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Mata-Fernández A, Hershey MS, Pastrana-Delgado JC, Sotos-Prieto M, Ruiz-Canela M, Kales SN, Martínez-González MA, Fernandez-Montero A. A Mediterranean lifestyle reduces the risk of cardiovascular disease in the "Seguimiento Universidad de Navarra" (SUN) cohort. Nutr Metab Cardiovasc Dis 2021; 31:1728-1737. [PMID: 33895077 DOI: 10.1016/j.numecd.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/18/2020] [Revised: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS A healthy lifestyle is essential to prevent cardiovascular disease (CVD). However, beyond dietary habits, there is a scarcity of studies comprehensively assessing the typical traditional Mediterranean lifestyle with a multi-dimensional index. We assessed the association between the Mediterranean lifestyle (measured with the MEDLIFE index including diet, physical activity, and other lifestyle factors) and the incidence of CVD. METHODS AND RESULTS The "Seguimiento Universidad de Navarra" (SUN) project is a prospective, dynamic and multipurpose cohort of Spanish university graduates. We calculated a MEDLIFE score, composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, for 18,631 participants by assigning 1 point for each typical Mediterranean lifestyle factor achieved, for a theoretically possible final score ranging from 0 to 28 points. During an average follow-up of 11.5 years, 172 CVD cases (myocardial infarction, stroke or cardiovascular death) were observed. An inverse association between the MEDLIFE score and the risk of primary cardiovascular events was observed, with multivariable-adjusted hazard ratio (HR) = 0.50; (95% confidence interval, 0.31-0.81) for the highest MEDLIFE scores (14-23 points) compared to the lowest scores (0-9 points), p (trend) = 0.004. CONCLUSION A higher level of adherence to the Mediterranean lifestyle was significantly associated with a lower risk of CVD in a Spanish cohort. Public health strategies should promote the Mediterranean lifestyle to preserve cardiovascular health.
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Affiliation(s)
- Arancha Mata-Fernández
- University of Navarra, Emergency Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria S Hershey
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Juan C Pastrana-Delgado
- University of Navarra, Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Miguel A Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; Department of Nutrition, Harvard T.H Chan School, Boston, MA, USA
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA; Navarra Institute for Health Research (IdisNa), Pamplona, Spain; University of Navarra, Department of Occupational Medicine, Pamplona, Spain.
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Santiago S, Zazpe I, Fernandez-Lazaro CI, de la O V, Bes-Rastrollo M, Martínez-González MÁ. Macronutrient Quality and All-Cause Mortality in the SUN Cohort. Nutrients 2021; 13:nu13030972. [PMID: 33802782 PMCID: PMC8002396 DOI: 10.3390/nu13030972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3–14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59–1.06; Ptrend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45–0.90; Ptrend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.
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Affiliation(s)
- Susana Santiago
- Department of Nutrition and Food Sciences and Physiology, Campus Universitario, School of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain; (S.S.); (I.Z.)
| | - Itziar Zazpe
- Department of Nutrition and Food Sciences and Physiology, Campus Universitario, School of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain; (S.S.); (I.Z.)
| | - Cesar I. Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, Campus Universitario, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (V.d.l.O.); (M.B.-R.)
| | - Víctor de la O
- Department of Preventive Medicine and Public Health, Campus Universitario, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (V.d.l.O.); (M.B.-R.)
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, Campus Universitario, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (V.d.l.O.); (M.B.-R.)
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, Campus Universitario, School of Medicine, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (V.d.l.O.); (M.B.-R.)
