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Zabaleta-Del-Olmo E, Casajuana-Closas M, López-Jiménez T, Pombo H, Pons-Vigués M, Pujol-Ribera E, Cabezas-Peña C, Llobera J, Martí-Lluch R, Vicens C, Motrico E, Gómez-Gómez I, Maderuelo-Fernández JÁ, Recio-Rodriguez JI, Masluk B, Contreras-Martos S, Jacques-Aviñó C, Aznar-Lou I, Gil-Girbau M, Clavería A, Magallón-Botaya R, Bellón JÁ, Ramos R, Sanchez-Perez A, Moreno-Peral P, Leiva A, González-Formoso C, Bolíbar B. Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial. BMC Public Health 2021; 21:2208. [PMID: 34863136 PMCID: PMC8642878 DOI: 10.1186/s12889-021-11982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/19/2020] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".
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Affiliation(s)
- Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Balmes 22, 08007, Barcelona, Spain
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
| | - Haizea Pombo
- Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation-Biocruces Bizkaia Health Research Institute Innovation Unit, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain
- Deputy Directorate of Healthcare Assistance, Osakidetza-Servicio Vasco de Salud, C/ Araba 45, 01006, Vitoria, Araba, Spain
| | - Mariona Pons-Vigués
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Àrea Assistencial. Servei Català de la Salut (CatSalut), Travessera de les Corts 131-159, Edifici Olímpia, 08228, Barcelona, Spain
| | - Enriqueta Pujol-Ribera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Carmen Cabezas-Peña
- Department of Health, Deputy Directorate of Health Promotion, Public Health Agency, Goverment of Catalonia, Roc Boronat, 81-95 (Edifici Salvany), 08005, Barcelona, Spain
| | - Joan Llobera
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Ruth Martí-Lluch
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
- Unitat de suport a la recerca de Girona. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Carrer Maluquer Salvador 11, 17002, Girona, Spain
- Group of research in Vascular Health, Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí Julià - Edifici M2, Carrer del Dr. Castany, s/n, 17190, Salt, Spain
| | - Caterina Vicens
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
- Centro de Salud Son Serra-La Vileta (Ibsalut), Masanella 22, 07013, Palma, Balearic Islands, Spain
- Facultat de Medicina. Universitat de les Illes Balears, Carretera de Valldemossa, km 7.5, 07122, Palma, Balearic Islands, Spain
| | - Emma Motrico
- Universidad Loyola Andalucía, Avda. de las Universidades, s/n, 41704, Dos Hermanas, Sevilla, Spain
| | - Irene Gómez-Gómez
- Universidad Loyola Andalucía, Avda. de las Universidades, s/n, 41704, Dos Hermanas, Sevilla, Spain
| | - José-Ángel Maderuelo-Fernández
- Institute of Biomedical Research of Salamanca (IBSAL), Edificio Virgen de la Vega, 10.a planta. Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Avda. Portugal 83, 37005, Salamanca, Spain
- Health Service of Castilla y León (SACyL), C/ Arapiles, 25 - 33, 37007, Salamanca, Spain
| | - José I Recio-Rodriguez
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Avda. Portugal 83, 37005, Salamanca, Spain
- Departamento de Enfermería y Fisioterapia, Universidad de Salamanca, Calle Donantes de Sangre, s/n, 37007, Salamanca, Spain
| | - Barbara Masluk
- Departamento de Psicología y Sociología, Universidad de Zaragoza, C/Pedro Cerbuna 12, 50009, Zaragoza, Spain
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP), Instituto de Investigación Sanitaria, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Sara Contreras-Martos
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - Ignacio Aznar-Lou
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, C\ Doctor Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029, Madrid, Spain
| | - Montserrat Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, C\ Doctor Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Spain
| | - Ana Clavería
- Área de Xestión Integrada de Vigo, Servizio Galego de Saúde, c/Rosalía Castro 21-23, 36201, Vigo, Spain
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, Bloque Técnico, Planta 2, Carretera Clara Campoamor n° 341, Beade, 36213, Vigo, Spain
| | - Rosa Magallón-Botaya
- Facultad de Medicina, Universidad de Zaragoza, c/ Domingo Miral s/n, 50009, Zaragoza, Spain
- Arrabal Health Centre, Servicio Aragonés de Salud, Andador Aragüés del Puerto 3, 50015, Zaragoza, Spain
