on health in adolescence.
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Affiliation(s)
- Rodrigo Fernandez-Jimenez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Pere Virgili Health Research Center, Universitat Rovira i Virgili, Reus, Spain; Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Xavier Orrit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Domènech Haro
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Carolina Storniolo
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Mónica Domènech
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ramon Estruch
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Rosa Maria Lamuela-Raventós
- Biomedical Research Networking Center-Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Government of Spain, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XaRTA, INSA, University of Barcelona, Barcelona, Spain.
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, United States.
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Fernandez-Jimenez R, Al-Kazaz M, Jaslow R, Carvajal I, Fuster V. Children Present a Window of Opportunity for Promoting Health: JACC Review Topic of the Week. J Am Coll Cardiol 2018; 72:3310-3319. [PMID: 30527619 DOI: 10.1016/j.jacc.2018.10.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 01/04/2023]
Abstract
Cardiovascular disease is the leading cause of death and disability in the world, largely because of risk factors modifiable by changes in behavior. There is evolving evidence that our behavior as adults has its roots in the environment that we live in from early childhood. Early sustained multicomponent educational programs focused on health promotion in children may represent a window of opportunity to potentially prevent disease in adulthood. The integration of school-based, family-based, and community-based strategies, along with the support of public policies, are likely necessary for the success of these programs. In this review, the authors describe the future of promoting health. Specifically: 1) reasons why children should be a focus for health promotion (alarming trends of risk factors, association between unhealthy factors and subclinical disease, and cost-effectiveness); 2) strategies for health promotion in children (school-based, family-based, and community-based approaches) along with legislative efforts; and 3) research gaps are discussed.
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Affiliation(s)
- Rodrigo Fernandez-Jimenez
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Mohamed Al-Kazaz
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Risa Jaslow
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
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15
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Gómez-Pardo E, Fernández-Alvira JM, Vilanova M, Haro D, Martínez R, Carvajal I, Carral V, Rodríguez C, de Miguel M, Bodega P, Santos-Beneit G, Peñalvo JL, Marina I, Pérez-Farinós N, Dal Re M, Villar C, Robledo T, Vedanthan R, Bansilal S, Fuster V. A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol 2015; 67:476-85. [PMID: 26562047 DOI: 10.1016/j.jacc.2015.10.033] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jose Luis Peñalvo
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Iñaki Marina
- Internal Medicine Department, Catalan Health Institute, Viladecans, Spain
| | | | - Marian Dal Re
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Carmen Villar
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Teresa Robledo
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | | | | | - Valentin Fuster
- SHE Foundation, Barcelona, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
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16
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Quiñones D, Carvajal I, Perez Y, Hart M, Perez J, Garcia S, Salazar D, Ghosh S, Kawaguchiya M, Aung MS, Kobayashi N. High prevalence of bla OXA-23 in Acinetobacter spp. and detection of bla NDM-1 in A. soli in Cuba: report from National Surveillance Program (2010-2012). New Microbes New Infect 2015; 7:52-6. [PMID: 26236494 PMCID: PMC4511621 DOI: 10.1016/j.nmni.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022] Open
Abstract
As a first national surveillance of Acinetobacter in Cuba, a total of 500 Acinetobacter spp. isolates recovered from 30 hospitals between 2010 and 2012 were studied. Acinetobacter baumannii–calcoaceticus complex accounted for 96.4% of all the Acinetobacter isolates, while other species were detected at low frequency (A. junii 1.6%, A. lwoffii 1%, A. haemolyticus 0.8%, A. soli 0.2%). Resistance rates of isolates were 34–61% to third-generation cephalosporins, 49–50% to β-lactams/inhibitor combinations, 42–47% to aminoglycosides, 42–44% to carbapenems and 55% to ciprofloxacin. However, resistance rates to colistin, doxycycline, tetracycline and rifampin were less than 5%. Among carbapenem-resistant isolates, 75% harboured different blaOXA genes (OXA-23, 73%; OXA-24, 18%; OXA-58, 3%). The blaNDM-1 gene was identified in an A. soli strain, of which the species was confirmed by sequence analysis of 16S rRNA gene, rpoB, rpoB–rpoC and rpoL–rpoB intergenic spacer regions and gyrB. The sequences of blaNDM-1 and its surrounding genes were identical to those reported for plasmids of A. baumannii and A. lwoffi strains. This is the first report of blaNDM-1 in A. soli, together with a high prevalence of OXA-23 carbapenemase for carbapenem resistance in Acinetobacter spp. in Cuba.