- Correspondence: ; Tel.: +34-948-425-600 (ext. 806463)
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Fernandez-Lazaro CI, Martínez-González MÁ, Aguilera-Buenosvinos I, Gea A, Ruiz-Canela M, Romanos-Nanclares A, Toledo E. Dietary Antioxidant Vitamins and Minerals and Breast Cancer Risk: Prospective Results from the SUN Cohort. Antioxidants (Basel) 2021; 10:antiox10030340. [PMID: 33668391 PMCID: PMC7996327 DOI: 10.3390/antiox10030340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/16/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
There is growing interest in natural antioxidants and their potential effects on breast cancer (BC). Epidemiological evidence, however, is inconsistent. We prospectively evaluated the association between dietary intake of vitamins A, C, and E, selenium, and zinc and BC among 9983 female participants from the SUN Project, a Mediterranean cohort of university graduates. Participants completed a food frequency questionnaire at baseline, and biennial follow-up information about incident BC diagnosis was collected. Cases were ascertained through revision of medical charts and consultation of the National Death Index. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI). During an average follow-up of 11.3 years, 107 incident BC cases were confirmed. The multivariable HRs (95% CI) for BC comparing extreme tertiles of energy-adjusted dietary intakes were 1.07 (0.64–1.77; Ptrend = 0.673) for vitamin A, 1.00 (0.58–1.71; Ptrend = 0.846) for vitamin C, 0.92 (0.55–1.54; Ptrend = 0.728) for vitamin E, 1.37 (0.85–2.20; Ptrend = 0.135) for selenium, and 1.01 (0.61–1.69; Ptrend = 0.939) for zinc. Stratified analyses showed an inverse association between vitamin E intake and postmenopausal BC (HRT3 vs. T1 = 0.35; 95% CI, 0.14–0.86; Ptrend = 0.027). Our results did not suggest significant protective associations between dietary vitamins A, C, and E, selenium, or zinc and BC risk.
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Affiliation(s)
- Cesar I. Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Inmaculada Aguilera-Buenosvinos
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | - Andrea Romanos-Nanclares
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948-425-600 (ext. 806224)
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Aguilera-Buenosvinos I, Fernandez-Lazaro CI, Romanos-Nanclares A, Gea A, Sánchez-Bayona R, Martín-Moreno JM, Martínez-González MÁ, Toledo E. Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project. Nutrients 2021; 13:nu13020687. [PMID: 33669972 PMCID: PMC7924827 DOI: 10.3390/nu13020687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption-and their subtypes-and incident BC in a Mediterranean cohort. The SUN ("Seguimiento Universidad de Navarra") Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence (pnonlinear = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HRQ2vs.Q1 = 0.49 (95% CI 0.28-0.84); HRQ3vs.Q1 = 0.49 (95% CI 0.29-0.84) ptrend = 0.623) and with moderate low-fat dairy product consumption (HRQ2vs.Q1 = 0.58 (95% CI 0.35-0.97); HRQ3vs.Q1 = 0.55 (95% CI 0.32-0.92), ptrend = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.
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Affiliation(s)
- Inmaculada Aguilera-Buenosvinos
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
| | - Cesar Ignacio Fernandez-Lazaro
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Andrea Romanos-Nanclares
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Alfredo Gea
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Clinical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jose M. Martín-Moreno
- Department of Preventive Medicine and Public Health, Medical School & INCLIVA, University of Valencia, 46010 Valencia, Spain;
| | - Miguel Ángel Martínez-González
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Estefanía Toledo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948425600 (ext. 806224)
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Fernandez-Lazaro CI, Zazpe I, Santiago S, Toledo E, Barbería-Latasa M, Martínez-González MÁ. Association of carbohydrate quality and all-cause mortality in the SUN Project: A prospective cohort study. Clin Nutr 2020; 40:2364-2372. [PMID: 33190989 DOI: 10.1016/j.clnu.2020.10.029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/23/2020] [Accepted: 10/17/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND & AIMS Emerging evidence supports shifting the focus from carbohydrate quantity to carbohydrate quality to obtain greater health benefits. We investigated the association of carbohydrate quality with all-cause mortality using a single, multidimensional carbohydrate quality index (CQI) designed to account for multiple characteristics of carbohydrate quality. METHODS A prospective study was conducted among 19,083 participants in the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort of middle-aged university graduates. The CQI was based on four dimensions: high total dietary fiber intake, low glycemic index, high whole-grain carbohydrate: total grain carbohydrate ratio, and high solid carbohydrate: total carbohydrate ratio. RESULTS During 12.2 years of median follow-up, 440 deaths were identified. We found an inverse association between the CQI and all-cause mortality. The multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest tertile of the CQI was 0.70 (95% CI, 0.53-0.93; Ptrend = 0.018). However, each individual dimension of the CQI was not independently associated with lower mortality risk, with HR (95% CI) between extreme tertiles as follows: 0.77 (0.52-1.14; Ptrend = 0.192) for high fiber intake; 0.81 (0.59-1.12; Ptrend = 0.211) for low glycemic index; 0.87 (0.69-1.11; Ptrend = 0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; Ptrend = 0.139) for high solid carbohydrate: total carbohydrate ratio. Our analyses remained similar after using repeated measurements of diet with updated nutritional exposures after a ten-year follow-up. CONCLUSIONS The CQI as a whole, but none of its individual dimensions, was associated with lower mortality. The CQI seems to comprehensively capture the combined effects of quality domains.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