- Institute of health research of Aragon (IIS Aragón), Avda. San Juan Bosco, 13, 50009, Zaragoza, Spain
| | - Juan-Ángel Bellón
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Civil Pabellón 5. 2a Planta, Plaza del Hospital Civil, s/n, 29009, Málaga, Spain
- El Palo Health Centre', Andalusian Health Service (SAS), Avenida Salvador Allende 159, 29018, Málaga, Spain
- Department of Public Health and Psychiatry, Facultad de Medicina, University of Málaga (UMA), Campus de Teatinos, 29071, Málaga, Spain
| | - Rafel Ramos
- Unitat de suport a la recerca de Girona. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Carrer Maluquer Salvador 11, 17002, Girona, Spain
- Group of research in Vascular Health, Girona Biomedical Research Institute (IdibGi), Parc Hospitalari Martí Julià - Edifici M2, Carrer del Dr. Castany, s/n, 17190, Salt, Spain
- Department of Medical Sciences, School of Medicine, Campus Salut, Universitat de Girona, Emili Grahit 77, 17003, Girona, Spain
| | - Alvaro Sanchez-Perez
- Primary Care Research Unit, Deputy Directorate of Healthcare Assistance- BioCruces Bizkaia Health Research Institute, Basque Healthcare Service -Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Civil Pabellón 5. 2a Planta, Plaza del Hospital Civil, s/n, 29009, Málaga, Spain
| | - Alfonso Leiva
- Unitat de Recerca, Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears, C/Escola Graduada 3, 07002, Palma, Spain
- Institut de Investigació Sanitària de les Illes Balears (IdISBa), Carretera de Valldemossa, 79. Hospital Universitari Son Espases, Ed S., 070112, Palma, Spain
| | - Clara González-Formoso
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, Bloque Técnico, Planta 2, Carretera Clara Campoamor n° 341, Beade, 36213, Vigo, Spain
- Unidade de Calidade de Coidados, Área sanitaria de Vigo. Hospital Álvaro Cunqueiro, Estrada Clara Campoamor n° 341, 36312, Vigo, Spain
| | - Bonaventura Bolíbar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
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Rodríguez-Martín C, Garcia-Ortiz L, Rodriguez-Sanchez E, Maderuelo-Fernandez C, Lugones-Sanchez A, Martin-Cantera MS, Soriano-Cano JF, Arietaleanizbeaskoa M, Magdalena-Belio JA, Menendez-Suarez C, Gómez-Marcos MA, Recio-Rodriguez JI, Evident Investigators Group OBOTEI. The Relationship of the Atlantic Diet with Cardiovascular Risk Factors and Markers of Arterial Stiffness in Adults without Cardiovascular Disease. Nutrients 2019; 11:nu11040742. [PMID: 30934975 PMCID: PMC6521051 DOI: 10.3390/nu11040742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Studying the adherence of the population to the Atlantic Diet (AD) could be simplified by an easy and quickly applied dietary index. The aim of this study is to analyse the relationship of an index measuring compliance with recommendations regarding the Atlantic diet and physical activity with cardiovascular disease risk factors, cardiovascular risk factors, obesity indexes and arterial stiffness markers. METHODS We included 791 individuals from the EVIDENT study (lifestyles and arterial ageing), (52.3 ± 12 years, 61.7% women) without cardiovascular disease. Compliance with recommendations on AD was collected through the responses to a food frequency questionnaire, while physical activity was measured by accelerometer. The number of recommendations being met was estimated using a global scale between 0 and 14 points (a higher score representing greater adherence). Blood pressure, plasma lipid and glucose values and obesity rates were measured. Cardiovascular risk was estimated with the Framingham equation. RESULTS In the overall sample, 184 individuals (23.3%) scored between 0⁻3 on the 14-point index we created, 308 (38.9%) between 4 and 5 points, and 299 (37.8%) 6 or more points. The results of multivariate analysis yield a common tendency in which the group with an adherence score of at least 6 points shows lower figures for total cholesterol (p = 0.007) and triglycerides (p = 0.002). Similarly, overall cardiovascular risk in this group is the lowest (p < 0.001), as is pulse wave velocity (p = 0.050) and the mean values of the obesity indexes studied (p < 0.05 in all cases). CONCLUSION The rate of compliance with the Atlantic diet and physical activity shows that greater adherence to these recommendations is linked to lower cardiovascular risk, lower total cholesterol and triglycerides, lower rates of obesity and lower pulse wave velocity values.