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Affiliation(s)
- D Quiñones
- Tropical Medicine Institute 'Pedro Kourí', Havana City, Cuba
| | - I Carvajal
- Tropical Medicine Institute 'Pedro Kourí', Havana City, Cuba
| | - Y Perez
- Tropical Medicine Institute 'Pedro Kourí', Havana City, Cuba
| | - M Hart
- 'Hermanos Ameijeiras' Hospital, Havana City, Cuba
| | - J Perez
- Pediátrico 'J. M. Márquez' Hospital, Havana City, Cuba
| | - S Garcia
- 'V. I. Lenin' Hospital, Holguín, Holguín, Cuba
| | - D Salazar
- Tropical Medicine Institute 'Pedro Kourí', Havana City, Cuba
| | - S Ghosh
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan ; Department of Biomedical Science, Ross University School of Medicine, St Kitts, West Indies
| | - M Kawaguchiya
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M S Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - N Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan
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17
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García-Vicuña R, Carvajal I, Ortiz-García A, López-Robledillo JC, Laffón A, Sabando P. Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment. Spine (Phila Pa 1976) 2000; 25:520-3. [PMID: 10707401 DOI: 10.1097/00007632-200002150-00021] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up. OBJECTIVES To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence. SUMMARY AND BACKGROUND DATA Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial. METHODS The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up. RESULTS After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed. CONCLUSION Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.
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Affiliation(s)
- R García-Vicuña
- Rheumatology Unit, Hospital de la Princesa, Madrid, Spain. psabando/
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18
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Sepúlveda F, Carvajal I, George-Nascimento M, González L. Feasibility of the utilization of Udonella calligorum (plathyhelminthes: udonellidae) in the biological control of caligid copepods parasites on cultured salmonids in Chile. Parasitol Int 1998. [DOI: 10.1016/s1383-5769(98)80420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Peñas PF, Buezo GF, Carvajal I, Daudén E, López A, Diaz LA. D-penicillamine-induced pemphigus foliaceus with autoantibodies to desmoglein-1 in a patient with mixed connective tissue disease. J Am Acad Dermatol 1997; 37:121-3. [PMID: 9216536 DOI: 10.1016/s0190-9622(97)70224-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P F Peñas
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
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20
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Camacho Vázquez C, Alonso Pulpón L, Maicas Bellido C, Carvajal I, García-Vicuña R, Hotait H, Oteo JF, Ugarte J. [Heart transplantation in a patient with rheumatoid arthritis]. Rev Esp Cardiol 1997; 50:357-9. [PMID: 9281016 DOI: 10.1016/s0300-8932(97)73234-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 56 year-old woman with rheumatoid arthritis was diagnosed with idiopathic dilated cardiomyopathy. She developed progressive heart failure that was refractory to conventional medical management. Heart transplantation was performed bearing in mind the controversy that surrounds its use in patients with a systemic disease. Transplant and rheumatoid arthritis were favorable at 33 month evolution. The immunosuppressive therapy required for the transplant helped the control of her articular disease.
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21
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Abstract
Osteoporosis is a common disease among patients undergoing transplantation. Its prevalence and complications have been well described in solid organ recipients, especially kidney, liver, and heart. However, studies in bone marrow transplantation (BMT) are scarce. Among the mechanisms invoked in the pathogenesis of BMT osteoporosis are the baseline disease, the use of immunosuppressive drugs and, more remarkably, secondary hypogonadism. We present a study of 27 women who underwent BMT, all of them suffering ovarian failure. We studied different biochemical markers of bone formation/resorption and also evaluated the presence of osteopenia/osteoporosis by dual energy X-ray absorptiometry (DXA) of the lumbar spine. Osteopenia was observed in nine patients (33%) and osteoporosis in another five (18%), according to the World Health Organization criteria. We also detected a subgroup showing elevation of several bone turnover biochemical markers, indicating high osseous remodeling. A remarkable increase in urine hydroxyproline/creatinine was detected in 95% of cases, although an explanation is lacking. We outline a reasonable therapeutic approach for osteoporosis in BMT emphasizing the need to monitor these patients after transplantation.