| | - Itziar Zazpe
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain
| | - Susana Santiago
- IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; University of Navarra, Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, 31008, Pamplona, Spain
| | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain
| | - María Barbería-Latasa
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, 31008, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029, Madrid, Spain; Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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Razquin C, Menéndez-Acebal C, Cervantes S, Martínez-González MA, Vázquez-Ruiz Z, Martínez-González J, Guillén-Grima F, Toledo E. Hypertension and changes in cognitive function in a Mediterranean population. Nutr Neurosci 2020; 25:612-620. [PMID: 32635835 DOI: 10.1080/1028415x.2020.1788773] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Severe cognitive decline is one of the major public health problems in developed countries. Finding modifiable risk factors could become essential to develop strategies to prevent or delay dementia progression and stop its rising incidence.Objective: Our aim was to investigate the association between hypertension and cognitive function and to assess whether better adherence to the Mediterranean diet may modify this association.Methods: A subsample of 764 participants from the 'Seguimiento Universidad de Navarra' (SUN) cohort older than 55 years was evaluated with the Spanish Telephone Interview for Cognitive Status (TICS-m) at two-time points, separated by 6 years. Multivariable-adjusted linear regression models were used to prospectively assess the association between hypertension -also according to adherence to the Mediterranean diet- and 6-y changes in cognitive function.Results: The adjusted between-group difference in the 6-year change of the TICS-m score between hypertensive participants and their non-hypertensive counterparts was -0.36 (95% CI -0.70, -0.02). This association was stronger among participants with a lower adherence to the Mediterranean diet [-0.62 (95% CI: -1.09, -0.15)] but the differences between hypertensive and non-hypertensive participants were no longer significant among participants with a higher baseline adherence to the Mediterranean diet.Conclusion: In this Mediterranean cohort, hypertension was inversely associated with cognitive function, but an attenuation of this detrimental association by a moderate/high adherence to the Mediterranean diet was suggested.
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Affiliation(s)
- Cristina Razquin
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,IdiSNA, Pamplona, Spain
| | | | - Sebastián Cervantes
- Complejo Hospitalario de Navarra, Osasunbidea-Servicio Navarro de Salud, Pamplona, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,IdiSNA, Pamplona, Spain.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zenaida Vázquez-Ruiz
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,IdiSNA, Pamplona, Spain
| | | | - Francisco Guillén-Grima
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,IdiSNA, Pamplona, Spain.,Department of Preventive Medicine, Clinica Universidad de Navarra, Pamplona, Spain
| | - Estefania Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,IdiSNA, Pamplona, Spain
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Alonso-Pedrero L, Ojeda-Rodríguez A, Martínez-González MA, Zalba G, Bes-Rastrollo M, Marti A. Ultra-processed food consumption and the risk of short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. Am J Clin Nutr 2020; 111:1259-1266. [PMID: 32330232 DOI: 10.1093/ajcn/nqaa075] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telomere length (TL) is a marker of biological age that may be affected by dietary factors through oxidation and inflammation mechanisms. In addition, ultra-processed food (UPF) consumption has increased worldwide and it has been associated with the risk of developing several diseases. OBJECTIVES We aimed to evaluate the association between UPF consumption and the risk of having short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. METHODS This is a cross-sectional study of 886 participants (645 men and 241 women) aged 57-91 y recruited from the SUN Project (Spain, 1999-2018). TL was measured from saliva samples by real-time qPCR at baseline and UPF consumption was collected using a validated 136-item FFQ and classified according to the NOVA system. We evaluated the association between consumption of energy-adjusted UPF categorized into quartiles (low, medium-low, medium-high, and high consumption) and the risk of having short telomeres (<20th percentile) using logistic regression models. RESULTS Those participants with the highest UPF consumption had almost twice the odds of having short telomeres compared with those with the lowest consumption (adjusted OR: 1.82; 95% CI: 1.05, 3.22; P-trend = 0.03). CONCLUSIONS A higher consumption of UPF (>3 servings/d) was associated with higher risk of having shorter telomeres in an elderly Spanish population of the SUN Project.This trial was registered at clinicaltrials.gov as NCT02669602.