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Affiliation(s)
- Carmela Rodríguez-Martín
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
| | - Luis Garcia-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37008 Salamanca, Spain.
| | - Emiliano Rodriguez-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
| | | | - Alba Lugones-Sanchez
- Universidad de Castilla-La Mancha. Health and Social Research Center. 16071 Cuenca, Spain.
| | - Maria S Martin-Cantera
- Primary Health Care Research Unit of Bizkaia. Basque Health Service-Osakidetza, 48014 Bilbao, Spain.
| | - Jose F Soriano-Cano
- Torre Ramona Health Center, Aragon Health Service, Instituto de Investigacion Sanitaria IIS-Aragón, 50013 Zaragoza, Spain.
| | | | - Jose A Magdalena-Belio
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
| | - Cristina Menendez-Suarez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
- Department of Medicine, University of Salamanca, 37008 Salamanca, Spain.
| | - José I Recio-Rodriguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACYL), Primary Care Prevention and Health Promotion Research Network (REDIAPP),37003 Salamanca, Spain.
- Department of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain.
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Recio-Rodriguez JI, Gómez-Marcos MA, Agudo-Conde C, Ramirez I, Gonzalez-Viejo N, Gomez-Arranz A, Salcedo-Aguilar F, Rodriguez-Sanchez E, Alonso-Domínguez R, Sánchez-Aguadero N, Gonzalez-Sanchez J, Garcia-Ortiz L. EVIDENT 3 Study: A randomized, controlled clinical trial to reduce inactivity and caloric intake in sedentary and overweight or obese people using a smartphone application: Study protocol. Medicine (Baltimore) 2018; 97:e9633. [PMID: 29480874 PMCID: PMC5943855 DOI: 10.1097/md.0000000000009633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Mobile technology, when included within multicomponent interventions, could contribute to more effective weight loss. The objective of this project is to assess the impact of adding the use of the EVIDENT 3 application, designed to promote healthy living habits, to traditional modification strategies employed for weight loss. Other targeted behaviors (walking, caloric-intake, sitting time) and outcomes (quality of life, inflammatory markers, measurements of arterial aging) will also be evaluated. METHODS Randomized, multicentre clinical trial with 2 parallel groups. The study will be conducted in the primary care setting and will include 700 subjects 20 to 65 years, with a body mass index (27.5-40 kg/m), who are clinically classified as sedentary. The primary outcome will be weight loss. Secondary outcomes will include change in walking (steps/d), sitting time (min/wk), caloric intake (kcal/d), quality of life, arterial aging (augmentation index), and pro-inflammatory marker levels. Outcomes will be measured at baseline, after 3 months, and after 1 year. Participants will be randomly assigned to either the intervention group (IG) or the control group (CG). Both groups will receive the traditional primary care lifestyle counseling prior to randomization. The subjects in the IG will be lent a smartphone and a smartband for a 3-month period, corresponding to the length of the intervention. The EVIDENT 3 application integrates the information collected by the smartband on physical activity and the self-reported information by participants on daily food intake. Using this information, the application generates recommendations and personalized goals for weight loss. DISCUSSION There is a great diversity in the applications used obtaining different results on lifestyle improvement and weight loss. The populations studied are not homogeneous and generate different results. The results of this study will help our understanding of the efficacy of new technologies, combined with traditional counseling, towards reducing obesity and enabling healthier lifestyles. ETHICS AND DISSEMINATION The study was approved by the Clinical Research Ethics Committee of the Health Area of Salamanca ("CREC of Health Area of Salamanca") on April 2016. A SPIRIT checklist is available for this protocol. The trial was registered in ClinicalTrials.gov provided by the US National Library of Medicine-number NCT03175614.