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Affiliation(s)
- S Castañeda
- Rheumatology Section, Hospital Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain
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Carvajal I, Bernis C, Sanz P, Garcia A, Garcia-Vadillo A, Traver JA. Antineutrophil cytoplasmic autoantibodies (ANCA) and systemic sclerosis. Nephrol Dial Transplant 1997; 12:576-7. [PMID: 9075145 DOI: 10.1093/ndt/12.3.576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- I Carvajal
- Rheumatology Department, Hospital de la Princesa, Madrid, Spain
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González-Alvaro I, Carvajal I, Estevez M, López-Bote JP, García-Vadillo A. Carpal tunnel syndrome as initial manifestation of inflammatory connective tissue diseases. Ann Rheum Dis 1995; 54:782. [PMID: 7495357 PMCID: PMC1010003 DOI: 10.1136/ard.54.9.782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Malavé I, Perdomo Y, Rojas I, Pocino M, Malavé H, Carvajal I, Tlaskalová H. Antibodies to dietary antigen in serum from patients with sickle cell anemia. Int Arch Allergy Immunol 1994; 104:144-9. [PMID: 8199458 DOI: 10.1159/000236722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The levels of antibodies of the IgG, IgA and IgM isotypes reacting against ovoalbumin (OVA), gliadin (GL) and cow's milk proteins (CMP), were determined by ELISA in sera from a group of adult patients with sickle cell anemia (SCA) bearing homozygous Ss hemoglobinopathy and from matched health donors. Only patients with steady-state disease were included in the study. Increased amounts of IgG and IgA reacting with OVA, GL and CMP were observed in the group of patients as compared with the controls. In contrast, the levels of IgM antibodies against each of the three dietary antigens were similar in patients and controls. Increased levels of IgG and IgA antibodies against dietary antigens in SCA may result from enhanced permeability of the gut mucosa to macromolecules of dietary origin as a consequence of microinfarctions, chronic polyclonal B cell activation and/or diminished inhibitory control of antibody synthesis.
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Affiliation(s)
- I Malavé
- Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
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25
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Carvajal I, Malavé I, Correa C, Castillo C, Pérez M, Hammar S, Camejo G. [Changes in the serum lipid fractions of malnourished children with and without clinical infection. Paradoxical hypertriglyceridemia in malnutrition]. Arch Latinoam Nutr 1992; 42:250-8. [PMID: 1342158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have studied the levels of total triglycerides, total cholesterol and high, low and very low density lipoproteins, in serum from undernourished children and from eutrophic controls matched by age, race and socioeconomical condition with the undernourished group. Malnourished children were classified according to the severity of the nutritional deficiency and according to the presence or absence of associated overt infections. Serum lipids fractions were evaluated by colorimetric procedures and by electrophoretic isolation and elution of the desired lipoprotein followed by colorimetric evaluation of the cholesterol content. Increased levels of total triglycerides and very low density lipoproteins were observed in the undernourished group. The rise in the levels of total triglycerides and very low density lipoproteins was more marked in children with moderate and severe undernutrition as well as in undernourished with associated overt infection. In contrast, as expected, serum levels of total cholesterol, high density and low density lipoproteins were significantly diminished in undernourished children. The depression in the amount of total cholesterol, high density and low density lipoproteins was more marked in the severe forms of undernutrition. Increased levels of total triglycerides and very low density lipoprotein could be determined by a defect in the clearance of these lipid fractions due to depressed activity of lipoprotein lipase.
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Affiliation(s)
- I Carvajal
- Instituto Venezolano de Investigaciones Científicas IVIC
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