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Affiliation(s)
- Lucia Alonso-Pedrero
- University of Navarra, Department of Nutrition, Food Science and Physiology, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Ojeda-Rodríguez
- University of Navarra, Department of Nutrition, Food Science and Physiology, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miguel A Martínez-González
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain.,Harvard TH Chan School of Public Health, Department of Nutrition, Boston, MA, USA
| | - Guillermo Zalba
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,University of Navarra, Department of Biochemistry and Genetics, Pamplona, Spain
| | - Maira Bes-Rastrollo
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
| | - Amelia Marti
- University of Navarra, Department of Nutrition, Food Science and Physiology, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Physiopathology of Obesity and Nutrition Networking Biomedical Research Centre (CIBERobn), Spanish National Institute of Health Carlos III, Madrid, Spain
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8
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Godos J, Galvano F. Insights on Mediterranean Diet from the SUN Cohort: Cardiovascular and Cognitive Health. Nutrients 2020; 12:E1332. [PMID: 32397062 DOI: 10.3390/nu12051332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022] Open
Abstract
Epidemiological evidence has demonstrated the association between dietary factors and non-communicable diseases. Great attention has been payed to the Mediterranean dietary pattern, given its richness in anti-oxidant and anti-inflammatory molecules. Numerous reports from the SUN (Seguimiento Universidad De Navarra) cohort have shown that higher adherence to the Mediterranean dietary pattern may be inversely associated with mortality, type 2 diabetes and cardiovascular diseases. Likewise, a link with mental health outcomes, such as depressive symptoms, cognitive status and quality of life was also found, suggesting its beneficial effects toward brain health.
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9
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Sánchez-Quesada C, Romanos-Nanclares A, Navarro AM, Gea A, Cervantes S, Martínez-González MÁ, Toledo E. Coffee consumption and breast cancer risk in the SUN project. Eur J Nutr 2020; 59:3461-71. [PMID: 31955220 DOI: 10.1007/s00394-020-02180-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Breast cancer prevalence is growing worldwide. Many factors, such as diet and lifestyle could be determinants of the incidence of breast cancer. Coffee has been extensively studied in relation to several chronic diseases because of its multiple effects in health maintenance and its elevated consumption. We studied the relationship between coffee intake and breast cancer risk in the SUN (Seguimiento Universidad de Navarra) prospective cohort. MATERIALS AND METHODS We evaluated 10,812 middle-aged, Spanish female university graduates from the SUN Project, initially free of breast cancer. Coffee consumption was assessed with a 136-item validated food-frequency questionnaire (FFQ). Incident breast cancer cases were confirmed by a trained oncologist using medical records and by consultation of the National Death Index. We fitted Cox regression models to assess the relationship between baseline categories of coffee consumption and the incidence of breast cancer during follow-up. We stratified the analysis by menopausal status. RESULTS During 115,802 person-years of follow-up, 101 new cases of breast cancer were confirmed. Among postmenopausal women, more than 1 cup of coffee per day was associated with a lower incidence of breast cancer (HR 0.44; 95% confidence interval: 0.21, 0.92) in the fully adjusted model, compared to women who consumed one cup of coffee or less per day. We observed no significant differences in regard to premenopausal women. CONCLUSION Even though the number of cases was low, slight indications of an inverse association between coffee consumption and breast cancer risk among postmenopausal women were observed. Further longitudinal studies are warranted to confirm this finding.