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Affiliation(s)
- José I. Recio-Rodriguez
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
- Department of Nursing and Physiotherapy
| | - Manuel A. Gómez-Marcos
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
- Department of Medicine, University of Salamanca
| | - Cristina Agudo-Conde
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
| | - Ignasi Ramirez
- Centro de Salud Sta Ponça de Palma de Mallorca, Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
| | | | | | | | - Emiliano Rodriguez-Sanchez
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
| | - Rosario Alonso-Domínguez
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
| | - Natalia Sánchez-Aguadero
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
| | - Jesus Gonzalez-Sanchez
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
- Department of Nursing, University of Extremadura
| | - Luis Garcia-Ortiz
- Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACYL), Biomedical Research Institute of Salamanca (IBSAL), Spanish Network for Preventive Activities and Health Promotion (REDIAPP)
- Department of Biomedical and Diagnostic Sciences, University of Salamanca,Spain
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Gamella-Pozuelo L, Fuentes-Calvo I, Gómez-Marcos MA, Recio-Rodriguez JI, Agudo-Conde C, Fernández-Martín JL, Cannata-Andía JB, López-Novoa JM, García-Ortiz L, Martínez-Salgado C. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk. Medicine (Baltimore) 2015; 94:e1218. [PMID: 26222851 PMCID: PMC4554114 DOI: 10.1097/md.0000000000001218] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker.This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity-PWV, carotid intima-media thickness-C-IMT, and ankle-brachial index-ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate).Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product.Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage.
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Affiliation(s)
- Luis Gamella-Pozuelo
- From the Unidad de Fisiopatología Renal y Cardiovascular (LG-P, IF-C, JML-N, CM-S), Departamento de Fisiología y Farmacología, Instituto Reina Sofía de Investigación Nefrológica, Universidad de Salamanca, Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL) (IF-C, MAG-M, JIR-R, CA-C, JML-N, LG-O, CM-S), Salamanca; Unidad de Investigación (MAG-M, JIR-R, CA-C, LG-O), Centro de Salud La Alamedilla, SACYL, Salamanca; Servicio de Metabolismo Óseo y Mineral (JLF-M, JBC-A), Instituto Reina Sofía de Investigación Nefrológica, Hospital Universitario Central de Asturias, Oviedo; and Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL) (CM-S), Unidad de Investigación, Hospital Universitario de Salamanca, Salamanca, Spain
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Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Rodrigo-De Pablo E, Cabrejas-Sánchez A, Arietaleanizbeaskoa MS, Repiso-Gento I, Gonzalez-Viejo N, Maderuelo-Fernandez JA, Agudo-Conde C, Garcia-Ortiz L. Glycemic index, glycemic load, and pulse wave reflection in adults. Nutr Metab Cardiovasc Dis 2015; 25:68-74. [PMID: 25315672 DOI: 10.1016/j.numecd.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 02/04/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.
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Affiliation(s)
- J I Recio-Rodriguez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain.
| | - M A Gomez-Marcos
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | | | - E Rodrigo-De Pablo
- Passeig de Sant Joan Health Center, Catalan Health Center, Barcelona, Spain
| | - A Cabrejas-Sánchez
- Cuenca III Health Centre, Castilla La Mancha Health Service-SESCAM, Cuenca, Spain
| | | | - I Repiso-Gento
- Casa del Barco Health Center, Castilla and León Health Service-SACYL, Valladolid, Spain
| | - N Gonzalez-Viejo
- Torre Ramona Health Center, Aragón Health Service-Salud, Zaragoza, Spain
| | - J A Maderuelo-Fernandez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - C Agudo-Conde
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - L Garcia-Ortiz
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
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