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10
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Mendonça RD, Carvalho NC, Martin-Moreno JM, Pimenta AM, Lopes ACS, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Total polyphenol intake, polyphenol subtypes and incidence of cardiovascular disease: The SUN cohort study. Nutr Metab Cardiovasc Dis 2019; 29:69-78. [PMID: 30459074 DOI: 10.1016/j.numecd.2018.09.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 04/09/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Polyphenol-rich diets have been associated with reduced risk of cardiovascular disease (CVD). However, few prospective epidemiological studies have examined the relationship between classes of ingested polyphenols and risk of CVD. Our aim was to evaluate the association between polyphenol intake and risk of major cardiovascular events in a prospective Spanish cohort. METHODS AND RESULTS We included 17,065 university graduates (60.7% women, mean age: 37.2 years, age range: 20-89) followed-up for a mean of 10.1 years. Polyphenol intake was assessed at baseline using a validated semi-quantitative 136-item food frequency questionnaire and matching food consumption data with the Phenol-Explorer database. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for incident cardiovascular events (myocardial infarction, stroke or cardiovascular death). Cherries, chocolate, coffee, apples, and olives were the major sources of variability in polyphenol intake. Participants with higher flavonoids intake (fifth quintile) had a 47% lower incidence of cardiovascular events compared to those in the lowest quintile (HR: 0.53, 95% CI: 0.29-0.98; P for trend = 0.09) after adjusting for potential confounders. The results were non-significant for other polyphenol types. CONCLUSION The intake of flavonoids showed an inverse association with risk of cardiovascular events in a prospective cohort of Spanish middle-aged adult university graduates. REGISTRATION NUMBER FOR CLINICAL TRIALS NCT02669602 in Clinical Trials.
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Affiliation(s)
- R D Mendonça
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Departament Nutrition, Universidade Federal de Minas Gerais, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - N C Carvalho
- Department of Food and Nutrition, University of Campinas, Brazil
| | - J M Martin-Moreno
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Department of Preventive Medicine & INCLIVA, University of Valencia, Spain
| | - A M Pimenta
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Department of Maternal-Child Nursing and Public Health, Universidade Federal de Minas Gerais, Brazil
| | - A C S Lopes
- Departament Nutrition, Universidade Federal de Minas Gerais, Brazil
| | - A Gea
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; CIBERobn, Institute of Health Carlos III, Madrid, Spain
| | - M A Martinez-Gonzalez
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; CIBERobn, Institute of Health Carlos III, Madrid, Spain; Harvard TH-Chan School of Public Health, Department of Nutrition, Boston, MA, USA
| | - M Bes-Rastrollo
- University of Navarra, Preventive Medicine and Public Health, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; CIBERobn, Institute of Health Carlos III, Madrid, Spain.
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11
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Garralda-Del-Villar M, Carlos-Chillerón S, Diaz-Gutierrez J, Ruiz-Canela M, Gea A, Martínez-González MA, Bes-Rastrollo M, Ruiz-Estigarribia L, Kales SN, Fernández-Montero A. Healthy Lifestyle and Incidence of Metabolic Syndrome in the SUN Cohort. Nutrients 2018; 11:E65. [PMID: 30598006 DOI: 10.3390/nu11010065] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 01/22/2023] Open
Abstract
We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The “Seguimiento Universidad de Navarra” (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 years, 67% women) initially free of metabolic syndrome were followed prospectively for a minimum of 6 years. To evaluate healthy lifestyle, nine habits were used to derive a Healthy Lifestyle Score (HLS): Never smoking, moderate to high physical activity (>20 MET-h/week), Mediterranean diet (≥4/8 adherence points), moderate alcohol consumption (women, 0.1–5.0 g/day; men, 0.1–10.0 g/day), low television exposure (<2 h/day), no binge drinking (≤5 alcoholic drinks at any time), taking a short afternoon nap (<30 min/day), meeting up with friends >1 h/day, and working at least 40 h/week. Metabolic syndrome was defined according to the harmonizing definition. The association between the baseline HLS and metabolic syndrome at follow-up was assessed with multivariable-adjusted logistic regressions. During follow-up, we observed 458 (4.24%) new cases of metabolic syndrome. Participants in the highest category of HLS adherence (7–9 points) enjoyed a significantly reduced risk of developing metabolic syndrome compared to those in the lowest category (0–3 points) (adjusted odds ratio (OR) = 0.66, 95% confidence interval (CI) = 0.47–0.93). Higher adherence to the Healthy Lifestyle Score was associated with a lower risk of developing metabolic syndrome. The HLS may be a simple metabolic health promotion tool.
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12
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Hu EA, Martínez-González MA, Salas-Salvadó J, Corella D, Ros E, Fitó M, Garcia-Rodriguez A, Estruch R, Arós F, Fiol M, Lapetra J, Serra-Majem L, Pintó X, Ruiz-Canela M, Razquin C, Bulló M, Sorlí JV, Schröder H, Rebholz CM, Toledo E. Potato Consumption Does Not Increase Blood Pressure or Incident Hypertension in 2 Cohorts of Spanish Adults. J Nutr 2017; 147:2272-2281. [PMID: 29046405 DOI: 10.3945/jn.117.252254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/26/2017] [Accepted: 09/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Potatoes have a high glycemic load but also antioxidants, vitamins, and minerals. It is unclear what mechanisms are involved in relation to their effect on blood pressure (BP) and hypertension.Objectives: This study aimed to assess the association between potato consumption, BP changes, and the risk of hypertension in 2 Spanish populations.Methods: Separate analyses were performed in PREDIMED (PREvención con DIeta MEDiterránea), a multicenter nutrition intervention trial of adults aged 55-80 y, and the SUN (Seguimiento Universidad de Navarra) project, a prospective cohort made up of university graduates and educated adults with ages (means ± SDs) of 42.7 ± 13.3 y for men and 35.1 ± 10.7 y for women. In PREDIMED, generalized estimating equations adjusted for lifestyle and dietary characteristics were used to assess changes in BP across quintiles of total potato consumption during a 4-y follow-up. Controlled BP values (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) during follow-up were also assessed. For SUN, multivariate-adjusted HRs for incident hypertension during a mean 6.7-y follow-up were calculated.Results: In PREDIMED, the total potato intake was 81.9 ± 40.6 g/d. No overall differences in systolic or diastolic BP changes were detected based on consumption of potatoes. For total potatoes, the mean difference in change between quintile 5 (highest intake) and quintile 1 (lowest intake) in systolic BP after multivariate adjustment was -0.90 mm Hg (95% CI: -2.56, 0.76 mm Hg; P-trend = 0.1) and for diastolic BP was -0.02 mm Hg (95% CI: -0.93, 0.89 mm Hg; P-trend = 0.8). In SUN, the total potato consumption was 52.7 ± 33.6 g/d, and no significant association between potato consumption and hypertension incidence was observed in the fully adjusted HR for total potato consumption (quintile 5 compared with quintile 1: 0.98; 95% CI: 0.80, 1.19; P-trend = 0.8).Conclusions: Potato consumption is not associated with changes over 4 y in blood pressure among older adults in Spain or with the risk of hypertension among Spanish adults. This trial was registered at www.controlled-trials.com as ISRCTN35739639.
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Affiliation(s)
- Emily A Hu
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; .,CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Lipid Clinic, Endocrinology and Nutrition Service and
| | - Montse Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Family Medicine, Unit Research, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Lluís Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Research Institute of Biomedical and Health Sciences, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain; and
| | - Xavier Pintó
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición and
| | - Cristina Razquin
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición and
| | - Mònica Bulló
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Human Nutrition Unit, Faculty of Medicine and Health Sciences, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
| | - José V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición and.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Helmut Schröder
- CIBER Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.,Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Estefania Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición and
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13
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Perez-Cornago A, Sanchez-Villegas A, Bes-Rastrollo M, Gea A, Molero P, Lahortiga-Ramos F, Martinez-Gonzalez MÁ. Relationship between adherence to Dietary Approaches to Stop Hypertension (DASH) diet indices and incidence of depression during up to 8 years of follow-up. Public Health Nutr 2017; 20:2383-2392. [PMID: 27335121 PMCID: PMC10261567 DOI: 10.1017/s1368980016001531] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/15/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression. DESIGN In a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed. RESULTS After a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped). CONCLUSIONS Moderate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.
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Affiliation(s)
- Aurora Perez-Cornago
- Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain
| | - Almudena Sanchez-Villegas
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Patricio Molero
- Department of Psychiatry and Medical Psychology, University Clinic of Navarra, Pamplona, Spain
| | | | - Miguel Ángel Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain
- Biomedical Research Center Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
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14
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Mendonça RDD, Pimenta AM, Gea A, de la Fuente-Arrillaga C, Martinez-Gonzalez MA, Lopes ACS, Bes-Rastrollo M. Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr 2016; 104:1433-1440. [PMID: 27733404 DOI: 10.3945/ajcn.116.135004] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/08/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ultraprocessed food consumption has increased in the past decade. Evidence suggests a positive association between ultraprocessed food consumption and the incidence of overweight and obesity. However, few prospective studies to our knowledge have investigated this potential relation in adults. OBJECTIVE We evaluated the association between ultraprocessed food consumption and the risk of overweight and obesity in a prospective Spanish cohort, the SUN (University of Navarra Follow-Up) study. DESIGN We included 8451 middle-aged Spanish university graduates who were initially not overweight or obese and followed up for a median of 8.9 y. The consumption of ultraprocessed foods (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for incident overweight and obesity. RESULTS A total of 1939 incident cases of overweight and obesity were identified during follow-up. After adjustment for potential confounders, participants in the highest quartile of ultraprocessed food consumption were at a higher risk of developing overweight or obesity (adjusted HR: 1.26; 95% CI: 1.10, 1.45; P-trend = 0.001) than those in the lowest quartile of consumption. CONCLUSIONS Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.
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Affiliation(s)
- Raquel de Deus Mendonça
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Departments of Nutrition and.,CAPES Coordination for the Improvement of Higher Education Personnel Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Adriano Marçal Pimenta
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Maternal-Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alfredo Gea
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain.,Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and
| | - Carmen de la Fuente-Arrillaga
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain.,Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and
| | - Miguel Angel Martinez-Gonzalez
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain.,Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Maira Bes-Rastrollo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; .,Navarra Health Research Institute, Pamplona, Spain.,Biomedical Research Center Network in Physiopathology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain; and
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15
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Abstract
An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose-response curve and the potential existence of a nonlinear threshold effect have not yet been established.
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16
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Perez-Cornago A, Martinez-Gonzalez MA, Ruiz-Canela M, Jaurrieta I, Carlos S, Sayon-Orea C, Bes-Rastrollo M. Prebiotic consumption and the incidence of overweight in a Mediterranean cohort: the Seguimiento Universidad de Navarra Project. Am J Clin Nutr 2015; 102:1554-62. [PMID: 26561624 DOI: 10.3945/ajcn.115.121202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/01/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The consumption of prebiotics (fermentable and nondigestible carbohydrates) has been proposed as a potentially protective factor against overweight and obesity. However, to our knowledge, no previous prospective studies have assessed the association between the consumption of prebiotics and the incidence of overweight or obesity. OBJECTIVE We evaluated the association between prebiotic consumption [fructans and galacto-oligosaccharides (GOSs)] and the incidence of overweight [body mass index (BMI; in kg/m(2)) ≥25] in the SUN (Seguimiento Universidad de Navarra) Project, which is a prospective cohort of Spanish, middle-aged university graduates with initial BMI <25. DESIGN The SUN Project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with an overall retention rate of 90%. The study population encompassed 8569 Spanish university graduates (mean age: 37 y) who were initially free of overweight or obesity. Self-reported weight (previously validated) was collected at baseline and updated every 2 y during the follow-up period. Fructan consumption and GOS consumption were assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire and were updated after 10 y. Time-dependent Cox proportional hazards models were used to estimate HRs and 95% CIs for incident overweight and to adjust for potential confounding factors. RESULTS During follow-up (median: 9 y), 1964 incident cases of overweight were identified. After potential confounders were adjusted for, risk of overweight was 15% lower in participants in the highest quartile of fructan consumption (≥2.3 g/d) (95% CI: 0.74, 0.97; P-trend = 0.019). Subjects in the highest quartile of GOS consumption (≥0.45 g/d) had 17% lower risk of overweight (95% CI: 0.74, 0.94; P-trend = 0.001). CONCLUSIONS Higher prebiotic consumption was associated with lower risk of overweight in a cohort of initially normal-weight, middle-aged adults. This potential protection has been previously scarcely assessed; therefore, additional longitudinal studies are needed to confirm our results.
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Affiliation(s)
- Aurora Perez-Cornago
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Miguel A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; and Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; and Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Ignacio Jaurrieta
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; and Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Carmen Sayon-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; and Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; and Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
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